Blog

“This is a bad science fiction movie that is real”,

Augustin Fuentes, an evolutionary anthropologist at the University of Notre Dame commented about how COVID-19 may alter the human journey. There have been plenty of calamities thrown up at humankind, whether natural or manmade, but the present coronavirus pandemic is on an unprecedented scale.

Coronavirus pandemic brings with it not only the dimension of physical health, but also its impact on mental health. A glaring example of what a pandemic can do to mental health, is the suicide of Finance Minister of German State, Hesse, Thomas Schafer. The stress of being unable to manage the fulfillment of the expectations of the people regarding government aid for fighting COVID-19 led him to take the extreme step.

Fear and anxiety, about a disease can be overwhelming and cause strong emotions in adults and children. This coupled with social distancing can significantly affect the mental health. MHA (Mental Health America) is a community based non-profit organisation that has been using its database to monitor daily, the increase in anxiety. According to them, there has been a 19% increase in screening for clinical anxiety in the first two weeks of February and a 12% increase in the first two weeks of March.

Chronic infectious diseases, such as tuberculosis and HIV are associated with higher levels of mental disorders as compared with general population. Studies show that depression rates usually soar after infections (Herpes exposure and Anthrax scares). Although the effects of Coronavirus on mental health have not been systematically studied, it is anticipated that COVID-19 will have rippling effects.

Robert L Berg in “The Second Fifty Years” defined social isolation as the absence of social interactions, contacts and relationships with family and friends, with neighbors on an individual level and the society at large on a broader level. The psychological stress that social isolation causes can have extremely detrimental effects on a person’s mental, emotional, and even physical health. Dr. Julianne Holt Lunstad, a professor of Psychology and Neuroscience at Brigham Young University, found that lack of robust social connections can raise one’s health risks as much as smoking 15 cigarettes a day or abusing alcohol- that is twice as much the impact of obesity.

The psychological impacts of isolation to the extreme, have been extensively studied in prisoners subject to solitary confinement. Many of them experience episodes of anxiety, paranoid hallucinations and panic attacks. Astronauts are another class of people who experience the effects of loneliness and isolation. Whether you’re stuck miles above earth or quarantined in your own apartment, social isolation can take a toll on your health in more ways than one. Being connected to one another socially, is widely considered a fundamental human need and is crucial to both wellbeing and survival. In the present scenario, social distancing will likely need to be practiced in the foreseeable future, so the effects of isolation will be increasingly seen in times to come.

Manifestations of Stress

Manifestations of stress can vary. It may manifest as worrying about one’s own health or about the health of the loved ones. There could be changes in sleep patterns, like difficulty falling asleep or staying asleep. Appetite could be increased or decreased. People often find it difficult to concentrate. Increased use of alcohol, tobacco or other drugs is also reported under stress. Certain chronic health problems like hypertension, may worsen under stressful conditions. People with preexisting mental health conditions need to continue their treatment and be aware of new or worsening of symptoms.

Response to Stress of different Subsets of Population

These are stressful times for everybody, but how each person reacts or responds to these stresses, depends on their background, on the factors that set each person apart from the other and also on the community they live in. Certain subsets of the population may respond more adversely to the stress of a crisis compared to others. These include the following:

1. Elderly and People with chronic diseases

It is well known that this group is considered high risk for severe manifestations of COVID-19. To be made aware of the special risk they face, may increase the stress level amongst this group. The psychological impact on this population can include heightened anxiety and even anger. This can be particularly difficult for older people who may already be experiencing cognitive decline or dementia. Some of them may already be socially isolated and experiencing loneliness, added to that the dimension of social distancing, can only worsen things.

2. Children and Teenagers

These are unprecedented times for everybody, more so for the children. Since schools have closed down, the children no longer have the sense of structure and stimulation that is provided by that environment. They have less opportunity to be with their friends, which under normal circumstances provides support that is essential for good mental wellbeing. Teenagers may resort to alcohol and drugs in stressful times.

3. Healthcare Workers

A review article was published by Peter Roy-Byrne MD in NEJM Journal Watch. It was a review of the article by Lai J et al JAMA New Open 2020 March 23. A cross sectional, geographically stratified, survey of 1257 healthcare workers from 34 hospitals in China, was done. The data was taken at the peak of the outbreak at Wuhan. High rates of depression (50%), anxiety (45%), insomnia (34%) and distress (72%) were found in the healthcare workers (42% of whom were directly caring for COVID-19 patients). The effects were greatest in nurses, women, those directly caring for COVID-19 patients and others working at the epicenter at Wuhan.

4. Patients with Preexisting Mental Health Conditions

According to Hao and Jian etal, the emotional responses brought on by the COVID-19 pandemic may result in relapses or worsening of an already existing mental condition, because of high susceptibility to stress compared with the general population. A lot of these people have regular outpatient visits for evaluations and prescriptions. However, regulations of travel and quarantine have resulted in these visits becoming more difficult and impractical to attend. This has compounded the problems of this vulnerable group.

Patients of Generalized Anxiety Disorder (GAD) are already prone to sheer anxiety and panic. The knowledge of the fact there is no definitive treatment for COVID-19 elevates their anxiety. Contamination obsessions are very common in Obsessive Compulsive Disorder (OCD). Therefore cleaning and washing compulsions are a core feature of OCD. This can easily be exacerbated by the threat of infectious pandemics.

Psychotic patients may also have worsening of their symptoms. Repeated media exposure to alarming facts along with distrust of organizations and government as well as misinterpretations of physical symptoms can result in delusions. On the other hand fears can quickly lead to clinical decompensation which needs to be carefully monitored.

Strategies to cope with Stress related to COVID-19 Pandemic

Each person has his own way of coping with stress. Possible strategies to cope with the stress related to the pandemic (especially under lockdowns) are:

• Take breaks from watching, reading or listening to News Stories including Social Media. Repeated exposure to distressing facts and figures can be upsetting.
• Take care of your body, like exercising regularly, taking deep breaths, meditation, eating healthy and balanced meals and getting adequate sleep. At the same time alcohol and drugs are to be avoided.
• Try to plan your day in such a way that you have time to do the things you enjoy.
• Connect with others. Share your concerns and feelings with friends and loved ones. Take special care to communicate with the elders in the family.
• Address the concerns of children and teenagers in a calm and confident way without exposing them too much to the upsetting details.

To fight this challenge, we as human beings, need to realize that we are all in this together and need to stand together, giving strength to each other. It is not to be forgotten that mental wellbeing is as important as physical wellbeing for an individual to function normally in a society.

References:

1. Lai J et al: Factors associated with Mental Health Outcomes among Healthcare Workers exposed to Coronavirus disease 2019. JAMA New Open 2020 March 23; 3:e203976

2. Mental Health and Psychological resilience during the COVID-19 pandemic. Press briefing by Dr. Hans Henry P Kluge, WHO Regional Director for Europe.

3. Hao Vao, Jian-Hua Chen, Yi Feng Xu: Patients with mental health disorders in the COVID-19 epidemic. The Lancet: April 2020, Vol 7, Issue 4.

4. *van den Heuvel L, Chishinga N, Kinyanda E, et al. Frequency and correlates of anxiety and mood disorders among TB- and HIV-infected Zambians. AIDS Care. 2013;25:1527-1535.

5. Kuan V, Denaxas S, Gonzalez-Izquierdo A, et al. A chronological map of 308 physical and mental health conditions from 4 million individuals in the English National Health Service. Lancet Digital Health. 2019;1:e63-e77.

6. Gale SD, Berrett AN, Erickson LD, et al. Association between virus exposure and depression in US adults. Psychiatry Res. 2018;261:73-79.

7. Mason BW, Lyons RA. Acute psychological effects of suspected bioterrorism. J Epidemiol Comm Health. 2003;57:353-354.