Psychological concerns and musculoskeletal pain amidst the COVID-19 lockdown

Sir,

Lockdown is “ an official order to control the movement of people or vehicles because of a dangerous situation” as defined by the Oxford Learners’ Dictionary.[1] In the case of the COVID-19 pandemic, a lockdown would restrict mass movements to help alleviate the spread of the infection. This sort of restriction is done by “stay home orders” or “movement control orders”.[2] Like in case of natural disasters such as earthquakes, floods and storms, lockdowns as a result of pandemics may become a fertile ground for several psychological disorders. A lockdown can be the best action at the time of such a crisis to save lives. However, both the pandemic and the lockdown may present with complex challenges to mental health that may go far beyond worrying about the crisis to worrying about administration reaction time and the future.[3,4] The multitude of effects may include inciting fear, phobia, and anxiety amongst people.[5] Loneliness, which is an important indicator for social wellbeing, would be a common experience to many at this time of lockdown. Loneliness itself can give rise to or escalate physical and psychological issues.[6] Literature suggests that during such situations, persons may suffer from adverse psychological outcomes such as anger, depression, and post-traumatic stress disorder. Factors like the duration of staying at home, fear of infection, worry about ample home supplies, worry about receiving timely information, monetary loss, and stigma related to the pandemic can trigger psychological disturbances.[4,7] Decreased financial security and mindset switch from living to survival are the other factors which contribute to mental health issues.[8] Also, unemployment due to lockdown can cause low self-esteem and physical health consequences.[9] In a recent study,[10] it was found that depression and anxiety were significantly increased after the announcement of lockdown. Amongst persons under 35 years of age, factors like living alone or with children and those who are affected more financially appear to be most at risk of developing depression and anxiety.[10] During the lockdown period, people may have difficulty in sleeping, concentrating at household work and may have alcohol or substance withdrawal issues or indulge in such use. Patients with a previous history of medical or psychiatric illness may have problems such as being more irritable, withdrawn, and have difficulty accessing treatment facilities or procuring medications. This could lead to relapse of illness.[11]

Children and elderly persons may be highly vulnerable to mental health issues during this phase. Children who are in the active stages of their lives are at homes due to closure of schools. This may lead to them being confined in a closed milieu making them deficient of stimulation and interaction with their peers, both of which are essential for their mental health. They may experience anxiety, fear of getting infected, fear that someone in their family will die, and the fear of going for treatment, just like adults do. Children may model the behaviour of their anxious parents and be stressed during these times. The elderly population is also a highly vulnerable group, especially the ones who have preexisting physical illnesses. Many of them would have already been experiencing reduced social interaction and the current scenario would intensify the negative impact of social isolation on their psychological health, making them prone to depression and anxiety disorders. The lockdown may induce fear, anxiety, and acute stress,[12,13] particularly when the information that elderly population are more affected[14] is delivered to them via their family, friends, media, or internet sources.

Social isolation, loneliness, physical inactivity, or sedentary lifestyle, although are inter-related, are individual entities. Owing to the present social isolation where the public interaction is restricted, the above can interplay and interfere in health status of the person as a whole and we believe it will have effects on musculoskeletal pain. Smith et al.,[15] in their study, accomplished that although people who suffer from long-lasting musculoskeletal pain have a higher risk of being lonely, they have a lower chance of being socially isolated. Another study which assessed the health risks associated with social isolation concluded that socially isolated people irrespective of their age had relatively higher risks of impaired self-rated health and musculoskeletal issues.[16] The literature is ambiguous to explore a cause and effect relationship between musculoskeletal pain and isolation. However, the imposed restriction on social interaction and outdoor activities will eventually have twofold manifestation. It would affect an individual’s pain threshold as evidenced by increased inflammatory and pain modulating markers level, especially in those who are already suffering from chronic pain syndromes.[17] Also, the lack of physical activity because of the current restrictions would lead to musculoskeletal pain especially upper and lower backache.

FIGHTING THESE EFFECTS OF THE LOCKDOWN

Maintaining social contact and routines may be essential for maintaining mental health. In conditions like in the current lockdown period in India, this may not be possible. Hence, staying linked with acquaintances and family members online or via phone may be worthwhile. An interesting diagrammatic representation on how to manage uncertainty while staying at home during the lockdown periods, prepared by Dr. Igor Thiriez, a psychiatrist from France and translated by Dr. Caroline Pontvert, a psychiatrist from the United Kingdom is shown in Figure 1.[18,19]

Figure 1:

The corona-worry (with permission from Dr. Igor Thiriez).

In case of children, fear and panic may be reduced by adequate care and attention, making them understand the current situation in simple ways and maintaining honesty.[10] Children may also spend more time outside home during a pandemic due to lack of awareness of the gravity of the situation and become hosts of COVID-19. To avoid such occurrences, certain interventions such as paid leave for parents may be beneficial.[20] For older persons, approaches such as physical exercises, keeping routines at home, and maintaining social connectivity if they are acquainted with gadgets may help.[10] Early detection and awareness of psychological wellbeing can go a long way in minimising the risk and improving the wellbeing of society.