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In December 2015, a major newspaper carried out an article headline as one in four young doctors may have the blues. According to 54 global studies, 28.8% of trainee doctors show signs of depression. Few studies have previously indicated that suicide rate is higher in doctors as compared to general population. According to WHO’s anxiety and depression disorders would surpass the cardiac diseases and other physical disorders in year 2020. This statistical estimation came true through the viral infection of Covid-19. This pandemic is only enabling the mental health issues to come to forefront faster and in bigger numbers.

The pandemic of Covid-19 is impacting individuals mental health. from paediatric to geriatric age range across the globe.

·         It has drastically altered social and working environment, in several ways. Social distancing policies, mandatory lockdowns, isolation periods, and anxiety of getting sick, along with the suspension of productive activity, loss of income, and fear of the future, jointly influence the mental health of citizens and workers.

·         Given increasing mental health concerns coupled with quarantine, there has been a sharp increase in violence against women during the GOVID-I9 pandemic.

·         Older adults experienced disproportionately greater adverse effects from the pandemic including higher mortality, concerns about disruptions to their daily routines and access to care, difficulty in adapting to technologies, and concerns that isolation would exacerbate existing mental health conditions.

·         Children, teens, older Students have been also severely impacted due to change of mode of education, lack of real-time interpersonal interactions with friends and peers, learning social cues of behaviours. Of course, the excessive access to the virtual world, making some of them addicted to gaming, and content viewing.

Stress is inversely proportional to immunity. Higher the stress levels, lower the immunity goes.

the question as “what are those factors that can cause a long-lasting impact of Covid-19 on an individual”?

Let me explain the Factors that weaken mental strength

Early trauma leads to poor health: Early life experiences such as violence, poverty, and neglect are associated with accelerated biological aging. There are 02 type of childhood adversity- THREAT RELATED (experiencing or witnessing violence) and DEPRIVATION RELATED (neglect by families or institutions). Both adversities caused cortical thinning of different regions of brain. Thus, making the body and the brain prone to physical, mental, and emotional disorders. Hence there is a likelihood that individuals with mental illness, low cognitive functioning, intellectual disabilities, substance addictions will require comprehensive care and long-term management to recover from COVID-19.

For some covid patients as People very ill, hospitalized with COVID-19 are at high risk of developing delirium , a disorder characterized by fluctuating attention and disorientation, emotional extremes, agitation, paranoia, or sometimes the opposite, a very flat emotional expression, and hallucinations. The sleep-wake cycle is usually disrupted, and the delirium classically gets worse as the day progresses. Delirium in hospitals is a frequent occurrence, affecting 10 to 15 percent of hospitalized on the general medical floors and 50 to 70 percent of patients in the ICU. Delirium can be caused by all sorts of things—infections, medications, withdrawal, surgery—and it seems to be a common brain reaction to serious illness or consciousness-altering medications. Delirium is associated with longer hospital stays, more complications, and a higher risk of death.

Treating delirium involves careful monitoring of medications and withdrawal, treating underlying infections, and making sure there are plenty of cues in the hospital room about time, date, and familiar items for the patients such as a photograph of the family at the bedside. In the context of COVID-19, much longer than normal ICU stays under heavy sedation and restrictions on visitation from family mean delirium is extremely likely for very ill patients .

Besides delirium, SARS-CoV-2 can have direct effects on the brain and nervous system. There have been documented cases of encephalitis (brain infection), spinal cord infection, seizures, nerve damage, neurodegeneration, and neuroinflammation. SARS-CoV-2 particles have been found in the brain . High levels of brain inflammation can lead to symptoms such as memory loss, cognitive fog, and/or depression, which can sometimes last for significant periods after the acute infection with the virus. Up to 45 percent of patients in the hospital experience some sort of neurological symptom.

COVID-19 is not just a respiratory illness; it can have profound effects on the brain. Understanding these pathologies can help us treat those who become ill in future, but also learn about the mental health consequences of other infections, and prepare us for the next pandemic.

The Pandemic’s uncertainty and stress combined with disrupted routines seems to be encouraging some people to heavier drinking habits and substance abuse, overuse. They undercut efforts to remain sober. Multiple stressors can foster reliance on alcohol, nicotine and other substances -drugs. Alcohol misuse also BOOSTS chances of contracting the virus, due to impaired immune systems. According to research work by WANG et al in Molecular Psychiatry 2020. People with substance use disorders are more likely to develop Covid- 19 with worse outcomes. Under the influence of the substance people lose inhibitions and lower their guard down about distancing, handwashing and other appropriate behaviors.

Also because of lockdowns, isolation, limited or no access to adequate medical care, restricted hospital visits due to fear, no follow ups or refills of medication available mentally ill patients suffer more.

Another e.g. An anxious person will feel more overwhelmed in the pandemic situation.  Many of us live-in make-believe systems. Many had a false notion that the virus will not reach ME, in the heat of INDIAN SUMMER the virus will die, Indians have very robust immunity etc. etc. But at every juncture the virus and the carnage it is creating is unparallel in written human history.

The pandemic has created a VUCA STATE i.e., VAGUE, UNCERTANITY, CONFUSION, ANXIETY.

Now Multiple stressors can foster increased worrying, despair, anxiety: as getting an infection, getting hospitalized or finding adequate medical facilities, losing family members, friends, colleagues due to the COVID-19 infection, lost jobs, financial insecurities, juggling work in the changed environment, childcare, changed education systems with ambiguity around opening of academic institutes, exams, halted future plans and many more. These factors are adding on stressors to an individual and it is going to have short and long-term impact on mental health.

We are seeing a surge of grief reactions due to personal losses of family members, financial losses due to poor business output, losing jobs. As some deaths have happened in a short period of time. People did not have the belief specific rituals around criminations/burials, so many family members have the ambiguity about the loss and departure of the person.

It is very important and essential to address this grief state. If not checked NOW, we are going to see a Tsunami of collective grief, for a very long period. Not to trivialize the passing of the loved ones, their crossing over to the other unknown side of the Rainbow. Many surviving humans are likely to be affected by trauma related disorders, anxiety, depression, increase in substance abuse, violence going up and suicides.

We have to be mindful in supporting people in grief reaction by listening to them, slowly supporting them in small modalities. Occasional summation of talking about equivalence of sad and happy moments in life of all human beings. In any given situation for any individual the attitude matters about the outlook and sustenance.

Brain and body are interdependent, in other words mental and physical health are two sides of the same coin. None can be good if the other is bad or compromised.

Accept feelings: Being in a stressful situation can cause a lot of different emotional reactions like anger, frustration, anxiety, regrets, second guessing yourself, self-blame etc. These are normal reactions in an abnormal RATHER THE NEW NORMAL CIRCUMSTANCES.

The past year has forced most of us to think creatively, consider new possibilities, and work together toward the promise of a healthier and safer tomorrow. This will only come with intentional investments, commitments of energy, time and attention

Regularly remind yourself that: • this WILL end, not tomorrow, but in a matter of few months or so. • the vast majority of people who contract COVID-19 get better and return to their normal level of functioning • Humans have coped with difficult situations before and succeeded, they can draw on the positive skills and resilience developed in those situations and use them now.

As a concluding remark I would like to repeat the famous book title I’M OK YOU ARE OK. It’s time for the humans to heal collectively. Even if one (01) person remains infected, it can lead to a cascade of untoward event right from becoming sick to dying, and multi-dimensional disruptions all around.

STAY POSITIVE BUT DON’T TEST POSITIVE.

Credits: Dr. Namita Singh
Consultant Psychologist
Apollo Hospitals Jubilee Hills, Hyderabad.