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RESPONDING TO THE COVID-19 PANDEMIC: CHALLENGES OF INDIAN PSYCHOLOGISTS
KALPNA, DR. NOVRATTAN SHARMA
Maharishi Dayanand University, Rohtak, Haryana
Introduction
COVID-19 (Corona Virus Disease 2019) is a highly infectious disease caused by SarsCov-2 (Wang et al., 2019, WHO, 2020). With its outbreak in China in December 2019 (Wang, 2020) it is now globally affecting the health and wellbeing and has therefore been declared as a world public health emergency by the World Health Organization in January 2020 (WHO, 2020). Physical health and psychological problems have been reported by researchers (Wang et al., 2019; Rajkumar, 2020). People around the world are worried about their safety. The associated uncertainty and spread of SarsCov-2 pose threat to psychological well being, particularly emotional and cognitive wellbeing. There are research findings that are consistent with Behavioural Immune System (BIS) theory which says that people experience anxiety, depression (negative emotions) and negative cognitive assessments for protecting themselves. (Schaller et al., 2015). They tend to develop extreme avoidant behaviours while trying to follow physical distancing.
Uncertainty about future situations causes cognitive dissonance that results in mental discomfort. Social risk assessment has been reported to be higher and lower life satisfaction after COVID-19 outbreak (Holmes et al., 2020; Nicola et al., 2020). Lack of cure and treatment and adverse socio-economic outcomes because of the lockdown measures are projected as the reason for mental health problems among people (Holmes et al, 2020, Nicola et al, 2020). The current article focuses on understanding the psychological problems faced by people at large during the COVID-19 pandemic and the mental health issues that were reported from other countries as well as India.
Extent of the Problems
There are other studies that have reported mental health issues among general population in the community during previous exposure of Corona Virus like SARS and MERS (Taylor et al., 2008, Sprang & Silman, 2013) as well as current pandemic of COVID-19 (Goyal et al., 2020, Lei et al., 2020; Kang et al., 2020). Mowbray (2020) in his study reported Post-Traumatic Stress Disorder (PTSD) to be ranging from 4-41% in the population and Major Depression was observed in 7% of the population in Beijing after the outbreak. The same study also highlighted that factors like low Socio Economic Status (SES), interpersonal conflict, excess use of social media, lack of social support increased the risk of such conditions.
The above mentioned factors may also increase the occurrence of anxiety, substance abuse, loneliness, domestic violence and child abuse. For example, Li et al., (2020) reported prevalence of anxiety and depression to be 8.3% and 14.6% respectively among the general population in the community. This percentage increased to 12.9% and 22.4% for anxiety and depression respectively if a person in close contact has been quarantined. The same authors reported that in China 40% of the general population in the community have mental health problems. Another study by Zhou et al., (2020) reported that China’s adolescents experienced symptoms of depression (43.7%), anxiety (37.4%), and a combination of both during the current pandemic (31.3%). Therefore, the increase in mental health related issues is a new reality that we should not overlook.
Lockdown, social distancing and quarantine measures taken by our government have been able to contain the spread of the virus. Lockdown has also restricted the sale of alcohol, marijuana, heroin and other addictive substances which on the one hand might be good because easy availability is one of the reasons for heavy use of the substances. On the other hand, those who are drug dependent faced several psychological problems ranging from withdrawal symptoms to increase in domestic violence, which impacted the psychological well-being of themselves and also their family members. This is an important aspect which both the professionals and the policy makers should take into consideration while implementing measures to contain the virus. There are some groups of people who are stuck like the migrant workers due to lockdown and unable to get back to their home state and hence face problems like anxiety, stress, loneliness, depression, fear and other adverse emotional reactions (Mishra & Sayeed, 2020).
Previous studies have reported that there are indications of distress, lower reported rates of physical and mental health and life satisfaction during lock down, (Taylor et al. 2008). In Australia where due to the outbreak of highly infectious equine influenza lockdown was imposed, they reported that adults in lockdown had feelings of distress, lower physical and mental health and lower life satisfaction. Due to lockdown socio-economic activity has been hampered and people from the low SES (daily wage earners, migrant workers and people from similar strata) are facing financial strain which can lead to stress, conflict, anxiety, and affect the cognitive development of children due to lack of nutritious food.
In India, researchers from different disciplines have opined about the impact that the COVID-19 pandemic can have on the general population. In a review article, Rajkumar (2020) concluded that anxiety, depression, disturbed sleep and stress can be the most common responses to COVID-19. Moreover, migrant people getting back to their homes and staying with family may lead to felt lack of space (crowding) which may also lead to psychological problems. There is evidence suggesting that increased use of the internet during lockdown has restricted physical activity and this has associated effects on physical health and psychological well being. Excess use of internet/ gaming/social media can lead to more serious problems such as cyber bullying and excess dependence on the internet. (Thakur et al., 2020).
Quarantine Related Psychological Problems
Quarantine is defined as, ‘separating and restricting people’s movement who have had potential exposure to a contagious disease to ensure if they get sick, so as to reduce the chances of them infecting others’ (Brooks et.al.,2020). They observed that this often resulted in unpleasant experiences for those undergoing quarantine. This means getting separated from loved ones, losing freedom, and boredom which can result in dramatic psychological effects on individuals. Those who have been quarantined because of their possible exposure to virus experience fears of getting infected and suffering, leading to a negative impact on their psychological well being.
Another observation is that those who have been diagnosed as corona positive, fear the possibility of infecting others who are close to them and as a result feel guilty leading to further psychological problems (Brooks et.al.,2020). Sprang and Silman (2013) compared those who were in quarantine due to H1N1 in USA and Canada on the symptoms of PTSD in parents and children with those who were not quarantined and the outcome of the study reflected that the mean score of PTSD was four times higher in children who had been quarantined than in those who were not quarantined and 28% of the parents quarantined reported symptoms that warranted a diagnosis for a mental health problem as compared to 6% of those parents who were not quarantined. Other studies have also reported high depressive symptoms among the quarantined (Brooks et.al.,2020, Kang et al., 2020, Mowbray, 2020). In addition, fear due to lack of information related to the pandemic, fake news, lack of threat to the perception that there is no no cure of COVID-19 also lead to worries and tensions impacting well-being (Mowbray, 2020).
Studies have reported that those quarantined are more likely to experience stigmatization, rejection from people around the neighborhood (Brooks et al., 2020; Hawryluck, 2020). Participants reported experience of them being avoided by others, being treated with fear, suspicion and critical comments by others Another study reported that some respondents in their research reported not being able to resume work in office after quarantine as others feared of getting infected by them (Cava et al., 2005).
The above findings from other countries indicate that the customs in our society to invite relatives and friends in large numbers for most of the social functions like marriage and other life events, post COVID-19 scenario is likely to be very anxiety provoking and stressful. The exclusion of people with or without infection is also likely to create unpleasantness and negative emotions.
People Infected with COVID-19 and Mental Health Issues
Studies conducted in China suggested that people diagnosed as SarsCov-2 positive experienced adverse mental health problems. Gou et al., (2020) compared COVID-19 patients with non-COVID-19 participants in Shanghai and found a higher prevalence of mental health problems like depression, anxiety, PTSD, insomnia and tension among COVID-19 patients. Huang and Zhao (2020) had reported suicidal tendencies among the patients in China. Hossain (2020) reviewed other studies and reported that there is reduced quality of sleep among patients with COVID-19. The current pandemic more adversely affected those who have pre-existing physical and psychological problems. Intensive care unit patients reported more confusion (65%) and 21% of those who subsequently died reported altered consciousness. In the same study 33% patients reported ‘dysexecutive syndrome’ which Baddeley et al., (1998) described, after their discharge from hospital (Hossain (2020).
Psychological Problems of Health Care Workers
Healthcare workers could develop symptoms of psychiatric disorder when coping with such stressful events. Lee et.al., (2018) in their study in Singapore during the 2013 SARS-COV outbreak revealed 27% of healthcare workers experienced Post Traumatic Stress Disorder (PTSD). Similarly, in Democratic Republic of Congo, medical staff reported to experience high levels of anxiety due to the work they were engaged in (Park et al., 2018). Interpersonal isolation and feeling that they would transmit infection to relatives was also reported among health care workers (Lee et al., 2018). Another study from Wuhan related to COVID-19 revealed that risk of infection, overwork and inadequate protection measure increased experience of negative emotions, frustration, insomnia, depression, stress, denial, anger, fear and exhaustion among health care workers.
Further, it was noted that these psychological problems can in turn affect attention, decision making capacity and have long term impact on their well-being (Kang et al., 2020). Niuniu Sun et al., (2020) in their research on nurses caring for COVID-19 patients in China concluded that negative and positive emotions intertwined and co-existed in them and in early stages negative emotions were dominated and as time passed on, gradually positive emotions appeared. The evidence suggesting psychological impact of COVID-19 from other countries can be a pointer to the impact that COVID-19 can have on our health workers and even among psychologists who are responding to COVID-19 in different health settings. Comorbidity of physical health problems like diabetes as well as mental health problems were associated with poor subjective and psychological wellbeing and mental health problems among healthcare workers in Singapore and India (Chew et al., 2020) and among people with psychiatric illnesses in China (Hao et al., 2020).
Socio Demographic and other related to Mental Health Problems
Huang et al., (2020) and Thakur et. al (2020) identified young age as a risk factor due to prevalence of high level of generalized anxiety disorder and that the effect of the pandemic situation in older people was associated with higher risk, because of pre-existing depressive symptoms and their inadequate access to mental health services. In relation to gender, females reported to have experienced more anxiety and depression compared to men (Kang, 2020; Li et al., 2020; Ozdin & Bayrak, 2020). Marital Status was significantly related to mental health problems (Tan et al., 2020). More mental health problems have been reported among those less educated (Lei et al.,2020). Zhou et al., (2020) reported that students with high grades experienced symptoms of depression, which could be due to academic stress. Occupation and income are another risk factor. For example, Huang et al., (2020) reported that healthcare workers experienced poor sleep compared to those from other occupations. Moreover, loss of economic opportunities because of “Social Vaccine” can be a trigger for psychological problems. In the Indian context, it was hypothesized that marginalized people are more likely to be susceptible to mental health problems due to lockdown (Hossain, Purohit, Sharma, 2020). Research evidence suggested that living in urban areas is significantly related to mental health problems like depression, stress and people who live in areas with high infection rates are more likely to experience psychological problems (Lei et al., 2020,).
Impact of Media and Psychological Issues
Inadequate information by public authorities can act as a stressor. Studies have reported that if rational and clear guidelines are not given related to quarantine it could cause PTSD (Brooks et al., 2020). Hawryluck (2020) reported that having clarity about levels of risk was related to the level of feeling of distress. In an online survey he reported that 50% of respondents didn’t receive adequate information regarding home infection control measures and that resulted in distress. Another study reported the impact of Fake news on social media can also result in lack of threat perception and not adopting the required safety measures (Hao et al., 2020). In addition, Hao et al., also reported that spending more than two hours per day seeing, reading COVID-19 related news was found to be associated with anxiety, stress and generalized anxiety disorder.
What is Being Done and Needs to be done?
Psychologists around the world need to understand the variable effect of COVID-19 on people. We need to appreciate the fact that it is not affecting everyone equally or in similar ways (Zhao, 2020). Realizing the psychological impact of COVID-19, various psychological associations in India and universities across India have come forward to render their services by providing free tele-counselling (Divyaprabha et al., 2020, Kumar, 2020). Research is being carried out to assess the psychological impact of COVID-19 which is a step-in right direction, as all the above observations and studies have indicated.
People need to be educated about the psychological impact of pandemic, people need to be encouraged and motivated to adopt healthy behavior practices, they need to be taught strategies to cope with the current crises, COVID-19 patient and their care-givers to be empowered and need to be sensitized about the problems faced by survivors of COVID-19 and the families. In addition, special teams of qualified professionals were made to address emotional distress among people (Duan & Zhu,2020). However, for these efforts to be successful, we need trained manpower, infrastructure and acceptance from people. As the number of cases are on the increase, it can be seen that the psychology professionals are facing challenges as well as opportunity. The challenge remains addressing the issues discussed above and opportunity is to implement the suggestions that are feasible. Liang et al., (2020), Lei et al., (2020), Li et al., (2020), and Hunag& Zhao, (2020) have reported that the coping style is significantly and positively related to psychological wellbeing. Therefore, we need to think of innovative strategies that can help people of different sections of our society. (Mishra & Sayeed, 2020)
The Way Forward:
We need to improve methods and measurements of tools for assessing the psychological welling as their reliability and validity during pandemic is not known. Therefore, we need to develop instruments that are more reliable during emergency situations. Conducting multi-disciplinary research is need of the hour as COVID-19 is posing challenges across all aspects of human life (Holmes, et al,2020). There is a felt need to synthesise research evidences globally and we need to do that inter state research that helps in understanding the reactions as well as coping in a better way. People have different levels of resilience and coping style that results in the experience of different metal health problems, which may have cultural influence. At present, most research evidence in relation to COVID-19 available is cross-sectional in nature and therefore it is not appropriate to infer incremental changes over time.
Effective mental health interventions and multi pronged strategies need to be developed that can be offered via digital platforms but their effectiveness and quality needs to be ascertained before using them on people (Manickam, 2020). Efforts to bridge the digital divide for this is crucial. It is need of the hour for integrating psychological care with existing primary healthcare by providing psychological services in family health care centres to effectively deal with the current pandemic (Anindya, Debora & Manickam, 2020). Community based social health care program can be run by training them in basic psychosocial care. We need a stronger, flexible and responsive system with contingency measures in place for emergencies (Mishra et al., 2020). We need to improve access to psychological and psychosocial services and it can be envisaged as preventing strategy for boosting psychological immunity.
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