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May 16, 2020 Saturday 04:11:31 PM IST

Lockdown and Mental Health

Health Monitor

Lockdown is the separation and restriction of movement of people who have potentially been exposed, or might be exposed to a contagious disease, in order to prevent it or to ascertain if they become unwell, so reducing the risk of them infecting others. The process is increasingly normal and medically endorsed; it’s already clear that limiting social contact is absolutely the best way to reduce the spread of COVID -19 pandemic. But that doesn’t make it easy.

The bad news is that quarantine and isolation are usually accompanied by unwelcome side effects, including depression, anxiety, and post-traumatic stress. Economic and other fallout of such massive lockdown have incalculable negative consequences. Medical quarantine, and isolation in general, is associated with serious mental health effects. A recent review of research, published in The Lancet found that quarantine is linked with post-traumatic stress disorder (PTSD) symptoms, confusion, and anger, with some research suggesting these effects are long-lasting. Given that the coronavirus crisis is likely to be with us for some time, the mental health implications can’t be dismissed. 

INCREASING ANXIETIES

The problem is that nobody knows what to do. Even countries like France, USA, UK, etc, are merely experimenting. Unfortunately, this is one case where science, too, is not of much help. Most countries are trying to “flatten the curve” or reduce the number of cases through social distancing and hand hygiene. India was one of the first few countries to take action on this front — even before the first case was reported. Most countries are trying to show that it would be common to see an increase in stress, depression, and anxiety, both in the general population and among frontline workers aiding efforts to combat the virus. 


As the virus spreads globally, governments must address public mental health needs by developing and implementing well-coordinated strategic plans to meet these needs during the COVID-19 pandemic. A recent survey conducted by the Indian Psychiatry Society revealed that there has been a 20 percent rise in mental illness cases. The study claims that people have been living in fear of losing their jobs, businesses, etc due to the lockdown, resulting in mental distress. 

The lockdown has had a massive impact on the lifestyle of people. They are staying indoors with limited resources, and often with limited space. (Dharavi, Mumbai is a stark reminder). They are now suffering from anxiety, panic attacks, and even alcohol withdrawal syndrome. Clients in therapy have reported experiencing panic attacks, exhaustion, anxiety-induced headaches, difficulty in sleeping and overall, a heightened sense of anxiety in the light of COVID-19.

On March 19, a 23-year-old young man, suspected of being infected with the novel coronavirus died after he jumped off the seventh floor of Delhi’s Safdarjung Hospital. The family complained that the doctors did not counsel the man who had just returned from Sydney with his mother. Students who intend to appear for competitive exams are a worried lot, due to many uncertainties in academics and in the social milieu. Let’s have a glance at the stressors of this pandemic that upsets our lives and livelihood, leading to mental stress and illness.

MAJOR STRESSORS


A Sense of Helplessness

Being quarantined gives one a sense of being at the mercy of other people and other uncontrollable forces such as a pandemic which includes the fear of death. This leads to a feeling of helplessness and uncertainty about the future that can be very unsettling. They also often have catastrophic appraisals of any physical symptoms experienced during the quarantine period. This fear is a common occurrence for people exposed to a worrying infectious disease. Boredom and isolation will cause distress; people who are quarantined should be advised about what they can do to stave off boredom and be provided with practical advice on coping and stress management techniques. 

Stigma and Fear of Social Exclusion

Stigma and xenophobia are two aspects of the societal impact of pandemic infectious outbreaks. Stigma from others is a major problem, often continuing for some time after quarantine, even after containment of the outbreak. In a comparison of health-care workers quarantined versus those not quarantined, quarantined participants were significantly more likely to report stigmatization and rejection from people in their local neighbourhoods. Healthcare workers themselves are often quarantined and this means, they, like the general public, are negatively affected by stigmatising attitudes from others. There were many such cases reported in the media.


Socio-economic stressors

The crisis has already transformed into an economic and labour market shock, impacting not only supply (production of goods and services) but also demand (consumption and investment). The crisis is most likely to adversely affect small and medium enterprises (SMEs), and workers in casual and daily wage employment in the informal sector, which NITI Aayog estimates as 81% of all employment in the country. The wages and working hours are likely to be adjusted downwards across leading to increased poverty and depression of demand. The outlook is frightening indeed.

Financial Crisis

You may be facing financial hardship as a result of the COVID-19 outbreak. Many employees are unemployed due to a shortage of work because of closed or decreased operations due to COVID-19. A long-term assessment of your capacity to maintain your current lifestyle is important. Consider any impacts on your income, grocery bills, housing, utilities and other necessities that still need to be paid. You may be worried about the impact of the current COVID-19 pandemic on your finances. Whatever the source, financial emergencies can be stressful and cause considerable hardships for you and your family.


Medical Emergencies

Know how to provide support to people who are affected by COVID- 19 and know how to link them with available resources. This is especially important for those who require mental health and psychosocial support. The stigma associated with mental health problems may cause reluctance to seek support for both COVID-19 and mental health conditions. Ensure availability of essential, generic psychotropic medications at all levels of health care. People living with long-term mental health conditions or epileptic seizures will need uninterrupted access to their medication, and sudden discontinuation should be avoided. Children will observe adults’ behaviours and emotions for cues on how to manage their own emotions during difficult times. (WHO Guidelines).

Info Overdose

It’s OK to turn off social media for a bit. It’s very tempting to watch and watch (and then watch some more) all the information that’s coming in. But don’t do that to yourself. A near-constant stream of news reports about an outbreak can cause anyone to feel anxious or distressed. Research shows that our perceptions of the frequency of negative events, like contracting the virus, are heavily influenced by what we see and read in the news.


In these uncertain and unprecedented times, it is natural to experience stress and anxiety. However, an awareness of these stressors better positions us to address them. And there are many tools and coping strategies available to combat the strains on our mental health. There are many small things we can do to support our mental health, and all of them can be done while still practicing social distancing.

A Strategy to Reduce Stress

LIMIT EXPOSURE TO NEWS: It’s good to know what’s happening in the world but constant exposure to the endless stream of breaking news headlines can lead to unnecessary levels of anxiety and stress. It’s alright to turn off social media for a bit.

EXERCISE: We all know about the benefits of exercise. But exercise isn’t just good for our physical health, it’s good for our mental health as well.


CONNECT WITH FAMILY AND FRIENDS: It’s easier than ever to stay in touch with loved ones. So, if you can’t meet up with your friends and family in person, try skyping or calling them on the phone. Finding ways to connect to others helps to lower anxiety and improve mental health.

ENGAGE IN ACTIVITIES YOU LOVE: Play isn’t just for kids. Research shows that engaging in fun, playful activities can help reduce our levels of stress and contribute to overall well-being.

PRACTICE RELAXATION TECHNIQUES: Relaxation techniques such as slow breathing or meditation can help us cope with stress by calming down our nervous system. And reduced stress helps our immune systems to work better.

KEEP UP YOUR DAILY ROUTINE: Strike a balance between having a routine and making sure each day has some variety. It can be hard to begin to accept this new normal. But also change it up a little. Learn simple daily physical exercises you can perform at home. Keep a To-Do list so you can see you’re achieving something. We need to keep in mind that fight with this pandemic is a marathon, and we need to come to terms psychologically to face inconvenience in the long haul. That is absolutely essential to flatten the curve and prevent a mortal run on our limited health facilities. We are creative creatures. We are also social creatures. So, we are finding ways to remain socially connected while physically disconnecting. Perhaps we will also emerge from this crisis with a better appreciation and respect for our fellow humans and citizens, a better realization that we need to co-exist with nature, and we live in a tiny pebble of a planet which is our common home.



Dr. Jose Cletus Plackal

Licensed clinical psychologist, BET-MRT, Jeevas Centre, Aluva, Kerala.

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