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| PERSPECTIVE/VIEWPOINT - COUNTRY/REGIONAL |
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| Year : 2020 | Volume
: 2
| Issue : 2 | Page : 129-131 |
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Psychosocial Aspects of Covid-19, the Indian Way
Santosh K Chaturvedi1, Manoj K Sharma2
1 Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
2 Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| Date of Submission | 17-May-2020 |
| Date of Decision | 29-May-2020 |
| Date of Acceptance | 02-Jun-2020 |
| Date of Web Publication | 14-Aug-2020 |
Correspondence Address:
Prof. Santosh K Chaturvedi
Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | 6 |
DOI: 10.4103/WSP.WSP_32_20
The psychosocial impact of the Covid-19 pandemic has been related to not only the viral epidemic but also by the sudden and extended lockdown. The prominent psychosocial issues are related to the stigma, changed lifestyle, impact on persons with mental health problems and mental illnesses including alcoholism and substance use, chronic medical illnesses, and this being one or more major life event. Social issues due to this stigma manifest as avoidance, discrimination, isolation, and seclusion of persons suspected to be anyway related to Covid-19. There are also self-stigma and fear of spreading it to the family members. However, the stigma associated with Covid-19 reduced stigma toward mental health and focused on the need of mental health support. This pandemic and its consequent lockdown to contain the spread of the viral infection will form a new health-related life event. During this period, there is a growing concern about the rise in domestic abuse and violence being reported by the media. Lockdown brought about reports in media about emotional disturbances and maladjustments within families including families of persons with mental illness. Finally, there has been a revival of cultural defenses in the form of traditional practices; people are reverting back to a folded hand “namaste” instead of a handshake, washing hands frequently, and use of a mask.
Keywords: Covid-19, expressed emotions, health-related life events, lockdown, stigma
How to cite this article:
Chaturvedi SK, Sharma MK. Psychosocial Aspects of Covid-19, the Indian Way. World Soc Psychiatry 2020;2:129-31 |
| Introduction | |  |
The Covid-19 outbreak, which started with a spread of viral infection, causing a worrisome morbidity and alarming mortality, is heading toward a plethora of psychosocial consequences and mental health issues. In the Indian scenario, one can say that the psychosocial impact has been related to not only by the viral epidemic but also by the sudden lockdown. Some of the prominent psychosocial issues are related to the multifaceted stigma, changed lifestyle, impact on persons with mental health problems and mental illnesses including alcoholism and substance use, chronic medical illnesses, and these unprecedented circumstances evolving into one or more major life event. There are other serious issues related to migrant workers, their loss of wages, homes, and difficulties in returning to their homes, which require detailed description.[1]
| The Good, Bad, and Ugly Stigma | | |
Many forms of stigma have evolved and become noticeable with the Covid-19 outbreak and affected a large and varied section of the society. There is stigma toward–
- Those with a travel history to places where Covid-19 first appeared and in large numbers, outside or within the country. This was further aggravated by putting a stamp of indelible ink on their hands and sticking a poster outside their homes to prevent people coming in contact with them. However, this stigmatized the affected persons and created fear and phobia in others
- Those who had come in contact with persons who were Covid-19 positive, either their family members or friends and colleagues
- Frontline health-care workers, doctors, nurses, ward attender, and looking after Covid patients, directly or indirectly, were the unfortunate targets of wrath of the public, as these were considered high risk to spread the infection
- Police and security personnel who are directly involved with persons who are at a high risk
- Those advised hospital quarantine
- Those advised self or home quarantine
- Those sneezing and/or coughing due to any reason.
Social issues which have emerged due to this stigma are avoidance, discrimination, isolation, and seclusion of persons suspected to be anyway related to Covid-19. General public fears the presence of such persons in the open and avoid them. There have been instances reported in media about assaulting such persons. There are also self-stigma and fear of spreading it to the family members.
Social causes of corona phobia have been noted to be due to different factors. Initially, the fear was of contracting the infection and fear of death or severe respiratory failure. Later, once the lockdown was imposed with the help of police, the fear was of being caught outside the home, being beaten by the police, or being forced to be in quarantine in an inhospitable place.
On the positive note, government and public became aware of the mental health issues, fears, anxieties, and stress related to Covid-19 and launched a massive public education and mental health education on this aspect. Counselors were sought after and multiple help lines launched. Thus, stigma associated with corona reduced stigma toward mental health and seeking counseling!
| Health-Related Life Event | | |
This pandemic and its consequent lockdown to contain the spread of the viral infection will form a new health-related life event (HLE). HLE is a life event primarily involving various aspects of a person's health. These could be diagnosis of Covid-19, its treatment, and hospitalization, in self or in family members. In a recent study,[2] patients with somatic symptoms disorders had higher frequencies of all types of HLE including viral infections. Current life event scales neither have such Covid like outbreaks nor lockdown like situation as a life event. Health anxiety, psychosomatic or psychiatric disorders, and medically unexplained symptoms may manifest in future. Already, clinicians are reporting functional and medically unexplained symptoms such as fatigue, tiredness, bodily distress, aches, and pains, which may be due to the anxiety or tension or due to the viral infection like other influenzas.
| Expressed Emotions | | |
Lockdown brought about reports in media about emotional disturbances and maladjustments within families[3] including families of persons with mental illness. Day-care facilities used to reduce the negative impact of expressed emotions from family members by minimizing face-to-face contact between person with a mental health problem and their family members have been halted. Being homebound during the lockdown, the expressed emotions worsened again enhancing the risk of aggravation of mental health issues and risk of relapse.[3] Families have been contacting their mental health professionals regarding difficulties in managing persons with mental illness living with them, in confined spaces, without an opportunity to go out of the home.
| Home, Home Everywhere, not a Home to Live | | |
If home has become school, home has become office, and home has become a gym and playground, one may ask where is home to live? When school and workplace are both at home, it is a complex situation, as parents are working from home and the children are studying from the same home. Unless there are suitable structure and discipline in work from home and school from home, there would be periodic interferences. Ideally, both the school from home and work from home should come to a close at the traditional timings. One of the sad consequences of the homebound lockdown is the disintegrating of the traditional “home.” On a positive note, due to closure of temples and religious places, online streaming of temple activities has brought Gods and Goddesses into the drawing room of any house which wants them.
There are limited activities which persons with or without mental health problems can engage in at home. There is a limit to play board games or do yoga and meditation more than a few minutes every day. This has enhanced their use of mobile phones, Internet, and use of social media to keep themselves engaged.
The use of digital technologies has seen an average increase of 30% for leisure and work-related activities during the lockdown period in India and around 70% in Bangalore.[4] Social media usage has seen a 42% increase and time spent on the use of chat services has increased by 43%.[5] Similarly, a 39% increase in download of games has been witnessed along with a 44% increase in the time spent on online gaming.[5],[6] The streaming video series viewed over smartphones have also shown an increase of 32% in its consumption in the category of online entertainment, whereas a 52% increase was noted on time spent on watching movies over smartphones.[6]
| Impact on Social Skills | | |
Mental health rehabilitation helps a person deal with their social skills deficits through social skills training and encouraging social interactions and reducing social distances. The social distancing, home quarantine, and closing down of day-care facilities are likely to have a negative impact on their clinical outcome. Having to stay at home will not only slow down the progress in social skills developments but also reduce their self-reliance and self-confidence and affect their vocational potentials.[3] This would also enhance the caregiver stress and burden and affect the caregiving.[3]
| Rise of Domestic Violence | | |
There is a growing concern about the rise in domestic abuse and violence being reported by the media.Stress and associated risk factors for family violence such as unemployment, reduced income, limited resources, and limited social support are likely to contribute to this situation. In addition, alcohol abuse, a commonly reported risk factor for family violence, has been linked to an accumulation of stressful events and a lack of social support (both likely occurring as a result of Covid-19).[7] The survivors also reported serious, pervasive, and persistent negative outcomes of technology-facilitated abuse in their lives.
Similar trends have been reported from China, France, Brazil, and Italy.[7] The growing global trend of increasing reports of domestic violence cases is likely to continue throughout the pandemic and may only represent a “tip of the iceberg,” as many victims still find themselves trapped with the perpetrator and unable to report the abuse which is also very similar to a country like India.
| Namaste | | |
Revival of cultural defenses in the form of traditional practices can be considered a welcome event. Due to the risk of spread of infection through handshakes, people are reverting back to a folded hand “namaste” instead of a handshake! or bowing head or body down as a greeting. Frequent handwashing with soap and water is also encouraged instead of the use of tissues and papers for cleaning. Similarly, if the use of face mask becomes a long-term healthy practice, it would remind us of the traditional “purdah” system, hopefully without its notorious ill effects.
Health-care systems were not prepared for this outbreak or the lockdown even less so about its impact on mental health. Suitable mental health care should continue without compromising caution and physical risk of infection.[3] This issue of the journal will provide many themes and topics for research on social psychiatry related to a viral infection.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Andrade C. Covid-19, Humanitarian and health care crisis in third world country. J Clinical Psychiatry 2020;81:20com13383.  |
| 2. | Reddy B, Chaturvedi SK, Desai G, Manjunatha N, Guruprasad S. Health-related life events in patients with somatic symptom disorders: A case control study. Int J Soc Psychiatry 2019;65:265-70. |
| 3. | Chaturvedi SK. Covid-19, Coronavirus and Mental Health Rehabilitation at Times of Crisis. J Psychosoc Rehabil Ment Health 2020;7:1-2. |
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| 7. | Campbell AM. An increasing risk of family violence during the Covid-19 pandemic: Strengthening community collaborations to save lives. Forensic Sci Int Rep 2020;2:100089. |
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