25 Mar Pandemics can be stressful

The coronavirus disease 2019 (COVID-19) pandemic may be stressful for people. Fear and anxiety about a new disease and what could happen can be overwhelming and cause strong emotions in adults and children. Public health actions, such as social distancing, can make people feel isolated and lonely and can increase stress and anxiety. However, these actions are necessary to reduce the spread of COVID-19. Coping with stress in a healthy way will make you, the people you care about, and your community stronger.

Specific and uncontrolled fears related to infection

This is commonly one of the most frequent psychological reaction to pandemics. Several existing studies demonstrated that those who have been exposed to the risk of infection may develop pervasive fears about their health, worries to infect others and fear infecting family members. Studies have reported that these individuals are more vulnerable than others to manifest worries if they experienced physical symptoms potentially linked to the infection and fear that symptoms are directly associated to actively having the infection even several months after the exposure.

Pervasive anxiety

Social isolation related to restrictions and lockdown measures are linked to feelings of uncertainty for the future, fear of new and unknown infective agents resulting in abnormally increased anxiety. Anxiety may be directly related to sensorial deprivation and pervasive loneliness, in this case first insomnia but later depression and post-traumatic stress occurs. In addition, anxiety is closely associated with fatigue and reduced performance in healthcare workers while boredom and loneliness are directly related to anger, frustration and sufferings linked to quarantine restrictions. Furthermore, additional tragic effects associated with pervasive anxiety in a pandemic period may include the perceived lower social support, separation from loved ones, loss of freedom, uncertainty and boredom.

Frustration and boredom

Distress, boredom, social isolation and frustration are directly related to confinement, abnormally reduced social/physical contact with others, and loss of usual habits. As reported by Jeong et al. frustration and pervasive loneliness seem to derive by the inhibition from daily activities, interruption of social necessities, not taking part in social networking activities. Unfortunately, in this context hopelessness together with other individual characteristics such as the experience of childhood maltreatment as well as extreme sensory processing patterns may significantly and independently predict suicidal behavior but even the unbearable anger related to the imposition of quarantine may lead to negative outcomes.

Disabling loneliness

The final effect of social isolation is pervasive loneliness and boredom, which have potential dramatic effects on both physical and mental individual well-being. Pervasive loneliness may be significantly associated with increased depression and suicidal behaviour. Unfortunately, the isolation is progressively enhanced by anxiety, panic or collective hysteria. Cognitive functions and decision making are firstly impaired by hyperarousal and anxiety and later by disabling feelings of loneliness. In addition, social isolation and loneliness are also associated with alcohol and drug abuse. Both frustration and pervasive loneliness seem to derive by the inhibition from daily activities, interruption of social necessities, inability to take part in social networking activities enhancing the risk of hopelessness and suicidal behaviour in this specific context. Overall, it is well known that long periods of social isolation or quarantine for specific illnesses may have detrimental effects on mental well-being.

What can be done…

The new realities of working from home, temporary unemployment, home-schooling of children, and lack of physical contact with other family members, friends and colleagues take time to get used to. Adapting to lifestyle changes such as these, and managing the fear of contracting the virus and worry about people close to us who are particularly vulnerable, are challenging for all of us. They can be particularly difficult for people with mental health conditions.

Fortunately, there are lots of things that we can do to look after our own mental health and to help others who may need some extra support and care.

Here are tips and advice that we hope you will find useful.

• Keep informed. Listen to advice and recommendations from your national and local authorities. Follow trusted news channels.
• Have a routine. Keep up with daily routines as far as possible, or make new ones.
  Get up and go to bed at similar times every day.
  Keep up with personal hygiene.
  Eat healthy meals at regular times.
  Exercise regularly.
  Allocate time for working and time for resting.
  Make time for doing things you enjoy.
• Minimize newsfeeds. Try to reduce how much you watch, read or listen to news that makes you feel anxious or distressed. Seek the latest information at specific times of the day, once or twice a day if needed.
• Social contact is important. If your movements are restricted, keep in regular contact with people close to you by telephone and online channels.
• Alcohol and drug use. There is no evidence of any protective effect of drinking alcohol for viral or other infections. In fact, the opposite is true as the harmful use of alcohol is associated with increased risk of infections and worse treatment outcomes.
• Screen time. Be aware of how much time you spend in front of a screen every day. Make sure that you take regular breaks from on-screen activities.
• Video games. While video games can be a way to relax, it can be tempting to spend much more time on them than usual when at home for long periods. Be sure to keep the right balance with off-line activities in your daily routine.
• Social media. Use your social media accounts to promote positive and hopeful stories. Correct misinformation wherever you see it.
• Help others. If you are able to, offer support to people in your community who may need it, such as helping them with food shopping.
• Support health workers. Take opportunities online or through your community to thank your country’s health-care workers and all those working to respond to COVID-19.

The Future

As I look ahead these are some of the challenges:

• COVID-19 has created a great deal of stigma mainly through a lack of awareness about how the disease spreads and how it attacks the human body.
• In many cities, healthcare workers, who are treating COVID-19 patients during the day, have been forcefully evicted from their homes out of fear that they may be bringing the virus back at night.
• People who tested positive are being shunned in apartment complexes by their resident associations.
• The real need is to build community-based capacity in order to handle local issues long after the acute phase of the epidemic.
• Unless the community is empowered to take care of itself, we are staring at an ever-growing shadow of mental distress which will last much longer than the pandemic.
• For adolescents, it is reset time. It is time to build mental wellbeing and resilience into schools, the community, and their families

As I close, I would like to quote what UNICEF has rightly said, “The stakes could not be higher. If not adequately or appropriately addressed, the mental health consequences for a generation of children and young people could far surpass the immediate health and economic impact of the COVID-19 pandemic, leaving long-term social and economic consequences in its wake.”

References:

Serafini et al. (2020). The psychological impact of COVID-19 on the mental health in the general population. QJM: An International Journal of Medicine, 113(8), 529-535. DOI: 10.1093/qjmed/hcaa201
Healthy At Home -Mental Health. (2020). Retrieved from https://www.who.int/teams/mental-health-and-substance-use/covid-19
Dr Sharon Ruth, Consultant Clinical Psychologist, Victoria Hospital/ Bangalore Medical College and Research Institute.