Mental health during the coronavirus pandemic condition needs special treatment. Coronavirus disease pandemic 2019 / COVID-19 also changes several aspects of life, including social distancing, quarantine, and self-isolation, activities at home, panic buying, to changes in handling in health facilities. The rapid changes in conditions for an indefinite period, as well as ongoing news, cause changes in mental health. A survey conducted in China showed an increase in anxiety disorders, panic, and depression, related to the conditions of the changes that occurred.

Mental Health Issues During Coronavirus Pandemic
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Factors Affecting Psychological Distress

A survey of psychological distress related to COVID-19, conducted in China, Hong Kong, Macau, and Taiwan, involved 52,730 respondents. The survey results indicate several factors that play a role in increasing psychological distress, such as an increase in overall anxiety disorders, panic, and depression, namely:
  • Women are more prone to stress and can experience post-traumatic stress disorder (PTSD).
  • Age 18-30 years or above 60 years are vulnerable. It is because the age of 18-30 years is productive, and it is easier to get much information from social media, thus increasing the occurrence of stress. Meanwhile, the high mortality rate in patients over 60 years of age causes increased psychological distress in this age group.
  • Higher education level is related to self-awareness towards higher health, so they are prone to stress.
  • Migrant workers experience an increase in distress related to concerns about the risk of transmission from public transportation, as well as a decrease in income due to delays or reduced jobs.
  • Communities living close to the central region are the highest cases.

Other things that affect psychological distress levels are:
The availability of health resources, the efficiency of the public health system, as well as the control and preventive actions taken by the government for the pandemic situation.

Mental Health Related to Quarantine

Quarantine is one of the steps taken to prevent the spread of coronavirus outbreaks. This action has psychological deterioration effects, including the occurrence of PTSD symptoms, confusion, and anger.

Factors that are considered to be stressors during quarantine include:

  • Quarantine duration that is longer than 10 days is associated with increased mental disorders, especially PTSD symptoms, avoidance behavior, and anger.
  • Fear of infection and transmitting it to other people. This fear especially occurs in pregnant women and those who have young children.
  • Frustration and boredom result from loss of daily routines, and there is a reduction in physical and social contact with others, including due to feelings of being isolated from the surroundings
  • Not having enough reserves of basic needs, such as food, drinks, clothing, or accommodation, including medicines to personal protective equipment.
  • Lack of official information from the government regarding the steps to be taken, the distribution of risk levels, and the objectives of quarantine. This lack of information is one predictor of the onset of PTSD symptoms.

Post-quarantine can cause new stressors:

  • A study in Korea stated that anxiety and anger symptoms persist for 4 to 6 months after quarantine has finished.
  • Decrease or lose financial support, especially for workers with low-income levels. It becomes a risk factor for anger and anxiety, in a few months after quarantine is complete, and socio-economic distress develops.
  • Bad stigma towards people who experience quarantine are treated differently, avoided, considered scary and dangerous, considered infectious, and received criticism.
  • For medical workers who work to overcome the plague, get the assumption that the work is too risky, and cause tension in the family. Some health workers and patients who survived the plague also showed fear of back to work because they felt afraid that they were the source of the spread of the disease.

Mental Health of Health Workers

Facing infectious cases in large numbers put medical workers under physical and mental pressure. There is a tendency for medical personnel to minimize the risk of contracting themselves, refusing to rest, and refusing to need psychological help. The magnitude of the psychological impact experienced is strongly related to cultural factors.

Issues that are directly faced by medical personnel are: 

  • feelings of anxiety of being infected and dying, 
  • separating from families related to work demands, 
  • witnessing traumatic scenes including patients who are in critical condition or dying, 
  • working in chronic overburdened settings,
  • experiencing despair due to the loss of the patient's life in numbers high despite trying to the maximum, 
  • lack of reinforcements and replacements, as well as fatigue or burnout.

Some other concerns include:

  • worry about making the family worry, 
  • worry about bringing the virus to home, 
  • worry about lack of personal protective equipment / PPE, 
  • or worry about the inability to care for patients.

These high burdens and worries certainly increase stress levels, such as depression, anxiety, hostile behavior, and somatic symptoms. This condition can occur even after 1 pandemic year has passed, so it can be concluded that it can be acute or chronic.

Mental Health of Patients

The mental health of patients is affected by the severity of symptoms, complications, sequelae, therapeutic effects, and the ability to access health services. Difficulty undergoing daily functions due to illness symptoms or residual symptoms experienced can cause a person's mental health disorders.
Some patients can experience feelings of helplessness, even feelings of grief due to the loss of those closest to them, including fellow patients in care. Also, the spread of infection to the central nervous system can cause neuropsychiatric symptoms depending on the area of ​​the brain affected. These neuropsychiatric symptoms can be permanent or improve after the infection is resolved.

Elderly patients are classified as vulnerable because they have a higher risk of transmission and have limited access to health services. Symptoms of depression are also often encountered as a direct result of the limitations they have.

Patients with comorbid Mental Disorders

Patients with comorbid mental disorders will more easily experience relapses and impairment in daily functioning. Especially in comorbid psychotic disorders or developmental disorders that are difficult to obtain routine treatment. 
Stress by a pandemic can also increase:
  1. psychotic symptoms, 
  2. mania, 
  3. depression, 
  4. anxiety, 
  5. substance abuse, and suicide risk, 

Thereby increasing the use of psychotropic drugs, especially antipsychosis and benzodiazepines.

Family Mental Health

Families of both health workers and patients confirmed to be infected with COVID-19 are reported to have an increased risk of psychological distress. The increase in depressive symptoms of health workers' families is in line with the long working hours of health workers. In contrast, families of high-risk patients experience overall anxiety disorders associated with a high risk of infection transmission and fear of death.