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   Table of Contents - Current issue
January-March 2021
Volume 37 | Issue 1
Page Nos. 1-137

Online since Wednesday, March 31, 2021

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Marginalized and neglected psychosocial aspects related to COVID-19: Some reflections! p. 1
Achal Bhagat, Nitin Gupta, Shikha Tyagi
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Safeguarding the Mental Health of Women of India in times of COVID 19: Challenges and ways forward Highly accessed article p. 3
Mirai Chatterjee
Self Employed Women's Association (SEWA) is movement of 1.8 million women workers in 18 states of India. This is an early narrative based report on how women have been affected by COVID 19 in India. There is description of loss of livelihood, malnutrition of children, increased responsibility of care giving, decreased access to health care and increased incidents of violence at home. The article also outlines how women have been resilient and have been active participants in supporting recovery. Mental Health awareness has been initiated by members of SEWA in 11 states.
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Human trafficking, mental health and COVID-19 p. 7
Sunitha Krishnan
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Mental health crisis among children: A parallel pandemic Highly accessed article p. 10
S Navin Sellaraju
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“Feared and Avoided”: Psychosocial effects of stigma against health-care workers during COVID-19 p. 14
Pulaparambil Vani, Debanjan Banerjee
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Mental health and related issues during COVID-19 p. 19
Roshan Lal Dewangan
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.
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COVID-19-related social stigmas in India and the approaches to mitigate them p. 24
Janmejaya Samal
Coronavirus disease-2019 (COVID-19) is a pandemic and a public health emergency of international concern as declared by the Word Health Organization. The entire world is affected by the scourge of this disease and has created equal amount of tension in the social spheres as in science and medicine. There are reports of racism, xenophobia, discrimination, and ostracization in several communities throughout the globe, both urban and rural owing to the social stigma associated with it. Stigma can result owing to a lack of knowledge about COVID-19 and can lead to more fear and anxiety in the society. It can cause harm and allow myth and rumor to gain traction in societies. Thus, it becomes imperative that during this international crisis period, all human beings should stand together to fight against this menace and be informed correctly about the disease from appropriate sources, not from social media, and help each other. The concerned stakeholders such as community, media, and government agencies need to play their role which would ultimately bring about change in the society and ward off the social stigma and discrimination. It is ultimately the community that suffers a lot from such pandemics, thus every community member should stand with solidarity and help each other; the media should bring about the appropriate information from appropriate sources and help creating awareness to prevent racism, biasness, and xenophobia. At this crisis moment, the government agencies should bring about notices, circulars, and public information and lay down the roles and responsibilities of different government departments to curb this menace.
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Addressing psycho-social and behavioral responses toward the COVID-19 pandemic in an Indian model p. 30
Ananta Manna, Amitava Dan
Infectious diseases have plagued humankind since its antiquity. On the way of modern civilization of the species, in the realm of agrarian, industrial, or technological revolution, humankind experienced several such devastating waves in the form of Plague, Cholera, Spanish Flu, H1N1 Influenza, and many more. Every time the whole ecosystem was not at all prepared to combat against these unprecedented happenings, resulting in extreme human suffering with substantial death tolls. Like physical distress, human mind also responded to these cataclysmic events in a vulnerable way. Affliction of a deep emotional impact was inevitable especially to the people of the countries with limited resources including India. To manage these crises in an integrated and optimal way, these diathetic social and behavioral responses of the people should be addressed essentially. This is to supplement the physical intervention as a part of a multidisciplinary approach, to have a favorable outcome.
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Lockdown and mental health: The glass half full p. 37
Harneet Kaur, Nitin B Raut, Om Sai Ramesh
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Positive in negative…does the COVID-19 lockdown has any positive aspect too? Highly accessed article p. 41
Sunny Dua, Ashish Aggarwal, Arun Kumar Pandey
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Post-COVID-19 mental health service delivery in India: Potential role of artificial intelligence p. 45
Seshadri Sekhar Chatterjee, Abhijit Dasgupta, Abir Mukherjee, Kaustav Chakraborty
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Indian community's knowledge, attitude, and practice toward COVID-19 p. 48
Balvir Singh Tomar, Pratima Singh, Deepak Nathiya, Supriya Suman, Preeti Raj, Sandeep Tripathi, Dushyant Singh Chauhan
Background: The COVID-19 pandemic has caused unprecedented human health consequences. It is imperative to understand the society's awareness toward knowledge, attitude, and practice (KAP) level and the extent of measures required by health authorities. Aims and Objective: The aim of the study was to assess the KAP of the general public of India on COVID-19. In this study, a web-based cross-sectional survey was conducted between March 10 and April 18, 2020. Materials and Method: A 19-item questionnaire was generated using Google Forms and distributed through social media networks via snowball sampling technique. The Chi-square test was used to compare categorical data, and multiple linear regression was used to identify factors influencing KAP. Result: Among 7978 participants, the overall KAP score was 80.64%, 97.33%, and 93.8%, respectively. In multiple linear regression analysis, male gender (β = 0.036: P < 0.001), urban population (β = 0.006: P < 0.002), higher education (β = 0.029: P < 0.001), and higher occupation (β = 0.002: P = 0.05) were associated significantly with high knowledge score. There was a positive significant correlation between knowledge and attitude, knowledge and practice, and attitude and practice. Conclusion: The KAP level among the general public was adequate, however there is a necessity to target specific category population with tailored health education program to ameliorate the level of knowledge and attitude. knowledge and attitude.
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Stress, sources of stress and coping during the Covid-19 lockdown: A population study from India p. 57
Jessy Fenn, Noble Chacko, Tony Thomas, Varghese K Varghese, Sanju George
Background: Pandemics such as COVID-19 (with or without lockdown) can cause considerable stress to individuals, testing their coping resources. To contain the pandemic, there was a nationwide lockdown in India from March 25, 2020, severely limiting movement of the 1.3 billion population till the first relaxation came on April 21. This study was done in the 3rd week of April, just before relaxations were announced, to study the perceived stress, sources of stress, and coping strategies of adults during this core lockdown period in Kerala, India. Materials and Methods: We gathered data from 1073 adults using sociodemographic information, perceived stress scale, sources of stress checklist, and COVID-19 coping strategies scale. Correlation analyses, t-test, and one-way analysis of variance were employed for data analyses. Results: 65.7% of respondents scored high on the stress scale with 8.3% experiencing severe stress and 57.4% reporting moderate stress. Stress was negatively correlated with age, education level and income. Anxiety about the impact of the pandemic on the world and their own personal future were the main sources of stress. This was followed by financial worries, stress due to frustration of limited movement, and fear about contracting COVID. The five most common coping strategies used were increased hygiene, social distancing, increasing awareness about the disease, increased communication with family, and distraction through movies and books. Conclusion: During the core lock down period in April 2020 in India, there was high levels of stress among the people primarily due to the worry about the future impact of the pandemic as well due to the restrictions imposed.
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A study on psychological distress, functional impairment, and social attitude toward the COVID-19 pandemic and lockdown among Indian population p. 64
Meghna Badola, Ruby Chauhan, Neha Taneja, Rajiv Janardhanan
Objective: The objective was to evaluate the prevalence of psychological distress, functional impairment, and social attitude toward the COVID-19 pandemic and induced lockdown among the Indian population. Methodology: A cross-sectional study was conducted among 155 people residing in India. Data were collected on sociodemographic variables, psychological distress, functional impairment, and social attitude toward COVID-19 and the induced lockdown via an online survey. Kessler's K10 scale was used to measure psychological distress and Work and Social Adjustment Scale (WSAS) was used to evaluate functional impairment due to the COVID-19 pandemic. Descriptive statistic and Chi-square test were applied, where P < 0.05 was considered statistically significant. Pearson's analysis was used to measure the correlation between psychological distress and functional impairment. Results: Overall, the mean age of the study participants was 29.24 (standard deviation = 7.869) years. Majority of the study participants were female (63.9%). On applying K10 scale, it was found that 20% of the participants suffered from mild psychological distress and 16.1% were moderate-to-severely distressed. On applying WSAS scale, it was found that 23.9% of the study participants suffered from significant functional impairment and 7.9% from severe functional impairment. On assessing the social attitude, 63.9% of the participants purchased groceries from local market and 56.8% said that they would visit mall after the lockdown gets over. Eating out in a restaurant (P = 0.028) and visiting shopping mall (P = 0.032) after the lockdown gets over were significantly associated with psychological distress. Conclusion: Our findings identified the level of psychological distress, functional impairment, and social attitude toward the COVID-19 pandemic and the induced lockdown. Such evidences can be used to formulate interventions to improve the mental health and well-being of people during such emergencies.
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Experiences of quarantine for individuals during the COVID-19 outbreak in Kashmir: A qualitative study Highly accessed article p. 71
Zahid Maqbool
Context: The coronavirus disease 2019 (COVID-19) outbreak originally occurred from Wuhan, China, in December 2019 and gradually spread to other countries in different parts of the world. The COVID-19 outbreak has led many countries ask people who have potentially come into contact with the infection to isolate themselves at home or in administrative quarantine facilities. Thus, quarantine at different levels, from individual to community, was seen as an effective measure of preventing the spread of this disease. Aims: The aim of the present study is to explore the experiences of quarantine for individuals returning from Bangladesh during the COVID-19 outbreak in Kashmir. Settings and Design: This study follows qualitative narrative design. Subjects and Methods: This study used an in-depth, semi-structured interview guide. Purposive sampling technique was used to select the participants who varied in terms of gender and age. Results: Despite individual differences, the experiences narrated by participants followed stages beginning before, during, and after ending the quarantine. The government authorities adopted a policy of mandatory quarantine to all the incoming passengers with the aim of preventing the spread of this pandemic. However, participants reported facing several issues such as shock and fear, feeling of isolation and loneliness, frustration and boredom, and loss of routine activities during this period. Conclusions: Quarantine as a method of preventing transmission of severe disease outbreak should be carefully used after effectively weighing its potential benefits and risks. The results of the study can be used to devise a proper policy framework and practice for effectively managing future quarantine and isolation-related health emergencies.
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Psychosocial impact of the COVID-19 lockdown in school-aged children and adolescents in Karaikal – A longitudinal study p. 77
Sree Latha B Venkat, KR Ananthakrishnan
Background: The pandemic caused by SARS-CoV-2 has forced many nations to complete lockdown. Fear of the infection, financial loss, and insecurity of future, affect human psychology. Children and adolescents are also at risk of psychological disturbances causing behavioral problems. Increasing screen time and parental stresses add to the mental trauma. Objectives: The objectives of this study were to assess the prevalence of behavioral abnormalities in school-aged children and adolescents and the influence of lockdown on their behavior. Materials and Methods: A prospective longitudinal cohort study was conducted in the community setting of homes of healthy children aged 6–12 years (n = 123) and adolescents aged 13–18 years (n = 115) living with parents under the lockdown during March–April 2020 in the low coronavirus disease 2019 transmission district of Karaikal. Change of behavior from the 1st day of lockdown over a month was assessed using parent-completed Strength and Difficulty Questionnaire (SDQ). The total scores of initial assessments and follow-up were calculated. Results: At initial assessment, 4% (n = 3) of the children and 6% (n = 7) of the adolescents had high scores in four-band categorization of the parent-completed SDQ. One month in lockdown, it increased to 17.8% (n = 22) in children and 26.9% (n = 31)) in adolescents. Very high scores were recorded in 1.7% (n = 2) of children and 7.8% (n = 9) of adolescents. Emotional and hyperactivity scores were high in children (P < 0.001), while peer and conduct problems were higher in adolescents (P < 0.001). Longer screen time (P < 0.001), parental conflicts (P < 0.001), and lower socioeconomic state (P < 0.05) correlated with high scores. Conclusion: The psychological impact of lockdown on children and adolescents is high. Longer screen time has a serious impact on the behavior of children as well as adolescents. Parental conflicts correlated positively with adverse behavior in adolescents than children.
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Factors determining psychological stress among Indian adolescents and young adults during the COVID-19 outbreak p. 82
Neha Agarwal, Mandara Muralidhar Harikar, Rishi Shukla, Anurag Bajpai
Background: Strict isolation measures imposed during the coronavirus disease (COVID-19) pandemic have confined families in their homes, interrupted functioning of schools and colleges, and disrupted play and exploration time. Aim: The aim was to analyze psychological stress and its determinants among Indian adolescents and young adults during the COVID-19 pandemic. Methodology: A cross-sectional, observational study design was adopted. A semi-structured survey including demographic details, COVID-19 awareness, Perceived Stress Scale (PSS-10), and coping methods was distributed among 12–24 year olds, and analyzed to study the determinants of stress. Results: Out of a total of 235 (112 males; 19.4 ± 4.0 years) participants, nearly half of the participants (53%) reported moderate stress; low stress was perceived by 42.3% and severe stress was observed in 4.7%. The mean PSS score was 13.4 ± 8.9. Higher PSS score was associated with age (r = 0.194, P = 0.003), female gender (mean rank = 132.0, P = 0.001), higher education (mean rank = 154.5, P = 0.006), salaried occupation (mean rank = 143.79, P = 0.047), dissatisfaction with the available information (mean rank = 155.64, P = 0.009), and accessing information multiple times a day (mean rank = 133.51, P = 0.041). On multivariate linear regression analysis, age, gender, dissatisfaction with the available information, and higher frequency of accessing information were identified as significant correlates of mean PSS-10 score. Conclusion: Stress was highly prevalent among the Indian adolescents and young adults during the pandemic. Older age, female gender, higher education, salaried job, dissatisfaction toward the available information, and a tendency to view updates frequently were associated with higher stress levels.
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Prevalence of anxiety and depression among COVID-19 patients admitted to tertiary care hospital p. 88
Pankaj Kumar, Rupesh Chaudhary, Sandeep Chhabra, Jasleen Kaur Bhalla
Context: COVID-19 patients undergo myriad of psychological problems such as mood swings, depression, fear of isolation, fear of dying, feeling helpless, insomnia, anxious forebodings, and nervousness. These are commonly seen among isolated and quarantined patients who experience notable levels of anxiety, uncertainty, anger, confusion, stress and insecurity. Aims: This study aims to determine the prevalence of anxiety and depression among these infected patients admitted to tertiary care center. Settings and Design: This cross-sectional study was conducted on 100 COVID-19 patients admitted to DMC&H, Ludhiana. Subjects and Methods: The data were collected on sociodemographic parameters and assessment was done using Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Rating Scale (HARS) at the time of discharge from the hospital. Statistical Analysis Used: SPSS 21 version for Microsoft Windows. Results: Majority of the patients were males and in the age group of 31–50 years. 48% patients had comorbid depression. Moderate-to-severe levels of depression were found more in males (25%) as compared to females (15%). Comorbid anxiety was seen commonly in females (60%) than male patients (28.75%), though the moderate-to-severe level of anxiety was more in males (71.25%) as compared to females (40%). On symptom checklist of HDRS and HARS, patients had high scores on insomnia (75%), psychic anxiety (45%–50%), somatic symptoms (gastrointestinal [50%], muscular [56%], and respiratory [81%]) and loss of weight (40%). Conclusions: COVID-19 patients score higher on comorbid anxiety and depression. Moderate-to-severe level of anxiety and depression is commonly seen among male patients than female patients.
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A qualitative study of the psychological experiences of health care workers during the COVID 19 pandemic p. 93
Priyanka Dang, Naveen Grover, Prashant Srivastava, Savita Chahal, Ashish Aggarwal, Vishal Dhiman, Gauri Shanker Kaloiya
Background: Health-care workers (HCWs) are at the forefront of managing the massive responsibility of public health response to COVID-19. The aim of the present study was to explore the psychological experiences of these frontline HCWs. Methods: A qualitative study was carried out with 24 frontline HCWs posted in COVID-19 wards, using purposive and snowball sampling methods. Data were collected using focus group discussions and individual interviews, which were transcribed and analyzed using Braun and Clarke's six-phase framework of thematic analysis. Results: HCWs were overburdened. It caused them to experience symptoms of depression and anxiety. Most of them showed positive appraisal coping and believed that people would have to learn to live with it. Conclusions: Continued support for professional help is needed for HCWs at present and in the aftermath of the pandemic.
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Psychological impact and coping strategies in health-care workers during the coronavirus disease 2019 pandemic at a dedicated coronavirus disease 2019 hospital: A cross-sectional study p. 98
Smita Nikhil Panse, Disha Devang Parikh, Manjeet S Santre, Gaurav P Wadgaonkar, Shwetali D Gholap, Kalyani A Raidurg, Jyoti B More, Arvind V Karad, Nimish S Meshram, Rachit S Sikchi
Background: Health-care workers (HCWs) are on the frontline dealing with the Coronavirus Disease 2019 (COVID-19) pandemic all over the world. Several hospitals in India are now functioning as Dedicated COVID-19 Hospitals (DCH). This study has been designed to understand the psychological impact of the pandemic in HCWs at a DCH. Objectives: the objective of the study was to assess psychological impact and coping strategies in HCWs during the COVID-19 pandemic at DCH. Subjects and Methods: This is a cross-sectional observational study conducted at a DCH. The study used a semi structured questionnaire for demographic details and the tools-Depression Anxiety Stress Scale (DASS-21) and Brief COPE for assessing psychological impact and coping strategies, respectively, in HCWs willing to participate. Chi-square test was applied to establish an association between the demographic variables and psychological symptoms and Spearman's correlation coefficient was used to assess correlation between coping strategies and psychological symptoms. Results: Out of 136 participants, 43.4% (n = 59) had at least one of the symptoms among stress, anxiety, or depression on the DASS-21 scale. Resident doctors and nurses had a higher incidence of psychological symptoms (P = 0.009, χ2 = 13.58, df = 5). The presence of chronic illness was significantly associated with psychological symptoms (P = 0.036, χ2 = 4.38, df = 1). Higher values on the anxiety (ρ = 0.216, P < 0.05) and depression (ρ = 0.226, P < 0.05) subscales correlated with the increased use of avoidant coping strategies. Conclusions: There is significant psychological impact of the COVID-19 pandemic on HCWs. Regular assessment and mental health interventions must be part of the pandemic management. Building positive approach coping strategies can reduce stress and other psychological symptoms.
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Assessment of mental health in indian medical students during the coronavirus disease-2019 pandemic p. 105
Sridhar Mangalesh, Sharmila Dudani, Neeru D Dave
Context: Medical students are more anxious and depressed than their peers, and the prevalence of various mental health problems is on the rise. The coronavirus disease-2019 (COVID-19) pandemic has had far-reaching psychosocial consequences on the Indian population. Aim: The aim of this study is to assess the mental health status of Indian medical students during the COVID-19 pandemic and lockdown. Settings and Design: A questionnaire-based, cross-sectional study of medical students from across India. Methodology: The general health questionnaire with 28 items (GHQ-28) was adapted to GoogleForms® and circulated extensively to medical students in various colleges across India among the nationwide lockdown that began from March 22, 2020. A total of 1000 responses were collected for a period of 1 month from May 12 to June 11. Other questions included uncertainty due to the pandemic about one's career as a medical student, satisfaction with the field of medicine, the year of training, and how long the student believed the effects of the pandemic would last. Statistical Analysis Used: A Chi-square test was applied to compare the proportions, and Mann-Whitney U or Kruskal–Wallis test was used to compare the continuous variables between the groups. Results: A total of 60.3% (57.2–63.2) of students had GHQ-28 scores above the cutoff of >23 and had mental health problems. Female sex, smoking, alcohol, dissatisfaction with medicine, and uncertainty due to the pandemic were associated with mental distress. GHQ-28 scores increased uniformly with the year of training of the student, except in the case of IInd year, where scores were the least. Similar trends existed for the somatic, anxiety, social-dysfunction, and depression score components of the GHQ-28. Conclusions: Mental health issues are very common among medical students, particularly now during the COVID-19 pandemic. Early identification along with guidance and counselling is essential for all-round development of medical professionals.
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Safeguarding human rights: An indispensable component of the COVID-19 emergency response p. 111
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
In the ongoing battle against the Corona Virus Disease-2019 (COVID-19) pandemic, it is very important that the national leaders and health authorities must take appropriate measures to maintain an equilibrium between safeguarding the health, minimizing socioeconomic disruption, and protecting human rights of all the sections of the community. It is really a sad fact that the people who have been infected with the novel infection have been subjected to stigma and discrimination. As many nations have resorted to restriction of movements of the citizens, the girls and women are the most affected as their sexual and reproductive health needs are not being met, and in other words, these restrictions have aided in the violation of their human rights. In conclusion, the political leaders should understand the gravity of the situation and ensure that the human rights of all the sections of the society are given due importance by means of adoption of a comprehensive approach. In fact, safeguarding the human rights of the people is an important domain of the emergency public health response, and we all should not encourage discrimination of any kind against anyone.
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“Lockdown was a blessing in disguise for me as it stopped me gambling” – First person account of a lottery addict from god's own country (Kerala, India) p. 113
Sanju George, Jessy Fenn, Noble Chacko
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Homeward bound; Reintegrating a homeless mentally III person and his family during the COVID-19 pandemic lockdown p. 115
GG Gopika, Pulaparambil Vani, Dhruva Ithal, C Jayakumar
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Opioid use disorder and COVID-19 in India: Waiting for an epidemic within the pandemic? p. 117
Pawan Sharma, Prashant Gupta, Arghya Pal, Arpit Parmar
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Alcohol dependence in the time of COVID-19: A possible silver lining p. 119
A K. A B. Baminiwatta, M U. P. K. Peris
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Mental health issues arising due to socioeconomic crises during the COVID-19 pandemic p. 121
Sheikh Shoib, Sheikh Mohammed Shariful Islam, Sheikh Mohd Saleem
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Frontline health workers: The warriors of the COVID-19 pandemic p. 123
Anwesha Mondal, Manish Kumar
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Healthcare workers' stress associated with the COVID-19 outbreak p. 125
Ravi Parkash, Neharika Saini
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Interests in yoga during the COVID-19 pandemic in India: A google trends study p. 127
NA Uvais
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A pyramidal, stepped care model with disaster color coding to address the psychosocial well-being of COVID.19 patients using telephone counseling p. 129
Smitha Ramadas, Binu Areekal, TP Sumesh, MA Andrews
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Vulnerable transgender community during COVID-19 and lockdown in India p. 131
Jatin Chaudary
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The age of pandemics (1817-1920): How they shaped india and the world p. 133
R Srinivasa Murthy
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Ten lessons for a post-pandemic world p. 136
R Srinivasa Murthy
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