CPQ Orthopaedics (2021) 6:1
Perspective

The Impact of COVID-19 on Mental Health

Márcia Filipa Soares Cavaleiro

¹Graduated with a Postgraduate Degree in Physical Therapy from Escola Superior de Saúde do Porto, Portugal

*Correspondence to: Dr. Márcia Filipa Soares Cavaleiro, Graduated with a Postgraduate Degree in Physical Therapy from Escola Superior de Saúde do Porto, Portugal.

Copyright © 2021 Dr. Márcia Filipa Soares Cavaleiro. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: 19 November 2021
Published: 15 December 2021

Keywords: Mental Health; Pandemic; COVID-19; Social Isolation

Abstract

In nearly two years, COVID-19 has spread across the world, creating a global pandemic situation. This pandemic has caused profound changes in the way we live, both individually and as a community. These changes, together with the fear and uncertainty of being infected, the loss of employment or income due to the instability and unpredictability of the disease’s evolution, are classified as the main risk factors for the mental health of the general population, namely, for problems such as anxiety, depression, post-traumatic stress disorder and burnout. In the absence of effective pharmacological interventions against COVID-19, many governments have implemented confinements, some of them prophylactic, and other social isolation measures, which it has contributed to the deterioration of mental health. From Chinese tourist’s victims of judgments and prejudice to people previously diagnosed with psychological pathologies, to children, to health professionals, to animals to the elderly; it is important to find strategies that help each individual and teach them how to cope with the situation we face. Not only is it important to make a conscious survey of the demographic distribution in each city along with the economic situation of each country, as well as its conditions, but it is also even more important to ensure that the information that circulates and reaches the population is correct, true and without any kind of misrepresentation. Even though this pandemic originated from a virus, it can be described as a mental health pandemic and emphasizes the importance of making all care related to mental health classified as primary and with equal access. There has been a notable creation and increase of mental health support service lines, but there is still a great stigma worldwide. For this reason, it is necessary to promote and include in the education of adults and children, and make people understand that taking care of mental health is just as important as taking care of their heart, food, respiratory, digestive or even gynecological tracts, because without it our clarity and sanity are not clear, and we lose the ability to make good decisions.

Introduction
As we all know, by the end of 2019, the world met a virus (SARS-CoV-2) that quickly spread to every other country and got known as COVID-19, for being derived from coronavirus. Most governments started by implementing prophylactic quarantines varying from weeks to months, depending on the country and he government, which implicated that everyone stayed at home for a determined period of time. This included the closing of schools, companies, stores, markets, transportations, with the exception of hospitals specific supermarkets with very strict schedules [1-3].

This obligatory isolation imposed on us, especially in an unforeseen way, has brought some problems, not only for the country and its economy in general, but also for the individual himself. First, we are talking about a recently discovered virus with very little information about its physiology. It is an invisible enemy with little-known forces and consequences that affects anyone without looking at age, gender, ethnicity or race. This fear and uncertainty of being able to contract the virus or infect someone are present all the time, even in isolation, especially due to the lack of a vaccine or possible treatment. Secondly, being the human being highly dependent on social interaction, this presents adversity because it will now be forced to be confined without any access to the outside world, including family and friends [4,5].

Pandemics are traumatic events of a proportion comparable to natural disasters and wars, with the ability to individually and collectively change the micro and macrosocial components of societies, in particular in younger groups [6].

According to the WHO, mental health concerns “a state of well-being in which the individual perceives his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully and is able to contribute to his community” [1,3].

The absence of contact with family members and friends can produce psychological instability, resulting in high rates of post-traumatic symptoms. This implies that not only people affected by the virus but also people in the general population who have never been infected can demonstrate a major impact on mental health. In general, quarantine contributes and triggers feelings of stress, anger, hysteria, anguish, loss of control, irritability, fear of contracting and propagating disease, frustration, confusion, despair, numbness or emotional exhaustion [3,7-10].

By being located in the first line of contact, it is important to mention the health professionals who are on the front line in the treatment and fight against the virus. Several factors contribute to the mental strain of this particular niche, such as daily exposure to the virus, the lack of previously existing staff that causes them to have to work longer shifts and more often, the possibility that co-workers may become infected and this implies that they have to take care of them and have more work for themselves, concern about the possibility of infecting family members, in cases where health professionals are allocated away from home the prolonged distance of family members, lack of hospital supplies and their own access to mental health support services [11-13].

The fact that, at the beginning of the pandemic, some news referred to this virus as something “of Chinese origin”, brought a lot of discrimination and insecurity to all people of Chinese or Asian origin. This injustice, perpetuated by some elements of the population due to fear of the disease, came in the wrong, false and ethically wrong way in which the news was transmitted [14]. Even today we see this with different topics.

In the context of the pandemic, the media emerged looking for more information about the disease. However, many occurrences were false news disguised as reliable strategies and preventive measures, which created a great deal of misinformation. In this process, there was interference in people’s health and behavior [15].

Thus, the excess of information accompanied by slow and fabricated fraud news, emerged to designate the term “fake news” produced and published by mass media outlets, dominating traditional social platforms and becoming increasingly present in people’s daily lives. In addition, fake news multiply and spread much faster and act as a narrative that omits or adds information to the facts [15].

When analyzing the potential risk of misinformation, the willingness to spread incorrect information or rumors is directly related to the development of anxiety in populations of different ages [15].

To add to consequences with impact on daily routine due to pandemic and quarantine, it is necessary to mention the food component. One of the socio-economic consequences of the pandemic by COVID-19 was the decrease in the purchasing capacity of many families, with consequent reduction in their frequency, conditioning the consumption of fresh food. There was a decrease in the purchase of fruit and vegetable products due to the perception of the risk of contamination of fresh products. This is generally the purchase of horticultural products rich in vitamins and minerals, antioxidants, seems to have been strongly restricted or modified during the chemical crisis and, on the other hand, the purchase of cheaper foods with lower nutritional value and longer shelf life will have increased [16,17].

A relationship was found between quarantine and isolation and depressive symptoms with increased consumption of comfort foods, high energy density and nutrient-poor. This not only contributes to and increases the risk of developing chronic diseases such as obesity and diabetes mellitus. Malnutrition can also influence the hypothalamic-pituitary-adrenal axis, with impaired immune system and also increased mental illnesses such as depression [16,17].

For younger ages, children and adolescents have become completely deprived of their friends and with completely altered routines. In young people with changes in mental health, school routines are very important coping mechanisms and, with the closure or alteration of these, they lose this important pillar, which potentiates and exacerbates symptoms. It is important to highlight that measures of social distancing resulted in social isolation on the part of young people in abusive homes and environments. Not to mention the fact that not all children and young people have the same conditions at home. The increase in widespread stress in the population makes the environment at home harmful and also a source of ill-being against mental health. In several cities, not only has there been a significant increase in reports of domestic violence, but also of child abuse, neglect and exploitation [17,18].

The effects of confinement on the mental health of the population may be more pronounced in urban communities due to the increased risk of infection and the scarcity of public space that allows the population to take to the streets safely. Urban life also limits access to nature. Not only is there a greater concentration of buildings and skyscrapers in cities, but there is also a greater tendency towards the predominance of quite small houses in quite large cities. This happens as an attempt to create a greater number of housing in city and urban space, which is only sustainable to some extent due to the high concentration of space. However, the use and contact with urban green spaces and other natural spaces may reduce the stress caused by confinement and provide opportunities for relaxation, promoting urban resilience. An increasing number of investigations have shown that physical and/or visual contact with green spaces is associated with better mental health indicators, including lower levels of anxiety, lower risk of depression, lower levels of biological stress markers and greater psychological well-being [19].

As for physical and mental health, with increasing age, after the age of 60 there is a greater difficulty in performing day-to-day activities. At this age there is a greater propensity to contract diseases such as hypertension and diabetes and take longer in their recovery. As a course, the use of medical services increases. At these ages, mental health begins to get more affected. Depressions are usually linked to losses, the onset of diseases, cognitive dysfunctions, the deficiencies that are felt and social aspects, as well as social isolation, physical weakness and decreased activities of daily living [20].

There are a number of negative stereotypes associated with the elderly, especially in European and American culture, considering that they are starting to get tired and with little coordination, and are more susceptible to infections and accidents. These end up being more isolated, possibly due to this fact and suffer from frequent mood swings. At the cognitive level, some changes and decreased processing speed begin to be evident. When there are mental disorders these can be devastating, as in the case of dementia, it can be caused by diseases such as Alzheimer’s or Parkinson’s. At this stage of the life cycle, it can be lived in a more or less rewarding and healthy way. With the reform, there is a decrease in professional or social activity, being tended to be seen as a burden for others (family members, friends), with greater isolation [20].

In the presence of a phase of isolation caused by a pandemic, which always brings additional concern to the closest ones and their own health, all these factors will be catalyzed in the worst way which creates greater affectation and promotion of mental health in older adults [20].

Now including other species on the topic, also domestic animals play an extremely important role in the mental health of individuals. Over time it has been proven that people who own pets report that the proximity they maintain with their animals encompasses effective reciprocity between them. In addition to this aspect, they mention that the comfort they have with their animals leads to a feeling of pleasure and well-being [20].

The presence of a pet in a child’s life demonstrates advantages in terms of physical, cognitive and social development. Caring for an animal helps the child to internalize the concept of responsibility and compassion. There is also some evidence that there is a lower risk of developing asthma and allergic rhinitis in children who are exposed to animals during their first year of life. It is also important to mention that interactions between the child and the animal can prevent the progression of emotional problems such as mental, emotional or behavioral disorders during adolescence or later in adulthood, and this may be supported by emotional support [20].

The growing appreciation of the presence of pets happens not only with children but also with the elderly. In both the adult and older population, individuals who share the house with pets have better mental health at the level of anxiety and less depressive symptoms [20].

Unfortunately, with the onset of the pandemic many people have been left without a job, as has been mentioned above. This event triggers a situation of financial problems or limitations for an indefinite period which makes many people with pets ponder the permanence of the animal in their home. This generates an increase in abandonment. On the other hand, people with more economic possibilities and who until then had no pets chose to live with pets, for the sake of isolation [20].

In conclusion, it is crucial to implement a system of measurement, prevention and management of mental health with equal access for the entire population. There is a great need to monitor the mental health of young people in the long term and to study how prolonged school closures, social distancing measures and the pandemic itself affect the well-being of children and adolescents [18,21,22].

Giving a greater focus on health professionals, intervention models in this area should be based on principles of resilience promotion such as attention to psychological self-care, self-efficacy and social connection, in order to promote consultations and mental health support. These models should be based on three fundamental pillars: peer support aimed at helping professionals understand emotions in a mutual way; support of specific units/departments for discussion and dialogue; and individual support for each professional with mental health consultants [21-24].

Bibliography