PSYCHOLOGICAL IMPACT OF COVID-19
Introduction
As an international public health emergency, the coronavirus disease 2019 (COVID-19) has gained
widespread attention from the public. Owing to COVID-19’s high infectivity and mortality rate
(3–4%), China initiated its first-level public health emergency response on January 25, 2020.The
Chinese government and health authorities strived to slow the virus’ spread by adopting a series
of preventive measures, such as strict quarantining, contact tracing, and social distancing. In
addition to the health-related and socio-economic concerns associated with COVID-19, the
psychological impact of the disease has also attracted considerable attention. In March, the
World Health Organization released mental health guidelines to support the psychosocial and
mental well-being of the general population.
Background
With the virus’ exponential diffusion and the related large-scale quarantine policies enacted by
most governments, a wide range of psychological disorders, including panic, fear, anxiety,
depression, and frustration, gradually emerged. To date, various studies have reported the
psychological impact of the COVID-19 pandemic on different populations. For example, patients
with COVID-19 have been reported to not only experience several physical symptoms but also
diverse psychological effects. Similarly, healthcare providers, especially nurses and physicians
caring for COVID-19 patients, experience considerable psychological distress associated with fear
of infection. The general population is simultaneously affected by COVID-19 infection as well as
social distancing measures.
Chinese online study by Wang et al showed that 16.5% of the general population had moderate
to severe depressive symptoms and 28.8% suffered from moderate to severe anxiety symptoms.
As the virus spreads globally, studies on the psychological impact of the COVID-19 pandemic have
proliferated among different nations. For instance, an Australian nationwide survey found that
the mental problems of residents during the pandemic were at least twice as high as those prior
to the pandemic. Italian series of studies have reported that the COVID-19 pandemic was an
important stressor comparable to a traumatic event.
Stress
Stress is a physiological, psychological, and behavioral process that occurs in individuals as a
response to environmental stimuli. Previous studies have demonstrated that stress causes
various mental health problems. Although moderate pressure is beneficial to stimulate individual
protective behaviors and improve environmental adaptability by developing a warning system,
long-term or intense stress causes psychological impairment and physical disease. This
phenomenon has been explained through a stress system model, which suggests that adverse
life events (stressors) can directly lead to individual stress responses or indirectly affect an
individual’s physical and mental health through their coping style, social support, personality
traits, and awareness.
COPING STYLE
Coping style refers to individuals’ cognitive and behavioral efforts to maintain mental balance in
stressful situations. Previous studies demonstrated that coping style functions as a mediator
between stress and psychological health. Adopting appropriate coping strategies against stressful
situations is positively linked to quality of life. Additionally, the role of coping strategies in medical
settings has been well-documented. For example, task-based coping strategies appear to prevent
the onset of depressive symptoms and help reduce the severity of hypertension. Disease
awareness (which refers to the self-evaluation of knowledge about disease transmission,
common symptoms, potential treatment, and risk factors associated with the disease) is critical
to control and prevent COVID-19. Further, having knowledge about a specific disease can
influence individuals’ perception and behavior towards it. Earlier studies have shown that a
higher level of COVID-19 knowledge is beneficial for the public to maintain an optimistic attitude
and maintain appropriate preventive measures and care-seeking behaviors. In addition, research
during the SARS outbreak suggests that the public’s knowledge was associated with a reduction
in symptoms of anxiety, fear and panic. Limited disease knowledge may aggravate psychological
distress and emotional responses. Therefore, coping styles and disease awareness play a
significant role in handling the psychological stress associated with the COVID-19 pandemic.
n 30 January 30, 2020, the WHO director-general declared COVID-19 a public health emergency
of international concern. To prevent the spread of the virus, individuals testing positive for the
disease should be placed in isolation, (“separation of ill or infected persons from others”).
Discharge required clinical recovery with two negative sequential RT-PCR results within 24 hours,
which was later updated to 10 days after symptom onset plus a minimum of 3 days without
symptoms for symptomatic patients and 10 days after a positive test for asymptomatic patients.
In addition to isolation, quarantine (“separation of persons who are not ill, but who may have
been exposed to an infectious agent or disease”), measures were introduced. Individuals
identified as contacts (e.g., providing direct care without the use of personal protective
equipment, having face-to face-contact within 1 m >15 minutes) of laboratory-confirmed cases
required 14 days of quarantine from the last time they were exposed to the patient.
IMPACT OF ISOLATION AND QUARANTINE
Although isolation and quarantine have distinct meanings in practice, they both involve the
separation of an individual from their loved ones, normal activities, and routines for the purpose
of infection prevention. The psychological impact of quarantine and isolation was exacerbated
by the harmful effect of limited physical activity and changes in dietary practices. Such changes
may result in dramatic and long-lasting psychological impact. A study on quarantined and isolated
individuals with severe acute respiratory syndrome (SARS) and H1N1 reported posttraumatic
stress symptoms, confusion, and anger. Stressors included longer quarantine, infection fears,
frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma. In
a study on health-care workers who had survived the Middle East respiratory syndrome
coronavirus (MERS-CoV) epidemic in Saudi Arabia in 2015, participants explained a variety of
painful experiences of rejection and avoidance by their colleagues and neighbors post recovery.
Similar avoidance was reported by SARS survivors, along with perceived barriers to service access
and employment and well beyond the initial outbreak. Stigma, including being shunned, insulted,
marginalized, and rejected in the domains of work, interpersonal relationships, use of services,
and schooling was also reported. In the context of the current pandemic, reports from China have
showed rates of up to 30% for anxiety, 17% depression, and 35% trauma-related distress
symptoms. Similar rates have also been reported in Italy following implementation of lockdown
measures. Furthermore, reports from India and Bangladesh have described suicidal behaviors
(e.g., suicidal ideation, suicide attempts, and actual suicide) for various reasons.
It is not to say that quarantine or lockdown strategy should not be used; it may be worse for the
psychological consequences of not taking timely measures and allowing the disease to spread
(Hawryluck et al., 2004). Government should proceed by informing people with the facts that
what is happening and why, explaining how long it will last and ensuring essential supplies (such
as food, etc.) and reinforcing the sense of altruism that people should, rightly, be feeling. If this
extended lockdown or quarantine experience is negative, there could be long-term effects that
impact not just the quarantined individuals, but also the health care system, policymakers and
the public. College students were the most affected among occupational categories in this study.
Although the number of college students that participated in this study was low, this result is
consistent with other studies reporting that the mental health of college students has been
significantly affected during the COVID-19 pandemic. Concerns of personal health, health of
family members, and finance, particularly for those impacted by prolonged closure of employers,
have been reported. The added impact of quarantine has led to high occurrence of distress,
depression, anxiety, stress, and even self-reported suicidal thoughts. Loss of income, poor-quality
housing, history of psychiatric follow-up, symptoms compatible with COVID-19, low levels of
physical activity, not living with family, weak sense of integration, low quality of social relations,
and receiving low-quality information were associated with all mental health issues. Consistently
with a recent systematic review, our findings suggested that people with preexisting mental
conditions are at highest risk of psychological distress and should be targeted for psychological
assessment and appropriate intervention. Based on the results of this study and others, female
college students with mental health conditions may be particularly vulnerable to psychological
impact due to isolation and quarantine. Given the immediate and long-lasting effects, such
groups must be the focus of psychological screening, intervention, and future research.
Not surprisingly, hospital isolation was more depressing than home isolation. The opposite,
however, was true for stigmatization. It is evident from the literature that those with infectious
disease have fears of infecting others during quarantine. Fear of infecting others or becoming
infected, potentially exacerbated by ignorance of infection transmission, may have resulted in
avoidance within the home beyond required social distancing measures. Such experiences of
avoidance from family members, as opposed to trained health-care professionals, may have led
to feelings of great hurt and shame, increasing the burden of stigma. Other contributing factors
were losing one’s job, experiencing social conflict or breakup, transmitting the infection to
others, or knowing someone who had died due to the disease. Duration between
isolation/quarantine and interview did not have a significant effect on psychological outcomes,
which could reflect the long-lasting effect of segregation. In one study, alcohol abuse and
dependence symptoms were reported among quarantined individuals 3 years after the SARS
outbreak.
RATIO OF PSYCHOLOGICAL IMPACT OF COVID-19 IN MEN AND WOMEN
Although most reports have indicated that men with COVID-19 have a poorer prognosis, there is
an increasing body of evidence to confirm that the psychological impact is more profound in
women. This agrees with our results, which showed that females exhibited more psychological
depression and distress.
CHILDREN AND TEENS AT RISK
Children, away from their school, friends, and colleagues, staying at home can have many
questions about the outbreak and they look toward their parents or caregivers to get the answer.
Not all children and parents respond to stress in the same way. Kids can experience anxiety,
distress, social isolation, and an abusive environment that can have short‐ or long‐term effects
on their mental health. Some common changes in children's behavior can be:
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Excessive crying and annoying behavior
Increased sadness, depression, or worry
Difficulties with concentration and attention
Changes in, or avoiding, activities that they enjoyed in the past
Unexpected headaches and pain throughout their bodies
Changes in eating habits
to help offset negative behaviors, requires parents to remain calm, deal with the situation wisely,
and answer all of the child's questions to the best of their abilities. Parents can take some time
to talk to their children about the COVID‐19 outbreak and share some positive facts, figures, and
information. Parents can help to reassure them that they are safe at home and encourage them
to engage in some healthy activities including indoor sports and some physical and mental
exercises. Parents can also develop a home schedule that can help their children to keep up with
their studies. Parents should show less stress or anxiety at their home as children perceive and
feel negative energy from their parents. The involvement of parents in healthy activities with
their children can help to reduce stress and anxiety and bring relief to the overall situation.
ELDERS AND PEOPLE WITH DISABILITIES AT RISK
Elderly people are more prone to the COVID‐19 outbreak due to both clinical and social reasons
such as having a weaker immune system or other underlying health conditions and distancing
from their families and friends due to their busy schedules. According to medical experts, people
aged 60 or above are more likely to get the SARS‐CoV‐2 and can develop a serious and life‐
threatening condition even if they are in good health. 10
Physical distancing due to the COVID‐19 outbreak can have drastic negative effects on the mental
health of the elderly and disabled individuals. Physical isolation at home among family members
can put the elderly and disabled person at serious mental health risk. It can cause anxiety,
distress, and induce a traumatic situation for them. Elderly people depend on young ones for
their daily needs, and self‐isolation can critically damage a family system. The elderly and
disabled people living in nursing homes can face extreme mental health issues. However,
something as simple as a phone call during the pandemic outbreak can help to console elderly
people. COVID‐19 can also result in increased stress, anxiety, and depression among elderly
people already dealing with mental health issues.
Family members may witness any of the following changes to the behavior of older relatives
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Irritating and shouting behavior
Change in their sleeping and eating habits
Emotional outbursts
The World Health Organization suggests that family members should regularly check on older
people living within their homes and at nursing facilities. Younger family members should take
some time to talk to older members of the family and become involved in some of their daily
routines if possible.
HEALTH WORKERS AT RISK
Doctors, nurses, and paramedics working as a front‐line force to fight the COVID‐19 outbreak
may be more susceptible to develop mental health symptoms. Fear of catching a disease, long
working hours, unavailability of protective gear and supplies, patient load, unavailability of
effective COVID‐19 medication, death of their colleagues after exposure to COVID‐19, social
distancing and isolation from their family and friends, and the dire situation of their patients may
take a negative toll of the mental health of health workers. The working efficiency of health
professionals may decrease gradually as the pandemic prevails. Health workers should take short
breaks between their working hours and deal with the situation calmly and in a relaxed manner.
STIGMATIZATION
Generally, people recently released from quarantine can experience stigmatization and develop
a mix of emotions. Everyone may feel differently and have a different welcome by society when
they come out of quarantine. People who recently recovered may have to exercise social
distancing from their family members, friends, and relatives to ensure their family's safety
because of unprecedented viral nature. Different age groups respond to this social behavior
differently, which can have both short‐ and long‐term effects. Health workers trying to save lives
and protect society may also experience social distancing, changes in the behavior of family
members, and stigmatization for being suspected of carrying COVID‐19. Previously infected
individuals and health professionals (dealing pandemic) may develop sadness, anger, or
frustration because friends or loved ones may have unfounded fears of contracting the disease
from contact with them, even though they have been determined not to be contagious.
However, the current situation requires a clear understanding of the effects of the recent
outbreak on the mental health of people of different age groups to prevent and avoid the COVID‐
19 pandemic.
PSYCHOLOGICAL IMPACT OF COVID-19 IN PAKISTAN
The pandemic of coronavirus disease 2019 (COVID-19) has created a public health crisis that has
had a drastic effect on the way we understand our world and our everyday lives. Since the
emergence of this outbreak on February 26, 2020 in Pakistan, the country is on high alert and has
implemented stringent containment measures including closing schools, restricting public
gatherings, and reinforcing smart lockdown.
Pakistan, being a collectivistic society heavily dependent on socialization (social reinforcement
and social connectivity), has been critical toward self-isolation, social distancing, and quarantine
and is reluctant to deal with the mental, psychological, behavioral, and social impacts of the
instability and unpredictability of this crisis. Besides the general public being affected, medical
workers were subjected to physical and psychological pressure including high risk of infection,
insufficient protective gear from contagion, isolation, exhaustion, and lack of family contact. The
intensity causes more mental health issues which not only impair the decision-making capacity
of medical workers but may also have a negative impact on their overall well-being in the long
term. Healthcare conditions in Pakistan are worsening on daily basis and therefore controlling
the disease would require holistic thorough management on both physical and mental healthcare
situations.
CONCLUSIONS
Although participants experienced inevitable psychological distress during the COVID-19
pandemic, with fear being the most common, most were in a positive psychological state. We
observed that the higher the participants’ avoidant coping style scores, the more severe their
public emergency psychological state, and that the higher the participants’ level of disease
awareness, the milder their stress response. In Hunan Province, the COVID-19 pandemic appears
to have a greater psychological impact on employees (such as company employees, migrant
workers, and businessmen), individuals with COVID-19-like symptoms, as well as on individuals
with limited discernment competence and unconcerned attitudes. With the continuous spread
of the COVID-19 epidemic, efforts to develop actionable policies and massive healthcare
education campaigns are necessary. Multi-departmental, multi-resource, and multi-component
psychological guidelines and interventions still need further development, especially for
vulnerable individuals at greater risk of psychological distress.
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7361582/
https://www.jmir.org/2020/9/e21279/
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