Common Mental Health Problems During COVID -19 Pandemic

Dr.Jyoti Prakash , Dr. Pankaj Gupta
INTRODUCTION
A new strain of Coronavirus family originated at Wuhan city of China in December 2019.This
novel corona virus is highly contagious and in just few months has become a serious threat to
human health all over the world 1
. The human to human transmission via droplets or direct
contact predicted incubation period of 6.4 days and reproduction number of 2.24- 3.58 of
COVID19 is probably responsible for its rapid spread 2
.The WHO has recently announced
COVID 19 as the sixth public health emergency of International concern 3
.It has taken the lives
of 288,239 people all over the world till May 12 ,2020.Even developed countries are failing to
control the increasing death rate due to COVID 19.The fatality rate of the virus is still under
assessment .
People’s anxious reactions trigger public disruptive behaviors as people rush to stores, health
centers, and pharmacies and health supply become scarce and the country health care service
provision is affected .Evidence also suggests that individuals may experience symptoms of
psychosis, anxiety, trauma, suicidal ideation, and panic during outbreaks of communicable
diseases . Anxiety is a facilitator of decreased immune response to infection and further increases
the severity of the disease4
.
Lockdown Effects
The need for social distancing was immense and the various world leaders were quick to pass
stringent lockdowns in most parts of the world . India similarly has been in a lockdown since
March 25,2020 . Public transport along with closing of various state borders in India have halted
the normal movement of patients to various OPDs in the cities. So a chain of continuous medical
Chapter
1
2
support through follow ups and use of pharmacy have been halted . This has lead to various
patients coming to the emergency services due to relapse of their previously stable diseases. This
has been mainly seen in the psychiatric emergency services . Various stressors have culminated
to breakdown in normal functioning of the individuals . Loss of jobs ,increased financial
strain ,rising prices of goods for consumption ,uncertainty regarding academic sessions and the
most important that is fear of the disease have all put a person across the limits of his
psychological well being . Data from ILO suggests a significant decline in jobs in the year of
2020 ,i.e. around 25 millions .
With heath and financial security playing on our minds, home schooling stress, concerned about
the welfare of our family and friends and frustration at being stuck in the house ,it is fair to say
most of our tolerance levels are low. With the lack of standard and specific treatment protocol
for covid 19 the uncertainty looms large among the kin of the affected individuals. Contrary to
other infections covid 19 presents a variable course of illness.
These above factors have increased unprecedented stress among masses.
Problems in people with Mental illness due to Covid 19
1.Anxiety disorders: COVID-19 pandemic and country-wide lockdown are likely to increase
the new onset of illness anxiety disorder and to cause exacerbation of symptoms in diagnosed
cases. Any simple flu like symptom increases anxiety due to COVID-19. As the symptoms of
various flu like disorders overlap among themselves , a slight cough can create a sense of doom
among people . The depiction and exaggeration of the current situation in the media has lead to a
panic like situation which is doing more harm than good.
2.Obsessive Compulsive Disorders (OCD): Obsessive Compulsive Disorder patients,
especially who have checking, hoarding and washing compulsion, are at higher risk. Abnormal
becomes the new normal for people who have washing compulsions and fear of
contamination.Advice on improving personal hygiene measures might increase the
contamination obsessions and washing compulsions.In the face of ongoing lockdown, patients
are more likely to resort to panic buying and excessive hoarding of essential items, even though
continuous supply of essential items is assured by the states .
3.Depressive Disorders : For recurrent depressive disorder patients, lockdown is a major stress
threatening normal daily routine, social rhythm and thereby increasing stress levels, which would
further escalate the cortisol level, resulting in a vicious exacerbation of depressive symptoms .
Inability to join work, dwindling finances and the long term impact on economy will have its
effect on new and preexisting depressive illnesses 7
. In a person with a previous psychiatric
disorder, all these problems can surface with renewed severity and can lead to PTSD or even
suicidal thoughts and attempts.
4.Substance abuse: For substance use disorder patients, this period could be lethal as nonavailability of substance or medicines can precipitate severe withdrawal symptoms and medical
3
emergencies like delirium or seizures, which can be life-threatening due to inadequate
accessibility to dwindling emergency services .
5.Psychosis : Patients with bipolar disorder and schizophrenia are likely to have relapses due to
risk in both the availability of regular medication and medication compliance.Anxiety can be so
overwhelming, that it can precipitate paranoia and nihilistic delusions.
6.Suicide: Suicide is reportedly the second leading cause of non coronavirus deaths in India
during lockdown, according to data compiled by journalist Rachel Chitra . A similar study by a
group of researchers found that 168 of 326 non Covid-19 deaths till May 9th 2020 (51%) were by
suicide. There have been a staggering number of suicides ,caused by fear of
infection,loneliness,lack of freedom of movement ,and alcohol withdrawal during lockdown.
Due to substance withdrawal effects seven people have died after consuming after shave and
sanitizer lotions which was taken due to the erroneous belief of the presence of consumable
alcohol .A large number of migrant laborers stuck in quarantine facilities, away from families,
died by suicide fearing infection and sometimes even the stigma attached to the disease .
Coping during the lockdown : Each person has a unique style of coping and adjusting. The
emotional impact of an emergency on a person can depend on the person‘s characteristics,
resilience and adjustment. Social and economic circumstances of the person and their community
compatibility, availability of local resources all determine the amount of adjustment an
individual can have. Though it may be an understatement but “The Ant‘s Rule Book Of Life” the
resilience and patience of the ant can teach us how to come out of this pandemic.
Fact checks: To realize that there are certain things which we cannot control:
1.Concern and worry are natural but will merely aggravate the situation.
2.The infection is likely to spread through the population in unpredictable ways. There is nothing
one can do about this. If one follows precautions one is are less likely to get sick.
3.There is some benefit to planning. One needs to move on and focus on living life rather than
worrying about the virus. One can try to control other people‘s reactions by listening and helping
people work through the facts concerning the virus.
4.Being in touch with a health care provider if stress reactions interfere with ones daily activities
for several days in a row.
Steps To Reduce The Stress And Improve Psychological Well Being
1.Avoid excessive exposure to media coverage of COVID-19.
2.Take breaks from watching, reading, or listening to news stories. It can be upsetting to hear
about the crisis and see images repeatedly.
3.Try to do some other activities you enjoy to return to your normal life.
4
4.When you do read news, avoid media outlets that build hype or dwell on things that can‘t be
controlled.
5.Instead, turn to information sources that provide reliable information about how to protect
yourself, such as the MoHFW.
6.Recognize the things you can control. Take care of your body.
7.Take deep breaths, stretch or meditate.
8.Try to eat healthy, well-balanced meals, exercise regularly, get plenty of sleep and avoid
alcohol and drugs.
9.Share your concerns and how you are feeling with a friend or family member.
10.Maintain healthy relationships.
11.Maintain a sense of hope and positive thinking.
12.Maintain proper infection control techniques such as hand-washing and social distancing.
13.Check how realistically you are viewing the situation.
References

World Health Organization (WHO),2020a,Huang et al., 2020.
World Health Organization (WHO),2020b,Lai et al., 2020.
World Health Organization (WHO),Guan et al., 2020; Holshue et al., 2020.
World Health Organization (WHO), 2020b; Taylor et al., 2008; Tucci et al., 2017.
Dong, L., Bouey, J., 2020. Public mental health crisis during COVID-19 pandemic, China.
Emerg. Infect. Dis.(July).
The COVID-19 outbreak: crucial role the psychiatrists can play. AsianJ.
Psychiatry(March (20)), 102014.
5
Severe Mental Illnesses (SMI) & Management
Issues During Lockdown
Dr Jitesh Kumar Gupta , Dr Pankaj Sureka
Introduction
During the month of January, a serious contagious disease had swept across many Asian countries
and threatened to become a major health emergency throughout the world.
In March 2020, WHO made the assessment that COVID-19 can be characterized as a pandemic.
In this state of emergency, adults, adolescents and children are often exposed to potentially
traumatic events. Such events trigger a wide range of emotional, cognitive, behavioral and
somatic reactions. Although most reactions are self-limiting and do not become a mental disorder,
people with severe reactions are likely to present to health facilities for help.
Treatment of psychiatric illnesses like schizophrenia, bipolar disorder is not merely
marked by the decrease in clinical symptoms but rather it involves comprehensive management of
the patient‘s wellbeing including relapse prevention through continuity of care .Already burdened
mental health care system due to ever-growing mental disabilities ,the pandemic and the
precedence given to it can have serious consequences . It is very important to ensure that the
maintenance treatment is not discontinued for pre-existing severe mental illnesses .Prioritizing
treatment and alleviation of urgent mental health and neurological complaints (e.g. delirium,
psychosis, severe anxiety or depression) within emergency or general healthcare facilities.
Severe Mental Illness (SMI) patients during acute episode finds it difficult to maintain
precautions needed to prevent spread of COVID-19. Special precaution need to be taken in low
immunity cases like anemia, elderly, using steroid inhaler like asthma cases.
Chapter
2
6
Impact of pandemic on major psychiatric illness1. Acute stressIn this emergency, adults, adolescents and children are often exposed to potentially traumatic
events. Such events trigger a wide range of emotional, cognitive, behavioral and somatic reactions.
People with severe reactions are likely to present to health facilities for help.
Focus should be made on:
 Listening carefully. DO NOT pressure the person to talk.
 Ask the person about his/her needs and concerns.
 Help the person to address basic needs, access services and connect with family and
other social supports.
 Protect the person from (further) harm.
 Family members should stay in contact with SMI patients who stay alone.
 If SMI patient is feeling too anxious should contact some trusted person.
 Identify issues which lead to irritability and anger. Try to maintain patience.
PsychosisDuring humanitarian emergencies, extreme stress and fear, breakdown of social supports and
disruption of health-care services and medication supply can occur. These changes can lead to
acute psychosis or can exacerbate existing symptoms of psychosis. During emergencies, people
with psychosis are extremely vulnerable to various human rights violations such as neglect,
abandonment, homelessness, abuse and social stigma.
Typical presenting complaints of psychosisa) Abnormal behavior (e.g. strange appearance, self-neglect, incoherent speech, wandering
aimlessly, mumbling or laughing to self).
b) Strange beliefs
c) Hearing voices or seeing things that are not there.
d) Extreme suspicion.
e) Lack of desire to be with or talk with others; lack of motivation to do daily chores and work.
7
Depression-
Moderate-severe depressive disorder may develop in adults, adolescents and children who
have not been exposed to any particular stressor.
In any community there will be people suffering from moderate-severe depressive disorder.
However, the significant losses and stress experienced during humanitarian emergencies may
result in grief, fear, guilt, shame and hopelessness, increasing the risk of developing moderatesevere depressive disorder.
SYMPTOMS-
● Low energy, fatigue, sleep problems.
● Multiple persistent physical symptoms with no clear cause (e.g. aches and pains).
● Persistent sadness or depressed mood, anxiety.
● Little interest in or pleasure from activities.
Epilepsy/Seizures-
The supply of antiepileptic medications is often disrupted during humanitarian emergencies.
Without continuous access to these medications, people with epilepsy may begin experiencing
seizures again, which can be life-threatening.
Management issues of Mental Disorders at the wake of the PandemicThis pandemic has squeezed the health resources of most of the developed countries and India is
starting to feel the heat in the recent weeks. The existing health resources are prioritized to handle
the pandemic. The worst hit among all are the Mental Health services ,who need long
term ,continued medical management and depend on the government services .
Several mental health professionals are catering services in various isolation wards and many
mental health facilities have been converted into temporary quarantine units. Disruption to
absence of access to care can have serious negatives consequences in patients with severe mental
health illnesses.
Though prioritizing the fight towards the pandemic is of utmost necessity but
the long term treatment of chronic psychiatric patients should also be kept into mind while
considering a broad approach to tackle the pandemic. Any change in behavior or thinking pattern
of SMI patient should be immediately brought in knowledge of psychiatrist.
A strategy based on Triage to classify different patients into treatment groups can render
the patient with adequate care.
8
a) Patients requiring medications only.
b) Patients who need frequent visits to an OPD setting to continue treatment .
c) Patients who require hospitalization.
For the patients classified under the group
(a) A comprehensive strategy which involves district mental health program along with the
associated NGOs can be applied and provisions to distribute door to door medication supply can
be ensured .
(b) Telemedicine services can replace the previously available general OPD services. The
telemedicine services should inculcate a well devised Audio-Visual establishment services.
Where possible use telemedicine service instead of physically going to hospital. For counseling
also online services can be approached.
(c) and the most vulnerable group, patients can be provided due services after taking utmost
universal aseptic precautions .The patients should be compulsory tested for Covid19 and
thereafter necessary intervention should be taken depending on the result. Physical and chemical
restraining should be duly considered for agitated patients to avoid unnecessary breach in social
distancing protocols .Early discharge should be initiated to avoid crowding and decrease the
pressure on already crippled health system. It should be emphasized to patient that there is no
evidence that recovering from COVID 19 makes person immune from re-infection. All
precautions against reacquiring infection should be taken. Patients should not consider
experimental procedures like ‗plasma therapy‘ as definitive treatment against COVID 19. Only
treatment as per Governmental guidelines should be relied on.
Role of ECT may be considered in highly distressed individuals(suicidal,
violent ,resistant to conventional therapies)but the inevitable risks acquired during giving general
anesthesia should be bore in mind .
Pharmacological treatment and related issues during a Pandemic:
1.Clinicians should consider long acting medications during this period because of the risks of
withdrawal symptoms in drugs specially Benzodiazepines ,antidepressants and anti epileptics .
Similarly, previously routine purchase of medications have been hampered by lockdown due to
decreased mobility in roads . So , in diseases like psychosis ,long acting injectables can provide
the patients with adequate steady state levels of drug and prevent relapse.
In a special case of Lithium , withholding or decreasing the dose should be considered because
recent studies have found Covid 19 to have a deleterious effect on the renal system. So clinicians
in telemedicine services should always inquire about possible side effects of lithium.
9
Sociological issues relevant to current scenario:
1) Extensive media coverage of issues related to Covid 19 generates lot of anxiety and panic.
One should limit time spent in accumulating and reading Covid 19 related news, watch
others topics also. Available free time can be used in productive activities like taking up
new hobbies, improving fitness, reading, yoga, aerobic exercise etc. Keep mind diverted
and prevent negative thoughts coming in mind.
2) Unemployment: Current job loss, business closure, financial losses or salary reduction
can increase risk of developing SMI.
3) Being stranded outside usual place of residence or work: Many people especially tourist
and migrant workers got stranded in outdoor settings. Living in camps can be stress and
lead to adjustment disorder.
4) Marital and family conflict: Multiple cases of spouse or family members blaming one
other for infecting them with corona.
5) Student distress: Postponing of various exams or their results has caused stress in many
students due to uncertainty about future.
6) Disruption of sleep wake cycle: Absence of usual work habits sometimes manifest in
disruption of sleep wake cycle. One should sleep adequately and try to maintain regular
sleeping and waking time.
7) Avoid over eating or high calorie fatty food intake.
CONCLUSIONS –
Psychiatric patients tend to be socially isolated with cognitive deficits .Still
many are homeless and neglected by the society. So in these patients awareness of the ongoing
pandemic is not easily dissipated .Moreover ,they will also have difficulty in following lockdown
measures due to their psychiatric illness . They have risk of contracting the disease. Special
attention should be given to them and their treatment should be highly individualized . Even
drugs for Covid 19 should be prudently used in mentally ill patients. General precautions like not
spitting in public places, use of mask, hand washing, avoiding touching of face is as relevant in
SMI cases as in general population.
10
References1. MhGAP Humanitarian intervention guide (mhGAP-HIG)-WHO-2015.
Ritchie EC, Ehret M, Peake NW, Richter KE (2019). When a disaster disrupts access to
psychiatric medications: Advance planning can help minimize the risks of withdrawal, other
consequences .Current Psychiatry, 18(5):22-7.
Brown AS, Meyer U (2018). Maternal Immune Activation and Neuropsychiatric Illness: A
Translational Research Perspective. American Journal of Psychiatry, 175(11):1073–1083.
Bogaczewicz J, Sobo´w T, Bogaczewicz A, et al (2014). Exacerbations of bipolar disorder
triggered by chloroquine in systemic lupus erythematosus – a case report. Lupus; 23: 188–193
11
Child And Adolescent Mental Health
During The Pandemic Lockdown
Dr. Jyoti Yadav, Prof. (Dr) Adya Shanker Srivastava
Introduction: The Pandemic lockdown has brought us all into a very crucial time. It is not only
affecting adults and older people but has also left children and adolescents worrisome. It is
affecting them physically and mentally which makes them vulnerable to various problems.
Parents play a vital role in helping children and adolescents during this tough time. Be patient,
empathic, non- judgmental, supportive and make them cope up with this time with ease.
Due to the nationwide lockdown, all the schools and institutions have been closed. There is a
sudden change in the environment of the children who are staying with their parents or any
caregiver as their outdoor activities and social interaction with friends have been restricted. Some
have been separated from their caregivers due to being infected or suspected from the virus.
Whereas, some of them are under the care of charity groups whose caregivers are infected or
have died.
Children are most susceptible to various mental health problems. Due to this lockdown many
children are suffering, and so significant changes occurring in a child‘s routine life and social
infrastructure can be seen.(1)
Mental health problems can broadly be fear of infection, irritability , boredom, anxiety, stress,
depression, unhealthy sleeping and eating habits, difficulty in attention and concentration.(2). An
undue indulgence with the social media is also being noticed. According to Sprang and Silman,
―The mean post-traumatic stress scores were four times higher in children who had been
quarantined than in those who were not.‖ (3)
WHAT CAN BE DONE TO HELP THE CHILDREN? (4, 5, 6)
Provide your child with clear information about the pandemic in order to reduce
anxiety and fear, but limit the use of social media and news.
Be supportive and empathic to the child.
Chapter
3
12
Engage them in activities like crafts from waste papers, dancing, singing, board
games and others to make them calm and relieved.
Make a daily time-table and ask the child to follow it regularly. Schedule the study
hours, if preferable, during their school timings.
Engage your child in some physical activities and exercises with the help of some
online videos at home to improve sleeping and eating habits.
Ensure to provide online content of courses but not to overburden your child with the
classes.
Keep children close to their parents or caregivers. If there is a need to be separated
(suspected or positive case); make sure to have a regular communication through
phones, video calls or any means of social media.
If the child comes to know about any upsetting news, reassure them and try to keep
them away from such things.
Encourage your child to learn some new activity daily.
For a child already on psychotropic medications, do not abruptly stop the medications.
Continue the medications and reach out your doctor through telemedicine or attend
emergency incase of any sudden need.
Family time should be given. Manage some family interacting activities like playing
indoor games and spending some hours chatting with one another.
Involve them in household chores like cooking, cleaning, gardening, watering plants,
serving food, cleaning utensils and others.
Allow them to be in touch with friends or classmates through phone or online media.
Help them to find ways to a bright future.
Teach them social distancing, hand and self-hygiene practices.
ADOLESCENTS: they can also suffer from the above problems along with involvement in
substance use or frustration arising from the lack of substance availability for the addict ones.
13
WHAT CAN BE DONE TO HELP THE ADOLESCENTS? (5, 6)
The above mentioned measures can also be applied for adolescents along with the following:
Parents or caregivers play a very vital role in helping adolescents during these difficult
times. Be patient, listen to them, and understand their problems related to studies, friends,
loneliness, substance or disease, without judging them. Try to give them a valid solution
and reassure them about the situation.
Involve them in non media activities as this is a time when adolescents run towards social
media. Use of internet should be restricted.
For adolescents living away from their homes, be in touch virtually every day and
whenever in need.
CONCLUSION:
During this crucial time, it is necessary for all of us to be calm and supportive for those suffering
in this lockdown phase. Be it our family or our friends, we should spread awareness and try to
make the situation lighter for them, instead of just stressing them out or leaving them alone.
REFERENCES:
1) Liu JJ, Bao Y, Huang X, Shi J, Lu L. Mental health considerations for children
quarantined because of COVID-19. The Lancet Child & Adolescent Health. 2020 May
1;4(5):347-9.
2) Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, Rubin GJ.
The psychological impact of quarantine and how to reduce it: rapid review of the
evidence. The Lancet. 2020 Feb 26.
3) Sprang G, Silman M. Posttraumatic stress disorder in parents and youth after
healthrelated disasters. Disaster Med Public Health Prep 2013; 7: 105–10.
4) Dalton L, Rapa E, Stein A. Protecting the psychological health of children through
effective communication about COVID-19. The Lancet Child & Adolescent Health. 2020
May 1;4(5):346-7.
5) World Health Organization. Mental health and psychosocial considerations during the
COVID-19 outbreak, 18 March 2020. World Health Organization; 2020.
6) http://nimhans.ac.in/wp content/uploads/2020/04/MentalHealthIssuesCOVID19NIMHANS.pdf
14
Issues Related To Geriatric Mental Health
During COVID 19 Pandemic
Prof. (Dr) Mona Srivastava
Background:
The crisis of the COVID-19 pandemic has created anxiety and panic all over the world. The
infection can occur to all age group but elderly are at a higher risk. In this population loneliness,
isolation, is already prevailing. The mental health problem may increase in elderly due to social
isolation and various medical issues, quarantine and loss of follow up for mental illness.
Pandemic may cause increase of existing or relapse of fears/phobias, anxiety disorders,
obsessive-compulsive disorder, may lead to posttraumatic stress disorder. Providing physical and
social safety, hope, connectedness and calming may be effective in preventing mental illness. It
is important that health professionals should be aware of these problems and be proactive in
providing measures to reduce the adverse effects of pandemic in elderly.
Introduction:
The crisis of the COVID-19 pandemic has spread throughout the world. Most nations have done
quarantine, lockdown and curfew to contain the community transmission. People are forced to
stay at home and maintain social distancing. Older age group are the most vulnerable group,
they have to take extra precautions for extended period. The severity and fatality of COVID-19
has been directly related to age and immune-compromised states, as 15 percent of the first wave
of deaths in China were aged above 60 years. According to Chinese Centre for Disease Control
and Prevention, the mortality rate in age group 60-69 years is 3.6 percent which can reach up to
18 percent at 80 years and above (1). World Health Organization in its guidelines has
recommended strict social isolation in the geriatric population to control the deaths in heavily
affected countries. Visiting community meetings, parks, neighbourhood, places of worship is
prohibited as these are the various ways of socialization for most of the elderly. With lockdown
or quarantine these are now not possible. The elderly also run the risk of getting neglected even
when they are with their families. This leads to social and psychological isolation, which may be
a contributor for poor mental health and many psychological problems.
Chapter
4
15
Social isolation and loneliness are problems in old age due to functional limitations, inactivity,
repeated exposure to disturbing news related to the pandemic, the interactional problem within
family members, and they might not able to share their worries . Prolonged lockdown and social
distancing, loneliness may lead to hopelessness and discouragement, which may lead to
depressive disorders and sometimes self-harming acts. Pandemic creates issues such as: fear of
contracting the infection (for self and family members), fear of quarantine or hospitalization,
death (of oneself or family members), anxiety related to day to day activity, regular health check
up visits and worries about family members living far away. It may aggravate fears and
precipitate anxiety disorders, phobic syndromes , painful memories , leading to distress. It may
exacerbate behavioural styles and symptoms of conditions such as obsessive compulsive disorder
(e.g. washing hands repeatedly, sanitizing the household articles). Sleep and appetite problems
may become more pronounced in the absence of physical inactivity during the lockdown.
Separation from loved ones, the loss of freedom, uncertainty over disease status, create more
disturbance .
New onset symptoms

Fear of contracting infection (self and/or family)
Fear of death (self and/or family)
Fear of separation from family
Insomnia
Nightmares
Generalized anxiety symptoms
Depressive symptoms
Compulsive hand washing,
Compulsive sanitizing household articles
Post-traumatic stress symptoms
Increased substance use (smoking, alcohol)
Worsening of existing conditions–
*Depressive disorder
*Anxiety disorder
*Obsessive compulsive disorder
*Post-traumatic stress disorder
16
*Substance abuse/dependence.
Mitigating adverse effects on elderly during pandemic
There are various ways to support older adults during the social isolation period during the
pandemic:

It is important to ensure that daily needs such as groceries and medications are delivered
regularly, and urgent action is needed to address the mental and physical health consequences of
pandemic.
2.Minimize watching, reading or listening to news about COVID-19 that leads to feelings of
anxiety and distress. Information should be taken only from trusted sources and practical steps
need to be taken. Most of messages on social media may be anxiety provoking and may lead to
misinformation. the need of the hour is to be away from the rumours and misinformation
3.Presentation of positive and hopeful stories and positive images of local people who have
experienced COVID-19. For example, stories of people who have recovered. Sharing of simple
facts and day to day updates in simple language so that older people can understand. Instructions
need to be communicated in a clear, concise, respectful and patient way. It may also be helpful
for information to be displayed in writing or pictures.
4.Engaging family members and other support networks .Keeping social contacts to provide
with assistance and how to get practical help if needed, like calling a taxi, having food delivered
and requesting medical care reduces uncertainty. Adequate access to any medications that are
currently being used and regular medicines that may be required.
Thematic analysis done by Gardiner et al identified six categories of interventions based
on their purpose, their mechanisms of action and their intended outcomes(2). The categories
were social facilitation interventions, psychological therapies, health and social care provision,
befriending interventions, pet therapy, and leisure/skill development.
Tsai et al evaluated a video conference program which aimed to facilitate contact
between an older person and their family (3 ). Creating a sense of companionship and keeping
them occupied were found to be effective in dealing with loneliness in older people. Befriending
interventions are defined as a form of social facilitation with the aim of formulating new
friendships, generating a sense of belonging and having a feeling of ‗knowing that there is a
friend out there(4)‘. Leisure activities and/or skill development included gardening programs,
computer/internet use, voluntary work, holidays and sports(5). Higher use of the internet may
give higher levels of social support and decreased loneliness.
5.Cognitive behavioural therapies could be delivered online to decrease loneliness and improve
mental wellbeing. Use of digital platforms such as telepsychiatry by video conferencing can be
used effectively to deliver services while maintaining social distancing. Non pharmacological
methods like yoga, relaxation, and other therapies may give some relief.
17
Conclusion: Elderly population are at higher risk to physical ,mental stress, which can
aggravates the pre-existing physical and mental problems .Proper preventive steps should be
taken during pandemic. Proper care ,communication, access to information and due respect
should be given. Quick seeking of available health care facility should be taken before any
problems arise.
References
1Meo, S. A., et al. “Novel coronavirus 2019-nCoV: prevalence, biological and clinical
characteristics comparison with SARS-CoV and MERS-CoV.” European Review for Medical
and Pharmacological Sciences 24.4 (2020):
Gardiner C, Geldenhuys G, Gott M. Interventions to reduce social isolation and loneliness
among older people: an integrative review. Health & social care in the community. 2018
Mar;26(2):147-57.
Tsai HH, Tsai YF, Wang HH, Chang YC, Chu HH. Videoconference program enhances social
support, loneliness, and depressive status of elderly nursing home residents. Aging and Mental
Health. 2010 Nov 1;14(8):947- 54.
Tse T, Linsey H. Adult day groups: Addressing older people’s needs for activity and
companionship. Australasian Journal on Ageing. 2005 Sep;24(3):134-40.
Cattan M, Kime N, Bagnall AM. The use of telephone befriending in low level support for
socially isolated older people–an evaluation. Health & social care in the community