Because the mind matters- Lakshmi Vijayakumar and Thara R.

Dr. Thara, Director, Schizophrenia Research Foundation (left) and Dr. Lakshmi Vijayakumar, founder of suicide prevention group, Sneha (right)

How one copes with an outbreak like COVID-19 depends on three factors, the individual, the community and the health system

Pandemics have never been just medical events or crises, they have affected lives of societies and nations in many ways. The mental health sequel of many pandemics has been documented.

How one copes with an outbreak like COVID-19 depends on three factors, the individual, the community and the health system.

A study conducted in the early phase of the outbreak in China by Wang and colleagues found that 53.8% of the respondents rated the psychological impact as moderate or severe and 16.5% reported moderate to severe anxiety.
The mental health issues have been related to: how widespread the pandemic is, how fast the spread is and lack of control over it.

It is also related to the mortality rate due to the infection and availability of good and effective treatments and vaccines.

Symptoms of stress can be:
1. Excess worry about one’s health and that of family, friends, etc
2. Difficulty in sleeping, loss of appetite and fatigue
3. Some symptoms of depression including suicidal ruminations
4. If isolated at home, the need to use more of alcohol and other substances of addiction
5. Irritability, anger borne out of helplessness and disruption of routines
6. Exacerbation of physical ill health such as increase in blood pressure / blood sugar etc
7. Need to hoard items like sanitisers or masks or some essential medicines itself can result in anxiety
8. Fear of acquiring a novel, yet unpredictable disease can increase negative thinking and behaviours

Who is more vulnerable?

The individuals who are likely to be more psychologically distressed are:
1. Older people with chronic diseases such as diabetes or hypertension who are more vulnerable to contracting COVID-19.
2. Children/adolescents as their routines are disrupted and they perceive the parent’s anxiety, stress, and change in lifestyle.
3. Physicians and other health workers who face the constant threat of exposure, overwork, inadequate resources and experience secondary traumatic stress.
4. Persons with pre-existing mental health conditions who may experience new or exacerbation of their symptoms.
5. People in quarantine. They are confronted with uncertainty about their state, fear for their family and friends , guilty and depressed about their isolation. Research during the previous SARS outbreak found 29% of those quarantined showed signs of PTSD and 31% had symptoms of depression.
The connectedness and resilience of the community is strongly reflected in the mental health of the people during an outbreak. When a member / family are stigmatised, isolated and ostracised, mental health suffers.

Mental health consequences of short term social distancing has not been studied in detail. Dr. Lunstad suggests two competing hypotheses. One, that it may exacerbate those who are already isolated and might trigger others to connect less. The other is that heightened awareness will prompt people to stay connected and focus on reaching out to others.

Help yourself

1. Educate yourself about the infection
2. Maintain basic hygiene, but do not overdo it. Persons with previous Obsessive-compulsive traits may have an exacerbation due to constant washing
3. Do not over stimulate yourself with news from various sources, specially social media. This can lead to fatigue, anxiety and stress. Do not constantly engage in conversation on this subject
4. Find ways to relax — be it yoga, music, walks, reading, family time etc
5. Healthcare professionals must ensure they do not burn out in the process of caring
6. While physical social distancing is advocated, stay connected with friends, family and well wishers. Emotional isolation does not help
7. Do not hesitate to seek help if you are not able to help yourself

The schools have been closed and children at home also need support.
Talk to the child, share simple information, don’t underplay the seriousness since they pick up information from other sources also.
Reassure them they are safe and have all the support they need, do not make your own anxiety very evident while you are around them, limit their sources of information since they could get frightened or misinterpret what they hear and plan home based activities together.

WHO chief Tedros Adhanom Ghebreyesus said that a crisis like COVID 19 can bring out the worst or best in humanity. We hope that it brings out the best in us.