Mental health aspects of pandemics with special reference to COVID-19

Metagenomics in the fight against zoonotic viral infections: A focus on SARS-CoV-2 analogues

Zoonotic viral infections continue to pose significant threats to global public health, as highlighted by the COVID-19 pandemic caused by the SARS-CoV-2 virus. The emergence of SARS-CoV-2 served as a stark reminder of the potential for zoonotic transmission of viruses from animals to humans. Understanding the origins and dynamics of zoonotic viruses is critical for early detection, prevention, and effective management of future outbreaks. Metagenomics has emerged as a powerful tool for investigating the virome of diverse ecosystems, shedding light on the diversity of viral populations, their hosts, and potential zoonotic spillover events. We provide an in-depth examination of metagenomic approaches, including, NGS metagenomics, shotgun metagenomics, viral metagenomics, and single-virus metagenomics, highlighting their strengths and limitations in identifying and characterizing zoonotic viral pathogens. This review underscores the pivotal role of metagenomics in enhancing our ability to detect, monitor, and mitigate zoonotic viral infections, using SARS-CoV-2 analogues as a case study. We emphasize the need for continued interdisciplinary collaboration among virologists, ecologists, and bioinformaticians to harness the full potential of metagenomic approaches in safeguarding public health against emerging zoonotic threats.

Attitudes and perceptions towards public health safety measures during a global health crisis: Social and personal consequences

The COVID-19 pandemic that spread throughout the globe has significantly altered our social and personal relationships. During the early phase of the pandemic, pharmaceutical interventions such as vaccine research and production were still in development, with international health agencies and governments promoting public health safety measures such as limiting mobility, school and work closures, lockdowns, economic incentives, mask-wearing, social distancing, quarantine, and hygiene to reduce the spread and flatten the curve regarding transmission and hospitalization. During the early wave (May 2020 through July 2020), we utilized a qualitative longitudinal research design coupled with weekly Zoom diary entries to investigate participant (n = 14) experiences. In doing so, we captured participant attitudes towards public health safety measures, as well as perceptions of social and interpersonal relationships during the pandemic. The main themes that emerged in our findings include feelings of safety and preparedness, personal accountability and collective responsibility, and changes to social life and relationships. While individuals have learned how to live with the pandemic, and have a new sense of normalcy, lessons learned from the impact of public health measures and social relationships have applicability moving forward post-pandemic. In particular, how to best protect against the deleterious effects of isolation during a future public health crisis.

Translation and psychometrics of the Bengali adaptation of Coronavirus Anxiety Scale

Background

The Coronavirus Anxiety Scale (CAS) was developed in April 2020 as an instrument to gauge the symptoms of stress and anxiety occurring secondary to the COVID-19 pandemic. It was constructed using the English language due to which its application to a multi-linguistic country like India became a hindrance.

Aim

To establish psychometric validity and reliability of the Bengali translation of CAS.

Materials and Methods

Experts well-versed in the English and Bengali languages translated CAS from English to Bengali. This was followed by further correction by forward and backward translation processes until a version with high accuracy and low redundancy was procured. The original scale was applied to 91 volunteers, and the translated version was applied to the same group after 14 days.

Results

The mean scores of the original version and the translated version showed a significant correlation. The Bengali version of CAS had high internal consistency, significant concurrent validity, and acceptable split-half reliability. It was hence deemed easily understandable and capable of measuring anxiety due to COVID-19 similar to the original scale.

Conclusion

The Bengali translation of the CAS can be accurately used to assess symptoms of anxiety and stress with high reliability and validity in those who are able to read the Bengali language.

Reliability and psychometric validity of the Marathi adaptation of coronavirus anxiety scale

Background

The coronavirus anxiety scale (CAS) was developed and validated in 2020 as a psychometrically suitable measure of anxiety incurred by the coronavirus disease of 2019 pandemic. Since it is available only in the English language, it cannot be used in the general population, most of whom are not English speaking.

Aim

The aim of this study is to determine the validity and the reliability of the Marathi adaptation of CAS.

Materials and Method

CAS was translated by bilingual experts, followed by forward and backward translation processes and pilot study. Final version was used. Eighty volunteers, who are versed in both English and Marathi languages, were included. The original English version of the scale was first applied, followed by the Marathi translation, after a hiatus of 14 days.

Result

Mean score of the original English version was 2.950 (±2.773) and that of the Marathi version was 2.775 (±2.778), showing significant correlation (.001 level) with Kendall's tau-b of 0.830. The Marathi version of CAS has a high degree of internal consistency as demonstrated by a Cronbach's alpha of 0.809. The scale has significant concurrent validity and acceptable split-half reliability. A principal components analysis with varimax rotation was performed on the CAS responses of the participants, which yielded one factors with an eigenvalue greater than one, representing 58.51% of the total variance. CAS was found to be easily understandable and capable of adequately evaluating and measuring various aspects of corona anxiety.

Conclusion

The Marathi adaptation of CAS is a valid and reliable instrument to assess anxiety due to coronavirus in the Marathi-speaking population of India.

Effects of acupuncture combined with medication on patients with COVID-19 complicated with bipolar disorder: A protocol of systematic review and meta-analysis

BACKGROUND

There is growing evidence that coronavirus disease 2019 (COVID-19) can trigger acute episodes of mood disorders or psychotic symptoms. Reports on the treatment of COVID-19-related bipolar disorder (BD) are limited. Our study aimed to investigate the potential for new or recurrent BD due to COVID-19. We qualitatively evaluate clinical treatments (acupuncture combined with medication) and any potential pathophysiological links between infection and BD.

METHODS

We searched Embase, PubMed, Cochrane Library, Web of Science and MEDLINE (via Web of Science), Scopus, Chinese Biomedical Literature Database (CBM), Chinese National Knowledge Infrastructure Database, and the Wanfang Database from December 1, 2019, to September 15, 2022, to identify all articles on acupuncture combined with drugs used to treat COVID-19 complicated with bipolar disorders. Two researchers will screen the articles and extract the relevant information.

RESULTS

The results will provide a systematic overview of the current evidence on the use of acupuncture combined with drug therapy to treat COVID-19 complicated with bipolar disorder.

CONCLUSION

The conclusions of this study will help clarify the effects of acupuncture combined with drug therapy on patients with COVID-19-related BD.

Impact of COVID-19 pandemic on mental health of health-care workers in a tertiary care teaching and dedicated COVID-19 hospital

AIM

We aimed to assess the consequences of dealing with patients during the COVID-19 pandemic lockdown period on the mental state of health-care workers.

MATERIALS AND METHODS

An anonymous online survey was conducted with 353 participants using a self-made questionnaire comparing the prevalence of low mood, apprehension, tension, and coping skills used and the Depression, Anxiety, and Stress Scale-21. The data were analyzed to compare the mental health of male and female doctors. To identify predictors of mental health outcomes, a multivariate logistic regression was carried out.

RESULTS

Both men and women were almost equally affected in terms of developing features of low mood, with easy physical and mental exhaustion. While the feeling of being isolated and irritability was slightly higher in females, both sexes were equally affected by the media. It was observed that the prevalence of smoking (tobacco/marijuana, etc.) had increased in both with slightly higher percentage in males as compared to females while there was a considerable increase in caffeine and alcohol consumption in males. The sleeping pattern and appetite were equally affected in both sexes. The sexual drive was also altered in both male and female residents, but the change was considerably more in males. The significant predictors of anxiety were age, depression, mental exhaustion, burden of increased quantity of work, and feeling of having no choice but to work due to obligation.

CONCLUSION

Both male and female doctors working during the COVID-19 pandemic developed anxiety and depression. While substance use and altered sexual drive were more in males, exhaustion and stress were more in females.

Analysis of change in knowledge, attitude, and practices about COVID-19 following and awareness session in rural population of Western India

BACKGROUND

Beginning of the pandemic showed our limitations in our understanding of the spread of the dreaded coronavirus-19 that had sprung from China and spread through thick and thin across the world. The measures to contain the spread of virus in the absence of specific treatment protocol had everyone grope for the solutions in a very short time frame. One such is the knowledge, attitude, and practice in the rural setup.

AIM

The aim of the study is to measure the change in knowledge, attitude, and practices (KAP) regarding COVID-19 following an awareness session in rural population.

MATERIALS AND METHODS

A cross-section interventional study was carried out in January 2021. An interactive awareness session was conducted with the help of audiovisual aids following MOHFW guidelines for COVID-19, and the change in KAP about COVID-19 was measured by pre- and posttest standardized questionnaire.

RESULTS

Of all the participants, statistically significant change in knowledge was seen from 43% to 52%. The villagers were educated about preventive steps and a positive change was measured in the practice of changing masks regularly (84%-100%), maintaining social distancing (44%-64%), frequent handwashing (52%-64%). No change was seen in wearing of masks (92%) and negative change was seen in avoiding handshakes (32%-28%). The preventive practices regarding COVID-19 pandemic changed significantly from 50% to 58%. Our study measured positive attitude change toward getting vaccinated from 64% to 72%.

CONCLUSION

A single, short awareness session led to significant change in KAP about COVID-19 in rural population.

Impact of COVID-19 on obsessive-compulsive disorder: A case series

A public health emergency of international concern, novel coronavirus disease (COVID-19), began in Wuhan, China, in December 2019. Since then, it has been caused a pandemic along with serious mental health problems. No other disorder is more vulnerable to the current situation than obsessive-compulsive disorder (OCD). Our case series focuses on the effects of COVID-19 on OCD along with its various manifestations. Most of our patients had exacerbated symptoms during the current situation, but there were also new onset OCD cases triggered by a variety of stressors.

COVID-19 lockdown: Online survey of psychosocial factors of adolescents

BACKGROUND

The coronavirus pandemic has affected more than 14 million people in the world. Adults are somehow able to manage their stress created by the most fearful disease. However, it is the children and adolescents who are most affected by COVID-19 lockdown.

AIM

This study aimed to assess the effect of COVID-19 lockdown on adolescent's psychosocial factors.

MATERIALS AND METHODS

Using the Google Form link, a questionnaire was developed and an online survey was conducted. This online questionnaire consisted of 40 items assessing personal, social, academic, and family domains related to adolescents.

RESULTS

A total of 223 responses were obtained. The results indicate that 6.5% of adolescents experience extreme level of anxiousness, 29.8% become little irritable and angry, affecting their personal/emotional domain. About 12.6% of the adolescents are uncomfortable with social distancing and 48.4% of them greatly miss their friends; 38.1% miss their school and 28.8% are unable to clear their doubts through online teaching. Mathematics was the most uncomfortable subject for them to deal with 49.8%. About 79% of adolescents suffer mildly from family distress, 43.3% (extremely) are eagerly waiting for the lockdown to end.

CONCLUSION

Among all four domains, the family domain was the most affected due to COVID-19 lockdown, followed by social, academic, and personal domains.

COVID-19 lockdown - Blessing or disaster?

Despite the dubious results of the nationwide lockdown in India state after state continue to clamp lockdowns indiscriminately and claim that it is a panacea for all their ills. Unverified claims abound and myths are perpetuated without any basis. It is time to take a close look at the hard data and come to logical conclusions regarding the utility of prolonged open-ended lockdowns. Unfortunately, the evidence does not support the use of prolonged lockdowns as a useful strategy to combat the COVID-19 pandemic.

Depression, anxiety, stress, and sleep disturbances in doctors and general population during COVID-19 pandemic

AIM

The aim of the study is to assess and compare depression, anxiety, stress, and sleep disturbances among doctors and general population during COVID-19 pandemic.

MATERIALS AND METHODS

This cross-sectional, analytical, case-control, web-based study was conducted during September 2020 to examine the impact of pandemic on mental health. The participants completed basic sociodemographic questionnaire, Depression Anxiety Stress Scale-21 (DASS-21), and Athens Insomnia Scale (AIS).

RESULTS

Of the 321 participants, 320 provided basic data, 22 were on psychotropics. Out of the 298, 286 were matched for age and sex and were included. On DASS-21, 41.27% of doctors and 30.76% of general population reported depression; 40.56% doctors and 26.57% general population had anxiety; 38.46% of the doctors and 24.48% of general population reported stress. Statistical analysis revealed that doctors had significantly higher levels of anxiety and stress as compared to general population. On the AIS, more doctors (48.25%) suffered from insomnia compared to the general population (37.06%), but the difference was not statistically significant.

CONCLUSION

Physicians have significantly higher anxiety and stress while dealing with COVID-19 compared to general population.

Impact of COVID-19 pandemic on healthcare workers

The COVID-19 pandemic is a healthcare crisis that has led to unprecedented impact on healthcare services. At the heart of the unparalleled crisis, doctors face several challenges in treating patients with COVID-19. The psychological burden and overall wellness of healthcare workers (HCWs) have received heightened awareness, with research continuing to show high rates of burnout, psychological stress, and suicide. Detrimental effects include high rates of infection and death, excessive financial hardships, stress related to known and particularly unknown information, and fear of uncertainty regarding continued impact. Some researchers focused specifically on COVID-19's impact on HCW sleep. Anxiety and stress were significantly increased, leading to negative impacts on both self-efficacy and sleep. Stress is an important factor in drug use. Efforts should be made to explore the factors that are associated with psychological distress, which may lead to symptoms of anxiety, depression, or provoke suicidal ideation, and efforts should be made to control the factors that are modifiable. There needs to be more awareness among doctors and further long-term studies focusing on their mental health as adverse mental health conditions will further affect them as the disease advances.

Impact of COVID-19 pandemic on persons with psychiatric disorders

From the beginning of COVID-19 pandemic, concerns have been raised about its effect on mental health and on patients with psychiatric illnesses. A few reports suggest that patients with COVID-19 have increased symptoms of anxiety disorders, post-traumatic stress disorder, depression, increased substance use, and insomnia. There is an increased trend seen in flare-up of psychotic symptoms and new emergence of psychotic symptoms in previously healthy adults. There is extensive research available on the impact of COVID-19 on physical health, but there is a paucity of studies on the effects of COVID-19 on psychiatric illness.

COVID-19 moral dilemmas viewed through Eastern and Western philosophy

COVID-19 has been a considerable major stress factor and has led to a great increase in psychological illnesses. Literature related to spirituality and philosophy can provide solace in times like these. We have taken excerpts from Bhagwad Gita which is a spiritual and philosophical scripture, existential philosopher Albert Camus's La Peste and the myth of Sisyphus and writings of the philosopher Immanule Kant. These literary masterpieces can provide a wealth of guidance and solace to both the medical fraternity and affected people and their caregivers. "We tell ourselves that pestilence is a mere bogy of the mind, a bad dream that will pass away. But it doesn't always pass away and from one bad dream to another, it is men who pass away." -Albert Camus.

Efficacy of psychological intervention in patients with post-COVID-19 anxiety

BACKGROUND

Individuals who suffered from COVID-19 remain stressed and worried about anxiety issues for significant changes in daily living activities, causing strong emotional distress.

AIM

The aim of this study was to assess the efficacy of psychological intervention in patients with post-COVID-19 anxiety.

MATERIALS AND METHODS

Thirty patients recovered from COVID-19 were selected for the study of age group 20-45 years of both the sexes. Initially, sociodemographic data sheet was filled, and after that, Mental Health Inventory (MHI) was administered. The patients who scored less on MHI were taken for the study, and psychoeducation, relaxation exercises, and activity scheduling were given to them. The goal of intervention was to prepare the patients to learn, interpret, and react to physical and psychological symptoms related after recovering from COVID-19 infection. The intervention was done for 30 min twice a week for 1 month, after that again postassessment was done to see the efficacy of psychological intervention.

RESULTS

Result reveals a significant improvement in mental health-related issues after psychological intervention as assessed by the MHI.

CONCLUSION

Psychological intervention resulted in significant improvement of post-COVID-19 anxiety and related mental health issues.

Burnout and resilience in doctors in clinical and preclinical departments in a tertiary care teaching and dedicated COVID-19 hospital

BACKGROUND

The worldwide COVID-19 pandemic has significantly altered our life. Doctors more so than the general public because of their involvement in managing the COVID-infected individuals, some of them 24/7 end in burnout. Burnout in doctors can lead to reduced care of patients, increased medical errors, and poor health. Burnout among frontline health-care workers has become a major problem in this ongoing epidemic. On the other hand, doctors in preclinical department have a lack of interaction with patients, with not much nonclinical professional work to boot, find the profession less gratifying which perhaps increase their stress level.

AIM

The aim was to study the prevalence of burnout and measure resilience in doctors in clinical and in preclinical departments.

MATERIALS AND METHODS

This observational, cross-sectional, comparative study was carried out in a tertiary care teaching hospital and COVID care center. By purposive sampling 60 preclinical and 60 clinical doctors in a tertiary health care center were included in the study. After obtaining the Institutional Ethics Committee approval and informed consent, the doctors were administered a self made socio-demographic questionnaire, the Copenhagen Burnout Inventory, and the Connor-Davidson Resilience Scale. Doctors were given a self-made questionnaire, the Copenhagen Burnout Inventory, and the Connor-Davidson Resilience Scale.

RESULTS

The prevalence of burnout was seen more in clinical doctors (55.47) and the resilience was observed more in preclinical doctors (88.9).

DISCUSSION

Resident doctors are a major force to combat COVID-19 as frontline health workers; hence, one can visualize burnout amongst them. On an individual basis, the work-related burnout was severely high in the clinical group owing to the workload which has been corresponding to a number of western studies. Nonclinical department doctors from pathology, community medicine, and microbiology did show burnout but showed a greater score in resilience. Psychological resilience has been identified as a component in preventing burnout.

CONCLUSION

Therapy sessions can be used in clinical doctors facing burnout to build up their resilience.

Quarantine: Psychological aspects

Quarantine is an age old methods of preventing the spread of infection by restricting the movement of persons or goods. It has again come to global attention due to its widespread implementation during the COVID-19 pandemic. While the public health utility of quarantine is well established, it is associated with few psychological effects which are neither well known nor recognized. In this communication, the psychological side-effects of quarantine and their prevention are briefly discussed.

Stigma associated with COVID-19

A number of incurable, deadly, and disfiguring diseases are associated with stigma which worsens the quality of life of the sufferer. Unfortunately, at the beginning of the COVID-19 pandemic, the disease was associated with severe stigma and extreme prejudice. Stigma of COVID-19 and its adverse effects are briefly discussed and solutions suggested.

Counseling patients with COVID-19: An experience at dedicated COVID-19 hospital

COVID-19 pandemic is generating considerable stress in the population. Uncertain prognosis, looming severe shortages of resources for testing and treatment, imposition of unfamiliar public health measures (infringing on personal freedoms), large and growing financial losses, and conflicting messages from authorities are few of the major stressors due to COVID-19. The effect due to COVID varies from individual to individual. Healthcare providers are more vulnerable as there is increased risk of exposure to coronavirus, concern about infecting and caring for loved ones, shortages of personal protective equipment, and longer working hours. Yashwantrao Chavan Memorial Hospital started functioning as Dedicated COVID-19 hospital since April 2020. Psychiatric services were also active and were delivered by means of telepsychiatry outpatient services, consultation-liaison psychiatry for COVID-19 patients, group counseling, supportive counseling, and psychosocial counseling center for relatives. Our experience is briefly described.

Effect of COVID-19 and sociocultural milieu on the psychopathology of mental health disorders: A hospital-based study

BACKGROUND

Coronavirus disease (COVID-19) has posed a remarkable threat to mental health all around the world. This pandemic has increased the incidence of common as well as severe mental illness (SMI) all around the world.

MATERIALS AND METHODS

We report 10 cases presenting to the psychiatric outpatient department (OPD) of Institute of Medical Sciences, Banaras Hindu University, from August to October 2020. They were either referred by other departments (3 patients) or came primarily to psychiatric OPD (7).

RESULTS

Five out of these 10 cases presented with predominant psychotic features; 3 cases had predominant obsessive-compulsive features; and 1 case was of dissociative trance possession.

CONCLUSION

COVID-19 can affect the psychopathology of both types of patients either with preexisting mental illness as well as new-onset SMI.

COVID-19-associated psychosis in Indian settings: A retrospective descriptive study

BACKGROUND

The coronavirus-19 (COVID-19) pandemic has affected millions of people across the world since early 2020. Besides the large number of case fatalities, this virus has produced significant health-related sequelae involving multiple systems of the body. As with previous coronavirus infections, this was also found to be associated with various neuropsychiatric symptoms. Psychosis has been uncommon, and the few reported cases across the world have forwarded association with either raised inflammatory markers or the consequences of social isolation.

MATERIALS AND METHODS

This is a retrospective descriptive study of 12 patients, who were admitted with COVID-19 infection and psychosis, between March 2020 and December 2020. Cases of head injury, any neurological or metabolic illnesses, and substance use disorders were excluded.

RESULTS

Cases with psychosis formed only 0.19% of all cases of COVID-19 admissions. All of them were young male and employed. Most of them had abrupt onset of psychosis with confusion, delusions, hallucinations, agitation, and sleep disturbances. Investigations including inflammatory markers (C-reactive protein) and computerized tomography scans were largely normal. Medications used were mainly benzodiazepines and antipsychotics. Most of the cases resolved within the second week, and follow-up after a month did not elicit any residual symptoms in majority. Diagnosis was acute and transient psychotic disorder (about 75%), bipolar affective disorder (2 cases), and schizophrenia (one).

CONCLUSIONS

The major findings included nonreactive inflammatory markers, quick resolution of symptoms, requirement of low doses of antipsychotic drugs, and no long-term sequelae.