COVID-19 and mental disorder
'Coronavirus outbreak may be stressful, coping is the way out'

Dr K Shantibala *

The outbreak of Corona virus disease 2019 (COVID-19) may be stressful for people. Fear and anxiety can result in overwhelming emotions in anyone be it children, adults or elderly. Coping is the way out.

Reactions to stress

Here, the stress is COVID-19 pandemic. Reaction to this situation will depend on various factors viz- your personality and background, the support system, community you live in etc.

However, certain groups may respond strongly to this crisis of COVID-19. They are – who are at higher risk such as elderly people, co-morbid chronic diseases, low social and economic security paediatric group and also teenagers; Health care providers, doctors, family members who have a positive case; And importantly people who have prior mental health issues, alcohol and other substance use disorders.

The sign/symptoms of the ongoing stress can include changes in sleep (increased or less) patterns, aggravation of chronic medical problems (acute or chronic conditions), increased or uncontrolled use of alcohol, tobacco or other drugs.

According to HaoYaoetal, The Lancet Vol 7, Issue 4, PE21, April 01, 2020 COVID-19 epidemic has caused a parallel epidemic of fear, anxiety, and depression. People with mental health conditions could be more substantially influenced by the emotional responses brought on by the COVID-19 epidemic, resulting in relapses or worsening of an already existing mental problem as they are more susceptible to stress as compared to general population.

Mental health disorders can increase the risk of infections including pneumonia and the possible explanations include cognitive impairment, little awareness of risk and diminished efforts to personal protection.

People with mental health disorder comorbidities to COVID-19 will result in treatment challenge and potentially less effective. A call for adequate and necessary attention to people with mental health disorders in COVID-19 epidemic is required.

Series of messages from WHO Department of Mental Health and Substance use

- March, 2020 – PANDEMIC
- Crisis that generates stress throughout the population

Messages for the general population

o COVID-19 likely to affect people from many countries and geographical locations and not to attach the disease to any particular ethnicity or nationality. Empathy, support, compassion and kindness is what those affected deserve.

o No wrong connotations such as "COVID-19 cases", "victims", "COVID-19 families" "the diseased" etc to reduce stigma.

o Avoid information that causes you anxiety or distress. Do not listen to rumours or disinformation. Get the facts from WHO website and local health authority platforms. Facts can minimize fears and anxiety.

o Be supportive; working together will help create solidarity in addressing COVID-19 together.

o Honour carers and healthcare workers and acknowledge their role in saving lives and keeping your loved ones safe.

Messages for Health workers

o In the current situations feeling pressured is a normal feeling and it does not mean you cannot do your job or that you are weak. Managing your physical, mental and psychosocial well-being is important

o Helpful coping strategies include rest during work or between shifts, healthy eating, physical activity, being in contact with family and friends. Avoid unhealthy coping behaviours such as use of tobacco, alcohol or other drugs. COVID-19 epidemic is a unique and unprecedented situation so one can use strategies to strategies that was useful in the past to manage stress. The scene today is going to be a marathon and keeping psychologically well is the need.

o Some healthcare workers may experience avoidance by their family or community owing to fear and stigma. It is important to stay connected with your loved ones and other colleagues and trusted persons for social support.

o Use understandable ways to share messages with people who have intellectual, cognitive and psychosocial disabilities.

o Providing support to people who are affected by COVID-19 and available resources.

Messages for team leaders or managers in health facilities

o Keeping all staff protected from chronic stress and poor mental health during this response to have a better capacity to fulfil their roles as the situation is not likely to go overnight, and a focus on long-term occupational capacity is required.

o Good quality communication and accurate information updates to all staff. Rotating workers from high-stress to lower-stress functions. Partnering inexperienced with experienced colleagues. The Buddy system helps to provide support, monitor stress and reinforce safety procedures. Encourage, initiate and monitor work breaks. Outreach personnel should enter community in pairs. Implement flexible schedules for workers who are directly impacted or have a family member affected by a stressful event

o Ensure all staff are aware of where and how they can access mental health and psychological support services and facilitate access for both workers and managers.

o Orient all responders, nurses, ambulance drivers, volunteers, case identifiers, teachers and community leaders and workers in quarantine sites to provide basic emotional and practical support to affected people using psychological first aid.

o Manage urgent mental health and neurological complaints (delirium, psychosis, severe anxiety or depression)

o Ensure availability of psychotropic medicines

Messages for carers of children

o Help children find positive ways to express feelings of fear and sadness. Every child has his or her own way of expressing emotions and this can be facilitated by creative activity such as playing or drawing. Children feel relieved if they can express and communicate their feelings in a safe and supportive environment.

o Keep children close to their parents and family and if separation is needed regular contact twice daily with parents and carers must be maintained.

o Maintain daily familiar routines and provide engaging age-appropriate activities for their learning.

o During time of stress and crisis children seek more attention and attachment and more demanding on parents. Discuss COVID-19 with your children in an honest and age-appropriate manner. This may ease their anxiety.

Messages for older adults, people with underlying conditions and their carers

o Older adults, especially in isolation and those with cognitive decline/dementia may become more anxious, angry, stressed, agitated and withdrawn during the outbreak or while in quarantine. Providing practical and emotional support is required.

o Giving clear information by sharing simple facts on how to reduce risk of infection by engaging family members and other support networks to practise prevention measures e.g. hand washing etc.

o For any underlying health conditions make sure to have access to medications currently in use.

o Be prepared and know in advance where and how to get practical help such as taxi, food delivery, requesting medical care etc. Two weeks of regular medicines must be ensured.

o Learn simple daily physical exercises to perform at home at home, quarantine or isolation to maintain mobility and to reduce boredom.

o Keep regular routines and schedules as much as possible and maintain regular contact with loved ones.

Messages for people in isolation

o Stay connected and maintain your social networks.

o During times of stress, pay attention to your own needs and feelings. Engage in healthy activities that you enjoy and find relaxing. Regular exercise, adequate sleep, healthy food will help.

o A near constant stream of news reports about an outbreak can cause anxiety or distress. Get information from health professionals and WHO website.

Review article by Shah K, Kamraid, Mekala H etal (March 25, 2020) concluded that there is substantial evidence from the past studies of the impact of SARS, MERS, influenza and ebola epidemics on the at-risk population, the suffering individuals and healthcare providers showed neuropsychiatric linkage.

The results are relative to the current COVID-19; they infiltrate fear, anxiety, emotional distress, and post-trauma. Stress symptoms as the affected individuals are viewed as minority and secluded from the rest of the population

It is therefore vital to emphasize the mental health well-being of the population and take proactive steps to minimize its detrimental effects during the COVID-19 pandemic.