Mental Health and Psychological Resilience during the COVID-19 Pandemic

As the coronavirus (COVID-19) pandemic sweeps across the world, it is causing widespread concern, fear and stress, all of which are natural and normal reactions to the changing and uncertain situation that everyone finds themselves in.

“The issue facing each and every one of us is how we manage and react to the stressful situation unfolding so rapidly in our lives and communities. Here we can draw on the remarkable powers of strength and cooperation that we also fortunately possess as humans. And that is what we must try to focus on to respond most effectively to this crisis as individuals, family and community members, friends and colleagues,” said Dr Hans Henri P. Kluge, WHO Regional Director for Europe.

WHO takes the impact of the crisis on people’s mental health very seriously and is monitoring the situation together with national authorities, while providing information and guidance to governments and the public.

Keywords:Mental Health; Covid 19; Elderly; Children; Resilence

As the coronavirus (COVID-19) pandemic sweeps across the world, it is causing widespread concern, fear and stress, all of which are natural and normal reactions to the changing and uncertain situation that everyone finds themselves in.

“The issue facing each and every one of us is how we manage and react to the stressful situation unfolding so rapidly in our lives and communities. Here we can draw on the remarkable powers of strength and cooperation that we also fortunately possess as humans. And that is what we must try to focus on to respond most effectively to this crisis as individuals, family and community members, friends and colleagues,” said Dr Hans Henri P. Kluge, WHO Regional Director for Europe.

WHO takes the impact of the crisis on people’s mental health very seriously and is monitoring the situation together with national authorities, while providing information and guidance to governments and the public.

At a press briefing held on 26 March, Dr Kluge, together with Dr Aiysha Malik, Technical Officer, Department of Mental Health and Substance Abuse, WHO Headquarters and Dr Dorit Nitzan, Acting Director of Emergencies, WHO/Europe, answered questions on mental health issues in the context of COVID-19 and offered insights on tools, techniques and interventions to address them.

“With the disruptive effects of COVID-19 – including social distancing – currently dominating our daily lives, it is important that we check on each other, call and video-chat, and are mindful of and sensitive to the unique mental health needs of those we care for. Our anxiety and fears should be acknowledged and not be ignored, but better understood and addressed by individuals, communities and governments,” Dr Hans Kluge noted.

Many of the questions focused on specific population groups, including children and older people [1].

This is indeed an unprecedented time for all of us, especially for children who face an enormous disruption to their lives. Children are likely to be experiencing worry, anxiety and fear, and this can include the types of fears that are very similar to those experienced by adults, such as a fear of dying, a fear of their relatives dying, or a fear of what it means to receive medical treatment. If schools have closed as part of necessary measures, then children may no longer have that sense of structure and stimulation that is provided by that environment, and now they have less opportunity to be with their friends and get that social support that is essential for good mental well-being.

Being at home can place some children at increased risk of, or increased exposure to, child protection incidents or make them witness to interpersonal violence if their home is not a safe place. This is something that is very concerning.

Although all children are perceptive to change, young children may find the changes that have taken place difficult to understand, and both young and older children may express irritability and anger. Children may find that they want to be closer to their parents, make more demands on them, and, in turn, some parents or caregivers may be under undue pressure themselves.

Simple strategies that can address this can include giving young people the love and attention that they need to resolve their fears, and being honest with children, explaining what is happening in a way that they can understand, even if they are young. Children are very perceptive and will model how to respond from their carers. Parents also need to be supported in managing their own stressors so that they can be models for their children. Helping children to find ways to express themselves through creative activities, and providing structure in the day – if that is possible – through establishing routines, particularly if they are not going to school anymore, can be beneficial.

Mental health and psychosocial support services should be in place, and child protection services need to adapt to ensure that the care is still available for the children of families who need it [2].

Regarding older people and also those with underlying health conditions, having been identified as more vulnerable to COVID-19, and to be told that you are very vulnerable, can be extremely frightening and very fear-inducing. The psychological impacts for these populations can include anxiety and feeling stressed or angry. Its impacts can be particularly difficult for older people who may be experiencing cognitive decline or dementia. And some older people may already be socially isolated and experiencing loneliness which can worsen mental health.

On a positive note, there are many things that older people can initiate themselves or with the support of a carer, if needed, to protect their mental health at this time. These include many of the strategies that we are advocating across the entire population, such as undertaking physical activity, keeping to routines or creating new ones, and engaging in activities which give a sense of achievement. Maintaining social connections is also important. Some older people may be familiar with digital methods and others may need guidance in how to use them. Once again, the mental health and psychosocial support services and other services that are relevant to this population must remain available at this time [3].

It is essential that we address the public mental health challenges over the coming weeks and months in Europe and beyond:

By distributing timely, understandable and reliable information from the youngest to the older members of our society;

• By providing psychological support to front-line workers and bereaved families;

• By continuing care and treatment of people with cognitive, mental and psychosocial disabilities; and

• By protecting human rights, especially of those whose rights are often overlooked or violated, including migrants and refugees, prisoners, residents in other closed settings such as mental hospitals or social care institutions, and people with disabilities.

• The sheer unexpectedness of the rise in Covid-19 cases has caused a lot distress and chaos all over the country. Mental health has been compromised, once again. Stress levels are running high. In circumstances like these, a sense of all-pervasive doom and helplessness is not unusual. So what to do?

• We spoke to psychologists and counsellors to get insights about dealing with mental stress as the Second Wave wreaks havoc all across the country. Here's what they had to say [4].

• Dr Lubhana Malik, who is a psychotherapist, shared how this new wave has brought about a bigger mental strain with it than last year did, "The Second Wave has not only seen a spike in Covid-19 cases, but also anger levels, frustration and low feelings in individuals. Even people who had been championing and coping with the stress, are really feeling pulled down now. This is because we often deny our feelings and push them under the carpet. Instead, we need to accept that it is okay to feel upset, it is okay to take some time off. It is important to validate one's feelings. Change always brings discomfort; however, all change is not bad".

• "Things will get better, but you shouldn't force yourself into thinking it will happen in the blink of an eye. Find comforting techniques for yourself," she suggested.

• "For some people it could be reading, or a quick chat with a loved one. Another important thing is to not let uncertainties overwhelm us. We must stick to what is in our control and act accordingly. As human beings, we adapt very quickly to a new normal after a small period of discomfort. For instance, despite fatalities related to air/road travel, we knowledgeably accept them and minimise the risk by taking precautions such as using seat belts, following speed limits. Similarly, being responsible citizens, we must follow all Covid protocols and get vaccinated when our turn comes. Fear of fatality is bogging people down. However, one needs to realise that fear itself raises our physiological responses and reduces our immunity, leading to a Catch-22 situation. Instead, we need to remain as calm as possible and cross the bridge when we get there. Remember, as a society, we are all in this together, and we shall make it through."

• Psychologist Dr Sarika Boora suggested one look for signs within their body and routine. "Changes in sleep pattern, loss of appetite, losing interest in things, these are all signs people can notice in themselves. Our body also shows physical reactions such as headaches, digestive problems, feeling irritated, when things are not okay."

• "I would say, keep yourselves from constantly checking the news. Overdose of news and the statistics shown can have a bad impact on one's mental health. Try to stay a bit more active at home, because it will keep you busy. It is also very important to be connected with people who bring you comfort and have your best interest in mind. Try not to stay aloof. Talking always helps."

• Counselling psychologist Dr Preeti Shaw agrees that this new wave has hit us hard, just when things had started to get better. "Everyone was already fighting a lot of odds, and the sudden spike has hit everyone's motivation hard. There has been a sense of diminishing control over our future, and life in general. That has increased multiple times more in this second wave. All of this came very unexpectedly, and that is what makes it worse. I would strongly suggest - watch out for any unusual signs. Like a loss of interest in what you actually liked doing, is a way of your body telling you to pay more attention to your emotional needs. Physical isolation must not lead to emotional isolation. Agreed that there has been a paradigm shift in the way we lead our lives, but we should prioritise mental and physical health over everything. Once you realise that things are making you uncomfortable, make it a point to reach out for help. Professionals and personal contacts can always help you. Never let it spiral out of control."

• Dr Shaw also urged people to stop blaming themselves for things not working out. "What is the definition of enough during a pandemic?" she asked. "I think a sense of disappointment has engulfed people because they feel they are not doing enough. If you are blaming yourself for not getting it all right in the first go, please pause. Pause and understand, your possibilities have diminished to a very great extent due to the pandemic. Don't be hard on yourself for not knowing, for not controlling it all. Because the truth is that you cannot control so many things right now due to the external limitations."

"The more informed you are about something, the more you feel you have it under control", says neuropsychologist Tejasvini Sinha. "So, knowing that a doctor in the society can be contacted, or knowing what medicine to take in case of some symptoms, can bring a lot of comfort to people. Don't rely on WhatsApp forwards, because most of them are far from true. Checking updates too frequently can really overwhelm you, so maybe just once in a while, check statistics from an authentic source, if you really must. Lastly, I would just advise, please take care of your body and have a routine. Try to help people virtually, because that will make you feel good too. Have a microscopic vision of life and be grateful for your blessings. The macroscopic reality of the world is hurtful, and we are hard-wired to feel guilt and regret a little too much. But try to shift your focus on what you can control, how you can be happy, and spread happiness around."

Feeling restless, tensed, or worried all the time? Concerned about a loved one who is hospitalised? The unexpected rise of Covid-19 cases has increased the stress levels and affected the mental health of people across age groups. Neglected mental health problems can escalate and may cause serious disorders like depression or anxiety disorders. Psychologists suggest that one of the best strategies for managing emotions is to name them and discuss them with your loved ones. These are tough times for everybody, but don’t let it bring you down. Here is what you can do to manage your mental health better [5,6].

The second wave of COVID is upon us. But more than the virus, it’s the fear that is even more dangerous. Fear is the emotional response to a perceived threat while anxiety is the anticipation of any future threats. It is comparatively easier to avoid viruses, but the psychological “virus” of fear is most contagious! Fear of loss (e.g., loved one/economic/occupational/status) is one of the most prevalent fears. Chronic or extreme fear has a direct effect on our health. Fear leads to excessive functioning of the sympathetic (fight-flight) nervous system. Physically, it weakens the immune system, causes headaches/body-pains, cardiovascular problems (hypertension, angina), and gastrointestinal issues (ulcers, irritable bowel). It can also lead to accelerated ageing and premature death. Emotionally, it causes disorders like panic attacks, anxiety disorders, dissociative states, obsessions, PTSD, depression, or even severe mental illnesses like psychoses [7,8].

To fight fear, it is important to strengthen the parasympathetic (rest-digest) nervous system. Some of these methods are:

• Relaxation techniques – Deep diaphragmatic breathing, guided meditation, yoga, stretching, jacobson’s progressive muscle relaxation method

• Self-hypnosis techniques like visualizing a happy place or positive affirmations

• Keeping a gratitude journal – write three good things that have happened to you that day before going to bed.

• Maintaining a thoughts diary – Scrutinize the negative thoughts that your mind is throwing at you. Look at the evidence, is it really true?

• Not being “perfect” all the time – Do not compare. Be kind to yourself. Be compassionate.

• Communicating your fears – Take the help of a mental health professional, if needed.

Here are 5 simple tips for all age groups for keeping yourself calm and maintaining your mental well-being in the times of COVID:

1. Eat small, regular meals – Avoid over-eating or fasting for long periods. Strictly avoid nicotine, alcohol, caffeine, and other addictive substances. 2. Develop a routine – Schedule a regular work pattern. Then, unwind. Take breaks. Develop a hobby. Do something fun after your daily work is over. 3. Get plenty of sleep – But also, exercise daily. Practice deep breathing, yoga, stretching, and relaxation techniques. 4. Connect positively with people -Share something positive or humorous with your friends and family. Avoid viewing/sharing/forwarding negative views or news. Repeatedly remind yourself of the important and positive things in your life. 5. Take this opportunity to help others – Do not entertain the victim’s role in your mind. Take charge of your thoughts and emotions. Stay calm. If unable to do so, seek help from your nearest mental health professional.

Here are some common myths and facts about mental health that need to be cleared:

Myth: One should keep smiling and be happy all the time.

Fact: Suppressing negative emotions such as sadness or grief, with a fake smile can actually make you feel worse. Accepting and expressing your emotions in an appropriate manner is more useful.

Myth: Venting your rage will help you to overcome anger.

Fact: Rather than calming you down, venting positively reinforces your anger, causing you to become angrier, and for a longer period. Taking a break from the triggering situation, channelizing your anger into an activity such as exercise, and identifying the true reason for your anger is far more effective.

Myth: Drinking alcohol reduces anxiety.

Fact: Drinking alcohol does not reduce anxiety or protect you against COVID-19 infection. In fact, it can be dangerous as it lowers immunity and increases your risk of health problems.

Dr. Shaunak Ajinkya – Consultant – Psychiatrist at Kokilaben Dhirubhai Ambani Hospital shares some great tips above about maintaining your mental health and staying resilient in these unprecedented times. Our Department of Psychiatry is available to help people feel better with online as well as offline consultations for all our patients. Do not suffer in silence, remember that taking care and seeking professional help for your mental health is as important as treating your physical health. The second wave of COVID is affecting more children Never ignore any symptom in your children; also keep an eye on any discomfort your children may be facing, because headache, unnecessary fatigue are also not that common but noticeable symptoms, said Dr Gitali Bhagawati, consultant and head, department of microbiology and infection control, Dharamshila Narayana Superspeciality Hospital.

The COVID pandemic has been extremely tough for children who have been forced to cope up with unprecedented changes, be it online education in confined places or restricted exposure to friends and family. But the new strain has made it even tougher as it is reportedly also affecting children. As such, what precautionary measures can one take and what is the level of severity among children? Dr Gitali Bhagawati, consultant and head, department of microbiology and infection control, Dharamshila Narayana Superspeciality Hospital shares some insights.

With time, the virus is mutating and different variants are breaking out. Also, COVID is not merely a respiratory disease; many infected people are experiencing a variety of symptoms and discomforts. COVID potentially affects the organs and blood vessels of a patient, and the same mechanism can manifest in multiple symptoms. Apart from diverse symptoms, many people are also reporting neurological issues, BP, leg pain, body ache, fatigue etc. even months after recovery, which did not even prevail before infection. Such is the larger and longer effect of this infection [9,10].

As far as children are concerned, after a long time they are coming out of their houses, many of them are getting regular with school and other outdoor activities; hence more chances of getting an infection are there. But at the same time, among children, while the second wave is surely spreading faster lesser cases of severity are being witnessed. “But in long-term what physical conditions can occur, it cannot be said yet. As this virus is entirely new for us, research and studies are taking place across the world. Hence precautionary measures are the key,” said Dr Bhagawati.

As mentioned, COVID symptoms are diverse because of its mutation. Apart from sore throat, high to low-grade fever, gastrointestinal symptoms (mainly diarrhoea), neurological issues etc. people are experiencing dry mouth (xerostomia), COVID tongue and ulcer because of non-salivation. Children may also suffer stuffy or running nose and loss of appetite.

Never ignore any symptoms in your children; also keep an eye out for any discomfort your child may experience, because headache, unnecessary fatigue are also not that common but noticeable symptoms.

* Home isolation is best for children. Wearing masks, social distancing, repeated hand washing are some of the precautionary measures, but managing COVID appropriate behaviour is quite challenging among children.

* Another challenge is COVID testing. Children may not allow or feel uncomfortable while taking oropharyngeal and nasopharyngeal swabs which results in Negative COVID RT-PCR. However, it doesn’t mean that children are really negative for COVID. They can act as super spreader of this virus. So, if children are affected, they should be ideally kept away from elderly people, or reverse isolation can be done.

* As guardians, we need to be more cautious about our children; the challenge of giving them a healthy environment to develop and learn is bigger than ever. Family members should get vaccinated as per government guidelines. Teachers at schools and family members at home should communicate and ensure precautionary measures at every level.

* Although Covid vaccine is not allowed for children yet, seasonal influenza vaccine can be given to them so that they can gain immunisation against the seasonal influenza virus.

* Keep their intake of vitamin B complex, vitamin C, D, calcium, zinc etc. high. Also, inspire them to take plenty of water and lead a healthy life, said Dr Bhagawati.

* Parents also need to follow the same rules they impose on children with the objective of good health instead of just ordering them. The act of ordering a child to eat green vegetables will go futile when adults at home are enjoying fast food. Parents need to be more active and develop more connections with children.

Besides following Covid-appropriate behaviour, psychiatrist Dr Samir Parikh suggested that one must try and not "look into social media too much".

We are living in challenging times that consume a lot of our mental energy and focus. (Photo: Getty Images/Thinkstock).

With the number of cases rising each day, near and dear ones getting affected, and amid lockdowns, stress and anxiety are at an all-time high in the second wave of Covid 19. “The second wave is severe not just because of the toll it’s taking due to the huge population being affected but also because it suddenly came when everything seemed to be returning to normal. Vaccine felt like a respite but there are millions yet to be vaccinated and people still haven’t recovered from financial and personal losses,” Dr Jyoti Kapoor, senior psychiatrist and founder, Manasthali.

In a recently released insight by Practo in March 2021, most discussed concerns of women in non-metro cities included depression, anxiety and panic attacks while most discussed concerns of women in metro cities were stress, obsessive-compulsive disorders, eating disorders, and mood disorders.

According to World Health Organization (WHO), “fear, worry, and stress are normal responses to perceived or real threats, and at times when we are faced with uncertainty or the unknown. So it is normal and understandable that people are experiencing fear in the context of the COVID-19 pandemic”.

Added to the fear of contracting the virus in a pandemic such as COVID-19 are the significant changes to our daily lives with our movements being restricted in support of efforts to contain and slow down the spread of the virus, as per WHO. Faced with new realities of working from home, temporary unemployment, home-schooling of children, and lack of physical contact with other family members, friends and colleagues, it is important that we look after not just physical health but mental health too.

Besides following Covid-appropriate behaviour, psychiatrist Dr Samir Parikh suggested that one must try and not “look into social media too much”. “Social support is the key – share and keep talking to people,” he said, while mentioning that one needs to keep a healthy lifestyle, have regular sleep, exercise, do yoga, do reading, listen to music and take multiple breaks.

The only way to manage stress in these times is to focus on living in the present, said Dr Kapoor.

*Avoid focusing on statistics that serve no purpose for the common man. All one needs to do is focus on their own self which means the same old stringent measures of wearing a mask and staying indoors.

*Follow a disciplined routine. Discipline helps the brain to focus on the task at hand and not stray away into unnecessary negative thoughts.

*Pursue a creative activity. Even if work from home is taxing, find time to indulge in hobbies you enjoy. It takes away the stress of achieving results for work. The process itself induces happy chemicals.

*Exercise releases endorphins which are natural pain killers. It also gives a sense of accomplishment while keeping us physically fit and improving immunity.

*Adequate sleep and sleep-wake pattern allows for the balance of neurochemicals to be restored so the emotional exhaustion and burn out is low.

*Healthy diet is always important to improve physical and psychological stress tolerance.

*Connect with family and friends. Don’t get into the same old Corona-related speculations; talk about other things like sports, science, universe.

*Read whatever interests you, go beyond newspaper; there is so much to choose from.

*Focus on all the things we still have. Sooner or later, things will change. We have a better understanding of diseases today than we ever had. Patience is a good virtue to learn today and forever.

*”Last but not least- be grateful. We will survive and in the process will also build a better world. So many things are changing for good,” said Dr Kapoor.

Getting a good night’s sleep is essential.

According to a new survey from the American Academy of Sleep Medicine, a third of Americans are sleeping worse than they did before the pandemic. About 30 percent say they have difficulty falling asleep or staying asleep. One in five also say they’ve experienced more disturbing dreams during the pandemic. This so-called “COVID-somnia” can be brought on by fears about the coronavirus, concern for our loved ones, economic worries, and limited social contact, said Dr Malik Merchant, consultant psychiatrist and psychotherapist, Wockhardt Hospital, Mumbai Central.

-increased stress and anxiety -an uptick in screen time -lack of exercise -increase in the use of tobacco and alcohol

Maintain a regular sleep schedule

Even if your schedule has changed because work or school is remote, or you aren’t working, you should aim to get at least seven hours of sleep a night and go to bed and get up about the same time every day, including weekends.

Limiting your screen time helps your body prepare for sleep, while avoiding news and social media before bed can reduce stress. Turn off your electronics at least 30 minutes before bedtime.

Start unwinding at least 30 minutes before your bedtime with quiet activities like reading or meditating, or take a warm bath or shower to help you relax.

A cool, dark room is best for sleeping. Keep the TV off and store smartphones and other electronics outside your room. “Good sleep habits will help restore the quality sleep. And that’s better for our overall physical and mental health,” said Dr Merchant What are the psychological effects of COVID-19 on children.

Children are likely to be experiencing worry, anxiety and fear, and this can include the types of fears that are very similar to those experienced by adults, such as a fear of dying, a fear of their relatives dying, or a fear of what it means to receive medical treatment. If schools have closed as part of necessary measures, then children may no longer have that sense of structure and stimulation that is provided by that environment, and now they have less opportunity to be with their friends and get that social support that is essential for good mental well-being.