As the United States works to stop the rise in coronavirus case numbers, behavioral health professionals warn that mental health will continue to deteriorate as a result of the pandemic.

Between March and May, one-third of Americans reported experiencing stress, anxiety and sadness that was difficult to cope with by themselves, according to a survey published this week by the Commonwealth Fund, a foundation focused on promoting a high performing health-care system, and Social Science Research Solutions, a market and survey research firm. The survey, which interviewed 8,259 adults in the U.S. and abroad, found that when compared with other high-income countries such as Canada, Australia, and France, the rate at which Americans experienced mental health symptoms was significantly higher.

Researchers suggested that the country’s lack of universal health insurance coverage, financial difficulties, and leadership response to the pandemic has negatively affected the mental well-being of Americans.

The findings reflect a similar report released in May by the American Psychological Association, which found that 70% of Americans cited the government response to COVID-19 as a significant source of stress. The same percentage of respondents said that the economy was a significant source of stress.

Donna Sudak, professor of psychiatry at Drexel University’s College of Medicine, said that while it’s important to recognize the toll the virus has taken is greater here than in some other countries included in the survey, there are cultural customs that can make coping harder for Americans as well.

“We’re a country that is accustomed to a lot of independence and the ability to be autonomous,” Sudak said. “Many people have a sense of well-being when they can go anywhere they want to. We’re accustomed to the escape value of that, and now that’s gone.”

The survey also found that despite heightened mental health symptoms, Americans are less likely to receive care during the pandemic — just one in three adults reported being able to get help from a professional, compared with one in two adults in Australia and Canada.

Eric Schneider, the senior vice president for policy and research at the Commonwealth Fund and an author of the report, said that could be because other countries are more likely to provide citizens with access to a trusted source of primary care.

“Primary care is often the first point of contact for people with mental health concerns,” Schneider said. “It is the main source of care for common mental health problems like depression and anxiety.”

Sudak also said Americans may hesitate to seek help because mental health care is not covered in the same way other forms of health care by insurers.

“Insurers have traditionally divided mental health and physical health,” Sudak said. “But we know that the body and mind are intertwined.”

Additionally, there is a “stigma that exists when it comes to accessing mental care,” she said.

Wei Du, chair of the psychiatry department at Drexel’s College of Medicine, said another possible reason that fewer Americans are reaching out to behavioral health professionals could be that until very recently, most mental health concerns were addressed in person. Although the use of teletherapy and telepsychiatry has increased exponentially in the past few months, Du said, some people may feel uncomfortable seeking therapy from their homes because they don’t want family members to find out about their struggles.

“A lot of people have begun to describe what they’re calling a post-COVID mental health surge,” Du said. “It’s going to come soon, and probably from a new population, such as professionals who have lost their jobs, or young adults in the transition group.”

Sudak said she would not be surprised if people felt worse now than they did in March. Many Americans feel disappointed that the country has not been able to tame the virus despite the sacrifices that have been made by the public.

“In the beginning, it looked like we were able to flatten the curve,” Sudak said. “Many people thought that flattening the curve had to do with making the virus go away. Everybody did what they were supposed to do then, and now people want to go out and do what they used to do, but the virus hasn’t gone away.”

Because cases across the U.S. continue to spike, she said, people are still dealing with a tremendous amount of uncertainty, which “is the thing that’s been the most distressing.” Human beings are wired to dislike uncertainty, she said.

“People have really been wanting a sense of certainty about being safe, and we did all the right things like social distancing from each other to get that,” Sudak said. “But we still don’t have a sense of security and safety as we should. There’s likely a tremendous amount of disappointment about that.”