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EDITORIAL
Year : 2020  |  Volume : 13  |  Issue : 6  |  Page : 580-584  

COVID-19 lockdown: Psychological effects


Department of Psychiatry, Dr. DY Patil Medical College, Hospital and Research Centre, Dr. DY Patil Vidyapeeth, Pune, Maharashtra, India

Date of Submission04-May-2020
Date of Acceptance08-May-2020
Date of Web Publication6-Nov-2020

Correspondence Address:
Suprakash Chaudhury
Department of Psychiatry, Dr. DY Patil Medical College, Hospital and Research Centre, Dr DY Patil Vidyapeeth, Pimpri, Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjdrdypu.mjdrdypu_230_20

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How to cite this article:
Chaudhury S, Samudra M. COVID-19 lockdown: Psychological effects. Med J DY Patil Vidyapeeth 2020;13:580-4

How to cite this URL:
Chaudhury S, Samudra M. COVID-19 lockdown: Psychological effects. Med J DY Patil Vidyapeeth [serial online] 2020 [cited 2020 Dec 5];13:580-4. Available from: https://www.mjdrdypv.org/text.asp?2020/13/6/580/300133



With the world facing one of its biggest challenges since World War II amidst the COVID-19 pandemic, countries are coming up with various effective measures to prevent the inexorable spread of the virus in the community. One such measure was the country-wide lockdown announced by the Prime Minister of India on March 24, 2020. At present, some form of lockdown has been imposed on one-third of the worlds' population involving approximately 2.6 billion people (half of them are in India). Apart from small nations like Singapore, no large country has attempted a complete nationwide lockdown, leading some to describe it as “the largest psychological experiment ever conducted.” Surprisingly, China at the height of the Covid 19 pandemic placed only about 760 million people under lockdown.[1]

The lockdown has reduced the spread of the virus but as expected it has had a severe adverse effect on the national economy. Every indicator of economic activity had spiraled down. Central and state government revenues have taken a big hit. At the individual level, best off are those in government service and those who can work from home. For the rest pay cuts, pay holidays, and layoffs rule the roost. Worst off are the daily wage earners for whom no work means no pay; people are stranded away from their families, there is a surge of panic associated with the rising number of cases and death toll in the country; and the uncertainty of how this all ends, plays a crucial role in defining the psychological impact of this crisis. This has led to a sense of insecurity among people whether they would come out of this lockdown with a stable job – or would merely be laid off. This sudden halt of daily activities has severely impacted the mental health of the common man.


  Prevention and Control of Epidemic Top


Prevention and control of a new viral pandemic are a major challenge. Viruses can only be defeated by universal vaccination and antiviral drug treatment of infected persons, and this takes many years. It is a tall order for a new virus since neither drugs nor vaccine are available and their development is not only capital intensive but complicated and time-consuming. Bypassing established protocols of drug and vaccine development are risky and can put thousands at risk of morbidity and mortality. The only intervention capable of immediate implementation are the nonpharmaceutical interventions which by interrupting transmission can give us time to improve medical preparedness to combat the virus. Three types of nonpharmaceutical interventions that can reduce contact rates between infected and susceptible individuals are: quarantine of the infected persons and their close contacts; social distancing to reduce contact within the population; and lockdown of the epicenter to prevent the movement of infected individuals and carriers to other regions.[2]


  Purpose of a Lockdown Top


The justification of lockdown is that by forcibly reducing contact with others, lockdowns temporarily reduce people to people transmission of infection, thereby flattening the curve of new cases and preventing an exponential take-off. Prior to the lockdown in India, Covid-19 positive cases were doubling approximately every 3 days - roughly the rate that other countries have seen without a lockdown. At this rate, it would take only 66 days for the infection to spread from 100 people to 420 million persons. Since the first 100 infections in India occurred by early March, the epidemic would peak by May, which would most likely overwhelm our unprepared health system. Due to the lockdown, the doubling time increased from 3 to 10 days giving us an additional 4 weeks to prepare our health infrastructure. The purpose of the lockdown was to reduce the rate of infection and give us some much needed time. This purpose has been fully achieved. Extending the lockdown will add little value at very great cost. Lockdown is a temporary measure; it cannot and will not stop infections as is being proved daily. It is time to restart the economy, with some important safety measures. It needs to be emphasized that the future spread of Covid-19 in India will be determined not by indefinitely continuing the lockdown but by how efficiently we continue infection prevention and control behavior post-lockdown.[3]


  Lockdowns, Isolation, and Mental Health Top


In view of the use of enforced and prolonged “national lockdown” to combat the Covid 19 pandemic in India, it is imperative to understand its effects on peoples' mental health.

In isolation people cannot easily perform “reality check”– like, for example, whether their thoughts and feelings are congruent or different from that of their friends and contemporaries. Loneliness and feelings of vulnerability promote paranoia and fear. This in turn promotes emotionally charged fantasy, leading to endless speculation in hopeful or fearful terms about the present and the future. We can maintain contact through telephones, television, radio, and the internet. However, experience has shown us that news is biased, fake news abounds on the net and many “experts” have large axes to grind. Moreover, the 24 × 7 news channels repeatedly highlight adversity while good news is glossed over. Every day, the increasing death count is highlighted while the fact that a far greater number are recovering is mentioned in passing. Recently, an Indian channel headlined that the U. S. has ordered 100,000 extra body bags. I failed to understand the utility or importance of this bit of news to us but certainly it would worsen the morale of the audience. Therefore, isolation is always emotionally tough. Add to this, the existential crises faced by us and our loved ones. It is a wonder that more people are not going insane. The longer the lockdown lasts, the greater will be the impact on psychological health.[4]

Apart from fear, anger and hope may drive our thoughts in ways that are unrealistic and unverifiable. The problem with isolation is that one has neither the resources nor the ability to check the truth of our own emotion driven thought processes. For example, during the coronavirus pandemic people are expected to have strong opinions about how the crisis has been and should be managed. Indignation and anger are fully justified if we perceive that the situation is being mismanaged by officials or politicians. However, “mens rea” being more important than “actus reus,” the logic behind the actions are of paramount importance. BUT…how does one know with any amount of certainty the reasons behind the actions – is it knowledge based, an attempt to look decisive or are they overwhelmed by events, is it incompetence or stupidity, or have we misinterpreted them totally? Many of these questions are unanswerable at present in the absence of official explanations for the actions, and spin doctors will ensure that they are never known. This lack of information adds to the confusion and is a source of anxiety and turmoil in its own right. Surprisingly, even our hope can sometimes be a problem.[4]

This is because some, if not many of us seeking salvation are perpetually looking for an all knowing and powerful leader who will show us the way to conquer our helplessness and susceptibility. Such a leader exists only in myths. In real life, all leaders are supported and surrounded by powerful individuals and institutions obsessed with retaining their power and credibility by being seen to make the “right decisions.” Knowing the importance of perception leaders are interested in dramatic actions that catch a large number of eyeballs. They firmly believe that course correction or backtracking is suicidal. Therefore, the underprivileged and voiceless often get platitudes and the worst deal. At the same time, successful leaders have the ability to feel the pulse of the masses. Feeling the undercurrents of anger and resentment in the populace they are quick to redirect everyone's fear, anger, and indignation onto someone else to make sure that it is not focused at them. Hence, a diligent search is performed for a scapegoat, who can be blamed for the people's woes. Mostly, scapegoats are weak and vulnerable people. The worry, anger, and despondency resulting from a crisis is typically not focused at people more powerful than oneself; that would be dangerous – they may retaliate. Thus, powerful negative emotions are usually re-directed at weaker people. This is followed by explanations to validate and defend the persecution. In addition, the scapegoats are also demonized. This is done to justify to themselves and the general public that the persecution is in the best interest of everyone.[4]


  Emotional Reactions to Lockdown Top


COVID-19 pandemic has produced astonishing challenges and mammoth disruptions to our daily lives. As we suddenly lose control over our lives and our futures, we may have overpowering feelings of doom and desperation. During lockdown we may experience five stages of emotional reaction including disbelief, anger, sadness, acceptance, and hope. These are strikingly similar to the stages of grief because both are connected to a profound sense of loss. It must be emphasized that reactions to a crisis vary: Some people will experience no symptoms; few will experience extreme reactions while the majority are in between. In addition, people do not experience emotions in any sort of linear order, and may even move back and forth between the stages.[5]


  Disbelief Top


As a result of the complete lockdown due to Coronavirus pandemic our lives has suddenly turned upside down. Newspapers are missing; you cannot go for a walk, eat out or even go to market. Healthy adults who did not have a moment to spare are now working from home or not working at all. A situation like this was unimaginable even two months back. Faced with these momentous changes the first psychological reaction of most people is disbelief, how can all these things happen to us. As reality sinks in people are able to overcome this stage.


  Anger Top


Grief on the death of a loved one is often laced with anger; similarly a feeling of anger at the loss of usual freedoms coupled with the sudden upheaval foisted on us by the coronavirus crisis is normal. One must recognize that this anger is counterproductive and a knee jerk reaction; the best option is to relinquish anger and to accept the situation.


  Sadness Top


Adjusting to this, totally new reality is painful to all and extremely painful to some. During this period of crisis, all persons will suffer from periods of low mood and be tearful. We must accept that tears are normal reactions to shock and change; they serve a purpose and they usually pass very quickly as we come to terms with the new reality.


  Acceptance Top


Worry and uncertainty about the new routines is perfectly normal and expected, be it working from home or loss of job, home schooling, house husbanding, or seeking support from the government. However, humans have immense power of adaptation and resilience and most people quickly accept and adjust to the new reality.


  Optimism Top


Acceptance is associated with a marked reduction in worry, anxiety, and stress. This is accompanied by changes in the nervous system which under stress was in an adrenaline-fuelled “fight or flight” mode. Now the brain regains its normal state which presumably is, or should be dominated by rational thinking. We are able to rationally appraise our situation, face the world with optimism and look for constructive solutions of our problems. Now, we start thinking about the positives brought about by this crisis-things like spending more time at home with family and being present for big milestones in our children's lives, since the pressure of the rat race has been relieved for people.[5]


  Psychiatric Effects of Lockdown Top


People under severe stress and in isolation commonly exhibit various symptoms of psychological stress and disorder-including low mood, insomnia, stress, anxiety, anger, irritability, emotional exhaustion, depression, and post-traumatic stress symptoms.[1] For some people, especially the elderly and the homemakers, socializing is a major part of their routine – sudden withdrawal of which can cause a restless mental state and sense of loneliness. There has also been an escalation or relapse of symptoms in known cases of psychiatric illnesses such as depression, anxiety, and psychotic disorders including Schizophrenia. This could be linked with the inaccessibility to their ongoing medication or a general state of panic created by the pandemic. Social isolation also creates sensory deprivation and a general sense of paranoia which may strengthen their delusional ideas and fantasy thinking. The fear that they or their family members may contract the illness may act as a stressor and predispose the vulnerable population into a psychological breakdown. The easy access to social media and news only leads to a greater panicked state.

Increased occurrence of psychiatric disorders following disasters is well known.[6] Epidemics are associated with a host of comorbid psychiatric disorders including anxiety, panic, depression, and trauma-related disorders.[7] Quarantine is associated with higher stress levels, irritability, depression insomnia, acute stress, and trauma-related disorders,[8],[9],[10],[11],[12],[13] Furthermore, being quarantined is associated with acute stress[12] and trauma-related disorders,[13] particularly in specific at-risk populations such as health workers.[14]

Regarding the COVID19 pandemic, a Chinese study involving 1210 persons reported the prevalence of anxiety and depression as 30% and 17% respectively.[15] An additional Chinese national survey of over 50.000 people reported a 35% prevalence of posttraumatic stress symptoms (PTSS). Significantly higher psychological distress was seen in women and young adults.[16] An internet-based survey of 18147 Italians respondents revealed the prevalence of PTSS, depression, anxiety, insomnia, high perceived stress, and adjustment disorder was 37%, 17.3%, 20.8%, 7.3%, 21.8%, and 22.9%, respectively. Any recent COVID-related stressful life event, job loss, being woman and younger age were associated with all of the selected outcomes. PTSS, high perceived stress, and alcohol dependence syndrome (ADS) were associated with having to work more than usual. An association of PTSS, anxiety, and ADS was found with quarantine.[17]

Doctors as well, are at high risk. Besides, the clinical pressure medical professionals face every day at work, they are also considered as first in line of contact and hence a high risk group. Countless working hours, lack of safety kits, inadequate information, and a callous attitude from the patient population and their relatives can inflict a sense of hostile work environment. Fortunately, studies indicate that doctors are a resilient lot. The evaluation of 470 health-care workers in two tertiary care centers in Singapore with the Depression anxiety stress scale (DASS-21) and the impact of events scale-revised (IES-R) revealed that 14.5% screened positive for anxiety, 8.9% for depression, 6.6% for stress, and 7.7% for PTSD. Nonmedical health-care workers had significantly higher prevalence of anxiety, significantly higher mean DASS-21 anxiety and stress subscale scores and higher IES-R total and subscale scores, implying that psychological counseling given to this vulnerable group may be beneficial.[18]


  Concluding Remarks Top


Although the Government is relentlessly trying to make this lockdown period easier by making essential goods and services available to every citizen, the implementation of the policy at best is patchy. Much more needs to be done. In these difficult times, there are a few measures one can take individually to sustain their psyche:

  • Access COVID or pandemic related information from authorized government portals made available to the general public – which show correct information of the current scenario
  • Raise awareness of your family related to the infection and prohibit them from spreading false information/ways to prevent the illness on social media
  • Maintain a schedule and try to stick to it to alleviate the sense of uncertainty and unproductivity. Do not fall prey to the pressure of coming out of this lockdown having learned a new skill/refined hobbies. Remind yourself that this is a global crisis and you surviving it on a day-to-day basis in itself is an achievement
  • Stay in frequent touch with your family which is now a child's play with evolving technology – their smiling faces will give you a sense of security and a consolation as to everyone you care for is safe and secure
  • Gain information about government helplines which provide counselors for people facing difficulty in coping or suffering from a mental health crisis
  • In the end, reassure yourself that you are helping just by staying at home and following government protocol. This too shall pass.




 
  References Top

1.
van Hoof E. Lock Down is the World's Wiggest Psychological Experiment and We will Pay the Price. World Economic Forum; 09 April, 2020. Available from: https://www.weforum.org/agen da/2020/04/this-is-the-psychological-side-of-the-covid-19-pande mic-that-were-ignoring/. [Last accessed on 2020 Apr 28].  Back to cited text no. 1
    
2.
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Laxminarayan R. Why it is Time to end Covid-19 lockdown. Financial Express; 28 April, 2020. Available from: https://www.financialexpress.com/opinion/why-it-is-time-to-end-cov id-19-lockdown/1941587/. [Last accessed 2020 May 02].  Back to cited text no. 3
    
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5.
Murphy A. The Five Emotional Stages of Sockdown and how to Cope with Each one in the Face of COVID-19-So which one are you in? Daily Mail Australia; 6 April, 2010. Available from: https://www.dailymail.co.uk/femail/article-8190399/The-five-emotional-stages-coronavirus-lockdown-impact-mental-health.html. [Last accessed on 2020 Apr 16].  Back to cited text no. 5
    
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Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al. The psychological impact of quarantine and how to reduce it: Rapid review of the evidence. Lancet 2020;395:912-20.  Back to cited text no. 8
    
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  In this article
   Prevention and C...
   Purpose of a Loc...
   Lockdowns, Isola...
   Emotional Reacti...
  Disbelief
  Anger
  Sadness
  Acceptance
  Optimism
   Psychiatric Effe...
  Concluding Remarks
   References

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