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 Table of Contents  
REVIEW ARTICLE
Year : 2021  |  Volume : 37  |  Issue : 1  |  Page : 19-23

Mental health and related issues during COVID-19


Department of Applied Psychology, Kazi Nazrul University, Asansol, West Bengal, India

Date of Submission12-May-2020
Date of Decision29-Jun-2020
Date of Acceptance18-Jul-2020
Date of Web Publication31-Mar-2021

Correspondence Address:
Dr. Roshan Lal Dewangan
Department of Applied Psychology, Kazi Nazrul University, Asansol - 713 340, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijsp.ijsp_110_20

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  Abstract 


Coronavirus outbreak in Hubei Province, China, has now spread all over the world. People are witnessing the loss of thousands of lives across the world every day. On the one hand, where most of the government advisory aimed at facilitating physical health, the need for mental health promotion was also recognized. The aim of the paper is to review the findings and commentaries of researches during COVID-19. Coming data suggest that COVID-19 pandemic can cause several psychological distresses during and after this pandemic. Stigma, violence, and other social factors can give extra challenges to mental health professionals. Among these challenges, one serious factor is the risk of suicide. Older individuals, females, and health workers have been identified as most prone to the mental health crisis. E-platform has been identified as the best service delivery system; however, service delivery can be compromised by some hurdles. Few suggestions have been made on the basis of available findings for readiness and mental health promotion.

Keywords: Depression, E-platform, health workers, pandemic, telehealth


How to cite this article:
Dewangan RL. Mental health and related issues during COVID-19. Indian J Soc Psychiatry 2021;37:19-23

How to cite this URL:
Dewangan RL. Mental health and related issues during COVID-19. Indian J Soc Psychiatry [serial online] 2021 [cited 2021 Jun 19];37:19-23. Available from: https://www.indjsp.org/text.asp?2021/37/1/19/312795




  Introduction Top


On December 31, 2020, the World Health Organization (WHO) received information of 44 cases suffering from pneumonia of unknown cause from Wuhan (Hubei, China).[1] Laboratory investigations on these cases revealed new type of coronavirus (nCoV) as etiological factor and other suspected causes such as severe acute respiratory syndrome coronavirus (SARS-CoV), Middle East respiratory syndrome CoV, and influenza were ruled out on January 7, 2020.[2] Later, this nCoV was identified as SARS-CoV-2 and disease was called coronavirus disease (COVID-19).[3] While writing this article, according to the WHO, there are 3,356,205 confirmed cases of COVID-19 which includes 238,730 deaths (https://covid19.who.int/). The impact of this pandemic is not limited to death due to disease, but global economic slowdown and social unrest are being reported in daily news. Health workers have mostly been put in 7 days and 24 h alerts to manage this large scale infectious disease, and these health workers are going through physical exhaustion and psychological burnout.

This article reviews the recent findings related to mental health issues among health professionals and the public who is facing physical, social, economical, and education constraints caused by COVID-19 and mental health services and hurdles in providing these services.


  Psychological Health of Public Top


Psychological distress during any disaster and pandemic is a natural response which may take several forms. The spread of distress can be identified among people by their daily use of words. When Weibo (microblogging social platform) posts of 17,865 active Weibo users were analyzed before and after the declaration of COVID-19, it was observed that expression of negative emotions and social sensitivity increased sharply, whereas the expression of positive emotion decreased.[4] It is necessary to understand nature, prevalence, and correlates of expected psychological distress for preventive measures and policymaking. Major difficulty of this pandemic is that researcher has to maintain physical distancing, and in many countries, lockdown has been imposed as a preventive measure. Online surveys and relying on people's self-report are methods largely being used for collecting data.

Psychological distress

A cross-sectional online survey[5] during COVID-19 outbreak (data collected in January 31 to Febuary 2, 2020) in Wuhan, China, comprised 4872 participants from 31 provinces and autonomous regions of China reported a higher prevalence of depression (48.3%, 95% CI: 46.9%–49.7%) and anxiety (22.6%, 95% CI: 21.4%–23.8%). Psychological distress due to this pandemic among caregivers is also high. Post-traumatic stress symptoms have also been reported among residents of Wuhan and surrounding cities[6] where females have shown significantly high severity (in symptoms like re-experiencing, negative thoughts, and hyperarousal). In a longitudinal study, which compared responses of 1738 respondents from 190 Chinese cities during the initial outbreak and 4 weeks later when epidemic was at its peak, it suggested that psychological distress can sustain for long among the general population.[7]

Increased death toll and more vulnerability of children and elders to the virus may escalate psychological distress among caregivers. When parents of children with pandemic hospitalization were compared with non-pandemic hospitalization, it was found that anxiety, depression, and dream-anxiety scores were higher and clinically significant among parents with children having pandemic hospitalization.[8] Peoples living in outbreak areas are generally in distress, and this distress escalates further when they come to know that someone known to them are having infection.[9] Educational institutes have been shut, hostels have been emptied, and college and schoolgoing children are confined to their home. However, these measures are extremely important; the finding suggests that the home confinement can have an adverse impact on students. Information collected from 1784 from primary schoolchildren suggests that 22.6% of children suffer from depression and 18.9% from anxiety symptoms.[10]

Violence

Experts are of the opinion that there is an increase in domestic violence. Children and women are expected to be most prone to domestic violence.[11] According to a report in “The Hindu,” domestic violence among Indian women is on its highest in the past 10 years for the same period.[12] From March 25 to May 31, 2020, there were 1477 complaints of domestic violence made by women, whereas a large number of cases (around 86%) remain unreported. Domestic violence may have different forms: intimate partner violence, child and elder abuse, and sexual violence.[13] Further, as this pandemic has affected all the services, including criminal justice and victim service agencies, the absence of timely intervention can engrave the issue.[14]

Suicide

The prevalence of suicide has been found high across all the mental illness compared to the general population.[15],[16] The increased suicide rate has also been reported during pandemic[17] and aftermath of natural disasters.[18] Various factors associated with COVID-19 have been expected to work as a risk to increase the rate of suicide in the US. These factors are economic burden, social isolation, decreased access to community and religious supports, poor access to physical and mental health care, overall national anxiety, and suicide among health workers itself.[19] These expected risk factors in the US seem applicable in other countries too. A review[20] of published news article during March to May 24, 2020, in India revealed 72 suicide cases related to COVID-19. The age of suicide ranges from 19 to 65 years, and most of them were males (87.5%). Fear related to COVID-19 infection was a cause of 29% of the suicide cases. Various other causes were financial crisis, loneliness, social stigma, COVID-19 work-related stress, and inability to return home due to lockdown. Surprisingly, people who committed suicide due to fear of COVID-19 infections were found COVID negative in an autopsy.


  Psychological Health of Health Professionals Top


Fear of self-contamination by virus, long duty hours with a warning of 24 h availability on call, living in covered protective equipments, spending time in isolation, and not being able to meet family members and relatives, all these reasons are sufficient to cause psychological distress among health workers. In 2003, there was an outbreak of SARS in multiple countries. During this period, a study was conducted in Taiwan to understand the stress reaction among medical staff.[21] The study reported quarantine as the most related factor of stress among medical staff. Surprisingly, 20% of staff reported stigmatized and rejection experience from other people, especially from neighbors. The severity of distress can be up to the extent of post-traumatic stress.[22] Similar findings may be expected during the current COVID-19 pandemic.

There are no systematic data available till date; however, few online surveys are alarming. A multicenter survey in China involving 1563 medical staff reported that 50.7% suffered depression, 44.7% generalized anxiety, 36.1% were with insomnia, and 73.4% reported stress-related symptoms.[23] The first outbreak of coronavirus was observed in China; a month before, other countries could get fully alert to take preventive measures. Thus, most of the data are coming from China. Another online survey,[24] during the reducing stage after the maximum point of the COVID-19 epidemic outbreak in China, screened 2182 participants which composed of 927 medical health and 1255 nonmedical health workers. In this survey, 33.9% of participants complained of insomnia, 10.4% complained of anxiety, 10.6% complained of depression, 3.5% complained of obsessive-compulsive symptoms, and 2.9% complained of phobic anxiety. Psychological problems were significantly high among medical health workers than nonmedical ones.

Symptoms of depression, anxiety, and insomnia are the most reported mental health problems among health workers.[25] The result is not always the same for few studies. In another study based in China, the level of anxiety and depression of medical staff at Fifth Affiliated Hospital of Sun Yat-sen University was assessed using Zung's self-rating anxiety scale (SAS) and Zung's self-rating depression scale (SDS).[26] Their finding suggests that levels of anxiety and depression both were comparable among the staffs who were working in COVID-19-associated departments (38 participants) and other departments (i.e., Pulmonary and Critical Care Medicine, Department of Cardiology and General ICU; 21 participants), however, the mean scores for SAS and SDS in these groups were lower than the cutoff scores. Overall, this pandemic is significantly causing psychological distress not only to those health professionals who are dealing directly with the infected cases from COVID-19, but also to other health professionals who are working in a medical setup.

Vulnerability and protective factors

Elderly and those with serious physical and psychiatric illness may severely get infected from COVID-19. First COVID-19 outbreaks in Korea occurred in the psychiatric ward, and similarly, China observed a large number of patients with severe psychiatric illness who were infected.[27] One of the reasons behind this vulnerability is poor health immunity. The dilemma of COVID-19 infection is that the patient is supposed to be on quarantine; infection itself may be a traumatic experience which is aggravated after the necessary measure of social isolation. As mentioned before, isolation may trigger anxiety, despair, and insomnia to the patient and to the general public.

Meta-analysis has suggested that hypertension, respiratory system disease, and cardiovascular disease were factors which can exacerbate the severity of infection;[28] these diseases are also linked to serious mental illnesses.[29],[30] Thus, mental illness can be a vulnerability for infection. Further, corona infection can contribute to mental illness in two ways: first, directly by affecting one's immunity and second by its impact on mental health via psychological distress adhering to it among people. Corona infection can form an organic basis for mental illness, as several infections have been linked to schizophrenia.[31],[32] Further research is required to explore this complicated association.

Female gender[6],[33] and migrant workers[34] have been reported as more vulnerable to psychological distress during COVID-19. Health information, information regarding outbreak situation, and information regarding precautionary measures are associated with lower distress.[33]


  Psychological Measures and Hurdles Top


Despite the WHO's assertion “to separate a person from having an identity defined by COVID-19, in order to reduce stigma,”[35] many occasions have been observed across different countries where stigmatization has created a big hurdle for service providers and caused a great length of suffering for the patients. Director of All India Institute of Medical Sciences, New Delhi, has accepted that due to stigmatization, patients are not coming forward which, in turn, delays the testing and treatment; thus, the mortality rate is increasing.[36] It was observed that some stereotypes and stigma have been linked to the COVID-19. Asians, persons with travel history, and frontline health-care professionals have felt stigma linked to COVID-19.[37] People suffering with coronavirus have faced rejections and hostility from others and have been manhandled on some occasions.[38] Mental health professionals might play a pivotal role in removing stigma by providing information regarding myths attached to coronavirus as well as they can also educate patients and caregiver about hygiene practice essential to COVID-19 precautionary measure.[39],[40]

Social distancing has been implemented worldwide as the best method to prevent transmission of the virus. China implemented home quarantine as preventive measures in its different cities during January to April 2020. Since then, many European countries, India, Russia, the USA, and many other countries have called for home quarantine or lockdown.[41] As discussed above, these measures are associated with psychological distress. One common suggestion to continue mental health service for the public during a pandemic is through e-platform. Studies favor the usefulness of this method for primary care providers for identifying cases and referring cases to psychiatrists.[42] A systematic review of 33 studies also suggests that e-conferencing was effective in the treatment for depression.[43] Community needs of psychiatric consultation can also be met successfully through the virtual psychiatric emergency department using telehealth technology.[44] E-platform for psychiatric and psychotherapeutic consultation is majorly practiced in western countries; however, it is also growing in the eastern world. Some difficulties which were experienced in Asian countries were highlighted in recent publications. Lack of awareness and low popularity of e-platform for health consultation, low rate of internet use in certain socioeconomic groups, and absence of authority to regulate and quality assurance are major concerns in China and India.[45],[46] Despite these limitations, psychiatric and psychological associations are proactive in mental health care in these regions.

Populations such as elderly people and person with severe illness who are at high risk of infection present another challenge. In a situation where transportation services are not easily accessible, e-platforms are considered as other alternative, which might not be appropriate for elderly due to their physical constraints and lack of digital education,[47] and even if they can manage to reach to the outpatient, it may be difficult to maintain proper distance and other hygiene measures.


  Conclusion and Future Directions Top


COVID-19 is an infectious pandemic which is causing loss of thousands of lives on daily basis. It has also caused economic and social disruption globally. One major burden this pandemic has caused is the mental health issue among the general public as well as health workers. There are obvious limitations in published researches. Although data are collected from large samples, there is no uniformity in applied tools. Most of the findings are cross sectional, and as one longitudinal study[7] reported that severity may decrease significantly as the threat of pandemic decreases. Thus, while interpreting these preliminary findings, research from previous pandemic should also be taken into consideration.

The current data are in favor of large cases with depression, anxiety, post-traumatic stress, and insomnia. This suggests that mental health professionals have to face the heavy burden of cases after this pandemic. Older people and females are in risk of psychological distress. Frontline health workers may also come in large number with burnout and post-traumatic stress. Government agencies and policymakers need to think over these issues to handle it effectively.

E-platforms are playing an important role; however, there is a lack of training and adaptation of telehealth as mode of practice among professionals.[48] In developing countries, like India, it will be very difficult to manage a large number of cases, illiterate or less educated cases, and cases with poor economic background through e-platform. The focus should be given soon on developing information technology and e-platform skills among professionals and public.

Finally, most of the information and research findings are presented in English which may limit the understanding, and thus the utility of information, to the non-English-speaking audience,[49] so information and research findings must be available in the native language.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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