Coronavirus: The possible long-term mental health impact

The world has experienced the unprecedented impact of the global health emergency due to COVID-19 that has also impacted on the mental health of millions of people. Since world is struggling to contain the spread of the corona virus, it has increased the level of anxiety, fear, isolation, uncertainty and emotional distress among the people.

The pandemic has had a particularly terrible impact on the domestic workers around the world.  As the numbers of cases and fear of contagion has spread, so too have confinement measures to prevent transmission. While domestic workers have suffered many kind of impact resulting from the pandemic, one of the main consequences of COVID-19 has been a reduction of working hours and in many cases, loss of jobs, resulting from fear and restricted mobility associated with confinement measures.

The impact could be perceived on both male and female domestic workers, as well as those in formal and informal employment. All formal and informal sectors, business, market, schools and livelihoods were affected due to pandemic. Movement, except the essential services were halted for couple of months and people were confined within the wall of boundary.

A survey report prepared by UNICEF shows that a third of the world’s schoolchildren-463 million children globally were unable to access remote learning when COVID 19 shuttered their schools.  And the actual number of students who cannot be reached is likely significantly higher than this estimate. Children remained at home were forced to listen what their parents instructed to. Children accessed to online classes were burdened with piles of assignment on daily basis. Playing with friends and outdoor visits were restricted in the fear of pandemic spread. Similarly, cases of domestic violence and exploitation were reported higher than what used to be recorded before the pandemic.

The outbreak resulted not only with sever sickness and deaths but also fetched unsought consequences as to mental health issues.  

WHO published the result of a survey of the impact of the COVID-19 on mental, neurological, and substance (MNS) use services in 130 WHO member states ahead of the world Mental Health Day on October 10. The Survey revealed that most countries are experiencing some disruption to MNS services, with the greatest impact on community-based and prevention and promotion services. Reasons for disruption included and insufficient number or redeployment of health workers to the COVID 19 response (in 30% of countries), use of mental health facilities as COVID-19 quarantine or treatment facilities (in 19% of countries), and insufficient supply of personal protective equipment (In 28% of countries).

The countries who faced the disruption of the services were found with detrimental impact compared to the countries who managed the required equipment timely. Historical incident that occurred in different times shows the terrible impact as pandemic can have on the mental health of affected population. For instance, outbreak of Ebola virus disease (EVD) had widespread impact in community causing anxiety and depression. A meta-analysis have found that depressed mood, anxiety, impaired memory, and insomnia were common symptoms among the affected people. The death of relatives, friends, stigmatization and exclusion of the survivor were the main reasons for depressed mood, anxiety, impaired memory and insomnia among the affected community.

In the case of COVID-19, non-pharmaceutical interventions (NPIs), although essential to halt transmission of the virus, have let to physical isolation, closure of school (with untold effects on the development and wellbeing of children), and widespread job losses. Misuse of substances, particularly alcohol, is rising. Emerging evidence suggests that COVID-19 could even have direct neurological consequences. And as with many other features of this pandemic, not all people have been affected equally.

Disruptions to MNS services, as reported by WHO, are disproportionately affecting people with pre-existing mental health conditions by limiting access to essential treatment and support services. People with salaried jobs are far less likely to be affected than those with informal, daily wage jobs, which include a substantial proportion of the workforce in lower-income countries. Frontline workers are experiencing increased workload and trauma, making them susceptible to stress, burnout, depression, and post-traumatic stress disorder (PTSD).

Even before COVID-19, mental health conditions were prevalent, accounting for about 13% of the global burden of disease. Yet, the world was woefully unprepared to deal with the mental impact of this pandemic. Years of underinvest in mental health, especially in low-income and middle-income countries, have left the people vulnerable. However, there has been huge progress in the development of long waited vaccine. The results obtained from the third phase trials has brought positive results which is in the process of the approval from the concerned authorities.

Two COVID-19 vaccines candidates, developed by Pfizer/biotech and Moderna were authorized to use only for the emergency purpose. America have already headed to roll out the vaccines that reaches among the 20 million people in first shot. Likewise, England has also authorized the vaccine to be used for the emergency purpose. The authorization was specified based on a vaccine efficacy rate of 95% demonstrated in the companies’ phase 3 clinical study in participants.

Regardless of significant achievement in the history, there is amalgamation of both doubt and trust among the people as vaccine were emanated in short time frame. It is to be observed if the vaccine works as it is supposed to do. Since the vaccine is new and still under long term trials, it takes time to reinstate the normal life which was before the pandemic. There is concern that mental-health problems may rise or are rising, but this needs to be better understood. It is essential to understand the risk and provide interventions to the various population those who are suffering from the mental health issues.

Impact on mental health in Nepal       

During the first 74 days of the lockdown, 1227 people across the country committed suicide. Among them, 149 were teenagers. Data of the Non-Communicable Disease and Mental Health Section of the Epidemiology and Disease Control Division also show that 6,261 people took their own lives in the fiscal year 2019-20. It is an alarming increase in the number of suicides, compared to 5,785 in all of last year.

The National Health Survey, Nepal 2020 also found that among the adults, 10 percent had experienced mental disorders in their lifetimes, and 4.3 percent were currently suffering from mental issues. The prevalence of lifetime mental disorder was highest among adults in Province 1 at 13.9 percent-13.3 percent in the 40-49 years age group and 12.4 percent among males.

The impact of the pandemic on people’s mental health is already extremely concerning, according to the World Health Organization which has stressed an urgent need to increase investment in service for mental health or risk a massive increase in mental health issues soon. The grim indicators of the surveys are serious concerns which need urgent resolution.

Mental health specialist say cases of disorders such as depression, anxiety and psychosis tend to increase significantly during high stress situation like pandemics, natural disaster and wars, sometimes at rate of 3 to 5 percent. The latest Red Cross report also shows that the pandemic has affected the mental health of one in two people. It also highlights the urgent mental health needs of those who have been on the frontline of the pandemic to ensure they can continue to care appropriately for other.   

Pertaining the Nepali people, many of have lost their jobs and seen massive pay cuts. All people were compelled to remain with within the boundary for 74 days deteriorating their livelihoods and incomes. After the massive loss of job, it has placed them in anxiety and depression. The economy of the country have also fallen down and have faced multiple crisis and collapse in commodity prices. There is considerable uncertainty about what the economic landscape will look like even after the pandemic is contained. There is no certainty of the time frame it would take to control and revive the economic. Hence, the cases of mental health issues have been found increasing across the country compared to the previous data.