Emerging mental health issues during the COVID-19 pandemic: An Indian perspective

Perceived risk of infection, ethical challenges and motivational factors among frontline nurses in Covid-19 pandemic: prerequisites and lessons for future pandemic

BACKGROUND

Infection risk was significant for front-line nurses during the Covid-19 outbreak. The pandemic presented several ethical difficulties and sapped nurses' drive to labor harder for longer periods. This study evaluates registered nurses' perceptions of Covid-19 infection risk, ethical dilemmas, and motivating factors.

MATERIALS AND METHODS

During March and April 2022, 400 registered nurses from a newly established tertiary care hospital participated in this cross-sectional exploratory survey. The risk assessment scale, motivation to work scale, and ethical dilemma scale were used to assess the perceived risk of infection, motivational factors and ethical challenges experienced by the nurses. Appropriate descriptive and inferential statistics were applied to compute the results.

RESULTS

76.4% of nurses feared working as a nurse put them at higher risk of infection. Besides the fear of contracting infection, nurses believed they were the source of infection to family members (70.8%) and people around (67.5%). 63.3% of nurses agree that they do not have the right to refuse treatment and every patient has the right to receive optimal care, regardless of age, gender, and medical conditions. Professional obligation to treat patients (72.3%) and sound professional knowledge and experience (83.5%) are important motivating factors to work during the pandemic. Multilinear regression analysis revealed that professional education (95% CI, 3.845 - 0.694, p = 0.005), Covid-19 positive status (95% CI,0.455-2.756, p = 0.006), and post-Covid-19 hospitalization (95% CI, 1.395-6.978, p = 0.003) and duration of hospitalization (95% CI, 0.754-0.058, p = 0.022) are independent predictors of higher perceived risk of infection among nurses.

CONCLUSIONS

During the pandemic, nurses were afraid to work and faced personal and family risks of contracting the virus. Despite these challenges, they still feel a strong sense of commitment and dedication to providing the best possible care. Nurse administrators need to create a supportive environment that follows ethical principles and meets the needs of nurses to boost their motivation and encourage them to continue working for longer periods.

A retrospective chart review of clinical profile of patients utilizing telepsychiatry services during COVID-19 pandemic at a tertiary care centre

Background

Telepsychiatry as a vehicle for delivering mental health services became evident due to outburst of mental health issues during coronavirus disease 2019 (COVID-19) pandemic and it was found useful in providing mental health care while maintaining social distancing norms and lockdown guidelines.

Aim

To study clinical profile and sociodemographic profile of patients utilizing telepsychiatry services during COVID-19 pandemic.

Materials and Methods

Total 70 old follow-up and 42 new patients were consulted on telepsychiatry, as per Indian Telepsychiatry Operational Guidelines 2020 given by NIMHANS, during 1st and 2nd wave of COVID-19 pandemic from June 2020 to May 2021. Sociodemographic and clinical data was extracted from all patients who utilized our telepsychiatry services in a semi-structured proforma for retrospective analysis using frequency tables.

Results

A total of 102 patients benefitted from our telepsychiatry services. Out of which, 66.7% were adults between 21 and 40 years, with slight female preponderance (55.9%) and majority (78.4%) participants living in urban areas. About 70.6% were graduates with 41.2% participants belonging to either private or public service. One-third of the participants were IT professionals. Around 59.8% participants had past history of psychiatric illness and 40.2% had new onset illness. The diagnostic distribution included depressive disorder (28.4%), anxiety disorder (26.4%), psychotic disorder (21.6%) and obsessive compulsive disorder (9.8%) and others (13.8).

Conclusion

Telepsychiatry has emerged as an important consultation modality in this COVID-19 pandemic. Its future use seems promising, which will require mental health practitioners to develop their skills while interacting digitally, conducting assessments, and therapy.

Mental health outcome in hospitalized COVID-19 patients: An observational analysis from North Indian tertiary care hospital

Aim

The study investigate the severity of perceived stress and wide domains of psychiatric symptoms reported on initial screening in hospitalized patients of COVID-19 with a second aim to determine the role of sociodemographic factors and coping styles in the hospitalized patients of COVID-19.

Method

Total 224 patients of COVID-19 infection, hospitalized in various isolation facilities were assessed via web-based self-reported questionnaires on perceived stress scale, brief cope inventory, and DSM-5 crosscutting level-1 questionnaire.

Results

Majority of the patients reported moderate level of stress followed by mild and severe. Depression and Anxiety symptoms were most common psychopathologies though the patients have reported greater severity in various domains of psychiatric symptoms. Coping styles explains most of variance (64.8%) of the perceived stress. Similarly total PSS scores, coping styles, COVID-19 status and sociodemographic factors contributed significantly to the variance of all psychiatric symptoms.

Conclusion

Factors like female gender, being married, belonging to nuclear families, service class and urban domicile are the significant factors determining higher risk of stress and developing more psychopathologies. Furthermore, coping styles used by the patients have a greater moderating effect on mental health symptoms and their perceived stress which can be a major area for interventions to reduce the mental health morbidities.

Investigating the burden of disease dimensions (time-dependent, developmental, physical, social and emotional) among family caregivers with COVID-19 patients in Iran

Background

The caregivers of patients with covid-19 face constant responsibilities such as providing personal, health, and social care to family, which can be physically, and emotionally exhausting resulting in a considerable stress burden. Therefore, given the importance of the subject, this study aimed to investigate the burden of disease dimensions (time-dependent, developmental, physical, social and emotional) among family caregivers with covid-19 patients in Iran.

Methods

This cross-sectional study was conducted one year after the onset of the Covid-19 outbreak in Iran. Family caregivers of Covid-19 patients discharged from the hospitals in Kerman city, Iran, were chosen by simple randomization (n = 1500). Data were collected utilizing a demographic characteristics inventory created by the researcher as well as the Novak and Guest Caregiver Burden Inventory. Descriptive statistics such as mean and standard deviations, frequency, and percentages and analytical statistics such as Kolmogorov–Smirnov, T-test, ANOVA, and Multivariate Linear Regression were used for data analysis using the 20, SPSS Inc., Chicago, IL Software at the level of P < 0.05.

Results

The results demonstrated that the mean score of family caregiver burden was 2.61±0.6 and the severity of this burden was in a moderate range. The finding showed a statistical difference was seen between the family caregiver burden mean score of participants in terms of gender, duration of treatment, age and employed status. The multivariable linear regression model showed demographic variables of caregivers included (female, married, employed, elderly, low income and poor education) had a beneficial influence on family caregiver burden.

Conclusion

The findings of this study can increase the awareness of health managers, about the level of burden of disease among family caregivers from the covid-19 patients and can help to provide economic, social and psychological support programs for improvement and reducing the burden of disease of caregivers during the covid-19 outbreaks.

Psychological distress and coping styles among baccalaureate nursing students: Promoting mental health of future nurses in COVID-19 pandemic

BACKGROUND

Coronavirus disease (COVID-19) causes significant psychological distress among nursing students. College-bound nursing students might have preferred different types of coping strategies to deal with psychological distress. This study aims to measure the psychological distress and role of coping styles to mediate the stress level among the baccalaureate nursing students amid the COVID-19 pandemic.

MATERIAL AND METHODS

A cross-sectional online survey was conducted in December 2020 at a nursing college attached to a tertiary care teaching hospital, North India. Nearly 251 baccalaureate nursing students completed the Impact of Event Scale-Revised (IES-R) and Coping Orientation to Problems Experienced Inventory (Brief-COPE) scale to report their psychological distress and coping styles, respectively. Chi-square test, independent sample t-test followed by binary and multivariable regression were used to identify the factors associated with distress in students during the pandemic.

RESULTS

Students' mean age was 22.22 ± 1.24 years. The mean IES-R was 19.59 ± 12.45 in nursing students. Psychological distress found a significant association with age (P = 0.022), academic class (P = 0.016), travel history (P = 0.034), and being positive reverse transcription-polymerase chain reaction (RT-PCR) for COVID-19 status of self (P = 0.018) and family members in the medical profession (P = 0.013). In binary logistic regression, stress level found a significant association with first-year academic level (OR: 3.250, 95% CI: 1.429-7.390, P = 0.005) and family members in the medical profession (OR: 4.44, 95% CI: 1.019-19.382, P = 0.047). Adaptive coping styles were more frequently preferred than maladaptive coping styles (54% vs 41%). Adaptive (r = 0.295, P < 0.001) and maladaptive coping (r = 0.403, P < 0.001) shows a significant positive relationship with stress in students, respectively.

CONCLUSIONS

Coronavirus pandemic causes significant distress among nursing students. Students were able to manage stress using acceptance and religious/spiritual coping strategies. During the pandemic, stress management to support mental health is highly recommended.

Engagement of health workers and peer educators from the National Adolescent Health Programme-Rashtriya Kishor Swasthya Karyakram during the COVID-19 pandemic: Findings from a situational analysis

Background

To understand the impact of COVID-19 on implementation of the peer education programme of the National Adolescent Health Programme-Rashtriya Kishor Swasthya Karyakram (RKSK); repurposing of the RKSK health workers and Peer Educators (PEs) in COVID-19 response activities and effect on adolescents´ health and development issues.

Methods

Virtual in-depth interviews were conducted with stakeholders (n = 31) (aged 15 to 54 years) engaged in the implementation of the RKSK and peer education programme at state, district, block, and village levels in Madhya Pradesh and Maharashtra (India). These interviews were thematically coded and analysed to address the research objectives.

Results

Despite most peer education programme activities being stopped, delayed, or disrupted during the pandemic and subsequent lockdown, some communication networks previously established, helped facilitate public health communication regarding COVID-19 and RKSK, between health workers, PEs, and adolescents. There was repurposing of RKSK health workers and PEs’ role towards COVID-19 response-related activities. PEs, with support from health workers, were involved in disseminating COVID-19 information, maintaining migrant and quarantine records, conducting household surveys for recording COVID-19 active cases and providing essential items (grocery, sanitary napkins, etc.) to communities and adolescents.

Conclusion

PEs with support from community health workers are able to play a crucial role in meeting the needs of the communities during a pandemic. There is a need to further engage, involve and build the skills of PEs to support the health system. PEs can be encouraged by granting more visibility and incorporating their role more formally by paying them within the public health system in India.

Anxiety and depression among adult tobacco users during the COVID-19 restrictions in India

Background

The world witnessed a highly contagious and deadly disease, COVID-19, toward the end of 2019. India is one of the worst affected countries. We aimed to assess anxiety and depression levels among adult tobacco users and people who recently quit tobacco during COVID-19 lockdown in India.

Materials and methods

The study was conducted across two Indian cities, Delhi and Chennai (July-August, 2020) among adult tobacco users (n = 801). Telephonic interviews were conducted using validated mental health tools (Patient Health Questionnaire-PHQ-9 and Generalized Anxiety Disorder-GAD-7) to assess the anxiety and depression levels of the participants. Descriptive analysis and multiple logistic regression were used to study the prevalence and correlates of depression and anxiety.

Results

We found that 20.6% of tobacco users had depression symptoms (3.9% moderate to severe); 20.7% had anxiety symptoms (3.8% moderate to severe). Risk factors associated with depression and anxiety included food, housing, and financial insecurity.

Conclusion

During COVID-19 lockdown, mental health of tobacco users (primarily women) was associated with food, housing and financial insecurity. The Indian Government rightly initiated several health, social and economic measures to shield the most vulnerable from COVID-19, including a ban on the sale of tobacco products. It is also necessary to prioritize universal health coverage, expanded social security net, tobacco cessation and mental health services to such vulnerable populations during pandemic situations.

Connection of Suicidal Behavior with COVID-19: Clinical Cases

The spread of the coronavirus infection has led to significant changes in people's lives. Prolonged isolation, fear of infection, frustration, changing the usual stereotype life style, lack of information, loss of revenues, and fear of stigmatization, as well as the disease itself have all influenced people's emotional and physical well-being. The impact of the viral infection itself on the human body, as well as the perception of a new reality, in some cases led to the formation of reactive, organic, or the exacerbation of existing chronic mental disorders. People with mental health problems are most susceptible to environmental influences and react acutely to rapidly changing circumstances. Often in critical situations, in a state of despair, patients see only one way to solve all problems - voluntary retirement committing taking own life. In this article, we present clinical cases that are descriptive in nature and are intended to illustrate the connection between depressive experiences and suicidal behavior amongst patients in a crisis situation when external circumstances were the reason for suicide attempts: loneliness as a result of restrictive measures, fear of infection or the disease itself, and the reason was a mental disorder that debuted earlier or re-emerged as a result of a viral infection. We have presented three clinical cases. All patients suffered from a new coronavirus infection of various severities and were treated in a psychiatric hospital, where they were transferred from an infectious diseases hospital or hospitalized directly in connection with suicidal actions. In each case, attention was paid to the organizational measures carried out, with an emphasis on the need for earlier screening of mental disorders, prevention of suicidal behavior in providing assistance to this contingent, and the development of the interaction between general medical and psychiatric services by the type of integrative care. The study is of interest to a wide range of specialists providing care to patients with COVID-19 or similar pathologies.

A cross-sectional survey of sleep patterns and quality and its association with psychological symptoms among doctors working in a COVID-19 care facility

CONTEXT

The coronavirus disease 2019 (COVID-19) outbreak has led to several psychological symptoms among frontline doctors of which sleep disturbances are common. Stress due to isolation and disease-related factors are known to be associated with sleep disturbances.

AIM

The aim of this study is to establish the prevalence of poor sleep and its association with psychological symptoms among doctors working in COVID-19 tertiary hospital.

SETTINGS AND DESIGN

A cross-sectional online survey was conducted among 150 doctors who were treating COVID-19 patients.

MATERIALS AND METHODS

The survey contained a semi-structured questionnaire including sociodemographic details, Depression Anxiety Stress Scale 21, and Pittsburgh Sleep Quality Index scale. Analysis was done using the SPSS v20.

RESULTS

Of 150 doctors, we found 67 (44.67%) and 83 (55.33%) doctors were poor sleepers and good sleepers, respectively. Those who were married (P = 0.001), had higher working hours per month (P = 0.001), the presence of family history of psychiatric illness (P = 0.008), and history of substance use (P = 0.007) were associated with poor sleep. Furthermore, poor sleep was associated with higher stress (P = 0.001), anxiety (P = 0.001), and depression (P = 0.001). A multiple logistic regression revealed that family history of psychiatric illness (odds ratio [OR]-5.44, P = 0.01) and the presence of substance use (OR-7.77, P = 0.01) predicted poor sleep.

CONCLUSION

Sleep pattern abnormalities were present in 45% of the frontline COVID-19 doctors studied. Family history of psychiatric illness and substance use was associated with higher chances of having poor sleep. It is important to recognize and manage sleep abnormalities as these could be initial signs of a psychiatric disorder or manifestations of underlying stress, especially in the vulnerable population.

Development and Validation of Structured COVID Perception Interview Guide (COPING) for Assessing the Acute Impact of COVID-19 Diagnosis

Objective  Structured COVID Perception INterview Guide (COPING) is a novel tool developed to understand the acute impact after receiving the diagnosis of coronavirus disease 2019 (COVID-19) in the Indian setting. The approach carries importance for interviewing patients in a state of shock immediately after receiving the diagnosis of COVID. The tool is developed emphasizing the grief, stigma, and acute psychological perception in the immediate aftermath of receiving the positive test results of COVID-19. Since COVID-19 is characteristically different from other infectious illnesses, a structured interview guide could help to address the concerns related to acute loss of health.

Materials and Methods  This study follows a mixed method design conducted from August 2020 to January 2021. In-depth telephonic interviews with mild to moderate COVID patients admitted to a tertiary hospital in central India was followed by development of COPING questionnaire.

Statistical Analysis  Item-Content Validity Index (I-CVI) and Scale-Content Validity Index Universal Agreement (S-CVI/UA) was computed. Factor analysis, Bartlett's test, and Kaiser–Meier–Olkin measure of sampling adequacy was performed. Principal component analysis, scree plots, and parallel analysis with varimax rotation was used to determine the number of factors to extract. For measuring internal consistency, Cronbach's α was computed.

Results  Out of 40 items, the final tool had 15 items after computing content validity, performing factor analysis and achieving desired level of internal consistency (Cronbach's α  = 0.702). Five domains identified after factor analysis were awareness, grief/bereavement, stigma, social reciprocity, and stress adaptation/coping.

Conclusion  COPING is a valid and reliable interview guide for Indian setting that will allow the assessment of perception of patients with acute COVID-19 infection. Taking into consideration the mental health implications of COVID-19, the availability of such a validated and reliable tool is a timely step to address the public health problem and assist the ongoing research on COVID-19 and similar illnesses in the future.

Psychosocial and Mental Health Issues of the Migrants Amidst COVID-19 Pandemic in India: A Narrative Review

BACKGROUND

The objective of this review was to identify and synthesize the findings of the existing literature that highlighted the psychosocial and mental health issues of the migrants during the COVID-19 pandemic in India.

MATERIALS AND METHODS

An exploration of the PubMed, Google Scholar, Web of Science, ScienceDirect, Google search, and some other manual searches was undertaken so that no relevant study was missed. A search on Indian scientific literature and cross-references retrieved was also conducted to get further information. The period of the search has been one year from March 1, 2020, to March 31, 2021. The database was searched with the terms "migrants," "migrant workers," "COVID-19 pandemic," "lockdown," "migrant population," "mental health issues," "psychosocial issues" to retrieve the published literature.

RESULTS

Initially, 48 research articles were retrieved and 10 of them were excluded as they had no sufficient information about mental and psychosocial challenges faced by the migrants. In the remaining 38 articles, 9 articles were original research work (n = 9) published from India related to the impact of COVID-19 on migrants. The second category consisted of editorials or commentary or letters to the editor or policy paper on psychosocial and mental health aspects of migrants during the COVID-19 pandemic (n = 17). The third category was 11 articles on perspectives or opinions or viewpoints (n = 11) related to various psychosocial and mental health issues among migrants in India during the COVID-19 pandemic. Predominantly psychosocial issues found among migrants were living conditions, basic needs, family concerns, and joblessness. The mental health issues found among migrants during the COVID-19 pandemic included psychological distress, depressive disorders, anxiety disorders, substance use disorders.

CONCLUSION

Existing literature from India has shown that the COVID-19 pandemic severely impacted the psychosocial and mental health status of the migrants in India. This review suggests the need for more research work from the affected states of India and the development of psychosocial and mental health intervention strategies to minimize the impact of the COVID-19 pandemic on migrants.

Repatriation of Bhutanese During COVID-19 Pandemic: The Unspoken Economic Burden of COVID-19 on the Bhutanese Government

Protecting the citizens who are living abroad has been a challenge for many countries during the current COVID-19 pandemic. In Bhutan, since the start of the pandemic, it has repatriated its citizens living and working abroad and putting them into a 21-day state-sponsored quarantine. They were also tested for COVID-19 on reverse transcription polymerase chain reaction (RT-PCR) that was funded by the government. While this measure is a blessing for its people, for the government it is a huge economic challenge.

Cuarentena y COVID-19, una percepción más allá de la infección

El síndrome respiratorio agudo severo (SARS), cuyo agente causal es el Coronavirus SARS-CoV, surgió en 2003, sin embargo, a finales del 2019, se observó que un nuevo Coronavirus (SARS-CoV-2) causaba una enfermedad similar a la influenza, denominada COVID-19 (acrónimo del inglés coronavirus disease 2019), la cual, presentaba desde síntomas respiratorios leves hasta lesiones pulmonares graves, y en algunos casos, cursando con insuficiencia multiorgánica y muerte 1,2,3.