What can be said about lifestyle and psychosocial issues during the coronavirus disease pandemic? first impressions

To the Editor,

The disease caused by the coronavirus disease (COVID‐19) which shows involvement mainly in the respiratory tract was declared as a pandemic on 11 March 2020 by the World Health Organization (WHO). ¹ Everything regarding COVID‐19 started with cases detected in the city of Wuhan in China ² and became a public even that concerns the entire world in a short time due to the disease's high contagiousness. ³ , ⁴ According to the official website of WHO, it was confirmed globally that more than 6 100 000 people had COVID‐19 infection by 2 June 2020, and the number of cases is increasing day by day. ⁵

Although the methods used by countries to take the COVID‐19 pandemic under control show a diversity, it is seen that the strategy that is common in the world involves calls for staying home. ⁶ , ⁷ Without a doubt, it is a necessity in terms of slowing down the spreading speed of the pandemic for governments to recommend people to self‐isolate and self‐quarantine, that is, deliberate social isolation. ⁸ , ⁹ Nevertheless, these restrictions mean reduced physical activity, and this is known as an unhealthy lifestyle. It is a known fact that regular physical activity helps prevent and treat noncontagious diseases such as cardiac diseases, paralysis, diabetes and breast and colon cancer. Regular physical activity not only helps prevent hypertension, overweight and obesity but also has the potential to increase mental health, quality of life and prosperity. ¹⁰ , ¹¹ In addition to this, restrictions that have been issued in the period of the COVID‐19 pandemic prohibited a large proportion of these open and social activities (eg, going to the gym) and led to a reduction in physical activity. Additionally, while people are encouraged to exercise at home during quarantine, there are questions regarding the functionality of this. Another important area regarding lifestyle involves changing dietary habits and difficulties experienced in effective weight management in connection with the availability of food products and transition to unhealthy foods. That is, due to the concerns on food availability problems in the future, individuals have a tendency to purchase packaged and long‐lasting foods rather than fresh foods. ¹² Such unhealthy dietary behaviors and ineffective weight management carry the potential of causing several noncontagious diseases, such as obesity, diabetes, cardiovascular disease, cancer, chronic kidney disease and osteoarthritis. ¹³ Furthermore, in the long term, negative effects of some behaviors that may be used in coping with problems in the pandemic process may also be experienced. In this context, usage of cigarettes, alcohol and other addictive substances which is defined among ineffective coping styles may present another unhealthy lifestyle. ¹⁴ Considering the multifaceted nature of healthy lifestyles, applying transdiagnostic approaches can contribute to achieving pragmatic results. ¹⁵ Indeed, unhealthy lifestyle behaviors encountered in the pandemic period are not just related to noncontagious diseases, but these behaviors are also closely in interacting with the mental health of individuals. Considering that unhealthy lifestyle behaviors due to quarantine, such as physical limitation and ineffective weight management are frequently comorbid with stress, anxiety, and depression, the mental health of individuals should not be neglected. ¹⁶ For all these reasons, from the perspectives of public health and protective care, there is an emergent need to provide information and interventions to individuals, communities and healthcare institutions for them to continue the healthiest lifestyle under quarantine. ¹⁷

Although governments encourage people to work from home in the period of the COVID‐19 pandemic, working from home does not seem to be suitable and sufficiently functional for the entire population, especially tradespeople. As this situation will inevitably have serious effects on mental health by increasing unemployment, lack of financial security and poverty, it is clear that pandemic management requires socioeconomic policies. The sense of loss experienced in the society in the pandemic process may be caused by losing direct social contact, and this loss may be in multiple forms (eg, loved ones, employment, education opportunities, recreation, loss of freedoms, and social support). ¹⁴ Moreover, since the losses experienced are known as important risk factors for depression and suicide, ¹⁸ they require more careful observation and approach. Under quarantine conditions, individuals not only get away from the sources of social support, but they may also need social support more than ever. If these individuals cannot receive sufficient social support from their children, spouses, relatives or surroundings, it is likely for their psychosocial adaptation to be affected negatively. It seems rational to consider the pandemic as a psychological crisis and accept that the uncertainty and unpredictability in the nature of this crisis will have social, psychological and behavioral effects. ⁶ , ⁷ In pandemics, uncertainty and the anxiety related to this have strongly remained since the past. ¹⁹ , ²⁰ Although it is argued that uncertainty is an experience that is always existent in the world of people, this may be felt more than ever in a period of a pandemic. ¹⁹ , ²⁰ , ²¹ While the speed of spread of the infection seems fast, ²² it is observed that the uncertainty, fear and anxiety caused by the virus spread more rapidly. Especially paranoia feelings related to hygiene may be largely affected by anxiety and show themselves as symptoms of obsessive compulsive disorder with compulsions such as the fear of catching the disease and aggressive hand‐washing. ¹⁴ As in pandemics in the past, the psychological effects of this quarantine may involve posttraumatic stress disorder, confusion, and disappointment. ⁷ It is also known that difficulties and stress experienced in the pandemic period may trigger prevalent mental problems such as anxiety, depression and suicidal thoughts. ¹⁴ , ²³ , ²⁴ At this point, it should be noted that fear and anxiety caused by pandemic and disease cause stigmatization in COVID‐19 pandemic ²⁵ as in previous pandemics. ²⁶ , ²⁷ Although disease stigma may have an adaptive effect in preventing transmission, it may be incompatible to the extent that it inhibits other components of public health responses to emergencies such as the COVID‐19 pandemic. For example, the stigma encountered during the Spanish flu pandemic of 1918 and the 1994 Indian plague epidemic prevented effective public health responses in several ways, including undermining efforts to detect and treat people with the disease. ²⁶ Given the past and present pandemic process, as well as the prediction of future pandemics, ²⁸ there is a need to be more prepared than ever to develop and test strategies to reduce pandemic stigma. All these psychological and social symptoms affect the normal function of an individual and may lead to deteriorations in their education, family life, employment opportunities and daily life activities. These aspects of the pandemic have a direct effect on psychosocial life, and this leads to reduced quality of life and problems in coping with the situation. Considering these effects of the COVID‐19 pandemic in social and psychological aspects, how the psychosocial statuses of individuals are affected is an important question that needs to be answered. Supportive interventions towards improving quality of life need to be multidimensional and utilize the physical, psychosocial, and emotional aspects. ²⁴

As we are still in the acute period of the pandemic, there is a never before seen effort in the entire world in terms of eliminating uncertainties regarding treatment. Moreover, while the projection of infection waves in the future are present, ¹⁴ it is needed to have short‐term (emergency) and long‐term strategic plans regarding issues related to lifestyle and mental health. This is because mental health and physical health are affected by each other. Additionally, the presence of individuals with mental and/or physical health problems existing before the COVID‐19 pandemic should not be neglected. Overcoming this difficulty seem achievable only by achieving integration between digital disciplines and other sectors including healthcare and social care. It is believed that, on these days where especially protecting social distance is crucial, it will be useful to turn towards online psychological counseling practices. Experts in the fields of lifestyle and mental health need to be prepared to face the probable increase in the numbers of noncontagious diseases and psychiatric problems that will emerge not only in the period of the pandemic and right after the end of the pandemic.

FUNDING INFORMATION

This research received no specific grant from any funding agency in the public, commercial, or not‐for‐profit sectors.

CONFLICT OF INTERESTS

The authors declare that there are no conflict of interests.