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LETTER TO EDITOR

Gearing up to tackle mental health issues in the post-COVID-19 world

Sir,

An earth-shattering crisis like this pandemic has shook the foundations of our identity, leaving all of us to feel different and pushing us to acclimatise to the “new normal”. We were probably not sufficiently equipped at the arrival of the coronavirus disease 2019 (COVID-19) pandemic, and we seem to be less geared for the post-COVID-19 era. Therefore, addressing the need areas for psychological support, building appropriate strategies, formulating target-based interventions, and getting the best out of ongoing research work is necessary before it is too late.

A plethora of mental health and psychosocial problems have been found to be associated with COVID-19. The psychological repercussions of the COVID-19 pandemic in the general population may last for a long time as compared to the acute medical crisis.[1] It is difficult to estimate the protracted enduring effects of this pandemic yet. The prime mental concerns after the pandemic may include the following: a) emerging mental problems like posttraumatic stress disorder, b) enduring mental health consequences from the current phase of the pandemic, c) exacerbation of pre-existing mental health issues, d) psychosocial issues such as social disruption and family segregation. Addressing the need areas should include focusing on possible susceptible groups of people such as elderly persons, children, currently unemployed persons, those suffering from monetary loss, homeless persons, those who are infected, those who are suspected to have the infection, those who have recovered, frontline healthcare workers, persons already diagnosed with psychiatric disorders, and caregivers of patients. It is also important to address possible risk factors with respect to these groups, e.g. misinformation in children, medical comorbidities in elderly persons and likewise, recognise the psychological issues that can show up in different patterns based on the type of vulnerable group.[2] Strategies for mental health support should aim at these possible vulnerable groups and their psychological issues. Prompt screening for mental health issues and timely action, psychological first aid, clear communication, multidisciplinary mental health teamwork, and implementation of public mental health policies are vital in improving the quality of people affected. There is a need for long-term psychosocial support to alleviate the mental health consequences of the current pandemic.

The importance of addressing cognitive styles, viz. “denialist” (not accepting scientific facts despite evidence/tendency to believe in conspiracy theories), “innumerate” (difficulty understanding risks/ probabilities, “fear-based”, “heuristic”, “bandwagoning” (pressure from the society) and, “analytical” has been emphasised by Poland et al.[3] Belief modification initiatives may involve strategies such as continual dissemination of unbiased and simple information, identification of sources that feed inappropriate beliefs, pointing out inconsistencies and fallacies generated by heuristic thoughts and, at the individual level, strategies such as those based on motivational interviewing. Addressing decision-making mechanisms and cognitive distortions should be important for target-based interventions in the post-COVID-19 era. An in-depth understanding of various psychological approaches such as the psychodynamic approach, person-centered approach, existential approach, cognitive behavioural approach and, also, mixed styles should be executed for maintenance of psychological well-being.[4] Ongoing research work related to COVID-19 would probably give us better insights into the psychological impact of the pandemic on people. Future research should focus on identifying the extent of psychological issues, recognising acute and long-term psychological issues.[2] This would aid in policy making and efficiently tackling mental health issues in the post-COVID-19 era.

ACKNOWLEDGEMENT

India-US Fogarty Training in Chronic Non-Communicable Disorders & Diseases Across Lifespan Grant # 1D43TW009120 (SS Bhandari, Fellow; LB Cottler, PI).

Nikhil Nayar1, Shijo John Joseph2, Samrat Singh Bhandari3, Sanjiba Dutta4, Sheikh Shoib5

1Department of Psychiatry, School of Medical Sciences & Research, Sharda Hospital, Greater Noida, Uttar Pradesh, India, 2Department of Psychiatry, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Gangtok, Sikkim, India, 3Department of Psychiatry, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Gangtok, Sikkim, India, 4Department of Psychiatry, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Gangtok, Sikkim, India, 5Department of Psychiatry, Jawahar Lal Nehru Memorial Hospital, Srinagar, Jammu and Kashmir, India

Correspondence: Dr. Nikhil Nayar, M.D., Department of Psychiatry, School of Medical Sciences & Research, Sharda Hospital, Sharda University, Greater Noida, Uttar Pradesh, India. PIN: 201306. drnikhil.nayar.1@gmail.com

Received: 11 July 2020

Revised: 17 July 2020

Accepted: 17 July 2020

Epub: 22 July 2020

REFERENCES

  1. Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al. Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. Int J Environ Res Public Health. 2020;17:1729.
  2. Das N. Psychiatrist in post-COVID-19 era - Are we prepared? Asian J Psychiatr. 2020;51:102082. doi: 10.1016/j.ajp.2020.102082. Epub ahead of print.
  3. Poland GA, Fleming DM, Treanor JJ, Maraskovsky E, Luke TC, Ball EM, et al. New wisdom to defy an old enemy: summary from a scientific symposium at the 4th Influenza Vaccines for the World (IVW) 2012 Congress, 11 October, Valencia, Spain. Vaccine. 2013;31 Suppl 1:A1-20.
  4. Joseph SJ, Gonçalves AP, Paul A, Bhandari SS. Theoretical orientation of a range of psychological approaches to address mental health concerns during the COVID-19 pandemic. Asian J Psychiatr. 2020;53:102221. doi: 10.1016/j.ajp.2020.102221. Epub ahead of print.

Nayar N, Joseph SJ, Bhandari SS, Dutta S, Shoib S. Gearing up to tackle mental health issues in the post-COVID-19 world. Open J Psychiatry Allied Sci. 2020 Jul 22. [Epub ahead of print]

Source of support: Nil. Declaration of interest: None.

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