Psychosocial And Behavioural Impacts Of COVID-19

• COVID-19 Positive Patients and Quarantined Individuals
  • Disease-associated Stigmatization: Disease-associated stigmatization among the sufferers and healthcare providers (HCP), particularly general practitioners, involved in COVID-19 affected patient care are found to be more common. Similarly, the COVID-19 outbreak may also give rise to stigmatizing factors like fear of isolation, racism, discrimination, and marginalization with all its social and economic ramifications. A stigmatized community tends to seek medical care late and hide important medical history, particularly of travel. This behaviour, in turn, will increase the risk of community transmission. Health crime originated out of the fear of being corona positive has also been reported from India
  • Psychosocial Burden of Quarantine and Isolation: COVID-19 has forced many countries across the globe to implement early quarantine measures as the fundamental disease control tool. Apart from physical sufferings, the consequences of this quarantine on the mental health and well-being at personal and population-levels are manifold. Imposed mass quarantine effected by nationwide lockdown programs is creating mass hysteria, anxiety and distress, due to factors like sense of getting cornered and loss of control. This can be intensified if families need separation, by uncertainty of disease progression, insufficient supply of essentials, financial losses, increased perception of risk, which usually gets magnified by vague information and improper communications through media in the early phase of a pandemic. It was one of the main factors that led to the mass exodus of migrant workers from cities like Delhi and Mumbai.
• Netizens and Coronavirus Infodemics: Within days of the onset of COVID-19 outbreak in China, the ‘social media panic’ characterized by relentless plethora of fake information as well as negatively skewed misinformation metastasized faster than the coronavirus itself. The director-general of WHO has referred this as “coronavirus Infodemics” which is breeding fright and panic by laying out unchecked mind-boggling rumours, flamboyant news propaganda and sensationalism. Mismatch between available fact sheets and dearth of clear-cut data can be compelling to entreat information from the unreliable and dubious but readily available social media sources. As soon as COVID-19 emerged to become a trending online content, many bloggers, groups or personal users in YouTube, WhatsApp, Facebook, Instagram and Twitter started the business of making profit off COVID’s popularity in many impulsive and unpredictable courses of action.
• Health-care Providers and Other Frontline Workers: Unavoidable stress, fear and anxiety about a poorly known contagious disease outbreak, like COVID-19, can be profound among the higher-risk groups, such as HCPs and other frontline workers, including bankers, policemen, armed forces etc. Being exposed to the COVID-19 cases in hospitals, being quarantined, the death or illness of a relative or friend from COVID-19, and heightened self-perception of danger by the lethality of the virus can all negatively impact the mental well-being of health workers. In the developing countries like India, where the health care system is already overburdened, surges of COVID-cases are likely to provoke acute anxiety, irritation and stress among doctors and nurses. This might be compounded by the inadequate hospital supply of required hand hygiene tools and significant shortage of personal protective equipment (PPE) among HCPs, who are at the highest risk of transmission.
• Children: Developmental psychology researches have largely found that learned experiences through environmental factors during early childhood engender the fundamentals for lifetime behaviour and success as it is a crucial phase for cognitive, emotional and psychosocial skill development. During a severe pandemic like COVID-19, community-based mitigation programs, such as closing of schools, parks, and playgrounds will disrupt children’s usual lifestyle and can potentially promote distress and confusion.
• Old Persons: The notion that older adults and people with serious comorbidities are particularly vulnerable to worse outcomes from COVID-19 can create considerable fear amongst the elderly. Other psychological impacts may include anxiety, irritability and excessive feeling of stress or anger.
• Domestic Caregivers: Feeling overwhelmed or excessively concerned about COVID-19 can affect the ability and resilience of family members while caring for morbid patients at home as they were doing prior to the outbreak. The newly generated secondary traumatic stress (STS) reactions due to this pandemic may include fatigue, fear, withdrawal and guilt.
• Marginalized Community- Migrants, Daily Wagers, Slum Dwellers and Prisoners: COVID-19 has made the largest lockdown happen in the history of civilization that can severely enhance miseries of these migrant workers, daily wagers and billions of slum dwellers worldwide. Losing jobs leaves these individuals unable to make both ends meet and this sudden misfortune of income poverty adds to their guilt, frustration, depression and mental anguish, ultimately leading to functional impairment and increased rates of suicide. Prisons are the epicentres of infectious disease; thus, its health should be prioritized in the time of a pandemic. The psychosocial needs, along with all the necessary preventive measures, must be addressed with utmost care.
• General Public: A study from Eastern India has noted that majority of the responders felt worried about financial restraint during lockdown, almost one-fourth experienced depressive symptoms and one-third found it difficult to adjust with this “new normal”. More than half of the subjects were “preoccupied with the idea of getting infected with COVID-19” and a considerable number of the respondents found that COVID-19 had threatened their existence. For people bereaved from the death of dear friends, colleagues, and loved ones due to COVID-19 and the inability to gain closure and cremate can result in anger, resentment, psychological trauma and long-term psychiatric sequelae. Religious misbelief, disbelief, xenophobia and communal disharmony are major issues which may tarnish all the great ventures taken against the pandemic in India. Reports of increasing domestic violence and women abuse are being reported globally during this pandemic. Distrust towards others in terms of disease spread and the government and healthcare services regarding their capability and efficiency to combat the disease might take birth in this period.

This unpredictable, fast spreading infectious disease has been causing universal awareness, anxiety and distress, all of which according to WHO are natural psychological responses to the randomly changing condition. Adverse psychosomatic outcomes among common people are nevertheless expected to increase significantly due to the pandemic itself and due to constant flow of readily available information and reinforced messaging obtained via online social networking services of almost all forms. Consequently, rapidly expanding mass hysteria and panic regarding COVID-19 may beget enduring psychological and mental health problems in public from all the socioeconomic domains, which could potentially be even more detrimental in the long run than the virus itself. In this light some important challenges are following:

• Neglected Area: Psychosocial Well-being and mental health which forms the core of our personhood is often neglected thereby impeding the development of an individual to full potential.
• Stigmatisation: Mental health illness is often considered a taboo that leads to reluctance on part of family members to seek diagnosis & treatment for the patient.
• Burden of Demography: According to WHO, the burden of psychosocial disorders is maximal in young adults. India being a young country (nearly 50% of its population below the age of 25) will face increased burden of psychological illness in the short term.
• Disproportionate Impact: It is the poor, dispossessed and marginalised who bear the greatest burden of mental health problems, but historically their sufferings are dismissed as a natural extension of their social and economic conditions.
• Lack of Specialists: Low proportion of mental health workforce in India (per 100,000 population) include psychiatrists (0.3), nurses (0.12), psychologists (0.07) and social workers (0.07).
• Dangers of Increase in Post-COVID Order: Mental health problems, tend to increase during a pandemic, leading to reduction in life-expectancy. This has been described by Nobel prize winning economist, Angus Deaton, as “Deaths of Despair”
• Prone to Abuse: Mentally ill patients are vulnerable to and usually suffer from drug abuse, wrongful confinement, even at homes and mental healthcare facilities which is a cause of concern and a gross human right violation.
• Issue of Affordability: Due to inadequate number of mental health caretakers, such services are often concentrated in Urban areas and are expensive also.

Considering that the current situation has taken a heavy toll on most peoples’ psychosocial well- being and addressing the situation is the need of the hour, the WHO released some psychosocial and behavioural considerations that should be followed during this crisis. Some important ones are as follows:

• Awareness: Spread adequate awareness and regular updates of appropriate precautionary measures about the COVID-19.
• Preparedness: Prepare beforehand to meet the challenges like scarcity of resources such as shortage of psychiatrists and counsellors, mental health infrastructure etc.
• Community Approach: Deploy community health workers who, with appropriate training and supervision, can effectively deliver psychosocial interventions for the needy people.
• Digital Initiatives: To help improve rural India’s mental health through telemedicine, initiatives like Schizophrenia Research India’s (SCARF) mobile bus clinic is being run by an NGO. There is need for scaling up such initiatives through public-private collaboration to bridge the rural-urban divide.
• Curtailing Disinformation: Ignore fake news and social media posts that spread panic among people.
• Recreational Activities: Include indoor recreational activities and relaxation exercises in daily routine.
• Destigmatising the Issue: Sharing one’s story about mental health (through media campaigns) is the most effective strategy to reduce stigma attached with mental illness. If any symptoms develop, people should approach the healthcare system.
• Scaling of Intervention: State governments need to increase the funding and scale up their psychosocial interventions through community health workers.
• Individual Support: Individuals who experience psychological distress must report or inform their difficulties, rather than hiding them. Individuals who experience persistent distress may seek help from the mental health professionals through available helplines or in hospitals in case of emergency situations.

COVID-19 carries significant psychosocial and mental health hazards. There is a paucity of research addressing the psychosocial well-being and behavioural issues during the COVID-19 pandemic. As the mortality and morbidity statistics are reaching new peaks every day, isolation and lockdown states are getting prolonged, recreational opportunities for people are lessened and the financial crisis is building in, mental health issues are likely to grow exponentially. There is a need to understand the psychosocial and behavioural perspectives of COVID-19 and delineate possible measures to cope with the pandemic for its effective management.