COVID-19 spreading at an unprecedented pace and associated uncertainty has put the world in a state of fear. The uncertainties about the viral characteristics, mode of spread, treatment have already impacted the people across the nations. The large scale measures like nation-wide lockdown, poor preparedness of public health facilities, reports of shortages of medical supplies and mortality rates have added to the negative effects on the mental well being of the individuals and community at large.
Health workers; Mental Health; Migrant Workers; Psychological Issues; Telecommunication
In times of COVID-19 (Coronavirus Disease of 2019) when the disease is spreading at such an unparalleled magnitude, and there is currently no definitive treatment, the proliferation of fear and consequential erratic behaviour among people is not-uncommon. The uncertain incubation period of the virus, asymptomatic transmission, unprecedented large-scale quarantine measures have caused additional fear and anxiety. Confinement of residents to their homes, reports of shortages of medical protective supplies and medical staff are causes of concern that have added to the negative effect on the mental well being of people. Global connectedness that has caused such an effortless spread of the COVID-19 has lead to social isolation.
Such a widely spreading disease, with very little information available, has a profound psychological impact in the general public at the individual level, at the community level and even internationally.
During the era of Covid-19 pandemic, psychiatric symptoms are even being faced by people without any prior history of mental illness. They experience anxiety, fear of falling sick, depression, somatic symptoms, psychosis. People feel helpless and blame others who have an illness[1-3]. The new set of symptoms can appear or the condition can get aggravated in those with pre-existing mental illness.
The sudden loss of loved ones during this outbreak can lead to anger, grief and resentment . People who are in quarantine or are sick may experience shame, or stigma, depressive symptoms or might suffer from post-traumatic stress disorder .
Even students and workers are expected to develop psychological symptoms due to stress, reduced autonomy and concerns about income, job, and security .
Psychological Impact on Special Population
On Healthcare Professionals
Healthcare professionals across the world are working in ‘impossible situations’. They are bound to make impossible decisions, work under extreme pressures with constrained or inadequate resources to provide care for all severely unwell patients. They at times face difficultly in balancing their own physical and mental healthcare needs with those of patients. Healthcare workers including paramedics and ambulance personnel experience heightened levels of stress, depression and anxiety. Because of unpreparedness in each part of the world, there has been lack of personal protective equipments for healthcare workers, which further increases stress and fear of getting infection among them. They might become emotionally vulnerable and feel traumatized, and would be at greater risk of developing adverse psychiatric outcomes. This is expected as the risk of getting infected is much higher with the risk of exposure they are prone to [7,8].
On the Elderly
Social isolation among older adults is a ‘serious public health concern’ because of the heightened risk of cardiovascular, autoimmune and neurocognitive problems. Moreover, elderly are already at greater risks of developing depression, anxiety, fear and other psychological adversities and psychiatric morbidities because of psychosocial and other medical issues .
On the Migrant Workers
Under normal conditions, migrant workers already have a lower quality of life and high risk of common mental disorders (eg, depression) than the local populations [10,11]. This situation can worsen due to lockdown, lost income, difficulty in accessing health services, absence of reliable information and stigma they face.
Psychological Impact at the community level
There can be distrust towards other communities, the government and healthcare services. The negative emotions experienced by people further gets intensified with the shutdown of industries and closure of community services, adding to helplessness, fear, depression and other psychological adversities .
Psychological Impact at the International level
With the spread of infection internationally, the blame game begins, countries target one another, this impedes international trade and tourism. Negative psychological makeup can result in people using remedies and unproven methods can that may be detrimental and can impede infection control [13,14].
Isolating infected or at-risk individuals, decreasing social contact and simple hygiene measures reduce the risk of infection, but unfortunately, also causes decreased access to family support, impede social life and cause loneliness. Psychological symptoms, psychiatric morbidities, fear and anxiety experienced in such conditions if left untreated, may have long-term health effects that will add to the cost burden of managing the illness and may cause more harm than COVID-19 itself [15,16].
Thus, the focus of management should also stress on mental health issues along with biological and physical repercussions of the outbreak.
Telecommunication and Telehealth
Importance of communication cannot be neglected, more so when individuals are suffering from heightened negative emotions. Telehealth becomes an important tool for supporting physical and psychosocial needs of individuals in this background. Smartphones come handy in these situations to provide quality care to individuals. These form an important part of providing psychological services without increasing risk for infection when isolation is important. Evidence to support the effectiveness of telemental health is fairly diverse, especially in the context of depression, anxiety, and PTSD. Videoconferencing, online forums, smartphone apps, text-messaging and e-mails have proven to be effective [17-23].
Mental health professionals can come forward to provide online psychological counselling services for patients and their family members. Information about psychological distress and psychiatric symptoms can be shared by the use of e-mails, text-messaging, videoconferencing. Online therapies may be provided to challenge cognitive biases of people seeking help; teach relaxation techniques, schedule activities to combat anxiety and depression, and alleviate stress in people who are infected and nursed in the isolation rooms. Monitoring of symptoms and further follow up of patients can also be done with the use of telehealth. Despite too much promising benefits of telemedicine, there are some limitations like, lack of face to face interaction, restriction on prescription of psychopharmacological agents and dealing with emergency situations.
Role of Government
The government should keep the public updated with regular news broadcasts and social media releases to clear doubts. The accurate and up-to-date information on the number of infected and recovered cases, mode of transmission, information on treatment (e.g. medicine or vaccine), is associated with lower stress and anxiety levels . Literature has shown that the spread of disinformation and “fake news” is associated with a higher prevalence of mental health problems, mass trauma and increased rates of post-traumatic stress disorder (PTSD) symptoms . So, the spread of such information should be curtailed and associated with legal actions.
Similarly, addressing the mental health needs of the migrant workers should be one of the public health priorities as fear, anxiety and misinformation among them may lead to unplanned large scale reverse migrations resulting in community spread of COVID-19.
People adhering to the precautionary and preventive guidelines laid down by the government and encouraging the community to work together help to combat the outbreak.
Role of Health Authorities
Health authorities must identify groups at high risk for psychological morbidities for targeted early psychological interventions. Health care professionals are at an increased risk of mental health problems while dealing with challenges of the COVID-19 pandemic. Thus, healthcare managers should take adequate measures to protect the mental wellbeing of the staff. The staff must be aware of the situations they are likely to face. They should hold frequent discussions regarding the challenges they face during patient care.
For those working in high-risk areas, the organizations should consider shorter working hours, rotating shifts and regular rest periods. Hospitals should ensure the availability of adequate training and standard operating protocols on infection control.
Early identification of psychological distress and support are the keys to protect the mental well being of health workers. The support from colleagues and immediate seniors have been shown to protect the mental health of the workers .
Psychological interventions should be individualized depending on the course, the severity of clinical symptoms, place of treatment to improve the effectiveness of interventions.
Support sessions like peer support programmes focusing on the identification of early symptoms of mental illnesses can be held at regular intervals. In cases of severe or persistent distress support from a mental health professional can be taken. Staff should be encouraged to step forward without fear of being blamed.
Although rapid research on medical aspects of the disease is undergoing, little is known about the psychological impact of this disease and measures taken for its control. Mental health burden during the COVID-19 outbreak is increasing, calling for an enhanced mental health support system. Treatment protocols must address both the physiological and psychological needs of the patients. Providing psychological treatment and support may reduce the burden of comorbid mental health conditions and ensure the wellbeing of those affected. Mental health care should be a priority.