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\begin{document}


\def\RunningAuthor{Divit Goel}
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\articleType{Review Article}
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\title{Effects of Covid-19 on Mental Health}
\author{Divit~Goel\textsuperscript{*}~\\[5pt]{Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Sawangi (M), Wardha {\textendash} 442004, Maharashtra, India}}

\begin{abstract}
The present global scenario of a pandemic has affected the human race as a whole and still continues to create unrest among all segments of the society, be it those from the economically weaker background or the affluent part of the society. When the entire human race is dealing with such a scenario, it is known that anxiety and fear among the masses grow due to lack of knowledge and lack of preparedness of healthcare infrastructure. Through this article, I~want to highlight the effects of such an unexpected mass event and particularly throw light on its effects on the mental well-being of individuals. It also aims to showcase the gravity of the issues related to mental health and how the number of people affected is exponentially increasing. The article will also discuss various coping mechanisms and ways to deal with stress, anxiety etc., to keep us mentally healthy and also suggest methods to promote mental health, thus creating a positive environment during such times of crisis. Thus it is safe to say that mental health is as important if not more important than physical health. A person is said to be COVID-19 positive when the person tests positive in an RT-PCR test. A CT Chest has proved to be helpful in judging the risk of complications. Imaging reveals non-specific changes like that of pneumonia. As of now, there is no definitive therapy for Covid-19, although a few drugs like dexamethasone have proved to reduce the severity of the disease.  
\end{abstract}\def\keywordstitle{Keywords}

\begin{keywords}symptoms,\newline psychological,\newline mental health,\newline positive
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\makeatletter{\raggedright\textsuperscript{*}Corresponding Author\par Name:\ Divit~Goel~\\ Phone:\ 8130619971~\\  Email:\ divit15goel@gmail.com
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\section{Introduction}
It is very important to know that COVID has affected people in various ways; one of the most prominent domains being mental health. With the outbreak of covid, the mental health of people has been severely affected, especially because of all the necessary norms put forward to prevent the spread of disease like social distancing, isolation, quarantine etc. The present global scenario of a pandemic has affected humans as a whole and still continues to create unrest among all segments of the society, be it those from the economically weaker background or the affluent part of the society. When the entire human race is dealing with such a scenario, it is known that anxiety and fear among the masses grow due to lack of knowledge and lack of preparedness of healthcare infrastructure.  These issues can compound other comorbid conditions like hypertension, anxiety, seizures, while other problems include depression, insomnia, loss of appetite, GI disturbances etc. Many psychological problems and important consequences in terms of mental health, including stress, anxiety, depression, frustration, uncertainty during the COVID-19 outbreak, emerged progressively. Other problems include depression, insomnia, loss of appetite, GI disturbances. Increased stress levels lead to early morbidity and mortality compounded by a weakening of the immune system making the person more susceptible to infections.  The concern that mental health should be given equal importance along with the diseases to prevent long term complications of covid is far too grave and should be given serious consideration.
    
\section{\textbf{CORONA AND ITS EFFECTS ON MENTAL HEALTH}}
Irrational and uncontrollable fear pertaining to the disease and its spread is one of the most encountered mental health issues. The fear of infection and the uncertainty of the course of the disease and its complications is increased exponentially in people who think that they are ``potentially infected'', especially after meeting RT-PCR positive person. Stress levels are increased if they fear infecting other members of the family, further complicating the situation. Pervasive anxiety about impending doom, loneliness, and losing loved ones adds to an already unwelcoming scenario. \unskip~\citep{1024951:21577491}. ``Social isolation related to restrictions and lockdown measures are linked to feelings of uncertainty for the future, fear of new and unknown infective agents resulting in abnormally increased anxiety.'' \unskip~\citep{1024951:21577487}.\textit{\space }Effects of isolation are visible immediately, which manifests as boredom and negative thoughts. This has an unprecedented effect on the mental and physical well-being of the individual. Such isolation also has long term effects of chronic depression, chronic anxiety and suicidal tendencies \unskip~\citep{1024951:21577490}.

For us to say that this pandemic is a cakewalk is unjust. It has affected all sections of society and people of all age groups, including children, adolescents, adults and the elderly. For school-going children, it had been a paradigm shift from the classical methods of teaching to the most advanced forms of digital education. This transition has particularly been more difficult on the economically weaker section of the society. From being surrounded by friends and classmates to being in total isolation, this pandemic has definitely taken a toll on their mental well-being. This problem has been highly neglected. The new methodology of evaluation has created an atmosphere of panic and unrest among the student population. 

These changes have a long term effect on the health (both mental and physical) of the students. This increases their chances of developing diseases like hypertension, migraine, insomnia, palpitations and reduces their life expectancy. This also will later affect the economy of the country as the work output of these young adults will be suboptimal. 

The effects of covid have been apparent on the working class as well. Due to the strict measures taken to curb the spread of this disease, like total lockdown and isolation, the worry of losing jobs has grown a sense of restlessness among the population under discussion. Feeling of breathlessness, chest pain, and sudden collapse, which are the tell-tale signs of myocardial infarction, have been increasingly seen in the working population due to the fear of losing jobs, inability to sustain their respective families and even have money for day to day expenses. Such difficulties, superimposed by sudden economic collapse, has led to a lot of working-class becoming jobless and taking to activities adversely affecting the economy like alcoholism, drug abuse and theft, among other criminal activities, thus further deteriorating the economy. Relationship problems, marital issues, loss of peace and harmony in the house due to rules implicated to reduce the exponential spread of disease leading to loss of personal space has also plagued this epidemic, further adding on to the already deteriorating mental health. Other problems include depression, insomnia, loss of appetite, GI disturbances. Increased stress levels lead to early morbidity and mortality compounded by a weakening of the immune system making the person more susceptible to infections.  Understanding the gravity of the issue and acting according to the current scenario, we need to stop believing false data which is not based on any research and is known to us through word of mouth or WhatsApp forwards. Myths about RT-PCR testing and the spread of infection (it spreads through air droplets and also through surface transmission) through the same should be abolished. Masses should also be educated about the importance of getting tested at a designated laboratory. 
    
\section{\textbf{HOW COVID AFFECTED MENTAL HEALTH SERVICES}}
A study was conducted in 130 countries between the months of June and August 2020, evaluating how the pandemic has affected almost all domains of our daily lives. It helped us identify how covid has created a huge pool of people suffering from mental health issues as well as disrupt the current infrastructure to fight issues pertaining to mental health, and how Governments of affected countries are adapting to overcome this unprecedented scenario.

Countries reported widespread disruption of many kinds of critical mental health services:


  
  \begin{enumerate}
  \item \relax Over 60\% 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\%).  
  \item \relax 67\% saw disruptions to counseling and psychotherapy; 65\% to critical harm reduction services; and 45\% to opioid agonist maintenance treatment for opioid dependence. 
  \item \relax More than a third (35\%) reported disruptions to emergency interventions, including those for people experiencing prolonged seizures, severe substance use, withdrawal syndromes, and delirium, often a sign of a serious underlying medical condition. 
  \item \relax 30\% reported disruptions to access medications for mental, neurological and substance use disorders.  
  \item \relax Around three-quarters reported at least partial disruptions to school and workplace mental health services (78\% and 75\%, respectively).
  \end{enumerate}
  Thus it is very evident that medical staff also needs adequate attention towards their mental health because if they are mentally fit, only then will they be able to help the patients in need \unskip~\citep{1024951:21577489}.

Various studies have indicated that people who are dependent on some sort of substance are more prone to develop mental health issues. Another study showed that women are more prone to develop mental health issues. \unskip~\citep{1024951:21577488}.

Recent studies have pointed towards the fact that there has been a drastic rise in the number of people consuming alcohol or some other sort of substance, either as an escape or a coping mechanism. Due to this, the number of people dependant on the substance has also increased, further adding on the burden on an already disrupted system of mental health service providers. The number of females who are suffering from mental health issues has also seen a sudden increase. This has been reflected in studies that indicate that the number of female drug abusers has increased. This issue is compounded if there are comorbidities like hypothyroidism, a polycystic ovarian disease leading to menstrual irregularities, which may further lead to infertility, adding on to the already existing stress and anxiety. Thus the vicious cycle of substance abuse and substance dependence. 

All the increasing concern about mental health issues is directly correlated to absenteeism from work which has adversely affected the economy of the country. WHO has issued guidance to countries on how to maintain essential services- including mental health services during COVID-19 and recommends that countries allocate resources to mental health as an integral component of their response and recovery plans. The Organization also urges countries to monitor changes and disruptions in services so that they can address them as required. 
    
\section{Discussion}
Understanding the gravity of the issue and acting according to the current scenario, we need to stop believing false data which is not based on any research and is known to us through word of mouth or WhatsApp forwards. It is of utmost importance to also help the general masses understand the chain of transmission of the disease. This will help them make informed decisions which will eventually help us curb the spread of the disease. Myths about RT-PCR testing and the spread of infection through the same should be abolished to reduce anxiety and fear of the unknown \unskip~\citep{1024951:21577493}. Masses should also be educated about the importance of getting tested at a designated laboratory. It is imperative that people understand the importance of COVID testing and its importance not only in helping curb the spread of infection but also in early diagnosis and early care and its importance in reducing morbidity and mortality. This is because of the life cycle of the virus, which progressively affects the lungs and from there on might affect other organs leading to multi-organ failure. It spreads through air droplets and also through contact (surface transmission). It affects the coagulation profile, which makes the blood hypercoagulable, making the affected person prone to other life-threatening complications like pulmonary embolism, deep vein thrombosis in lower extremities and cerebrovascular accidents like stroke (embolic stroke).

The general observation is that people who get tested positive have a tendency to have panic attacks, stress, anxiety and palpitations. It is important for us to educate the people who have tested positive about the course of the disease (whatever we know till now), its effects, the importance of drug compliance and the benefits of self-monitoring in order to reduce mortality and morbidity. This will help them make informed decisions which will eventually help us curb the spread of the disease. 

Mildly symptomatic patients are advised to stay home and isolate themselves. This creates a sense of loneliness, a sense of fear and anxiety, and adds to the restlessness in an already unwell and agitated person. Many psychological problems and important consequences in terms of mental health, including stress, anxiety, depression, frustration, uncertainty during the COVID-19 outbreak, emerged progressively.  This can further lead to a feeling of purposelessness and no desire to live. Isolation is known to cause a lot of stress which can exacerbate feelings of anxiety and uncertainty. It also creates unrest pertaining to the health of loved ones and the effects of covid on them.

For those who are more severely affected by the infection, a hospital stay is advised. This is a huge burden on the person who is affected as well as the family, both in terms of finances and mental health. It takes a toll on the entire family, mentally, physically and emotionally and makes them prone to palpitations, increased chances of trivial trauma due to absentmindedness, disturbed sleep and constant headache. The person who is admitted, undoubtedly, is affected the most. Most of the observational studies which have been performed in the recent past show an increased tendency of the affected person to suffer some or the other form of mental trauma, the severity of which is variable for different people. The amount of stress also is also directly related to the socio-economic status of the affected family as it has been observed that there has been an increase in the severity of mental issues in socially and economically weaker parts of the society. 

All the increasing concern about mental health issues is directly correlated to absenteeism from work which has adversely affected the economy of the country. The Governments of the affected countries should together pool all the resources in fighting this pandemic \unskip~\citep{1024951:21577492}. The health infrastructure needs to be strengthened and more so, mental health services need increased funding along with increased awareness. This can be achieved through programmes and campaigns across all forms of mass communications, including social media, print media and news. A prime example of such programmes is the "Let's invest more in mental health" event, which was hosted on world mental health day, which is on the 10\ensuremath{^{th}} of October. 
    
\section{\textbf{HOW TO KEEP YOURSELF MENTALLY HEALTHY}}
It is very important to know that COVID has affected people in various ways; one of the most prominent domains being mental health. When the entire human race is dealing with such a scenario, it is known that anxiety and fear among the masses grow due to lack of knowledge and lack of preparedness of healthcare infrastructure.  Understanding the gravity of the issue and acting according to the current scenario, we need to stop believing false data which is not based on any research and is known to us through word of mouth or WhatsApp forwards. 

Myths about RT-PCR testing and the spread of infection (it spreads through air droplets and also through surface transmission) through the same should be abolished. Masses should also be educated about the importance of getting tested at a designated laboratory. This will help reduce the fear of the unknown and the feeling of impending doom which will ultimately help them be mentally fit. One of the best ways to keep ourselves fit, both physically and mentally, is some sort of physical activity, how much ever is possible within the limits of the newly imposed regulations, taking due precautions to protect oneself and others from this disease. It has been found out through various researches that exercise in some form, or the other, helps you emotionally, physically and mentally. Other benefits of exercise include a reduction in stress levels, better sleep, improves memory, boosts energy, maintains immune functions, helps maintain proper posture and strengthens bones.

Many studies have shown that exercise causes the release of endorphins or the feel-good hormone, which boosts self-confidence, makes oneself feel good and elevates the mood. Physical activity helps in combating depression. Physical activity need not always be in the form of gymming or yoga, but simple activities like cleaning the house, drying clothes also account for physical activity. It helps in improving the overall cleanliness and living conditions which also helps in making us feel better. For people who are quarantined or are isolated, some form of deep breathing exercises or walking in the room might provide them with the necessary help to feel better. It also helps in preventing excessive weight gain, helps in muscle and bone growth by causing an increased blood flow to all the muscles. It calms the mind, relieves one from the pent up frustration and overall feels relaxed and happy. 

One can also keep themselves constructively busy by learning new skills or improving on their hobbies. 

Developing a sound mental space by doing what you love helps one feel content and relaxed. It can range from learning new instruments, acquire cooking skills, reading new books, learn stitching/ knitting. Painting is also considered a good form of constructive relaxation. Many other forms of constructional relaxation is gardening. Soil contains certain compounds which help in reducing depression and helps us in feeling happy. It is also a great form of exercise and helps us in interacting with nature and helps us appreciate it even more. Being confined to home, with ample availability of time, one can also try and get reconnected with old friends and those family members who have lost touch with each other. It helps us feel loved, being in contact with our loved ones also gives some assurance in terms of knowledge if their health and well-being.
    
\section{Conclusion}
The present global scenario of a pandemic has affected the human race as a whole and still continues to create unrest among all segments of society, be it those from an economically weaker background or the affluent part of society. When the entire human race is dealing with such a scenario, it is known that anxiety and fear among the masses grow due to lack of knowledge and lack of preparedness of healthcare infrastructure. It is very important to know that COVID has affected people in various ways; one of the most prominent domains being mental health. These issues can compound other comorbid conditions like hypertension, anxiety, seizures, while other problems include depression, insomnia, loss of appetite, GI disturbances etc. Various studies have indicated that people who are dependent on some sort of substance are more prone to develop mental health issues. Due to this, the number of people dependant on the substance has also increased, further adding on the burden on an already disrupted system of mental health service providers. The number of females who are suffering from mental health issues has also seen a sudden increase. Understanding the gravity of the issue and acting according to the current scenario, we need to stop believing false data which is not based on any research and is known to us through word of mouth or WhatsApp forwards. Myths about RT-PCR testing and the spread of infection (it spreads through air droplets and also through surface transmission) through the same should be abolished. Masses should also be educated about the importance of getting tested at a designated laboratory. All the increasing concern about mental health issues is directly correlated to the increasing absenteeism from work which has adversely affected the economy of the country. The health infrastructure needs to be strengthened, and more so, mental health services need increased funding along with increased awareness. Special ways need to be devised so that the broadcasted information reaches all the small towns and villages. The road to complete recovery from this pandemic is full of challenges even after the development of a vaccine, the biggest challenge of them all being the issue of deteriorating mental health of the masses. Thus the current global pandemic situation necessitates a multipronged approach towards healthcare delivery. It needs a holistic delivery model that takes into cognizance the multidimensional physical, mental, social and spiritual health of patients and communities.  

\textbf{Conflict of Interest}

The authors declare that they have no conflict of interest for this study.

\textbf{Funding Support}

The authors declare that they have no funding support for this study.
    

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