The ongoing Covid 19 pandemic has not only brought in its wake deaths and suffering to families but has also created a situation of socio-economic crisis and psychological distress which has impacted worldwide but more so in India considering the already prevalent poverty and unemployment problems from which the nation was slowly emerging.
The pandemic had led to social activities in nations coming to an almost standstill and individual movements restricted due to the lockdowns.
Many psychological problems and the consequences in terms of mental health including stress, anxiety, depression, frustration, uncertainty during COVID-19 outbreak emerged progressively. Common psychological reactions related to the mass quarantine which was imposed in order to attenuate the COVID-19 spread led to increased fear in communities and anxiety which are typically associated with disease outbreaks, and increased with the escalation of new cases together with inadequate, anxiety-provoking information which was provided by media.
The psychological reactions to COVID-19 pandemic may vary from a panic behavior or collective hysteria to pervasive feelings of hopelessness and desperation which are associated with negative outcomes including suicidal behavior. Importantly, other health measures may be compromised by abnormally elevated anxiety.
As the general population became increasingly exposed, anxiety-provoking topics related to the emergence of the health and socio-economic crisis need to be rapidly identified to early detect dysfunctional processes and maladaptive lifestyle changes potentially leading to the onset of psychiatric conditions.
The existing mental health-related initiatives include guidelines detailing about mental health and psychosocial considerations during the COVID-19 outbreak developed by the WHO Department of Mental Health and Substance Use, as a series of messages that can be used in communications to support mental and psychosocial well-being in different target groups during the outbreak.
Indian government’s nodal ministry, Ministry of health and family welfare, published materials on mental health care of the elderly and children. It also has materials on understanding the lockdown situation, handling isolation, dealing with mental health issues after recovering from COVID-19. Various other portals and institutions like The National Institute of Mental Health and Neuro-Sciences (NIMHANS), All India Institute of Medical Sciences, Indian Psychiatric Society have taken up independent responsibilities to promote and manage mental health issues during the COVID-19 pandemic in the form of online services, telemedicine services, etc.
NIMHANS suggested that a ‘Psychological intervention medical team’ be formed as a standalone team or be part of the general medical team attending to people affected by the pandemic. The staff should consist of psychiatrists, with clinical psychologists and psychiatric nurses participating and the teams should formulate interventions plans separately for different groups for example: (i) Confirmed cases who are hospitalised with severe symptoms (ii) Suspected cases and close contacts of confirmed cases (iii) People with mild symptoms who are in home quarantine (iv) Health care personnel working with people with COVID-19 (v) General public. As it is, mental health alone is a global challenge in itself and the COVID-19 pandemic greatly escalated the mental health burden as well.
Another initiative of the Indian government, the Aarogya Setu mobile application which is used to connect essential health services with the people of India in combined fight against COVID-19. The app is aimed at augmenting the initiatives of the Government, particularly the Department of Health, in proactively reaching out to and informing the users of the app regarding risks, best practices, and relevant advisories about the containment of COVID-19.
For the frontline workers fighting against this global crisis, routine support activities should be made available and must efficiently incorporate and include a briefing on moral injuries. It should also focus on raising awareness of other causes of mental ill-health and what to look out for.
Considering the rapid growth of technology and communication and faster modes of travel which had got restricted due to the pandemic which had led to the what is indeed a rare occurrence in contemporary society in that society has to face social isolation and restrictions which are linked to feelings of frustration and uncertainty. This unprecedented situation related to COVID-19 outbreak is clearly demonstrating that individuals are largely and emotionally unprepared to the detrimental effects of biological disasters that are directly showing how everyone may be frail and helpless.
Although government regulations are necessary to maintain social balance and guarantee the safety of all individuals, a direct strategy aimed to manage the psychosocial issues related to COVID-19 crisis and its consequences in the community is currently lacking.
The psychological outcomes for subjects who have been quarantined compared with those who did not, have been examined by both cross-sectional and longitudinal studies.
While the lockdown was intended to curb the spread of the virus, it had psychological ramifications on the citizens. The self-isolation and restrictions on physical mobility due to the lockdown caused major disruptions to routines in life and hindered the ability to meet regular responsibilities—potentially affecting the physical and mental health of individuals. Recent studies have reported higher levels of stress, anxiety, depression, and poor quality of life, during the COVID-19 crisis in different populations. However, the repeated extensions in the lockdown period in India led to longer restrictions on physical mobility and prolonged self-isolation measures. This could have increased the intensity of negative psychological outcomes among Indians, leading to a poorer quality of life not just during the lockdown but also after the crisis. Previous studies have shown that prolonged periods of isolation and limited mobility significantly impact mental well-being during crises. Further, a prolonged experience of negative mental health outcomes could have adverse effects on physical health outcomes such as sleep disorders and health-related quality of life.
One of the areas which needs a deeper study is the impact the lockdowns had on the mental health of the thousands of migrant workers in metropolis like Mumbai, Delhi, Chennai and Kolkatta who almost overnight were out on the streets and many had trek miles with families and belongings to their villages thousands of miles. In the process, they were forced all their hard earned savings on finding a transport home.
While mental health effects due to the lockdown are likely to be seen among a majority of Indian adults, the impact of a lockdown extended over longer periods might differ across vulnerable groups.
With longer lockdown periods, financially weaker individuals might face more challenges in meeting the basic needs of their families. Moreover, the continued restrictions on physical mobility could place a higher burden on the social networks of vulnerable individuals, thus reducing their access to social support over time and impacting their adaptability. Additionally, in a patriarchal society such as India, with a high prevalence of domestic abuse, the lockdown (especially limited mobility) can potentially increase the risk of experiencing domestic abuse. Prolonged exposure to the threat of domestic violence could worsen the mental health of women during this crisis.
