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   2020| September  | Volume 62 | Issue 9  
    Online since September 28, 2020

 
 
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REVIEW ARTICLES
Emerging mental health issues during the COVID-19 pandemic: An Indian perspective
PK Dalal, Deblina Roy, Prashant Choudhary, Sujita Kumar Kar, Adarsh Tripathi
September 2020, 62(9):354-364
DOI:10.4103/psychiatry.IndianJPsychiatry_372_20  
The current global health crisis, the COVID-19 pandemic, has posed an unprecedented challenge to our health systems, economy, socio-political organizations, and the infrastructure of most countries and the world. This pandemic has affected physical health as well as mental health adversely. Several recent evidence suggests that health systems across the world have to improve their preparedness in context to infectious pandemics. The research on mental health aspects of COVID-19 and other related pandemics is lacking due to obvious reasons. This narrative review article, along with our personal views, is on various current and future mental health issues in the context of the COVID-19 pandemic focusing on various challenges and suggested solutions. The aim is also to update mental health strategies in the context of such rapidly spreading contagious illness, which can act as a resource for such a situation, currently and in future. We recommend that there is a need to facilitate mental health research to understand the psychiatric aspects of the COVID-19 pandemic, include psychiatrists in the task force, and make available psychotropic and other medications with special attention to the deprived sector of the society.
  23,726 1,292 15
Psychological impact and psychosocial consequences of the COVID 19 pandemicResilience, mental well-being, and the coronavirus pandemic
Gabriel Ivbijaro, Claire Brooks, Lucja Kolkiewicz, Charlene Sunkel, Andrew Long
September 2020, 62(9):395-403
DOI:10.4103/psychiatry.IndianJPsychiatry_1031_20  
Since December 2019, the coronavirus (COVID19) outbreak has impacted everyone's daily lives globally, especially those experiencing mental health issues. The well-being and mental healthcare of patients, families, and health-care professionals who have been directly or indirectly affected by this pandemic has not been well addressed. Governments have asked their citizens to take actions, some of which include making sacrifices that may result in dignity violations and moral injury, a term originating in the military to describe the psychological distress that results from actions, or the lack of them, which violate a person's moral or ethical code. Health professionals, individuals, and communities have changed their way of life and working to decrease coronavirus infectivity, causing additional stress and increasing potential for moral injury. It is important to hear the first-hand experience of people affected to understand the new psychosocial stressors that they face in their day to day lives and what they found helpful in managing these. This global survey carried out by the World Dignity Project in collaboration with the Global Mental Health Peer Network is to ensure that the voices of people with lived experience of mental health, their families, and professionals that work with them are heard. Aims:
  • To understand the impact of the coronavirus pandemic on mental health, well-being, and dignity, what has helped and what lessons can be learned to support coping in future.
Materials and Methods:
  • Online qualitative and quantitative survey (April 15–June 15, 2020)
  • Participants gave narrative responses to several questions, posting photos or images.
Analysis: Narrative responses were analyzed using the Gioia approach, a systematic inductive approach to develop concepts that help make sense of socially constructed worlds. Visual ethnographic data was used to give insight into the participant's socio-cultural context.
  13,500 1,658 17
Children on the brink: Risks for child protection, sexual abuse, and related mental health problems in the COVID-19 pandemic
Sheila Ramaswamy, Shekhar Seshadri
September 2020, 62(9):404-413
DOI:10.4103/psychiatry.IndianJPsychiatry_1032_20  
In developing contexts such as India, children in adversity form a high-risk group, one that cannot be subsumed under the general category of children, who are generally considered as a vulnerable group in disaster and crisis situations. Child mental health issues in contexts of protection risks and childhood adversity tend to be over-looked in such crises. This article focuses on examining the impact of the COVID-19 pandemic and its socio-economic consequences on children in adversity, describing the increased child protection and psychosocial risks they are placed at, during and in the immediate aftermath of the COVID-19 crisis and its lockdown situation. It specifically links the lockdown and the ensuing economic issues to sexuality and abuse-related risks, as occur in contexts of child labour, child sex work and trafficking, child marriage and child sexual abuse, and that result in immediate and long-term mental health problems in children. It proposes a disaster risk reduction lens to offer recommendations to address the emerging child protection, psychosocial and mental health concerns.
  9,342 1,436 14
Internet use during coronavirus disease of 2019 pandemic: Psychiatric history and sociodemographics as predictors
Jelena Jovic, Maja Pantovic-Stefanovic, Marija Mitkovic-Voncina, Bojana Dunjic-Kostic, Goran Mihajlovic, Srdjan Milovanovic, Maja Ivkovic, Andrea Fiorillo, Milan Latas
September 2020, 62(9):383-390
DOI:10.4103/psychiatry.IndianJPsychiatry_1036_20  
Coronavirus disease of 2019 (COVID-19) pandemic and related containment measures have grossly affected the daily living and created a need for alternative ways of social communication and entertainment. The aim of this study was to explore the use of various Internet contents depending on sociodemographics and on psychiatric history of participants. This cross-sectional, population-based study is a part of a wider international multicenter study. A total of 1275 participants across Serbia (71.1% of females; average age = 41.81 ± 12.52 years) were recruited using two-level chain-referral sampling method. The participants filled in an anonymous online questionnaire that included questions on sociodemographic data, psychiatric history, and various aspects of increased Internet use since the pandemic. The data were analyzed using a series of multiple logistic regressions. About two-thirds of the sample reported using Internet more during the pandemic. All of the tested regression models, apart from models predicting browsing religion and travel/tourism, were significant, explaining from about 2% (for the contents specific for COVID-19) up to 34.4% (for the sexual content) of variance of use. Reporting a previously diagnosed psychiatric disorder was a significant predictor of greater Instagram use and browsing sexual and sport-related content since the pandemic. To the best of our knowledge, the study is the first to report on the relationship between Internet using and mental health, during COVID-19 pandemic, in the Balkan region. The findings showed various patterns of the increased use of Internet contents since the pandemic referring to both potentially positive and negative Internet influences.
  9,499 478 6
SYSTEMATIC REVIEW
Impact of the COVID-19 pandemic on psychosocial health and well-being in South-Asian (World Psychiatric Association zone 16) countries: A systematic and advocacy review from the Indian Psychiatric Society
Debanjan Banerjee, Mrugesh Vaishnav, TS Sathyanarayana Rao, M S V K Raju, PK Dalal, Afzal Javed, Gautam Saha, Kshirod K Mishra, Vinay Kumar, Mukhesh P Jagiwala
September 2020, 62(9):343-353
DOI:10.4103/psychiatry.IndianJPsychiatry_1002_20  
Background: Coronavirus disease 2019 (COVID-19) has emerged as a global health threat. The South-Asian (SA) countries have witnessed both the initial brunt of the outbreak as well as the ongoing rise of cases. Their unique challenges in relation to mental health during the pandemic are worth exploring. Materials and Methods: A systematic review was conducted for all the original studies on the impact of COVID-19 and lockdown on psychological health/well-being in the SA countries of the World Psychiatric Association Zone 16. PubMed, Google Scholar, PSYCHINFO, EMBASE, and SCOPUS were searched till June 2020. Studies conducted in the age group of 18–60 years with a minimum sample size of 10, and statistically significant results were included. Results: Thirteen studies were included in the review. They showed increase prevalence in nonpsychotic depression, anxiety, somatic concerns, alcohol-related disorders, and insomnia in the general population. Psychological symptoms correlated more with physical complaints of fatigue and pain in older adults and were directly related to social media use, misinformation, xenophobia, and social distancing. Frontline workers reported guilt, stigma, anxiety, and poor sleep quality, which were related to the lack of availability of adequate personal protective equipment, increased workload, and discrimination. One study validated the Coronavirus anxiety scale in the Indian population while another explored gaming as a double-edged sword during the lockdown in adolescents. Another study from Bangladesh explored psychosexual health during lockdown. Most studies were cross-sectional online surveys, used screening tools and had limited accessibility. Conclusion: The ongoing COVID-19 crisis and its impact serve as an important period for adequate mental healthcare, promotion, research, and holistic biopsychosocial management of psychiatric disorders, especially in vulnerable groups. Mental healthcare and research strategies during the pandemic and preparedness for postpandemic aftermath are advocated subsequently.
  7,996 1,409 36
Domestic violence and substance abuse during COVID19: A systematic review
Carmita Abdo, Eduardo P Miranda, Caroline Silva Santos, José de Bessa Júnior, Wanderley Marques Bernardo
September 2020, 62(9):337-342
DOI:10.4103/psychiatry.IndianJPsychiatry_1049_20  
Introduction: As COVID-19 develops around the world, numerous publications have described the psychiatric consequences of this pandemic. Although clinicians and healthcare systems are mainly focused on managing critically ill patients in an attempt to limit the number of casualties, psychiatric disease burden is increasing significantly. In this scenario, increased domestic violence and substance abuse have been recently reported. Objective: The objective of this study is to perform a systematic review of the literature regarding the consequences of severe acute respiratory syndrome-CoV-2 infection in terms of domestic violence and substance abuse, and compare incidences found. Materials and Methods: We conducted a literature search using the preferred reporting items for systematic reviews and meta-analyses guidelines. The keywords included “domestic violence,” “substance abuse” AND “COVID-19,” including multiple variants from December 2019 through June 2020. An extensive bibliographic search was carried out in different medical databases: Pubmed, EMBASE, LILACS, medRxiv, and bioRxiv. Titles and abstracts were reviewed according to the eligibility criteria. The risk of bias in the retrieved articles was assessed by the Joanna Briggs Institute's critical assessment instrument. Results: A total of 1505 papers were initially retrieved after consulting the selected databases. After browsing through titles and abstracts, 94 articles were initially included considering the predefined eligibility criteria. After a more detailed analysis, only six scientific articles remained in our selection. Of these, three were evaluating domestic violence against children, while the other three were about substance abuse. Conclusion: There is not enough evidence to support the concept that COVID-19 has led to an increase in the rates of domestic violence and substance abuse. The initial decrease in violence reports might not translate into a real reduction in incidence but in accessibility. Apparently, there has been a slight increase in alcohol and tobacco abuse, especially by regular users, which also requires confirmatory studies. The inconsistency between expert opinon articles and the actual published data could be a result of the limited time since the beginnging of the crisis, the fact that psychitaric patients have been chronically exposed to stressful situatons, and a possible stimulated increase in demand for psychatric consultations.
  7,386 1,230 17
ORIGINAL ARTICLES
Stress and stigmatization in health-care workers during the COVID-19 pandemic
Mikhail Yu Sorokin, Evgeny D Kasyanov, Grigory V Rukavishnikov, Olga V Makarevich, Nikolay G Neznanov, Petr V Morozov, Natalia B Lutova, Galina E Mazo
September 2020, 62(9):445-453
DOI:10.4103/psychiatry.IndianJPsychiatry_870_20  
Background: The health-care workers showed the highest risks of the adverse psychological reactions from the COVID-19 pandemic. Aim: This study aimed to evaluate the structure and severity of psychological distress and stigmatization in different categories of health-care workers during the COVID-19 pandemic. Materials and Methods: This study included two phases of online survey in 1800 Russian-speaking health-care workers (March 30 – April 5 and May 4 – May 10, 2020). The Psychological Stress Scale (PSM-25) and modified Perceived Devaluation-Discrimination scale (Cronbach's α = 0.74) were used. Dispersion analysis was performed with P = 0.05, Cohen's d, and Cramer's V calculated (effect size [ES]). Results: The psychological stress levels decreased in the second phase (ES = 0.13), while the stigma levels (ES = 0.33) increased. Physicians experienced more stress compared with nurses and paramedical personnel (ES = 0.34; 0.64), but were less likely to stigmatize SARS-CoV-2-infected individuals (ES = 0.43; 0.41). The increasing probability of contact with infected individuals was associated with higher levels of psychological stress (probable contact ES = 0.48; definite contact ES=0.97). The highest rates of contacts with COVID-19 patients were reported by physicians (χ2 = 123.0; P = 0.00, Cramer's V = 0.2), the youngest (ES = 0.5), and less experienced medical workers (ES = 0.33). Conclusion: Direct contact with coronavirus infection is associated with a significant increase in stress among medical personnel. The pandemic compromises the psychological well-being of the youngest and highly qualified specialists. However, the stigmatizing reactions are not directly associated with the risks of infection and are most prevalent among nurses and paramedical personnel.
  5,869 824 19
REVIEW ARTICLES
Impact of COVID-19 on mental health: Update from the United Kingdom
Wendy Burn, Santosh Mudholkar
September 2020, 62(9):365-372
DOI:10.4103/psychiatry.IndianJPsychiatry_937_20  
In January 2020, the World Health Organisation (WHO) declared the outbreak of a new corona virus disease, COVID-19 to be public health Emergency of International concern and by March 2020 it had progressed rapidly across several continents to be a pandemic. After COVID-19 was declared a global pandemic the U.K. Government placed strict measures in mid-March 2020 to limit spread by enforcing social distancing, travel restrictions and complete lockdown. In U.K. by end of April 2020 official estimates of confirmed COVID-19 positive cases reached 161,000 and the number of deaths has exceeded 26,000 in hospitals and in care homes. COVID-19 continues to have an impact on all aspects of life in U.K. The Royal College of Psychiatrists (RCPsych), London, a leading professional body of U.K. and global mental health professionals was prompt to act in this public health emergency. RCPsych has issued guidance for clinicians, patients & carers, organised a series of webinars to support members and undertook a membership survey. It has played a crucial role in influencing national policy decisions. This article will focus on mental health impact of COVID-19 pandemic in U.K. and the initiatives taken by RCPsych.
  5,785 879 9
MISCELLANY
Prevention of occupational stress in health-care workers during COVID-19 pandemic
Muhammad Irfan, Farooq Naeem, Muhammad Iqbal Afridi, Afzal Javed
September 2020, 62(9):495-497
DOI:10.4103/psychiatry.IndianJPsychiatry_844_20  
In a humanitarian crisis, healthcare workers are on the frontline in providing their services. Despite being crisis management personnel, healthcare workers may get exposed to occupational stress due to unprecedented circumstances, challenges in delivery of high-quality care, lack of resources, and most importantly for being at high risk to suffer from the impact of the situation itself. Therefore, it is imperative to maintain the mental health of healthcare workers on a regular basis and more so during a pandemic like COVID-19. For addressing the occupational stress in healthcare workers, a Cognitive Behaviour Therapy (CBT) based intervention is suggested, also supported by a Cochrane review, which can build/ improve/ enhance resilience, needed to shield individuals against the development of psychopathology, at the public health level in humanitarian crises. In addition to developing resilience, which will be helpful in combating anxiety, depression, somatization, and incapacitation, CBT will also help in dealing with the social isolation which has been part and parcel of COVID-19 and similar pandemic situations.
  4,625 757 4
ORIGINAL ARTICLES
The psychological impact of COVID-19 on the families of first-line rescuers
Zhiling Feng, Lizhi Xu, Peng Cheng, Li Zhang, Ling-Jiang Li, Wei-Hui Li
September 2020, 62(9):438-444
DOI:10.4103/psychiatry.IndianJPsychiatry_1057_20  
Under the COVID-19 epidemic, the families of front-line rescue workers are under unusual pressure. We aim to understand the extent of their psychological distress in this epidemic and whether they have received sufficient support. Thus targeted to provide support for them and indirectly reduce the concerns of the rescue workers. From February 27 to March 1, 2020, we used the scales of Perceived Stress Scale, 10-items Connor-Davidson Resilience Scale, Generalized Anxiety Disorder-7, Patient Health Questionnaire-2, and primary care-posttraumatic stress disorder (PTSD) to evaluate the mental health level of the family members of front-line rescue workers online. Six hundred and seventy one family members voluntarily filled out the questionnaire after reading the purpose of the study. A total of 671 family members of front-line rescue workers participated in the survey, including 194 husbands/wives, 52 parents, 49 children, 76 brothers and sisters, and 300 other relationships. Among them, 55% of the family members reported sleep problems, 49.0% of the family members had mild, and above anxiety symptoms, 12.2% of the family members reported clinically significant depression symptoms, and 10.4% of the family members may have PTSD, 8.3% of family members had thoughts of self-injury or suicide. The feeling of stress was positively correlated with anxiety and depression, but there was no significant correlation between psychological elasticity and various symptoms. Family members who are more worried about the safety, physical condition and living security of front-line rescue workers are more likely to report symptoms such as sleep disorders, anxiety, and depression. Family members' first-line rescue has a significant impact on their daily life, raising children and supporting the elderly, which is also related to the occurrence of mental and psychological symptoms. During the period of front-line support, they received support from the units or organizations of the first-line workers, mainly including telephone greetings and daily necessities. The top three concerns about the information of the epidemic were the time of the end of the epidemic, the time of the return of the family and the progress of COVID-19's treatment. After the end of the epidemic, what they most want to do is to pay more attention to and accompany their families, family gatherings, and do more exercise. The psychological impact of this epidemic on the families of front-line rescue workers is mainly sleep problems and anxiety. The psychological intervention of family members should mainly start from the relief of stress and increase of material and spiritual support.
  4,409 589 5
REVIEW ARTICLES
COVID-19 pandemic hype: Losers and gainers
Indira Sharma, Mrugesh Vashnav, Reet Sharma
September 2020, 62(9):420-430
DOI:10.4103/psychiatry.IndianJPsychiatry_1060_20  
Background: Ever since the COVID-19 pandemic was declared by the WHO as a Global Public Health Emergency the COVID-19 pandemic has been hyped by the media. Aim: To review the literature on COVID-19 pandemic hype, losers and gainers. Method: Literature on COVID-19 pandemic hype, January to August 2020, was retrieved from pubmed, google scholar and news media, and reviewed. Results: The COVID-19 Pandemic has been hyped directly by highly disturbing messages from the WHO, news of famous people getting infected and dying because of the coronavirus, and highlighted news in media. Indirect hype has been by fake news and verambitious attempt to contain the virus. There have been many losers and gainers of the corona hype. Conclusion: The COVID-19 pandemic hype has caused huge loss to the world community, but substantial gains are also being witnessed. Media coverage should be balanced. Intensive public awareness programs coupled with best possible medical treatment to symptomatic cases are recommended.
  3,180 397 4
Mental health impact of COVID-19: Australian perspective
Kevin Kendrick, Mohan Isaac
September 2020, 62(9):373-376
DOI:10.4103/psychiatry.IndianJPsychiatry_853_20  
Australia's response to the coronavirus outbreak has widely been considered to be among the most successful in the world. A bipartisan “national government” akin to that in wartime, a fairly unified COVID response by the federal and all the state governments, international border closures and quarantine, some of the best coronavirus testing in the world, and widespread public acceptance of physical distancing, all contributed to Australia being able to call itself the “lucky country” in its successful navigation of the COVID crisis. The country clearly had a plan for the mental health consequences of COVID. The impacts of lockdown were identified early, and steps taken to mitigate them. There was no spike in tertiary mental health presentations. Telehealth was embraced, support services mobilized, and public awareness of mental health issues made part of the conversation. While anxiety seemed raised nationwide, much of this lays at a subclinical level, manifesting through activities such as increased consumption of alcohol. Management of the burden of increased nationwide anxiety was carried out through online-based nongovernmental organizations, often directly recommended by the government itself.
  2,611 474 2
“Telepsychiatry” in the time of COVID-19: Overcoming the challenges
Sayuri R Perera, Harischandra Gambheera, Shehan S Williams
September 2020, 62(9):391-394
DOI:10.4103/psychiatry.IndianJPsychiatry_848_20  
Telepsychiatry, the application of telemedicine in the field of psychiatry is defined as the use of electronic communication and information technologies to provide or support clinical psychiatric care at a distance. COVID 19 and its implications related to physical distancing for patients and service providers has made tele- psychiatry and e-consultations an attractive option. Psychiatry, more than any other field in medicine stands to benefit through tele-psychiatry as a physical examination may not be always necessary to arrive at a diagnosis. Some have gone on to suggest that tele psychiatry is likely to replace in person psychiatric assessments pertaining to certain clinical situations. The article reviews the existing evidence for tele-psychiatry and addresses the challenges and pitfalls in the South Asian context.
  2,672 405 4
Mental health in the age of COVID-19, a Mexican experience
Thelma Sanchez, Edilberto Peña, Bernardo Ng
September 2020, 62(9):377-379
DOI:10.4103/psychiatry.IndianJPsychiatry_1048_20  
As of June 2020 the number of Coronavirus cases in Canada, Mexico, Central America and the Caribbean are just under 2.5 million infections and over 140,000 deaths. The health systems in half of the countries in the Americas and the rest of the world have faced the pandemic positioned from different perspectives. While Canada and the United States already had extensive experience in the practice of telemedicine, other countries such as Mexico and the Caribbean, doctors from both private and public sectors have been forced to start practicing medicine remotely. As a result there have been limitations such as poor access to technology, lack of privacy legislation, and difficulties with fee collection among many others. These situations must be taken in account to understand what is happening in the region. On the other hand, the need to continue providing medical attention is indisputable. We understand that COVID 19 besides other systems damages the CNS, patients present severe neuropsychiatric symptoms that range from headache, anosmia, ageusia, confusional state alteration of consciousness, toxic metabolic encephalopathies, encephalitis, seizures, cerebral vascular events, Guillan Barre-type demyelinating neuropathies, to the extent of conditions such as anxiety, acute stress disorder, post-traumatic stress disorder, depression, and eventually psychotic episodes. As time passes we try to differentiate the origin of the symptoms. We will learn which of these symptoms are a result of metabolic complications, which others are due to drug's secondary effects and which ones are adaptive response.Therefor our contribution to the editorial supplements is given in two lines of analysis: disease physiopathology and ways to deliver treatment to the population.
  2,572 493 2
EDITORIAL
Covid 19 and access to mental health care – Need of increased investment
OP Singh
September 2020, 62(9):328-329
DOI:10.4103/indianjpsychiatry.indianjpsychiatry_1140_20  
  2,384 518 2
ORIGINAL ARTICLES
Effectiveness of teleconsultation use in access to mental health services during the coronavirus disease 2019 pandemic in the Dominican Republic
Eddy A Peralta, Marisol Taveras
September 2020, 62(9):492-494
DOI:10.4103/psychiatry.IndianJPsychiatry_1047_20  
Background: The unique aspects of the global situation with respect to the 2019 novel coronavirus disease (COVID-19) pandemic places a significant burden on health and mental health services. During this period, there has been an increased demand in mental health-care services, whose prepandemic access was lower than necessary in many developing countries and is currently limited by international social distancing recommendations and protocols. Aim: This study aims to determine the effectiveness of teleconsultation use to increase access to mental health services, provided by volunteer staff during the quarantine of the COVID-19 pandemic in the Dominican Republic. Materials and Methods: A special telephone service was enabled, organized by different governmental and private entities, in addition, it was published a list of telephone numbers of a team of volunteers consisting of 598 psychologists and seventy psychiatrists, who interacted from March 25 to May 17 with people who needed their help using calls, video calls, and electronic messaging services. After providing mental healthcare, each volunteer completed an online form to record relevant consultation data provided with a total of 6800 interventions to date. Results: Nearly 67.3% of the interventions were requested by women. About 77.8% were adults between the ages of 18 and 59. 27.1% of the interventions were requested by people who worked as health personnel. Forty-six percent of the interventions were requested by people living in the province of Santo Domingo and 4.8% by people living outside the country. Of the interventions, 43% reported anxiety, 26%, sleep problems, 15%, depression, and 2% reported behaviors related to suicide. Of all the interventions, 5.3% required referral to a crisis intervention unit for face-to-face follow-up. Conclusions: The enablement of this teleconsultation model and the number of interventions made during this period of the COVID-19 pandemic, suggests that access to mental healthcare in the Dominican Republic has increased. Problems with anxiety, sleep, and depression are common during the COVID-19 pandemic. Only a small group of patients have needed to be referred for face-to-face care, demonstrating that teleconsultation has been an effective tool.
  2,411 382 7
Effect of lockdown on mental health during the COVID-19 pandemic among individuals attending services at a tertiary care center
Rachana Sharma, Subhash Chandra Sharma, Pawan Sharma, Sudarshan N Pradhan, Pratikshya Chalise, Jaya Regmee, Shaina Sharma
September 2020, 62(9):431-437
DOI:10.4103/psychiatry.IndianJPsychiatry_1038_20  
Background: Lockdown is an emergency measure or condition in which people are temporarily prevented from entering or leaving a restricted area or building during a threat or danger. Since the start of COVID-19 till date, almost one-third of the world's population is under some degree of restriction and lockdown, and the mental health effect of which is something that is being discussed widely. Aim: The study aimed to assess the effect of lockdown on mental health among individuals (patients or accompanying person) seeking services at a tertiary care center. Materials and Methods: Kathmandu Medical College is a tertiary care center and a medical college in Kathmandu, Nepal. In this study, we enrolled every 4th individual coming to the hospital's outpatient department registration counter to seek service and giving consent, for the duration of 1 month during the ongoing lockdown period. A semi-structured questionnaire was developed and approved by the department and was used to collect sociodemographic details and to rate the stress level. The General Health Questionnaire (GHQ-12) Nepali version was used to assess psychological well-being of the participants and a score of ≥3 by binary method was taken as positive case. Results: The total number of cases enrolled in the study was 204, out of them 62.2% were male and 32.8% were female and the mean age was 32.03 years. Twenty-three percent (23.5%) had preexisting health conditions. Out of the 204 participants, 67.6% said they were stressed following the lockdown and the mean rated stress was 2.90 in a scale ranging from 1 to 7. The frequently identified stressors were fear of contamination, restricted movement, and for inadequate supplies. Twenty-seven percent said they had some psychological symptoms and the most common symptoms were palpitation and sleep disturbance. Seventy-three individuals (36.5%) were found to have psychiatric problem according to their scores in GHQ-12. Rated stress and GHQ-12 scores were found to be strongly correlated (P = 0.000). Similarly, those who stated “Yes” in psychological symptoms significantly scored higher on GHQ-12 and stress (both P = 0.000). Conclusion: The lockdown has caused stress in majority of cases, and a significant number of individuals have diagnosable mental health conditions. Mental health impact of the lockdown is something that needs to be addressed seriously.
  2,238 425 2
What mental health experts in Slovakia are learning from COVID-19 pandemic?
Lubomira Izakova, Dagmar Breznoscakova, Katarina Jandova, Vanda Valkucakova, Gabriela Bezakova, Jozef Suvada
September 2020, 62(9):459-466
DOI:10.4103/psychiatry.IndianJPsychiatry_758_20  
Introduction: The COVID-19 pandemic was confirmed to have spread to Slovakia on 6th March 2020. To date of paper submission, it has very favorable course. However, since the beginning healthcare workers have been working under increasing pressure, anxiety and fear. Aim: Authors evaluated the psychosocial impact of COVID-19 pandemic on mental health experts and their clinical practice in Slovakia. Materials and Methods: A total of 157 mental health experts (79% women) submitted their responses via online questionnaire. Results: The most frequent occupation categories were 38.2% outpatient psychiatrists, 26.1% inpatient psychiatrists and 20.4% psychologists. The mental health experts felt maximum of stress during the peak of Slovak COVID-19 crisis, which was identified as the situation just after the declaring the state of emergency by Slovak government. The main sources of stress were statistical data, prognoses and other public presented information. Mental health experts felt mainly personal stress, then general and working stress. They identified also pathological effect of COVID-19 pandemic on the mental status of their patients, especially with anxiety and affective disorders and advantages of use of telemedicine. Conclusion: Psychosocial support in Slovakia was newly organized in COVID-19 pandemic for medical professionals, patients and other inhabitants under high stress within a very short time. This unexpected situation has revealed to Slovakia the need for reform of the mental healthcare system.
  2,258 273 3
Organization of mental healthcare in Bosnia and Herzegovina during coronavirus disease 2019 pandemic
Izet Pajevic, Mevludin Hasanović, Esmina Avdibegović, Alma Džubur-Kulenović, Marija Burgić-Radmanović, Dragan Babić, Nermana Mehić-Basara, Nera Zivlak-Radulović, Goran Račetović
September 2020, 62(9):479-491
DOI:10.4103/psychiatry.IndianJPsychiatry_1044_20  
Background: Coronavirus disease 2019 (COVID-19), like any other pandemic, has imposed an unprecedented threat to physical and mental health to all nations, worldwide. There is no enough evidence in the literature in this area. The present study has been done to explore the organization of psychiatric services in Bosnia and Herzegovina (BH) to meet mental health needs of BH citizens during the particular restrictive measures caused by COVID-19 pandemic. Materials and Methods: This online survey has been done for BH psychiatric institutions. Data were collected from psychiatric institutions in the mental health network of BH. A total of 38 complete responses have been received. Results: Of 38 study participants, three were the departments of psychiatry in university clinical centers, two were psychiatric hospitals, four were psychiatric wards in general hospitals, 27 were community mental health centers, and two were institutes for alcoholism and drug addiction. During the pandemic, all services functioned on a reduced scale, adhering to measures to protect and self-protect both staff and service users. Protective equipment was provided to staff in some institutions in a timely and complete manner and in some in an untimely and incomplete manner. Consultative psychiatric examinations were mainly performed through telephone and online, where it exists as a standard patient monitoring protocol. The application of long-acting antipsychotics was continuous with adherence to restricted and protective measures. In opiate addiction replacement therapy services, substitution therapy was provided for a longer period to reduce frequent contacts between staff and patients. Individual and group psychotherapy continued in reduced number using online technologies, although this type of service was not administratively regulated. An initiative has been given to regulate and administratively recognize telepsychiatry by health insurance funds in the country. A number of psychological problems associated with restrictive measures and fear of illness have been reported by patients as well as by the professionals in mental healthcare teams. There were no COVID-19-positive patients seeking help from institutions that responded to the questionnaire. In one center, infected people with COVID-19 from abroad sought help through the phone. Only one involuntary hospitalization was reported. The involvement of mental health professionals in the work of crisis headquarters during the design of the COVID-19 pandemic control measures varies from satisfactory to insufficient. Education of staff, patients, and citizens was regular with direct instructions through meetings, press, and electronic media. Conclusions: During the COVID-19 pandemic in BH, all psychiatric services functioned on a reduced scale, adhering to measures to protect and self-protect staff and service users. All patients who asked for help have been adequately treated in direct inpatient or outpatient mental healthcare or online, despite telepsychiatric services not being recognized in health system in BH. There were neither infected patients nor staff with COVID-19 in the psychiatric institutions who responded in this research. A large-scale, multicenter study needs to be performed to get a broader picture and to guide us for future better service planning and delivery.
  2,123 350 5
VIEW POINTS
COVID-19 in Peru
Enrique Bojórquez Giraldo
September 2020, 62(9):498-501
DOI:10.4103/psychiatry.IndianJPsychiatry_1045_20  
This article briefly describes the sanitary and mental health situation in Peru prior to the COVID-19 pandemic; the response measures taken by government authorities to confront them, analyzing their successes, errors, and limitations, and finally, some recommendations are made.
  2,033 396 4
ORIGINAL ARTICLES
A comparative study of access to inpatient psychiatric treatment in a public mental health service in Melbourne during COVID-19
Annie Itrat, Karuppiah Jagadheesan, Vijay Danivas, Vinay Lakra
September 2020, 62(9):454-458
DOI:10.4103/psychiatry.IndianJPsychiatry_852_20  
Introduction: Given the paucity of research on how COVID-19 pandemic-associated lockdowns have affected the access to inpatient treatment, the present study was carried out. Aims: This study aims to describe (1) the characteristics of patients who accessed inpatient treatment, (2) the length of inpatient stay and readmissions, and (3) the quality and safety of care as indicated by the type of admission (voluntary/compulsory) and seclusion use during the lockdown period. Materials and Methods: For this comparative database study conducted at North West Area Mental Health Service, the study group included patients who had an admission between March 16, 2020 (starting of social distancing measures in Victoria) and May 12, 2020 (when easing [Stage 1] of social restrictions started). The control group included patients admitted between March 16, 2019, and May 12, 2019. The hospital databases were sources of information. Results: The study and control groups included 104 and 109 patients, respectively. Compared to the control group, the study group had significantly more patients with separated relationship status, a lower number of severe mental illnesses (SMIs), a higher number of substance use disorders, and lower readmissions. A subanalysis within the lockdown period showed more voluntary admissions in the initial phase whereas more compulsory admissions in the later phase at trend significance. Conclusion: Patients with a separated relationship status and a substance use disorder sought inpatient treatment more than others. Aside from exploring the reasons for these findings, it is also important to investigate why SMIs and readmissions decreased during the lockdown period through further studies.
  2,053 344 11
Assessment of anxiety and depression symptoms in the Albanian general population during the outbreak of COVID-19 pandemic
Fatime Elezi, Griselda Tafani, Eugjen Sotiri, Herta Agaj, Kristi Kola
September 2020, 62(9):470-475
DOI:10.4103/psychiatry.IndianJPsychiatry_842_20  
Background: During the COVID-19 pandemic, the Albanian authorities declared mandatory stay-at-home measures, closing businesses, schools, and public places. This study aims to investigate the impact of these immediate changes on the mental well-being of the population. Methodology: Respondents (N = 1678) aged 18–60 years were selected through a convenient sampling method. A questionnaire was administered online for 26 days, where respondents reported the time spent daily in the COVID-19 topic and filled in their generalities, the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7. Results: Findings suggest a significant negative correlation between age and anxiety scoring (r(n=1678)= −0.121, P≤ 0.001) and between age and depression scoring (r(n=1678)= −0.232, P≤ 0.001), shown also on the ANOVA test for age and anxiety (F = 6.019, P ≤ 0.05), where younger populations had higher anxiety levels, as well as age and depression (F = 20.326, P ≤ 0.05), where older populations had higher levels of depression. Differences on the level of education resulted in a lower score of anxiety and depression (F = 3.524, P≤ 0.05; F = 7.739, P≤ 0.05, respectively) on respondents with higher education. Those who found themselves jobless from the pandemic scored higher on anxiety and depression (F = 9.760, P≤ 0.05; M = 6.21, ds = 4.686 and F = 16.051, P≤ 0.05; M = 8.18, ds = 5.791, respectively) compared with those who are still working. Significant differences were found on the ANOVA test related to different amounts of time spent daily on the COVID-19 topic for anxiety and depression (F = 25.736, P≤ 0.001; F = 5.936, P≤ 0.003, respectively), with people who spend <1 h scoring higher on depression (M = 7.57, ds = 5.849) and those who spent >3 h scoring higher on anxiety (M = 6.76, ds = 5.60). On the t-test, people on a romantic relationship scored lower levels of depression (t = −4.053, P≤ 0.0001) compared to single individuals, and females scored higher levels of anxiety (t = 12.344, P≤ 0.001) compared to males. Conclusions: Younger participants score higher levels of anxiety and depression. Higher education individuals show lower levels of anxiety and depression. Having a job translates into lower levels of anxiety and depression. People who spent more time on the COVID-19 topic daily have higher levels of anxiety, whereas those who spent less time have higher levels of depression. Being in a romantic relationship relates to lower levels of depression. Females report higher levels of anxiety compared to males.
  1,820 324 3
REVIEW ARTICLES
Digital psychiatry in low- and middle-income countries post-COVID-19: Opportunities, challenges, and solutions
Farooq Naeem, M Omair Husain, M Ishrat Husain, Afzal Javed
September 2020, 62(9):380-382
DOI:10.4103/psychiatry.IndianJPsychiatry_843_20  
Health systems are adapting to the unique challenges posed by the COVID-19 pandemic. Social distancing has forced clinicians to provide their services through online platforms in high income countries. Similar trends have been noticed in Low and middle-income countries (LAMIC). Digital health can help LAMIC address traditional barriers to care by overcoming issues related to stigma, discrimination, staffing, and physical and geographical resource constraints. Mobile phone subscriptions exceed 80% of the population in many LAMICs. Mobile platforms represent a viable resource in overcoming the significant mental health gap in LAMIC. This paper discusses the enormous potential that digital health has to transform healthcare delivery in LAMICs, as well as numerous challenges to implementation. We also discuss the need to develop national digital health strategies and suggest solutions to some of the barriers.
  1,640 337 5
ORIGINAL ARTICLES
Solutions to prevent and address physician burnout during the pandemic in Mexico
Bernardo Ng
September 2020, 62(9):467-469
DOI:10.4103/psychiatry.IndianJPsychiatry_840_20  
Background: The COVID-19 pandemic has tested the level of preparedness and readiness of governments globally. The demand for services exceeding the capacity of the health systems in both developed and developing countries has been the rule rather than the exception. Physicians and the rest of the health-care personnel have been put through unprecedented levels of demand, within a field of uncertainty, from an evolving and insufficient understanding of the pathophysiology of the viral process, the unclear benefit of face coverings used by the general public, numerous pharmacological candidates, insufficient personal protection equipment, and the highly expected vaccine. Aims and Objectives: Design a program to address the emotional and psychiatric needs of COVID-19 first response Healthcare personnel in Mexico. Materials: in march 2020, the Mexican Psychiatric Association was invited to be part of the Workgroup for the fortification of Mental Health during Disasters of the Ministry of Health in Mexico. The charge was to develop a program to address the needs and prevent burn out in physicians and the rest of healthcare personal. The details of how this program was planned, implemented, and launched will be presented. Results: The program was launched in two phases. Phase A through a chat with text messaging capability was launched on 25 April, 2020. B through telepsychiatric video calls, was launched on 15 June, 2020. Phase A had a very limited demand. Phase B also had a very limited demand until the month 5 September, 2020. Conclusions: from the time of program launch through the first four months, the demand was very low, what may be explained due to “normalization” of stress and/or stigma among healthcare professionals. Our personnel deserve the utmost support from their society.
  1,491 329 1
REVIEW ARTICLES
The self-coping method in online psychological aid at COVID-19 pandemic
Saya Nurmagambetova, Marat Assimov
September 2020, 62(9):414-419
DOI:10.4103/psychiatry.IndianJPsychiatry_1056_20  
Background: Today pandemic has set challenges for psychologists and psychotherapists in providing online first psychological aid to the community. Aim: At such moments, society especially needs psychological support, which should be feasible, short-term, and effective. Settings and Design: A method of self-coping, based on the concepts of behavioral and cognitive psychology. The following principles underlie the method: a person can cope with his/her conditions; the accumulation of unconscious feelings, sensations, images leads to the development of problem states; self-awareness of them through the conscious observation leads to their attenuation and extinction. Materials and Methods: The method consists of five steps. The first step is the differentiation of feelings, sensations, and appropriate images. The second stage is the observation of one's condition related to images. In the third stage, the client observes spontaneous images and related feelings and sensations. The fourth step involves observing spontaneous images. Fifth stage: A client obtains skills of ecological behavior: A person expresses feelings but does not exhibit them in a destructive way. The Add-on tools help at jam up issues. Results: The pre-pandemic experience of using this method has shown high efficiency, comprehensibility, and simplicity. The method has proven its usefulness in online consulting, positively perceived by clients, who note its ease of understanding, training, and use. Conclusion: The method has shown an efficacy during the pandemic and suggested to be effective in various conditions (obsessive/anxiety disorders, eating disorders, alcohol abuse, etc.)
  1,286 288 -
GUEST EDITORIAL
When will the pandemic end?
Mrugesh Vaishnav, PK Dalal, Afzal Javed
September 2020, 62(9):330-334
DOI:10.4103/psychiatry.IndianJPsychiatry_1030_20  
  1,127 222 2
CURRENT THEMES
The Canadian response to the COVID-19 pandemic
Pamela Forsythe
September 2020, 62(9):335-336
DOI:10.4103/psychiatry.IndianJPsychiatry_1039_20  
The Canadian Psychiatric Association (CPA), the national voice of Canada's 4800 psychiatrists and 900 residents, appeared before the Canadian Senate Standing Committee on Social Affairs, Science and Technology by videoconference on June 3, 2020. The Senate committee is studying the federal government's response to the COVID-19 pandemic, and Dr. Georgina Zahirney, CPA president, appeared before the committee to recommend four priorities for Canada in addressing unmet mental health needs.
  1,137 190 -
ORIGINAL ARTICLES
Features of minor depressive disorder subtypes in conditions of COVID-19 pandemic
Shokhrukh Sultanov, Nazira Khodzhaeva, Zarifjon Ashurov, Yekaterina Lyan, Lola Shadmanova
September 2020, 62(9):476-478
DOI:10.4103/psychiatry.IndianJPsychiatry_847_20  
Background: The continuous research on minor depressive disorder is one of the pressing issues in the context of the COVID-19 pandemic. We studied the features of minor depressive disorder subtypes in conditions of the COVID-19 pandemic. Materials and Methods: Sixty-two patients were observed with the administration of clinical follow-up research method. Results: The following major subtypes of minor depressive disorder were identified: Asthenic, hysterical, hypochondriacal, apathetic, and minor depressive disorder with obsessive–compulsive symptoms. Conclusions: The COVID-19 pandemic lead to an increase in the development of the minor depressive disorder with a predominance of asthenic and obsessive-phobic symptoms. Therapy of minor depressive disorder requires the involvement of a wide range of specialists, preferably with the inclusion of community-based treatment.
  1,050 188 1
PREFACE
Preface
M S. V. K. Raju
September 2020, 62(9):325-325
DOI:10.4103/indianjpsychiatry.indianjpsychiatry_1098_20  
  685 162 -
MESSAGE FROM THE PRESIDENT
Message from President Indian Psychiatric Society
PK Dalal
September 2020, 62(9):326-326
DOI:10.4103/indianjpsychiatry.indianjpsychiatry_1141_20  
  705 134 -
MESSAGE FROM THE DESK OF HONY. GENERAL SECRETARY
It is indeed with immense pleasure and happiness that I pen down these lines!
T S Sathyanarayana Rao
September 2020, 62(9):327-327
DOI:10.4103/psychiatry.IndianJPsychiatry_924_20  
  689 130 -
VIEW POINTS
The effects of the pandemic on mental health in Paraguay in a context of social unprotection
Carlos Alberto Arestivo
September 2020, 62(9):502-502
DOI:10.4103/psychiatry.IndianJPsychiatry_854_20  
  635 106 -