Indians vs.COVID-19: The scenario of mental health

Abstract

The fight with COVID-19 pandemic seems nowhere near the end and is extremely daunting. An upsurge in cases of mental illness in India post the pandemic is a clear indicator of its scary impact. The situation of lockdown is causing the feeling of distress, agitation and helplessness among the people. Healthcare workers, poverty-stricken people, elderly, kids and persons with some pre-existing medical condition are more vulnerable to anxiety currently. Practicing a healthy lifestyle; yoga, meditation, avoiding reading too much about the pandemic and being with family are the ways to assuage stress.

1. Introduction

Coronavirus disease 2019 (COVID-19) is a contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which is a single standard RNA genome [1,2]. The continuously rising number of the affected patients and deaths across the globe is overwhelmingly daunting. More than 851,099 people globally and 64,469 people solely in India have succumbed to this disease as of August 31, 2020 [3,4]. The number of active cases of COVID-19 in India by August 31, 2020 is 781,975 [3]. Since there is currently no drug or vaccine available against this virus, keeping social and physical distancing is the preferred way to slow down the spread by interrupting the chain of transmission [5]. Minimization of contact with infected surfaces, regular hand washing, wearing mask compulsorily, physical distancing (at least 1 m), and avoiding crowding are a few measures that each and every individual is advised to incorporate in their routine lives [6,7]. The present times are not only a test of physical immunity but also a test of mental strength and resilience [8].

2. Impact on mental health

COVID-19 pandemic is accompanied by increased stress, anxiety, sleep disturbance, and panic amongst the people [9]. The horrific pandemic led to an unprecedented situation of nation-wide lockdown in many countries including India [10,11]. The sudden changes in routine life because of the lockdown and prolonged isolation cause psychological distress [12]. The people living alone amidst the lockdown tend to get agitated feeling confined. People whose family member has some serious complications of COVID-19 could feel anticipatory grief [13]. In addition, the shortage of supplies can also augment the stress [9].

Healthcare workers, unemployed/poverty-stricken individuals, elderly people, children, pregnant women and those suffering from a pre-existing mental condition like obsessive-compulsive disorder (OCD) and depression are likely to feel more distressed [5,[14], [15], [16], [17]]. The front-line workers who have direct involvement in handling COVID-19 patients are at greater risk to develop psychological distress over others. Excessive working hours, inadequate personal protective equipment, and sensationalized news stories contribute to the anxiety [18]. The pandemic situation worsens the anxiety issues for people with major symptoms of OCD and individuals who overrate dangers. Such people worry about becoming contaminated and unintentionally spreading contamination [14]. Children and adolescents can find it very hard to spend such a long time at home continuously with a lack of personal meetings with friends causing them to feel agitated and bored [17]. There is also reportedly an increase in the violence against children during such a time which is fearsome for kids [19].

In the period of complete lockdown, sudden travel ban, no work, and financial crisis caused grievous panic amongst internal migrant workers in India forcing them to walk several thousands of kilometers to reach their respective native places. They are vulnerable to develop severe, acute and chronic mental health issues [20]. Moreover, massive job losses, salary cut, unemployment and mounting economic crisis have exacerbated the situation for the majority of the public causing obvious psychological distress [21]. Lockdown has encouraged excessive use of digital platforms and social media that can influence sleep patterns and negatively impact mental well-being eventually. Moreover, depressive symptoms in students and office workers during the period of lockdown have been reported to be greater when compared to before lockdown, possibly due to home confinement, stress as well as anxiety [11]. The Indian Psychiatry Society reported a 20% increase in mental illness cases since the pandemic [22]. The rate of suicide could be escalated possibly due to the fear of infection and feeling helpless [21].

The mental health situation during the pandemic situation is quite the same globally. Around 45% of adults reported an impact on mental health in the US [23]. The situation is reportedly quite similar in Australia where adolescents and young adults are excessively affected because of the pandemic [23]. In a web survey conducted in Albania during 25th March- April 20, 2020, around 47.74%, 31.82%, and 12.90% out of 715 participants expressed minimal, mild, and moderate depression after just 2 weeks after the commencement of quarantine [24]. Furthermore, investment in the infrastructure has been put by Taiwan to support clinical as well as psychosocial aspects of care in the course of the pandemic. People in Taiwan and Spain have been suggested to limit the consumption of news stories related to COVID-19 to only 30 min every day to minimalize the feelings of despair [23].

3. Treatment strategies in India

The frontline workers, doctors, nurses, healthcare staff, sanitation workers, police personnel, as well as volunteers are to be credited for the earnest efforts to curtail the number of COVID-19 cases [2]. People having mild symptoms may be given symptomatic treatment like an antipyretic drug for fever and pain. Hydroxychloroquine may be deliberated for persons having high-risk features for the severe disease under strict medical supervision [25]. Convalescent plasma therapy is another treatment strategy followed in India. Moreover, ‘ArogyaSetu’ mobile-application is also available which helps to inform people about the COVID-19 situation in their vicinity and self-assess their health [5]. On the vaccination front, three vaccine contenders against SARS-CoV-2 are presently in different phases of clinical testing in India including COVAXIN (developed by Bharat Biotech, Indian Council of Medical Research, and National Institute of Virology) and ZyCoV-D (developed by Zydus Cadila) apart from Oxford/AstraZeneca's contender ChAdOx1 nCoV-19 which is known as Covishield in India and is being tested and manufactured by the Pune-based Serum Institute [26].

Discussing mental health problems is considered a social stigma because of which seeking treatment for mental disorders is still not thought to be normal by a large proportion of people [27]. Nonetheless, a special task force and helpline concerning mental health issues during the pandemic has been set up by the National Institute of Mental Health and Neuroscience (NIMHANS), India. A continuum of care service has been established for persons with psychiatric, neurological as well as neurosurgical issues. Telemedicine facilities and teleconsultation are being provided to the patients [28].

India's strong socio-cultural framework and family culture can act as a savior during hard times where family members can comfort, cheer and motivate each other. Staying calm, keeping one self busy with routine activities, and rediscovering hobbies and interests are some way outs to assuage boredom. Healthy lifestyle and eating habits are also helpful; the use of ayurvedic herbs known for boosting immunity like tulsi, cinnamon, turmeric, etc., is also common in Indian households [29]. Indians commonly practice meditation and yoga which can aid in alleviating stress and anxiety [30]. Stress management, counseling and communication are essential during these hard times.

4. Conclusions

Feeling anxious amidst the pandemic and lockdown is inevitable. But, India is a country where people are used to hardships and compromises from a very early age. However, the current battle is a tough one where mental strength, patience and resilience are being tested. More communication with close ones, avoiding sensationalized news-stories, practicing healthy lifestyles with a positive mindset is the way out to keep anxiety away.

Declaration of interests

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper (Indians vs. COVID-19: The scenario of mental health).

Declaration of competing interest

The authors don't have any conflict of interest in the publication of the manuscript.