International Journal of Mental Health & Psychiatry.ISSN: 2471-4372

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Review Article,  Int J Ment Health Psychiatry Vol: 6 Issue: 3

Psychosocial repercussions of COVID-19

Joshi G1*, Hooda Y2, Roy D3

King George’s Medical University, Lucknow, India.

*Corresponding Author : Gunjan Joshi
King George ’ s Medical University, Lucknow, India
Tel: 08285242210
E-Mail:
[email protected]

Received date: May 30, 2020; Accepted date: June 10, 2020; Published date: June 22, 2020

Citation: Joshi G, Hooda Y, Roy D (2020) Psychosocial repercussions of COVID-19. Int J Ment Health Psychiatry 6:3. doi: 10.37532/ijmhp.2020.6(3).182

Abstract

Introduction: The sudden and unprecedented pandemic of COVID-19 brought about various changes in the lives of people worldwide. There hasn’t been a pandemic so widespread and impacting in the last few decades. This pandemic brought about great burden of communicable diseases as well as increase in the burden of other psychological and social issues. Methodology: We conducted an extensive review of literature. We reviewed the articles related to the psychosocial burden of diseases in the COVID-19 Pandemic. We conducted the review using key words such as (psychosocial burden, COVID-19, children, adolescents, elderly etc.) in the electronic databases. Results: This paper discusses about the finding of extensive review briefly. There is much more to the psychosocial aspects of COVID-19 than those of apparent in nature. The major issues reported are core psychological illnesses like anxiety, depression, PTSD, OCD and associated issues of substance use, domestic violence, insecurities etc. This pandemic has affected all sections of the population; ranging from the children, to elderly, people living on the edges of the society, people suffering from other medical co-morbities and other issues. Various studies have reported that sleep problems, anxiety, and novel behavioral addictions are at a rise and there is possibility of increased burden of mental illnesses after the COVID-19 pandemic. Conclusion and recommendations: The mental healthissues are plentiful during the pandemic and various populations are responding in different ways to the pandemic. The increased fatality and contagious nature, the measures to contain the spread of COVID-19, also has added to the strain of the pandemic. This can be a great opportunity for the mental health professionals to explore their capacities and work in ways increase the access to mental health for whoever needs it.

Keywords: COVID-19; Psychosocial issues; Comorbidities; Special populations; Psychological and physical illnesses; Behavioral problems.

Introduction

There is a strong connection between mental health and the physical environment of an individual. Past literature on the outbreak of SARS in 2003 and Ebola in 2014, have shown significant impact on mental health of the population. In fact, the mental health effects are observed to be greater in number, and for much prolonged duration than the physical effects of the specific illness [1-3].

Considering the spontaneous outbreak of COVID-19 since December 2019, the ongoing pandemic has clenched the entire globe with its torment. It has barely provided time for people to even establish a shock reaction, pertaining to its rapid spread thereby aggravating mental health of people. A recent study surveyed 2700 people from different parts of the world including US, UK, France, Germany, Singapore, Australia and New Zeeland to assess the reported mental health of people during on-going COVID-19 pandemic. Findings revealed that 67% people reported experiencing higher stress, 57% experienced greater anxiety, 54% were emotionally exhausted, 53% felt sad with each day passing by, 50% reported being more irritated and 42% felt their overall mental health as has declined since the COVID-19 outbreak. A nationwide online survey from India reported people are suffering from anxiety, paranoia, sleep disturbances and more than 80% of them reported perceiving the need for mental health support related to their problems primarily because of COVID-19 pandemic [4-6]. There have been varied types of responses by the people due to nationwide lockdowns which have been unpredictable and difficult to manage. A Literature review conducted by mentions vulnerable groups during this Pandemic that include the migrant workers, homeless, persons with pre existing mental illness, older people, students studying overseas, and pregnant women who are at risk for complications which put more of mental strain compared to the physical viral illness. Due to diffuse and boundless impact of COVID-19 outbreak on people, this paper aims to review studies tapping onto the psycho-social domains which have been affected with the ongoing pandemic [6-11].

Emotional Dysregulation

COVID-19 has caused disruption of emotion regulation with an increase of negative emotions, such as anxiety, and a decrease in positive emotions like happiness. Negative emotions observed in people affected by a public health emergency were wide range of fears related to death, isolation, stigma, lack of essential commodities and risk of getting infected through socialization in future. The world responded differently to the need for country wide lockdowns expressing a lot of negative emotions to the pandemic. An online study in China, with Weibo users as sample, provide evidence for rise in negative emotions and sensitivity to risks; and decline in positive emotions and life satisfaction [12-13]. This change of emotional regulation and a significant increase in negative emotions during pandemics can develop into various mental illnesses [14].

Health Anxiety and hoarding behavior

An increasing trend of Health Anxiety is observed in general population as the exaggerated information portrayed by Covid media has made people hyper vigilant of their bodily symptoms thereby leading to increased fear and misinterpretation of these symptoms. Many have resorted to maladaptive behaviors or mistrust in efficiency of authority figures as a result of their anxiety [15]. Moreover anxiety related to different aspects of a pandemic and imposed lockdown has led to hoarding of essential commodities by people [16].

Predisposition to OCD and Panic disorder

Government guidelines of washing hands frequently, washing the products bought, prioritizing hygiene, reducing the trips to markets can exacerbate OCD symptoms like checking, fear of contamination, compulsive behaviors of washing and hoarding despite assurance provided for availability of essential commodities. Preoccupations with safety measures, preventive hygiene practices like washing hands, using sanitizers, worry about the future and obsessions with cleanliness can develop into Obsessive Compulsive Disorder (OCD) and panic disorders [17].

Stress and Depression

Uncertainty about the duration of COVID-19 has led people to become increasingly stressed. People are now living in a threat of losing their job post pandemic which is creating a fear of loss of livelihood. This is creating increasingly levels of stress in individuals including migrant workers [18]. Living in isolation due to selfquarantine or government imposed lockdown has led to limited social support thus leading to higher levels of anxiety and depression. Moreover people living in isolation will be deprived of touch sensations which will directly increase their chance of developing depression [19].

Sleep Disturbances

A major consequential issue of lockdown is the sleep disturbances experienced by people with an increasing number of people reporting lack of quality sleep and difficulty in initiating sleep due to the extreme levels of stress and anxiety faced during the isolation period, away from their loved ones [20]. Moreover lack of opportunities of outdoor physical activities, frustration and boredom building up by staying indoors for prolonged duration is also contributing to insomnia amongst people [21]. Disturbances in sleep schedule, sleep hygiene and healthy diets is also observed among children, worsening their physical fitness [22,23]. Spread of misinformation and negative news on social media, uncertainty about future of the virus outbreak, isolation, worry about the risk of infection, doubts regarding the effectiveness of the treatment all contributed to the high prevalence rate of insomnia amongst medical workers, with one third of them suffering from insomnia [24].

Withdrawal Symptoms

Closing of liquor shops and empty stocks of alcohol at home during the lockdown has significantly increased incidences of Alcohol withdrawal symptoms and suicide cases among people with alcohol addiction [25]. In Thailand, Emergency Departments in hospitals are overburdened with cases of severe alcohol withdrawal, and delirium tremens, taking a toll on the already scarce resources [26,27]. Due to strong craving and withdrawal symptoms, some people with alcohol addictions tried to make home-made alcohol or consumed sanitizers, which proved fatal killing seven people as on 5th May 2020 in India alone [28,29].

Behavioral Addictions

As lockdown has forced people to stay indoors thus, limiting their sources of pleasure to indoor activities people are now observed to spend more time with the technology and gadgets, increasing their risk of behavioral addictions in the long run [30-31]. Another report on behavioral addiction was on pornography addiction which revealed that there has been significant rise in pornography, in numerous countries, even in the places where the access to the porn websites was not made free [32].

Marital conflicts and Domestic violence

Strong family bonds and supportive climate can act as a great buffer to the psychological distress provided the right approach is taken [33]. The period of lockdown has become a suffering for families where the relationships were not healthy thereby increasing their distress, impairing relationships as people have more time to fight and upsurge in reported cases of abuses and violence [34]. There has also been a significant rise in cases of domestic violence and sexual abuse where both the abuser and the victim are trapped in the same house [35].

Concerns in children

Inadequate or false information, prolonged confinement, lack of social interaction with peers, over indulgence by parents and financial insecurity at home might aggravate adverse psychological impact and behavior in children. Children have shown increased restlessness and symptoms of post-traumatic stress in quarantined homes [36].

Suicide

Suicide during COVID-19 can be attributed to factors like fear of getting infected, dying, fear of spreading the virus after getting infected by it, loneliness, stigma attached to the patients [37-38]. Two nurses in Italy committed suicide to prevent spread of the virus when they were diagnosed positive for it. Moreover 80 incidents of suicide were reported during the lockdown phase and the reasons for which were attributed to fear of getting infected, withdrawal symptoms which made people consume sanitizers, and the stigma.

Post-traumatic stress disorder

Previous literature on psychological consequences of epidemics and pandemics reveal that people who experience traumatic events during a global outbreak of a disease or any other disasters tend to experience higher level of stress leading to mental illness like complicated grief disorder, Post Traumatic Stress Disorder (PTSD), and depression. A study conducted on 730 COVID-19 patients also revealed symptoms of PTSD before their discharge from the hospital which will further thwart their quality of life and performance at work [40]. These results could be influenced by the quick spread of false and fearful information about the virus on media, more emphasis on the death statistics, and stigma towards patients with a positive diagnosis of COVID-19.

Coping Mechanism

The ongoing pandemic has caused people to use wide variety of coping mechanisms to deal with their anxiety, boredom and stress. Lockdown has facilitated avoidance as a coping mechanism as a huge number of people are coping by getting highly engaged with social media, playing video games for longer duration, binge watching movies and shows and resting for longer periods which could create more stress [41,42].

Conclusion and recommendations

Various psychosocial issues have been observed throughout the regions of the world in response to COVID-19. Considering the profound impact of this pandemic, a vast number of people are presently facing severe stress, emotional dysregulation, depression, health anxiety, substance withdrawal, sleep disturbances, family conflicts, domestic violence and failures in coping. In view of this deleterious impact amid COVID-19, there is a clear need for psychological intervention for both the general population and patients with pre-existing psychological illness so as to reduce their risk of developing a disorder or worsening their symptoms. Moreover due to the uncertainty about the duration of this pandemic, people are likely to experience post Covid stress along with other mental health issues. This is suggestive of high need of mental health professionals and their services. The mental health professional have to equip themselves with novel strategies to deal with the emergent psychological problems post the COVID-19 Pandemic. Truly the psychological Interventions will be in great demand and it will be a time to rediscover and explore newer psychosocial approaches and usage of technology to deliver the needed mental health care and increase the access to the needy.

Funding

No funding received

Conflict of Interest

None

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