By Wasim Kakroo
THE COVID-19 pandemic that began in China’s Wuhan city and has since spread across the world has become a global concern in the 21st century world. There has been an exponential increase in the number of infected cases and mortality over various parts of the world due to this infection over the past more than one year.
In many countries, including India, routine health services, including mental health care, have been negatively impacted over the past one year. Rapidly emerging mental health problems as a result of pandemic such as anxiety, depression, posttraumatic stress disorder-like symptoms, insomnia, and anger have the potential to destabilize people’s general well-being and can have a huge impact on the health system; as a result, mental health issues need urgent and decisive consideration and intervention.
MENTAL HEALTH ISSUES AMONG THE GENERAL POPULATION
After a traumatic incident or traumatic period such as pandemics, which are capable of causing a lot of stress among large populations, everyone will experience mental morbidity symptoms under huge stress. The probability of having these conditions is determined by a number of factors. The circumstances leading up to the event; the magnitude of the stressful event; the situations following the event; the rapidity of the event; the amount of instability involved; the potential for personal risk and risk to families or loved ones; and the general effect on the environment, employment, socio political institutions etc., and so on are some of the factors that influence the outcome of such events.
When a traumatic event happens, some segments of the population, such as women, teenagers, and the elderly, have been shown to be at a higher risk of experiencing difficulties. Past history of mental disorder, irresolvable loss or trauma, and a history of sexual abuse as a child are all pre-traumatic factors that can precipitate a psychiatric illness. Other risk factors are socioeconomic vulnerability, illiteracy, and drug abuse. Unsurprisingly, those who have a greater share of other personal issues are much more likely to respond adversely to a major traumatic event such as COVID-19 pandemic.
The specific mental health issues that can arise during the COVID‑19 pandemic are listed below:
- Emotional problems include fear, anger, agitation, and mood swings, as well as criticism and blaming (of oneself and others), dissatisfaction, depression, emotional numbness, and failure to cope.
- Biological issues, such as sleep disturbances and sexual dysfunction.
- Cognitive issues include impaired attention, poor memory, and problems in decision making, integrity loss, heightened alertness, perceptual distortions, distracting and unwanted memories, diminished self-esteem/confidence, and denial.
- Psychological and personality issues include emotional outbursts, frustration, argumentativeness, and failure to relax, withdrawal from social circles, inability to communicate with others, loss of appetite/reduction (or increase as a coping mechanism), reduction or loss of libido, inability to control drug use, and elevated risk-taking behaviors.
- People who are unable to cope with stress are prone to somatization. People have developed a state of constant hypervigilance as a result of the media coverage of COVID-19, contributing to the development of multiple somatic symptoms and panic levels of anxiety.
- Suicide rates or suicidal tendencies have been reported to increase around the world as a result of the COVID-19 pandemic.
- Because of the lockdown and inaccessibility of various substances, patients with substance use disorders are more likely to suffer withdrawal symptoms.
- Similarly, being confined to one’s home due to lockdown raises the likelihood of heavy Internet usage and binge T.V. watching, all of which can lead to technology addiction.
MENTAL HEALTH ISSUES OF PATIENTS ALREADY DIAGNOSED WITH
COVID-19 pandemic can lead to exacerbation in mental health issues including chronic depression, psychomotor agitation, psychotic symptoms, delirium, and even suicide. Quarantine periods can make patients feel even worse.
According to a recent online survey conducted in India, the COVID-19 pandemic, lockdown, and subsequent events resulted in a significant disruption in provision of mental health care across the country. As per this survey, the services such as brain stimulation, electroconvulsive therapy, inpatient and outpatient treatment, psychotherapy, etc. got badly affected. The failure to visit health-care facilities and obtain medications exacerbates feelings of isolation and helplessness. Inability to access day-care centres, religious institutions, and community centres can further intensify feelings of seclusion and alienation, which can increase the severity of depressive symptoms. The pervasive panic and distress associated with the pandemic may have a particularly negative effect on individuals who already suffer from anxiety disorders. They will need dosage adjustments as well as increased number of psychiatric as well as psychological consultations. Because of the difficulty and failure to access mental health providers, this may have a negative effect on them, increasing the risk of substance abuse in such patients.
Many patients will experience difficulties in the current time as a result of the loss or breakdown of their coping mechanisms in response to lockdown conditions, leading to rise in the levels of exchange of heated arguments and anger outbursts when such patients face a dysfunctional family system. This interaction of various factors can cause conflict within the family, affecting all family members.
Patients with substance use disorders can experience crises, particularly after relapse, but patients who are currently abstinent due to this lockdown may have a beneficial effect on their health by extending their abstinence time and allowing them to focus on their families and recognizing their support.
MENTAL HEALTH ISSUES AMONG HEALTH‑CARE PROFESSIONALS
Health care workers, especially those who work in medical facilities that treat patients with COVID-19 disease, are at a higher risk of illness and mental health problems. They might also be concerned that they may somehow spread the disease to their families, friends, or coworkers. Overall, health workers can have higher rates of psychological morbidity than the general population. The lack of adequate personal protective equipment (PPE) can cause stress among health-care professionals, and continuous reports on death of health care workers due to COVID-19 infection can cause anxiety and negative attitudes among health-care staff, making it difficult for them to provide proactive care to patients and the community.
Challenges for health‑care professionals
Lack of preparedness
One of the most significant issues with COVID-19 was a lack of preparedness. During the first wave of the pandemic in China, the scale of the outbreak was underestimated, and even after it was announced, there were insufficient studies and evidence to handle the situation. As a result, the deployment of facilities to deal with the pandemic in different countries has been delayed. The containment measures implemented in different countries were delayed, allowing the pandemic to spread globally and cause fatalities. Because of its rapid spread, the coronavirus pandemic posed problems for both developed and developing countries, resulting in a shortage of personal protective equipment (PPE), medications, hand sanitizers, and other life-saving supplies. Currently during the beginning of the second wave of Pandemic in India, medical professionals and policy makers were caught off guard without being sufficiently prepared and it is taking a huge toll on the infrastructure and medical help available to the people in need. With the result thousands of people are dying on a daily basis in India. As a result of the pandemic, there has been a lot of pressure to change conventional working style. Tele-consultations, online mediums of working, and other options are being suggested for continued working. While this resulted in the continuation of programmes, it also put pressure on many health-care providers to quickly become familiar with the technology, its application, procure funding, and reorganise services. It has become challenging particularly for those medical professionals who were not previously adept at using technology.
MENTAL HEALTH ISSUES OF PEOPLE AT RISK
People with a history of overseas travel, those who have been exposed to COVID-19 positive or suspected cases, or those who have moved from metropolitan areas to their hometowns during the lockdown are all deemed “at risk” patients for COVID-19. They are currently advised to home quarantine themselves and go for COVID-19 testing. The various factors that can impact the mental health of such a population include improper knowledge of the disease, its mode of transmission, and its consequences, as well as perceived stigma, a lack of adequate understanding between people and administrators, fear, etc. Others can be influenced by their surroundings they find themselves in, a lack of trust in hospitals and the government, socioeconomic status, literacy etc. These individuals are at a high risk of experiencing severe psychological stress as a result of these factors, which can contribute to psychiatric morbidities including anxiety and depression.
MENTAL HEALTH ISSUES AMONG SPECIAL POPULATIONS
COVID19’s effect on special populations is a major source of concern, since the virus’s natural history is uncertain, and it is a novel virus, leading to speculation and sporadic observations in some cases.
- Elderly: Though new mutated strains of the virus have been found to affect people from all age groups, however, the elderly have been particularly vulnerable to the COVID-19 pandemic in terms of morbidity and mortality. They are also vulnerable due to preexisting conditions such as cardiovascular, neuromuscular, and neurocognitive disorders that are often accompanied by autoimmune disorders and weakened immunity as a result of poor nutrition, making them more susceptible to dementia and depression. There is an increased risk of psychological distress (anxiety and depression) and exacerbation of chronic mental health problems, in addition to increased mortality.
- Children and adolescents: COVID‑19 is a never‑before experience for most of the world. The pandemic may have a wide range of effects on children and adolescents. Younger children may not be able to make sense of social isolation policies that have been imposed on them; their schools and play areas have been closed; and their peer group and friends have as if ceased to exist. As a result, they can experience depression and feelings of isolation, fear, anxiety, behavioural disturbances, irritability, and agitation. Children can regress and weep, and teenagers may turn to substance abuse as a coping mechanism. These dysfunctional coping strategies may contribute to both short- and long-term mental health problems.
- Pregnant women: COVID-19 poses a significant risk to pregnant women due to the disease’s rapid emergence and unknown natural history. Pregnant women, in general, need emotional support during their pregnancy, but social distancing protocols may prevent them from receiving the normal social support. When a woman who works in health care becomes pregnant during these periods, the problems get even worse. This can put undue strain on an already overburdened system, as well as put women under stress which may lead to their vulnerability to various psychological issues.
- People with comorbidities: People with medical comorbidities are at higher risk as comorbidities make them very vulnerable to the novel coronavirus infection. People with such conditions experience fear and anxiety as a result of this, which affects their ability to cope with the disease. Diabetes, chronic obstructive pulmonary disease, renal disorders, heart diseases, systemic hypertension, and multiple malignancies are the most frequently found comorbidities alongside COVID-19. As a result of these comorbidities, the immune system is weakened. When people with these conditions come into contact with COVID-19, their immune responses are altered, and they develop extreme forms of the disease.
- Telepsychiatry/teletherapy: Due to lock-down, social distancing, and the fear of contracting COVID-19 infection, telepsychiatry and teletherapy consultation has become increasingly common. Via telephones and the Internet, technological advancements have made health care more available. These have widespread public access through states and nations; and I feel now is the perfect time to field test telepsychiatry/teletherapy measures because conventional face to face visits pose a health risk to both patients as well as staff. In the wake of the COVID-19 pandemic, State mental hospital (IMHANS) has already begun to use mental health helplines for both psychiatric as well as psychological help. Clinicians (both psychiatrists as well as clinical psychologists) are also providing paid services to people who can afford. Psychological first aid, diagnosis of mental health problems, screening of psychological symptoms, and various psychotherapeutic interventions are some of the most common services that can be provided via online or phone by the clinical psychologists during the current COVID-19 pandemic. This would minimise the burden of work in hospitals and will be an important measure to reduce foot fall in the facilities, allowing the social distancing protocol to be maintained. This can also give the patients who are in need of help, the impression that someone is still listening and that support is on the way.
- E‑teaching: One of the most common current trends during this pandemic is e-teaching. They are interactive and online methods that protect students and teachers from contamination while also assisting them in receiving their lessons. This programme in schools and among medical professionals can also be used to train for COVID-19 management and to impart education about various mental health issues and their management while staying at home.
- Resilience: Despite the fact that everyone is affected by the coronavirus pandemic and is nervous and trying to adapt, not everyone can cope efficiently with stress and adapt rapidly to new situations. Living environments, deprivation, inadequate health-care access, potential future vulnerability (i.e., job risk), genetic predisposition, previous experiences, social interactions, and social assistance are all factors that influence resilience. Enhancing mental resilience will help combat the coronavirus pandemic effectively. All the people in general and people with vulnerability to various mental health issues can be helped to build resilience to the stress caused by the pandemics so that it does not affect their mental health significantly. Various online webinars should be conducted at government level as well as by the psychiatrists as well as clinical psychologists in private to discuss the impact of pandemic on the mental health of people and focus of these online workshops and webinars should be deliverance of ideas about psychological first aid and mental health first aid so that people get to know the early signs and symptoms of various mental health issues and so that they know how to deal with them while being at home so that they are able to stop any of these signs and symptoms to turn into something more serious.
Teaching Life Skills to Children and adolescents: Since children and adolescents are very vulnerable to develop various psychological problems due to the impact of pandemic, they should be equipped with various skills so that they are able to reduce its impact on their minds. Life skills as per age and level of education should be taught to children and adolescents. The various life skills include Communication and interpersonal skills,Decision-making and problem-solving, Creative thinking and critical thinking, Self-awareness and empathy, Assertiveness and equanimity, or self-control, Resilience and ability to cope with problems.
- Development of effective manpower: Students who are interested in the field of mental health can join internships under the supervision of professionals such as clinical psychologists to learn about the various mental health issues so that they become an effective workforce to cater to an ever increasing demand of various psychological services.
Views and information provided are the author’s own responsibility. They are strictly for awareness purposes and are not to be taken to be a substitute for medical advice.
- The author is a Consultant Clinical Psychologist at IMHANS
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