COVID-19 and Mental Health

A novel corona virus (COVID-19) was identified as the source of infection for cases of life threatening pneumonia were reported in Wuhan, China in December 2019. The number of cases rapidly increased in Wuhan as well as other Chinese cities. Subsequently the corona virus has also been found in other parts of the world. World Health Organization (WHO) declared COVID-19 outbreak a global pandemic on March 11, 2020. The emergence of corona virus disease 2019 (COVID-19) outbreak resulted in a situation of socio-economic crisis and psychological distress worldwide. Social activities have been restricted in most of the countries and almost all non essential individual movements were prohibited due to quarantine. The local health authorities received suddenly thousands of COVID-19 cases leading to spread of generalized fear and pervasive community anxiety which are typically associated with disease outbreaks and increased with the escalation of new cases together with inadequate, anxiety-provoking information which was provided by media. The psychological reactions to COVID-19 pandemic may vary from a panic behavior to pervasive feelings of hopelessness and desperation. Importantly, other health measures may be compromised by abnormally elevated anxiety. As the general population became increasingly exposed, anxiety provoking topics related to this emergence of the health and socio-economic crisis need to be rapidly identified leading to the onset of mental health problems.

COVID-19 has spread rapidly to countries throughout the world. In the absence of a vaccine, and given the high degree of transmissibility and potential lethality of COVID-19, social and physical distancing, including avoiding crowding, the closure of non-essential services, stay at home orders, and movement restrictions, have been the main public health measures adopted to control the transmission of the virus. Despite the potential benefits of such measures, they might also have negative short and long term consequences for mental health. Such as financial loss and the socioeconomic distress that can result from quarantine may give rise to emergence of psychological disorders. So monitoring the mental health of younger and economically vulnerable individuals may be especially important. They also indicate the mental health of general public during the pandemic that might not only be affected by the direct health consequences of COVID-19, but also by the economic implications of the pandemic.

The modern world in which all individuals are able to rapidly travel and communicate has been rarely forced to the current social isolation and restrictions which are linked to feelings of frustration and uncertainty. Social distancing and lockdown restrictions have been carried out first in China followed by in most European countries and other parts of world like in India where there is a tragic growth of the number of positive cases. Although government regulations are necessary to maintain social balance and guarantee the safety of all individuals, a direct strategy aimed to manage the psychosocial issues related to COVID-19 crisis and its consequences in the community must be followed. Higher prevalence of subjects with psychological symptoms such as emotional disturbance, depression, stress, mood alterations, irritability, insomnia, fear, anger, anxiety, confusion, grief and emotional exhaustion among those who have been quarantined may be identified. There may be long-term behavioral changes like frequent hand washing and avoidance of crowds as well as a delayed return to normality even after many months after the quarantine. Thus, the quarantine period seems to have important and dysfunctional psychological consequences on the individual’s mental health not only in the short-term but even in the long-term period.

There is increased risk of child maltreatment and domestic violence due to COVID-19 spread. One reason for this is that school closures force children to stay at home for longer durations, which may increase parenting stress. In India, all schools nationwide were temporarily closed starting from March 2020. There was a significant increase in parenting stress. Specifically addressing these issues through local and national policies may help in relieving parenting stress during this pandemic. Newer ideas could be obtained about effective coping methods that could be practiced at individual and household levels. It is possible that some families may find it difficult to implement such solutions due to their individual circumstances. These families will need additional support from governments and the private sector.

Those who have been exposed to the maximum risk of infection may develop pervasive fears about their health, worries to infect others and fear infecting family members. Social isolation related to restrictions and lockdown measures are linked to feelings of uncertainty for the future, fear of new and unknown infective agents resulting in abnormally increased anxiety. In this case first insomnia but later depression and post-traumatic stress may occur. In addition, anxiety and panic is closely associated with fatigue and reduced performance in healthcare workers while loneliness, lower social support, separation from loved ones, loss of freedom, uncertainty and boredom are directly related to anger, frustration and sufferings linked to quarantine restrictions. Cognitive functions and decision making are firstly impaired by hyper arousal and anxiety and later by disabling feelings of loneliness. In addition, social isolation and loneliness are also associated with alcohol and drug abuse, enhancing the risk of hopelessness and suicidal behavior in this specific context.

The general population as well as most of the front-line health care workers became vulnerable to the emotional impact of COVID-19 infection due to both the pandemic and its consequences worldwide. Many psychological problems and important consequences in terms of mental health including stress, anxiety, depression, frustration, uncertainty during COVID-19 outbreak emerged progressively. Implementing community based strategies to support resilience and psychologically vulnerable individuals during the COVID-19 crisis is fundamental for any community. The impact on mental health due to fear and anxiety induced by the rapid spread of COVID-19 pandemic needs to be clearly recognized as a public health priority by both authorities and policy makers, who should rapidly adopt clear behavioral strategies to reduce the burden of disease and the mental health consequences of this outbreak.