Psychiatric sequelae of COVID-19 - A Looming Mental Health Crisis

Dear Editor,

The COVID-19 Pandemic laid a tremendous impact on the mental well being of all rungs of people, be it the general public, Covid- 19 survivors, health care and front line workers etc. It is not surprising to expect grave repercussions in the Post Covid period in the form of a rise in the number of people suffering from psychiatric illnesses.¹

Factors responsible for a rise in mental health issues post COVID recovery are long term effects due to the pandemic, burden on health care professionals, restrictive measures i.e quarantine and socio economic effects associated with it and long term behaviour changes such as social distancing, vigilant hand washing and stigma. Stigma associated with Covid-19, fear of getting infected and stress due to loneliness are the main culprits responsible for mental health issues during quarantine. In addition to this, anxiety, depression, obsessive-compulsive disorder, confusion, anger, insomnia, social exhaustion is also evident among people. Closure of schools and care centres is a trigger factor for anxiety among children with dysfunctional family dynamics and domineering parents. People who are already in a Toxic/ Abusive relationship at home are likely to experience more extreme violence at home during the pandemic as they no longer have any chance to escape.²

Pre infection prevalence of psychiatric disorders has increased rapidly to 3% after 31 to 50 months of SARS-Co. Among the survivors about 54.5% were reported with PTSD (post traumatic stress disorder), pain disorder -36.4%, panic disorder -32.5%, OCD (Obsessive compulsive disorder) -15.6% of people and psychological symptoms are likely to persist for several years among the heathcare workers.%^3,4

About 1/3^rd (33.62%) of recovered patients were facing long-term psychiatry/neurological problems reported in the largest retrospective study involving more than 236,000 COVID-19 survivors after 6 months of COVID-19 diagnosis. Mood disorders, Substance abuse disorder, anxiety disorders and other Psychotic problems are being reported in the people as post Covid 19 Psychiatric manifestations.⁵

Orrù G et al. reported the loss of concentration and significant levels of insomnia after COVID-19 recovery.⁶ Mandal S et al. reported that 14.6% had depression after COVID-19 recovery in their long COVID study.⁷ Venturelli S et al. reported that 30.5% were experiencing post-traumatic psychological consequences after COVID-19 recovery.⁷ Al-Aly Z et al. reported that after COVID-19 recovery, people are experiencing sleep disorder and disturbances and increased level of anxiety, stress and fear-related disorders.⁹

Previously, few scientists reported that inflammatory syndrome (lymphopenia, raised C-reactive protein (CRP), tumor necrosis factor (TNF)-alpha and interleukin (IL)-6) had been postulated as a cause for emergent psychosis in schizophrenia and schizophreniform psychosis. The theory mentioned above can be applicable to COVID-19 since the inflammatory syndrome was also observed in COVID-19.¹⁰

During COVID-19 and Post COVID-19, there is a need for early assessment and screening of the patients for mental health problems. It's the time to improve healthcare access in every nook and corner of the country by utilising the advantage of tele medicine. As Covid-19 has laid a heavy toll on health care professionals, they must be provided with psychological, social and mental support during these times. There is an urgent need for making guidelines and protocols for the treatment and prevention of Post COVID-19 psychological problems. So, each country specific psychiatry societies can take up the task to formulate culture specific guidelines, which suits their needs.

In conclusion, a universal approach by promoting mental health wellness by following a healthy diet, regular physical activities (walking, yoga and exercises), mental health awareness campaigns, community support (stay connected with people and maintaining good relationships), maintaining adequate mental health services, and finally a combined effort from government and non-governmental organizations (NGO's) to fight against the current global mental health crisis - a parallel pandemic to COVID-19.

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