The COVID-19 pandemic is a global health crisis that has brought the entirety of civilization to a standstill, with currently 15 million active cases worldwide. Not only does a pandemic present risk associated with general bodily health, it comes with the added burden on the mental health of people. Living through a global pandemic means dealing with an immense amount of fear, stress, and anxiety on a daily basis. Unemployment is rampant and people cannot make ends meet, day to day activities are hampered, and people are left bewildered as to what they can and cannot do.
Apart from the fear of contracting the disease, people are also having to deal with never-ending lockdowns and social distancing measures. In an age where media is the backbone of society, there is also the risk of misinformation. We see the circulation of truly alarming messages which can wreak havoc in negligent minds, who cannot differentiate fact from fiction. Conversely, there exists a group of people who believe that the entire pandemic is an elaborate scam being conducted by the governments of the world and believe that they are invincible and cannot contract the disease.
The Psychological Impact of a Pandemic
The severe uncertainty in the environment during a pandemic can cause immense amounts of anxiety in the public. Currently, there is no vaccine for COVID-19, and no assured cure either. Added to this, many people have been separated from their loved ones, who are either in treatment or out of the country. In some extreme cases, people are not even allowed to conduct funerals for their family members who have succumbed to the disease.
According to an online survey conducted by a platform LocalCircles, there has been an increase of a whopping 166% in complaints of anxiety from the rolling out of Lockdown 1.0 to Unlock 1.0, mostly linked to the fear of increase in cases due to the relaxation of lockdowns (Figure 1). There was a 35% increase in the number of people reporting anxiety between April and June 2020.
A report by the WHO recorded that 78% of people in middle to low income countries receive no remedy for mental health disorders despite sufficient evidence that effective interventions can be made. India falls in one of these groups and the added pressure of COVID-19 is hampering an already delicate mental healthcare system. People are in acute shortage of healthcare services and unable to get the help they need. Being cooped up in their homes for extended periods of time tends to take an adverse effect on people’s minds, often pushing them into depression and severe anxiety disorders.
Figure 1: An increase in the number of people feeling worried or anxious during the lockdown in India
However, this is not the only way that harm is being caused. In order to cope with all the stress, people resort to maladaptive means such as alcohol consumption, tobacco, and use of mind-altering substances. Another coping mechanism is binge-eating, also known as stress eating, which mostly consists of unhealthy and fattening food. In May 2020, the Chairman of Nestle India was quoted that there was a 10.7% increase in sales, amounting to nearly ₹ 3.142 Cr, as customers stocked up on items like Maggi, KitKat, and Milkmaid condensed milk due to the surge of purchases (panic buying) during the beginning of the lockdown. This behaviour is likely to be detrimental to the health of a person when taken place in long periods of time, such as the current lockdown. Thus, they are not only under mental duress, but physical as well.
Impact of the Pandemic on Specific Sections of the Population
While it is true that all parts of the population have had an adverse reaction, we must focus our gaze to look at certain groups that are more vulnerable to the negative psychosocial effects, the first of which are elderly people. Older individuals are at a relatively higher risk of contracting the disease, due to their compromised immune systems and debilitated physicality. As a result, they experience higher levels of anxiety and fear of being infected as compared to other age groups. Elderly people are also more prone to cognitive decline and may not fully understand the seriousness of the situation. Conversely, some people may overestimate the risk and become increasingly worried for themselves and their family, which can lead to added fear and sadness. According to a survey conducted in China on people between the ages of 60-80, 37.1% of senior citizens experienced depression and anxiety. It is important to provide aid to them through clear information and support and comfort of friends and family.
Another group of importance is children. Due to lockdowns, routine daily lives of children are hampered, and they are not able to attend school or extracurriculars and are forced to stay at home. Due to this, they may feel increasingly bored and lonely, and often times do not know how to express their emotions. The familiarity of everyday being the same is taken away in such times, and children may feel lost and helpless. It is imperative for parents to maintain a modicum of normality so that children don’t feel overwhelmed. Another way children are affected is when parents transfer their stress onto them, thus making them more frustrated and anxious.
Figure 2: Parents’ reports of children’s difficulties during COVID-19 confinement (Italy and Spain)
Persons with pre-existing medical conditions
People with already existing mental health conditions like depression, anxiety, etc. are even more affected by the pandemic. Their feelings of anger, fear, frustration, and distress are exacerbated by the environment around them. In times like these where change is the only constant, people are left with no certainty to hold onto and are plunged into deeper issues. Being away from their loved ones has caused separation anxiety in a large part of the population. People with substance abuse have had to deal with sudden withdrawals often leading to agitation, delirium, and in some extreme cases, suicide.
The most important sections of the population during these times have been the frontline workers and first respondents. Healthcare professionals are under colossal stress as they have to deal with sick patients at work and are often seen performing 24-hour shifts with barely any breaks. Additionally, they have to take adequate precautions in order to keep their family members safe from the virus when they return home. In a survey conducted in China, 50% of healthcare workers reported depression, 45% reported anxiety, and 34% presented insomnia.  Furthermore, healthcare workers also have to deal with the stigma around the fact that they may be carriers of the virus. They are often shunned by their own friends and family out of fear, thus making an already difficult situation even worse.
Apart from these broad classifications, people in physically or psychologically abusive households experience significant mental distress. Due to lockdown restrictions, they are unable to escape the abuse and are stuck in a constant environment of conflict. The NCW (National Commission for Women)  reported a steep increase in the number of 239 for complaints relating to domestic violence between March 23 to April 16, 2020. Bearing the brunt of abuse and being cooped up inside the homes leads to deep psychological trauma in these people.
Another vulnerable group is people who have lost their jobs due to the pandemic. They struggle with the anxiety associated with unemployment and worry about making ends meet. Often times these people are the sole breadwinners of the family, and therefore, have the additional burden of supporting them as well. Cases of depression and anxiety are on the rise in people who are unemployed. With the entire world plunged into an economic crisis, some people may resort to suicide as they see no other way out.
Figure 3: Percent of adults who claim the coronavirus had a negative impact on their mental health, based on job or income loss
As we delve deeper into this seemingly never ending pandemic, mental healthcare professionals must learn to foresee possible problems and come up with solutions to combat them. One main problem is the unavailability of mental health and psychosocial services. It is high time that these be included as part of essential services in all countries. People are not able to seek the help they need, and therefore, are unable to cope. In order to promote a healthy environment, there must be community resources in ubiquity and in easy access for people who may need it. This could be in the form of periodic check-ins, working hotline numbers, and other methods of remote treatment through digital platforms like video calls and emails as well.
There must also be a system to check the validity of information being spread. People are seeing new notifications everyday through social media such as WhatsApp, Twitter, Instagram, etc. Most of the messages we receive through these are completely unfounded claims with no proof to back them up. The only thing they do is create unnecessary panic and stress in the minds of vulnerable people. To prevent this, there must be regular evidence-based information communicated to the people from reputable sources such as the government. Being up to date will prevent undue fear and reduce stress in people’s minds. The government must also include an empathetic response to the general population’s distress so that they feel they are not alone.
Psychiatric professionals should be treating people who have been diagnosed with COVID-19, as they are in acute stress relating to their survival in itself. Being isolated and devoid of any human contact adds to their feelings of loneliness and depression. These patients can be provided with adequate digital means of communication to their loved ones to put their minds at ease.
Mental health is an essential element to the well-being of an individual and the collective well-being of society. It is alarming to see the ill effects of COVID-19 on the mental health of people. Therefore, it is imperative that immediate action is taken, and psychiatric care is included as part of basic pandemic healthcare.
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 doi: 10.1016/j.psychres.2020.112983