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    Mental health: The silent pandemic amid coronavirus

    Mental health: The silent pandemic amid coronavirus

    Mental health: The silent pandemic amid coronavirus
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    By Rajesh Parikh   IST (Updated)

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    A study published in The Lancet on the burden of mental health in India between 1990 and 2017 has found 197 million Indians were suffering from mental disorders.

    On the 25th March 2020, Shivani, a single mother got the news—the Prime Minister had announced a 21-day lockdown. She rushed to the grocery waiting in line, rattling out her list in a rushed voice. The first few days were a struggle, keeping the kids entertained while cleaning and in the middle of chaos putting on a bright smile to sit for a zoom meeting. Slowly she started to adjust, fall into a routine, getting extra minutes with her children. The days blended into months and then it became a fog, fear of infecting her kids, worry about her parents alone, grief for the loved one who scummed to the illness. Constantly checking her phone, checking herself after every new symptom, panicking every time she heard someone else fell ill. Worrying about her job and how to manage if she lost it. She could barely sleep, barely eat, constantly thinking about the worst. Feeling alone, feeling frustrated, feeling scared. Needing mental help.
    For the last nine months, the world has been battling the COVID-19 pandemic. Worldwide, studies have found an average of 30 percent of the general population reporting psychological distress. An average of 40 percent of the population reported depression and/or anxiety symptoms. Many have been feeling significant anxiety and isolation leading to irritability and depressed mood. The fear of infection, infecting close ones, and the stigma attached to the diagnosis of COVID-19 can lead to stress. Reduced social connection, difficulty in handling technology is having devastating effects on mental health. In India over 65 percent of children reported anxiety, fear and helplessness. Loneliness is estimated to affect about 41 percent of the population in India, based on a review of studies.
    Along with the illness, we are battling its economic and social impact. Physical distancing precautions and COVID-19 induced lockdowns have had devastating impacts on economies. In India, the quarter of April to June saw a 23 percent contraction in Gross Domestic Product, the highest contractions worldwide. Between April and August, 21 million workers lost their jobs. The reduced economic activity and job loss and uncertainty, itself is taking a toll on individuals' mental health. When the lockdown was imposed, millions of migrant workers were left stranded, locked out of their homes in cities, with no means and no transport, many took on the long journey by foot. Now in their hometowns with no employment, the economic burden is another stressor for them.
    Is it just the pandemic or were there strong undercurrents that we didn’t pay attention to earlier? The WHO had suggested by 2030 mental illness would be the leading cause of burden worldwide. A study published in The Lancet on the burden of mental health in India between 1990 and 2017 has found 197 million Indians were suffering from mental disorders. Within these, 45.7 million are reported to have depressive disorders, and 44.9 million are suffering from anxiety disorders. These figures prior to the pandemic suggest that we were already at the brink of a mental health pandemic.
    During the pandemic, the number of individuals with mental health concerns is rising just as quickly as COVID-19 cases. Between 33 to 74 percent Indians reported psychological distress and over 40 percent reported depression and anxiety. Reduced social contact, increased household chores, fear of infection and infecting loved ones, lack of economic stability are increasing individuals' distress and ability to cope with the uncertainty. History has shown us that these effects are seen to persist over time. In China as well as in India research on the current pandemic has found that depression and anxiety was found in individuals up to 3 months. Studies demonstrate that healthcare workers, individuals in quarantine, with pre-existing physical health conditions and mental health conditions and those who battle COVID-19 are especially vulnerable to mental health concerns.
    A large study in the US found that individuals who had mental illness were six times more likely to report depression and four times more likely to report anxiety or post-traumatic stress than individuals without any mental illness. COVID-19 related worry, grief and insomnia are some of the prominent issues.
    Healthcare workers have an increased risk of infection, further due to long shifts many are facing physical exhaustion and mental burnout. Feelings of helplessness and uncertainty regarding treatment and care are adding to their stress. Research has found over 20 percent have reported stress, anxiety and or depression. In India, the figures are higher with close to 40 percent reporting anxiety, 35 percent reporting depression and 33 percent reporting stress.
    Almost 30 million people worldwide have been infected with COVID-19. Research in the US has found that over 22 percent of individuals diagnosed with COVID-19 have some kind of neuropsychiatric illness. During the SARS and MERS epidemics, it was found to have long-lasting effects on the patients' mental health. Over 10 percent of all patients were depressed 12 percent had anxiety and one study found that all the patients had some sleep disorder. For those who are critically ill with COVID-19 requiring ICU care, post ICU trauma is a real threat. They may have long-lasting emotional and psychological disturbances due to their prolonged stay in the ICU. At present we are looking at thousands of new patients.
    It has been suggested that the mental health crisis is going to be the wave of the pandemic. Research on mental health in past disease outbreaks has shown us that the mental health effects last up to 3 years following the illness. When the COVID-19 pandemic hit the world, we were not prepared for it. Now, before mental health practitioners face a similar crisis and shortages we need to prepare ourselves for the crisis to come.
    —Rajesh Parikh is the Director, Medical Research & Hon. Neuropsychiatrist, Jaslok Hospital & Research Centre, Mumbai. He is the co-author of The Coronavirus: What You Need To Know About The Global Pandemic. The views expressed are personal 
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