When Sumith* recently came to Dr U Vivek, a consulting psychiatrist at Renai Medicity in Kochi, he had an odd request. He wanted Dr Vivek to write him a prescription for hand sanitisers. “Sanitisers are in high demand due to coronavirus, and the pharmacist was only willing to sell him sanitisers if he got a prescription. The patient was willing to pay double the price too. He was obsessively washing his hands through the day; and the rate at which he was using the sanitiser, a bottle would not have lasted more than a day,” Dr Vivek tells TNM.
Meanwhile in Bengaluru, 42-year-old Seema* walked into an appointment with Dr Satish Ramaiah, a consultant psychiatrist at the People Tree Maarga Multi-Speciality Hospital. The last time she had consulted with him was two years ago. “She had recently started washing her hands obsessively, and developed a habit of counting on her fingers. Only once she had counted like that 10-12 times would she feel at ease that her family would not contract coronavirus,” Dr Satish tells TNM.
While Sumith has an anxiety disorder, Seema has lived with Obsessive Compulsive Disorder (OCD) for almost a decade. She was managing it quite well, and had even discontinued coming to Dr Satish for the last two years until last week. “She had anxiety and many questions about coronavirus when she came now. She was worried about relapsing into her OCD,” Dr Satish says.
The coronavirus pandemic has also been spreading in India, with health officials scrambling to treat people with COVID-19, contact tracing, and monitoring those suspected to have the disease. At the time of writing, there are at least 75 people who have tested positive for coronavirus in the country. And the resulting panic around the disease is having a mental health impact as well, particularly on those with underlying mental health issues.
TNM spoke to mental health practitioners on how the COVID-19 pandemic is affecting Indians, and what can be done to take care of one’s mental health in such a time.
Increased anxiety and related behaviours
Both Dr Vivek and Dr Satish have seen patients who have anxiety disorders with exacerbated symptoms after the coronavirus outbreak. “One type of patients are those who have called in repeatedly, asking if they can come out of their homes, or just take medication at home, or if they are likely to get coronavirus disease. The second type of patients are those who are prone to develop anxiety. They may display avoidance behaviours – stop going out of the house, stop sending kids to school, panic if just one person sneezes or coughs around them,” Dr Vivek says.
Meanwhile, Dr Satish has seen at least 3-4 people in the last week who have OCD, and are having more obsessive thoughts about coronavirus. “Those who have an obsession with handwashing or germs have seen worsening of their symptoms. There are also millions of people who may not have anxiety disorders, but have anxiety traits and obsessive behaviour regarding some things. Anxiety can stem from anxiety traits or triggers – and COVID-19 is definitely a trigger for some,” he explains.
There is also increasing fear and anxiety among a section of the elderly, observes Tanvi Mallya, founder of Tanvi Mallya's ElderCare Services in Mumbai. The death rate of seniors is much higher if affected by coronavirus – according to the Chinese Centre for Disease Control and Prevention, the mortality rate in those above 80 years was almost 15% by February 11, 2020. The rate for those under 30 was drastically lower, at less than 2%.
Pointing out that anxiety is part of neurodegenerative disorders like dementia, Tanvi says that they have been seeing elders – who either have only mild cognitive impairment or are still at a stage in their neurodegenerative disease where their comprehension is unaffected or less affected – getting more anxious about COVID-19.
“We are getting more and more questions about coronavirus from them. And in some, the panic around the disease has worsened the symptoms of degenerative diseases like dementia. Those who read are aware they are at a higher risk. Many may not even actively discuss it, but their restless behaviour has increased. We will see them walking around the house more often, work obsessively in the household, or they are more irritable or short-tempered than usual. Some, after weeks of anxiety, have also cancelled travel plans,” Tanvi says.
But how does one know when someone is crossing the line of preventive and precautionary behaviour against the novel coronavirus into something that could potentially be a mental health issue?
The logic is the same as what qualifies a normal emotion – such as anxiety and sadness – to be qualified as a mental illness. “When such behaviour starts affecting your functionality and daily life is when it becomes a mental health issue. So, with regard to coronavirus, broken sleep to check for fever or rashes, loss of appetite and interest in other things, obsessively washing hands, frequently changing clothes, hoarding food supplies for months are all signs that the behaviour has moved beyond normal precautionary measures,” Dr Vivek explains.
Mental healthcare practitioners anticipate that coronavirus-induced anxiety is only going to grow as more cases come to light. Gajalakshmi, a Chennai-based clinical psychologist, also anticipates that if supplies run out – as it is happening with masks and hand sanitisers – it could exacerbate the stress and fear among people.
Managing your mental health
While it can be scary to be living in these times, there are steps that one can follow to take care of their mental health and that of those around them.
The mental health practitioners TNM spoke to suggested that people must follow credible news sources on the coronavirus pandemic, and try to stay away from social media and news coverage if they find themselves overwhelmed.
When it comes to the elderly, Tanvi points out that they are likely to have more free time, so the constant rumination of an idea happens a lot more for them. “Physiologically, because we work, interact with more people outside our homes, the anxiety has some outlet. The elderly have limited activities to distract and engage them in comparison. Family members can try to filter out triggering news, and restrict conversations around COVID-19 if they find the elderly member getting affected mentally and emotionally,” she says.
“It is also a good idea to focus on some of the positive aspects – such as the actions being taken by authorities to treat and contain the virus. You can also talk about the recovered patients – which is most of them. Highlight reassuring facts, because anxiety stems from worst case scenarios. Encourage preventive measures and constructive discussion,” Tanvi adds.
Dr Satish suggests asking yourself if the fear and anxiety that you are feeling is disproportionate compared to the situation. “For example, the group that is majorly affected at this point are travellers. If neither you nor someone in your family has that travel history and have been taking precautions, then you do not need to worry. Don’t suppress or fight the anxiety, but try to disassociate it from it a little – attribute it to your anxiety traits. It will help you view things from a distance and can put you at ease.”
The World Health Organisation (WHO) and Centre for Disease Control and Prevention (CDC) have also released advisories on mental health and coping with the coronavirus pandemic. Some of the pertinent suggestions include the following:
- Switch off from excessive media coverage or distressing news of COVID-19. Check the news on the disease at specific times in the day once or twice rather than constantly.
- Seek information mainly to take preventive and practical measures to guard oneself and loved ones from the disease.
- Take care of your health – meditating, eating healthy, exercising, sleeping well.
- Do activities to unwind, take breaks, stay connected with loved ones and maintain healthy relationships.
- Amplify positive stories and images of people who have been affected by the novel coronavirus and have recovered, or those who have supported a loved one through this journey.
*Not their real names