6. Psychosocial Aspects of COVID-19 Pandemic Review Article How to cite: Kartikey, D., Kumar, S., Mishra, A.K., & Mishra, M. (2020). Psychosocial Aspects of COVID-19 Pandemic: A brief Overview. Journal of Psychosocial Wellbeing,1(2),28-34. Quick Response Code This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-Non Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms. Website : www.jpsw.co.in Access this Article online DOI: https://doi.org/10.5281/zenodo.4445598 28 Psychosocial Aspects of COVID-19 Pandemic: A brief Overview Introduction A n a i r b o r n e i n f e c t i o u s respiratory disease (COVID-19) has been spreading worldwide since December 2019. From being just a small virus, a non- living entity, it has now become a full blown pandemic by using the human biological system to spread worldwide and disrupt every sphere of our life, be it health, financial, psychological or social. The losses borne out of this pandemic are immense. Over a million people have died and around 50 million infected. All the major economies have either shrunk or have entered into recession. The lockdown i m p o s e d w o r l d w i d e h a s resulted in job loss and financial insecurity. According to the IMF (International Monetary Fund), the pandemic will result in loss of jobs and loss of trillion dollars worldwide. At this time, nature also seems to be very wild and chaotic, natural disasters like forest fires of Amazon and California and water calamities in India, China and Bangladesh. M o n e t a r y l o s s e s c a n b e calculated and compensated in due time but what about u n a c c o u n t e d l o s s e s l i k e psychological. The cost of all this are psychological shocks, to Journal of Psychosocial Wellbeing, 1(2), 2020 Correspondence Address: Subodh Kumar, Research Scholar, Department of Psychology, Banaras Hindu University, Varanasi, UP, India. Email: bhu.subodh@gmail.com 1 2 Divye Kartikey, Subodh Kumar 3 Alok Kumar Mishra, 4 Meena Mishra 1 Intern, Brain Behaviour Research Foundation of India (BBRFI), New Delhi, India 2 Research Scholar, Department of Psychology, Banaras Hindu University, Varanasi, UP, India. 3 Joint Secretary, Association of Indian Universities 4 Chairperson, Brain Behaviour Research Foundation of India (BBRFI), New Delhi, India Abstract Since the start of the COVID-19 pandemic everything has changed, from our daily routine activities to how we think and plan for the future. As we progress into the later stages of the pandemic, both our thinking and society will change and it is in this backdrop, taking a psychosocial perspective is important in understanding the psychological effect of COVID-19 pandemic on society. Psychological impacts due to such catastrophic events are largely subtle and hidden in nature due to stigma related to mental health issues. This review paper aims to uncover and demystify the extent to which societies were affected psychologically, and how it has impacted the course of the pandemic. A comprehensive analysis is presented on mental health problems in patients infected from COVID-19, frontline health workers, old age people and women, also of the people who are facing problems due to unemployment and loneliness. The social behaviors like anti-lockdown protests, anti-racial discrimination protests, anti-vaccine protests and panic buying are also discussed. Finally, some solutions are suggested as learning that we can take from this pandemic so that our society is better prepared psychologically for any future pandemic. COVID-19, Pandemic, Quarantine, Mental Health, LockdownKeywords: Submitted: 18.10. 2020 Revised: 15 Accepted: 09.12. 2020 Published: 23.12. 2020 .11. 2020 29 which everyone is subjected to at a personal level. These psychological shocks are in the form of depression, anxiety, post-traumatic stress disorder and inability to cope with grief and loss. These psychological effects led people to irrational social behaviors like panic buying, stockpiling, defying quarantine rules, not wearing masks, attending parties or large gatherings and most recently into anti-lock down protests and anti-vaccine protests. In this article we are focusing on the psychosocial perspective of COVID-19 pandemic. Psychosocial perspective means studying the problems from the view of psychological impacts on society. This is important because we have seen it for the first time in the history of humanity when every human is subjected to the same problem at the same time irrespective of caste, religion, color, creed, ethnicity and country. It is important to answer a few i m p o r t a n t q u e s t i o n s l i k e , ' H o w m u c h psychologically we were prepared for a crisis like this?', 'How we adapted or mal-adapted to this crisis?', 'How will we cope with loss and grief?', 'What is the psychological cost of such a crisis?', 'What type of irrationality were we subjected to?' and last but not the least 'What psychological pitfalls led to social unrest and worsened the pandemic?'. We have to answer all these questions if we want to have any learning to safeguard humanity from future pandemics. We will first look into broad psychosocial impacts of COVID-19 like, mental health problems in patients infected from COVID-19, mental health of frontline workers in essential services, mental health of vulnerable sections of society i.e. old age people, women, youth and adolescent, and workers in informal sector. Then we will make an attempt to inquire about the general attitude of masses during pandemic like, street protests, believing in conspiracy theories and not following the guidelines and the necessary health practices of wearing masks and practicing physical distancing. The role of cognitive biases will be taken into account and how it has led many people to make wrong decisions during pandemic, and how it has shaped the outcomes of the pandemic. At the end, some recommendations and important lessons will be given which we need to learn, so that our society is better prepared psychologically to handle such kind of future pandemics. Psychosocial impacts of COVID-19: Mental health problems in patients infected from COVID-19 Researchers are now concluding that the effect of this virus is beyond the normal physical symptoms. Virus can now cross the blood- brain barrier to influence the brain and mind. The first evidence of this was the common COVID-19 symptom of loss of smell and taste. There is evidence where patients after being discharged from successful treatment of COVID-19, suffered from depression, anxiety and post- traumatic stress. A Study conducted among patients infected from COVID-19 in San Raffaele hospital, Italy, found that more than half recovered patients suffered from post-traumatic stress disorder, insomnia, anxiety and depression. Out of the 393 patients studied, 28% suffered from post-traumatic stress disorder, 31% in depression, insomnia in 40%, anxiety in 42% and obsessive compulsions in 20% of the patients. The severity of these psychological problems was in proportion with the severity of COVID-19 infection (Parodi, 2020). An online study conducted in Spain among 3480 people, who had mild COVID-19 and were not hospitalized, found that 18.7% were in depression, 21.6% in anxiety and 15.8% showed symptoms of Post traumatic stress disorder (Gonzalez & Austin, 2020). Mental health problems in frontline health workers Mental health problems among frontline health workers have been serious. Inadequate personal Journal of Psychosocial Wellbeing, 1(2), 2020 Kartikey et al: Psychosocial Aspects of COVID-19 Pandemic 30 protective equipment, underpayment after long hours of duty and lack of psychological support is causing mental health problems like depression and anxiety. Recently, health workers in Italy and America even committed suicide due to fear that they might have infected other patients with COVID- 19 (Rahman, & Plummer, 2020). Study on Romanian medical residents found a high prevalence of burnout syndrome (Dimitriu, et al., 2020). Similarly, a study found burnout symptoms among Singapore health professionals (Tan, et al., 2020). Health Anxiety in public Health anxiety is the anxiousness that a person feels when bodily symptoms are misinterpreted or misjudged in an exaggerated form, based on limited knowledge. The anxiety resulting from this fixes the belief in a person's mind that they are suffering from a disease, which in reality may not be the case. This is fear-based self-diagnosis, which is reinforced every time whenever those bodily symptoms are present. The failure to take the objective view on this leads to more fixation of the belief and more impairment in the functioning of daily life (Tyrer, 2020). The most common symptom for COVID-19 was shortness of breath and it was a common site in society that normal body symptom of shortness of breathe due to daily activities was usually feared with contracting COVID-19 (Kartikey, 2020). Health anxiety was also present with people, who were already suffering from physical illness/es such as blood pressure, diabetes, heart ailments and cancer, and also those who were already suffering from mental illness like depression and anxiety before pandemic started. Fear of Loneliness Social distancing and quarantine were one of the first measures by every country to stop the spread of SARS-COV-2 virus. Nationwide lockdowns were imposed and everyone was forced to live in the confinements of their house. In countries like India, nationwide lockdowns were imposed with strict curfews to make sure that there are no large public gatherings. As the rate of infection reduced in countries, lockdowns were lifted, however, these continued in the form of localized lockdowns or area specific lockdowns. It is during these times that people suffering from mental illness like depression, anxiety, post-traumatic stress disorder etc. lost their social support from friends, relatives and neighbors. This either aggravated their symptoms of pre- existing mental illness or triggered relapse into previous cured mental illness (Chaurasiya & Chaurasiya, 2020). Financial insecurity and Unemployment Mental health is closely linked to financial insecurity and unemployment. COVID-19, from being a health crisis it has turned into an economic crisis and now transformed into a mental health crisis. Various surveys have shown that public mental health has worsened due to stated reasons. People working in sectors, which are heavily affected due to COVID-19 pandemic like hospitality industry, tourism industry, sports industry and above all those who are working in the informal sector, faced a significant amount of distress due to loss of livelihood and financial security. Those working in jobs are now in fear of losing their job or if they have lost their job then the big challenge in front of them is to re-skill them or update them to be market ready for any future employment. In a cross sectional study conducted in Lebanon, a developing country, among 502 participants, all were over 18 years, it was found that there was a direct link between poor mental health and a crashing economy. Lebanon has been under economic crisis for a long time due to civil war and political turmoil, but due to COVID-19 pandemic it never recovered, thereby resulting in job loss and the closing of many businesses. Significant stress and anxiety also was noted in people who were getting reduced salary as a result of pandemic (Salameh, et al., 2020). Food insecurity and mental health Food insecurity during COVID-19 pandemic took place in two ways. First, the inability to buy food for Kartikey et al: Psychosocial Aspects of COVID-19 Pandemic Journal of Psychosocial Wellbeing, 1(2), 2020 31 the family due to loss of job or daily wages and second, from the shortage of food supplies to cities. In a survey conducted in vermont city, United States of America, among 3219 people, an increase in food insecurity was found. People who had lost their job faced obstacles in finding access to food and were eating less. This not only made them vulnerable to malnutrition but also to stress and anxiety (Niles, et al., 2020). In many African countries, Iran, Pakistan and India, Locusts, a crop devouring insects, threatened the food security by attacking several agricultural fields and damaging tonnes of crops. One of the main reasons was failure to check the population of locusts due to pandemic and lockdowns. (Koshy, 2020). Women Mental Health During COVID-19 pandemic, women became more vulnerable to mental health issues because they play multiple roles in the family like being a homemaker and earning income for the family. Whether a woman is working or nonworking, lockdowns affect the lives of women like never before. Women now had to bear the burden of devoting extra time in the care of their families, in addition to their work from home. Women working in the informal sector lost their financial freedom due to loss of jobs. Pregnant women suffered from anxiety as they were subjected to not only the emotional and mood swings due to pregnancy but also from fear of going for delivery to hospitals which had themselves turned into COVID- 19 centers. Social distancing and restricted movement made them even more emotionally vulnerable which affected pregnancy. Domestic violence increased as women now had no choice but to spend more time with their abusive partners with whom they have turbulent relationships. They become silent sufferers of their own home environment (Matiti, et al., 2020). Youth and adolescent mental health The age of adolescence and youth is always considered vulnerable for mental health. It is known for depression, anxiety and post-traumatic stress. In a study of the psychological condition of 584 participants in China, of age group 14 to 35, through online questionnaires it was found that most of the participants suffered from depression, anxiety and post-traumatic stress. As social contacts got shrunk due to lockdowns, most of the youth and adolescents adopted many mal-adaptive, coping strategies like, tobacco, alcohol, marijuana, psychedelics and spending too much time surfing videos on the internet and social media. Such mal-adaptive coping techniques only perpetuate psychological distress in the long term (Liang, et al., 2020). Geriatric mental health Mental health of older people has worsened during COVID-19 pandemic due to social restrictions. Their inability to use technology to connect with others has shrunk their social support. If at all, they connect with others through technology, the element of realistic care and love was not there. In addition, mental health problems aggravated when older people were left without any social support and were not able to access health services, banking services, transport services and inability to get groceries. Study conducted on geriatric mental health during COVID-19 pandemic in the Arab countries of the Middle East and North Africa region, which included countries like, Lebanon, Kingdom of Saudi Arabia, Egypt and United Arab Emirates, found depression to be highly prevalent among old aged people. Elderlies with dementia and Parkinson's disease also had depressive symptoms (Hayek, et al., 2020). Panic Buying, 'Black Lives Matter', Anti-lockdown protests and Anti-Vaccine movement Panic buying or stockpiling is an irrational phenomenon wherein people buy more than usual in order to save their family from unforeseen adversities. The reason people reacted to the pandemic with panic buying was because of misinformation and fake news that items in shops will run out. To generate a sense of control over the Kartikey et al: Psychosocial Aspects of COVID-19 Pandemic Journal of Psychosocial Wellbeing, 1(2), 2020 32 situation, panic stricken people hoarded food items. The fall out of such incidences was that lower income people were not able to afford food items due to rise in price. Had there was no panic buying then it could have benefited everyone(Arafat, et al., 2020). All over the world, protests are also happening against the racial injustices and corrupt governance. But why during and pandemic? The possible explanation behind these is, as lockdowns and social distancing put people out of their daily busy routine, and with continuous active use of social media, they become more sensitive to old social and economic problems. The psychological impact of pandemic made individuals lose their personal life meanings only to move towards larger social meaning. People associated their personal identity with a larger social identity of people suffering racial discrimination. The element of enlarged social identity created a sense of common fate and shared interests among people, which when reached a tipping point resulted in black lives matter protests. (Duncan, 2020) A study conducted in eight cities in the United States of America, where protests took place due to the George Floyd incident. In all the cities there was an abnormal increase in COVID-19 infection. In six of the eight cities, the increase was significant. This was because the guidelines for social distancing given by the Centre for Disease Control were not followed (Valentine, et al., 2020). There were many anti lockdown protests in many parts of the world. Protests due to financial insecurity are understandable. But what explains anti- lockdown protests happening out of complete denial of COVID-19 pandemic? In the atmosphere of fear and uncertainty fake news and conspiracy theories are easily spread through social media platforms to misinform the general public. Through the media, fake information was spread to downplay the seriousness of the pandemic and false hopes were given that lockdowns will be lifted soon.Two cognitive biases, motivation perception and confirmation bias played crucial roles in this scenario. People formed false and unscientific beliefs related to pandemic and became motivated to see lockdown lifted, these beliefs were confirmed every time they spent some time on social media platforms (Bartholomew, 2020). Similarly in the anti-vaccine movement, fake information and conspiracy theories like vaccines can cause measles and autism, were spread through social media (Pierre, 2020). There has been a considerable psychological cost of COVID-19 pandemic. To deliver mental health services, online platforms were used everywhere. However, these were not able to reach people who are either not comfortable with technology or are unable to use technological devices. Poor people are also not able to access such services due to financial hardships. Although tele- mental health services are no match to face-to-face services, there is still a need to make them more user friendly, cost effective and easily accessible (Moreno, 2020). Study on Romanian medical residents has shown that many methods can be used to reduce mental health issues, like- encouraging residents to keep a balance between work and home, and sharing problems with colleagues (Dimitriu, et al., 2020). Similarly, study on burnout among Singapore healthcare workers has shown that avoiding prolonged shifts of more than 8 hours helped in reducing burnout and other mental health issues (Tan, et al., 2020). For vulnerable sections of the society like women, it is important to promote community based organization in delivering mental health services and to make strict laws against domestic violence (Matiti, et al., 2020). For youth and adolescents, it is important to engage them in healthy ways of coping with their mental health (Liang, et al., 2020). For old age people, there is a need of geriatric mental health specialists which can provide services as per their age (Hayek, et al., 2020). Study from Lebanon among people who are facing financial insecurity and unemployment, shows that there should be screening of mental health among Discussion Kartikey et al: Psychosocial Aspects of COVID-19 Pandemic Journal of Psychosocial Wellbeing, 1(2), 2020 people who are poor and financially insecure. Their poverty should not become a barrier to avail any mental health services, because recovery from psychological problems can help them to overcome financial challenges (Salameh, et al., 2020). Study on panic buying has shown that to avoid such happenings there should be strict regulation of essential commodities and tough laws against black marketing and hoarding. For food insecurity related mental health issues, policies should be made to encourage food assistance programme and home delivery businesses (Arafat, et al., 2020). Those people for whom lockdowns and quarantine were the time to re-skill and learn something new had positive outlook towards pandemic and were optimistic about their career and financial security in near future.It is important to have a mindset where people have internal locus of control, which means that situation can improve if right actions are executed. This is better than having a mindset which is based on external locus of control, in which the belief is that nothing can be done as outside events are more powerful in deciding the outcome. This pandemic is witnessing many social movements but also irrational social behaviors. It is because people are using a more top-down approach to pandemic than bottom-up approach. In top-down approach the perception of reality is blurred by pre- existing distorted ideas and opinions, thereby inhibiting the capability to see the real problem in a novel way. In the absence of any prior belief system in mind of the general public, people fell in the trap of their own cognitive biases and accepted distorted perception floating on social media and in the community. For example, people still have this belief system that wearing a mask is not effective against COVID-19, despite the availability of all the scientific evidence that masks are very effective in curbing the spread of infection. In bottom-up approach, the belief is formed but is not corrupted by pre-existing distorted beliefs and ideas. Those people who did not have any prior ideas and beliefs, as to how to act in such turbulent time, practiced mindfulness to come to the right conclusion by believing in science and hence acted much better in protecting themselves and others from getting infected. It is important for science to spread its clear message before misinformation and fake news reach the public through social media, and identify all the possible cognitive traps that people can fall into, so that scientific messages can be modified into people friendly language. Responsible journalism is the need of the hour to safeguard public rationale. To counter rumors more emphasis has to be on framing of messages for the target audience so that there is always clarity among people regarding what the stand of science is (Pierre, 2020). COVID-19 Pandemic is impacting our lives like never before and it is still unclear how long it will be like this. Psychosocial impacts of COVID-19 are so diverse that this article alone cannot cover everything under the sun. However, papers we reviewed for our topic have successfully given us information on the extent to which societies are psychologically affected and also solutions that can be implemented. We now know that people from all age groups are getting affected psychologically. People who were infected from COVID-19 were also psychologically affected, but the role of SARS-COV-2 virus in creating psychological problems needs more investigation. Deteriorating mental health among general public and social unrest shows us that to achieve real psycho-social well-being we not only have to stop COVID-19 from spreading but also work collectively on many socio-economic issues. Affordable and easily accessible mental health services, and right socio-economic government policies is the way forward. The papers we reviewed also throw light on how we should adapt to new challenges posted by new threats like pandemics. On one side it shows the bright side of the human capability to be adaptive and resilient but on other side it exposes our psychological vulnerabilities. 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