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Novel coronavirus disease or COVID-19 pandemic (officially designated by World Health Organization WHO) is a major health crisis that has affected several nations in the world. As of now more than 7.5 million cases have been reported and around 0.4 million people have died of this virus. It is the opinion of the renowned Clinical Psychologist Jonathan Porteus that ‘Our society is definitely in a collective state of trauma’.
The lockdown induced by novel coronavirus has brought the lives of people at an absolutely stand-still. Not being able to see the light of day, go to the gym to reduce stress, or see one’s family members and friends can be very lonely and depressing. Currently, around 2.6 billion (accounting for one-third of the world’s population) are living under some kind of lockdown or quarantine. This is arguably the largest psychological experiment ever conducted. Within a week of the commencement of the nationwide lockdown, the number of reported cases of mental illness in India rose by 20%, as depicted in a study by the Indian Psychiatry Society. A review was published recently in Lancet that studied literature on the psychological impact of the quarantine restrictions. According to Lancet the separation from loved ones and curtailment of the movement of people has potentially exposed them to a range of psychological conditions ranging from post-traumatic stress symptoms to anger, confusion, stress, depression, insomnia and emotional exhaustion. Recent news articles have also highlighted the increase in suicide rates and mental health concerns caused by the severe lockdown restrictions. In this article we will discuss the effect of lockdown on various groups of citizens.
Impact On Public in General
The isolation and fear associated with this lockdown is escalating nervousness among people all over the world. A woman with Obsessive Compulsive Disorder (“OCD”) cannot stop disinfecting furniture and kitchen appliances, sanitizing car keys and toys, keeping even vegetables and groceries in the sun. A man suffering from anxiety disorder terms this lockdown as an ‘invisible enemy’ and is finding it very difficult to cope with it. Constant health warnings and alerts are all that he hears. According to Kathryn Kinmond, a psychotherapist in Staffordshire and a member of the British Association for Counselling and Psychotherapy, uncertainty is a key driver of anxiety. “Coronavirus gives rise to lots of uncertainty, and this has particular resonance with people who suffer from anxiety.” It is not only anxiety and OCD that are worrying people all over the world, but also panic attacks can be seen as a response to the pandemic. According to David Crepaz-Keay from the Mental Health Foundation, “One of the things that lead to panic attacks is excessive worrying for unsubstantiated reasons”.
Thus, not only those with pre-existing psychiatric problems but also the elderly population are struggling with greater levels of loneliness and depression. Another man aged 70 years lives alone in an apartment and spends his time reading the newspaper, walking and cooking, but the lockdown has completely cut-off this ties from real people. “These are strange times,” says Pratima Murthy, head of department, psychiatry, at the National Institute of Mental Health and Neurosciences (NIMHANS) in Bengaluru. “What we generally prescribe for the elderly is social interaction for their emotional well-being. And now they’ve been told the opposite: to physically distance themselves, even from their grandchildren”, she says.
Amidst this lockdown, we must keep in mind that there is a difference between physical distancing and social distancing. Staying connected through digital platforms like Whatsapp, Facebook, video-calls with family members living far away plays a vital role in fending off anxiety and depressive behaviour. A 25-year old woman lives in Noida while her parents live in Ahmedabad. She calls them thrice a day, asking if they have taken their medicines, eaten food etc. In this time, she is constantly fearful of what would happen if something were to happen to them, and she was not able to reach them on time.
Staying together can be stressful as well. Anita, a homemaker, is drowning mentally and physically. She has to make a special effort to keep her children occupied all day, now that schools are closed, while at the same time keep the house in order. With her husband is working from home, he is not able to help with the household chores or the children either. It was seen that in cases where the parents were quarantined with children, the mental health toll became even steeper. In one study, no less than 28% of quarantined parents warranted a diagnosis of “trauma-related mental health disorder”. For people with dysfunctional family backgrounds, such as living with an abusive partner, dominating and over-indulgent parents can also trigger anxiety and depression.
Impact On Quarantines
We understand that the measures taken by the government to stop this health pandemic, including restrictions on movement, closure of schools and colleges are necessary to curb the spreading of the virus, and in turn to save lives.
However, this crisis is affecting many young people in ways that will risk long-term consequences for their mental health. Almost one in four children living under COVID-19 lockdowns, social restrictions and faculty closures are handling feelings of hysteria , with many in danger of lasting psychological distress, including depression. Their education, relationships and socialising have been severely disrupted and current projections for the economy and the job marketplace will be adding to their stress.
Due to the pandemic many children are unable to get access to help from the counsellors which they were taking before lockdown and this poses a significant challenge in front of the government. The statistics show that one in four youths with mental health issues cannot get help during lockdown. Children and youth who are already at risk such as those living in challenging home environments or those who lack social support or whose families are already facing poverty are especially vulnerable. Restrictions on the movement and not able to go out of the house have worsened their mental health because there is no escape for them. Another common problem that adds to their anxiety, is witnessing domestic violence and fights amongst family members.
Research shows that feelings of helplessness, loneliness and fear of being socially excluded, stigmatised or separated from loved ones are common in any epidemic, while prolonged stress, boredom and social isolation, as well as a lack of outdoor play, can lead to a higher number of mental health conditions in children, such as anxiety and even depression. A survey by the Royal Society for Public Health (RSPH) found that 70% of 18 to 24-year-olds are experiencing more anxiety than usual, compared to 47% people above the age of 75.
Impact On Health Workers
Dealing with the pandemic has had a significant negative impact on the mental health of health workers. These people have dealt with many a tragedy, but this is another form of crisis. Over and above all the sickness and death surrounding them, the fear of being infected takes a steep toll on their mental and emotional health as well. This is the time to ask them if they’re all right, and to tell them how to look after themselves.
Frontline medical workers are at risk not only of adverse physical outcomes due to coronavirus, but also of psychological ones. Previous pandemic data, particularly after long durations of quarantine indicates that the health care workers may develop symptoms of post-traumatic stress disorder, depression and drug use disorders. Preliminary data from China and Italy during the Covid-19 pandemic provide further evidence; health workers in China reported depression (50.3 per cent), anxiety (44.6 per cent) and insomnia (34.0 per cent). Concerns about these data are compounded by high rates of pre-existing mental health and substance abuse disorders in this population, with physicians having high suicide rates.
The pressure to act in a timely manner and successfully diagnose, isolate and treat has been overwhelming, particularly in the midst of intense public and media scrutiny. In addition, due to the increased risk of exposure to the virus, our frontline doctors, nurses and health care professionals fear that they may contract COVID-19 themselves. They are concerned about bringing the virus home and passing it on to their loved ones and family members. Our healthcare staff also reports increased levels of stress when dealing with patients who are unwilling to cooperate or refuse to comply with safety instructions. Feelings of helplessness when dealing with critically ill patients, in the context of limited intensive care beds and resources is commonly reported. The long-term use of protective equipment causes difficulty in breathing and limited access to toilets and water, resulting in subsequent physical and mental fatigue. A very recent study among healthcare professionals at the COVID-19 tertiary infectious disease hospital in China revealed a high incidence of anxiety and stress disorders among frontline medical staff, with nurses having higher incidence of anxiety than doctors. Almost 10% of the quarantine hospital staff reported “high depressive symptoms” up to three years after quarantine.
From studies conducted during the SARS epidemic, we know that quarantine has a serious effect on the mental health of health workers. Symptoms of acute stress disorder, depression, and alcohol abuse were predicted. Even three years later, quarantine was associated with post-traumatic stress symptoms, which were again more serious in health care workers. As a result, many experienced health-care professionals sought to minimize contact with patients. Some didn’t report back to work at all.
Mental responses such as anxiety, depression and panic attacks have an immediate negative impact on our sleep patterns, productivity, concentration and engagement. Therefore, if careful management is not implemented, it can have severe consequences. In the words of Walt Disney,
“Happiness may be a state of mind. It’s just consistent with the way you check out things”.
Lockdown is the best time for self-introspection i.e. time which is spent in exploring oneself and practising self -care. Three self- care steps if practised regularly can prove beneficial – do something that you love [sing, dance, etc], connect with someone you have not spoken to over a long time, and engage with inspiration such as nature, motivational quotes, art, communicating remotely with family and friends Practising mindfulness or meditation can boost mental and physical health. It helps in focusing attention, enhances concentration and calms the body as well as the mind. Feelings of depression can make a person lethargic and slow; on the other hand, anxiety can make a person rush. Therefore, maintaining a proper balance between the mind and body is very important. For this exercising becomes important as it lowers stress levels and gives immediate boost to one’s mood. One of the crucial wellness habits is practising social interaction. Switching to real- time communication is very important. Arranging informal video-calls with friends, family members, relatives can play a pivotal role during missed coffee breaks and other moments. But at the same time restricting from media and social media coverage to prevent it from becoming too overwhelming is also essential. We should obtain news only from credential resources.
The Government and NGOs can also take some steps to ensure self-help interventions are put in place, to help address the needs of the affected populations; educate people about the expected psychological impact and reactions to trauma if they’re curious about receiving it. Make sure people understand that a psychological reaction is normal; launch a selected website to deal with psychosocial issues; confirm that folks with acute issues can find the assistance that they need.
Authors: Soumya Sharma and Kanishka Pamecha from Dr. Ram Manohar Lohiya National Law University, Lucknow.
Editor: Astha Garg, Junior Editor, Lexlife India.