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  • The impact of Covid-19 on mental health 

By Dr. Charuni Kohombange

Covid-19 has changed the daily routines of individuals in a quite short time. The fear of getting infected, inevitable lockdowns, loss of jobs and fear of losing loved ones have created unrest in many minds. School closure for more than a year and missing friends have created distress in children. 

A nationwide study conducted in Italy to find out the psychological impact of the Covid-19 on adults and children at the time of the highest numbers of daily cases, have found that about one third of the participants reported moderate-to-severe psychological distress. According to this study, healthcare workers directly involved in providing Covid-19 care had significantly higher indexes of distress. Children’s ratings were correlated to those of their parents, and about 30% of them had indexes indicative of higher risk for post-traumatic distress. 

According to the World Health Organisation (WHO), globally only about 2% of the government health budgets are allocated to mental health expenditure. In some of the poorest countries it is less than $ 1 per person, struggling to meet their population’s needs in treating mental health conditions. 

In a media conference conducted by the Health Promotion Bureau (HPB), Dr. Sajeewana Amarasinghe, Consultant Psychiatrist of National Institute of Mental Health (NIMH) discussed common mental health conditions observed during and post-Covid-19 situations. 

This article contains excerpts of his discussion. 

Stress and depression 

It is being observed that stress and depression are quite common in patients affected with Covid-19. Extracting a follow-up study published in The Lancet, conducted in China using 1500 hospitalised patients, Dr. Amarasinghe pointed out that about 25% of patients still have depression up to some extent even after one year from the infection. A considerable number of patients were having physical symptoms such as tiredness and breathing difficulties even after six months from the infection, which has led to psychological distress. “Many patients feel agitated and depressed with these post-Covid-19 symptoms as they cannot cope-up with their daily routines. This condition gives rise to a vicious cycle leading to further feeling fatigue and other physical symptoms,” explained Dr. Amarasinghe. Hence, it is important to accept that it is common to have physical symptoms even after six months to one year from the infection. 

According to Dr. Amarasinghe, most of these patients are only having mild psychological distress such as fear of the disease, which cannot be categorised as depression. However, in a limited number of patients, symptoms of depression such as low mood or sadness which persists throughout the day, lack of energy and inability to enjoy the things which they usually enjoyed can occur. “If patients are having such symptoms it is important to seek advice from a psychiatrist, since in certain situations it can lead to suicidal ideations resulting in devastating situations,” said Dr. Amarasinghe. 

Factors leading to depression 

There are a number of reasons for developing depression during the pandemic situation. Fear of the infection and it’s symptoms, fear of family members getting affected, especially children and parents are commonest reasons for depression. In addition to these factors, death of relatives victimised to the infection and inability to pay last respects causes a massive impact on the psychological health. “It is customary to have funerals, paying last respects, and sharing sorrows with relatives and friends. This has a huge value when considering the psychological aspect as these rituals help to fade away the sorrows by sharing concerns with relatives and friends,” said Dr. Amarasinghe. With the current situation, as it is impossible to adhere to these rituals it is vital to stay connected with the relatives at least over the phone. “Many people think that talking about the deceased will further aggravate the sorrows, but it is not so. It is important to talk about the deceased, share feelings, lament and wash out the feelings,” explained Dr. Amarasinghe. 

Many individuals have lost their jobs and many have lost a significant share of their income. In certain families, some of the family members are living abroad and constant thoughts about them leads to psychological distress.  

Stress and depression in children 

With the closure of schools for more than a year, children have missed their routines. This has led to psychological distress in children. “Children may not show the usual symptoms of depression. They will express their tension in different ways such as irritability, aggression and lack of interest in learning activities,” noted Dr. Amarasinghe. 

Pointing out on the digital addiction of children, Dr. Amarasinghe explained that this happens as the depressed children use digital devices to while away the time. Explaining to a question raised by the media, Dr. Amarasinghe explained that it is impossible to keep the children completely away from digital devices, because of online learning. However, it is important to restrict the screen time whenever they are not engaged in online learning. Adhering to a timetable and encouraging indoor/outdoor games are important for the psychological health of children. 

Domestic conflicts 

Contrary to the common belief that being at home will improve the happiness and the unity in the family, it is apparent that domestic conflicts and intimate partner violence has increased during the lockdown period. “Many inquiries are being received to the NIMH hotline about domestic violence,” said Dr. Amarasinghe, emphasising the importance of focusing attention to minimising domestic conflicts. 

Searching for news and information about Covid-19 

It is apparent that continuous searching about Covid-19 and listening to news-related to Covid-19 and its victims can result in stress. Dr. Amarasinghe emphasised that it is important to restrict this searching and limit the news only to reliable sources. 

Mental health services affected worldwide 

According to a survey conducted by the WHO, the Covid-19 pandemic has disrupted or halted critical mental health services in 93% of countries worldwide while the demand for mental health is increasing. Many people are facing increased levels of alcohol and drug use, sleeplessness and anxiety. People with pre-existing psychological, neurological or substance use disorders are also more vulnerable to get infected as their compliance to health regulations are compromised due to the disease status. 

This survey has been conducted from June to August 2020 among 130 countries across WHO’s six regions to evaluate how the provision of mental, neurological and substance use services has changed due to Covid-19, the types of services that have been disrupted, and how countries are adapting to overcome these challenges. According to the findings, over 60% of countries reported disruptions to mental health services for vulnerable people, including children and adolescents (72%), older adults (70%), and women requiring antenatal or postnatal services (61%). Disruption to counselling and psychotherapy services has been reported in 67% of countries that participated in the survey. 

While many countries (70%) have adopted telemedicine or teletherapy to overcome disruptions to in-person services, more than 80% of high-income countries reported deploying telemedicine and teletherapy to bridge gaps in mental healthcare delivery positive, compared with less than 50% of low-income countries. 

Considering mental health as a priority, Sri Lanka has recognised mental health and psychosocial support as part of the national Covid-19 response plans. Continuous supply of medicines for the patients, establishing telemedicine services and attending to patients needing acute treatment are continuing throughout the pandemic without disruptions.  

Mental health helplines 

The National Institute of Mental Health has established the 1926 hotline, operating around the clock to help all needy patients who are having mental health concerns.  Further, all General Hospitals in the country conduct mental health clinics and patients can walk-in to seek advice and treatment for mental health conditions. 

In addition, the SLMA Doc Call 247 hotline also supports such patients with psychiatrists who have volunteered to join the system. This service can be obtained by dialling 247 from any mobile connection or by dialling 1247 from a fixed line connection.