THE COVID-19 PANDEMIC: DEPRESSION, ANXIETY, STIGMA AND IMPACT ON MENTAL HEALTH

Abstract


World Health Organization (WHO) declared the COVID-19 «outbreak a public health emergency of international concern», characterized it as a pandemic in order to emphasize the gravity of the situation and urged to take actions in detecting the infection and preventing its spread. The article considers the issues related to the occurrence of fear, depression, and stigmatization, analyses the causes of these phenomena, and identifies practical solutions for addressing mental health issues related by the precipitate coronavirus (COVID-19 Pandemic). During the quarantine, taking care of your mental health is essential more than ever, as one needs to remain calm, not stressed, and promote a positive well-being. Fear and self-stigmatization in both long-term and brief periods of isolation and loneliness can have negative consequences on both physical and mental well-being. Stigma can also create mental distress following the quarantine. Social and emotional support should be given to family members by mental health professionals.In addition, the author concludes that in order to maintain the mental health, it is necessary to examine the unique contribution of the salience of positive aspect stigma. A number of concrete scientific and organizational approaches to improve the actual situation were proposed.

Full Text

Introduction The history of mankind has been marked by the influence of various epidemics of infectious diseases. The introduction of a self-isolation regime, the quarantine, for a long time in society can cause, in addition to the most important advantages for our somatic health, long-term effects of mental and psychological health disorders, as well as unpredictable social effects for the whole society [1]. The word “quarantine” comes from the XIV century. The Italian quarantino is formed from quaranto, “forty” - for such a number of days, travelers arriving in Italian port cities had to stay in isolation. The practice originated in Ragusa, Italy (today Dubrovnik, Croatia): in 1377, a law was introduced on the trentino, a thirty-day isolation of new arrivals. Later, other cities began to do so, and the trentino was extended to quarantine. According to some versions, the forty-day period referred to biblical events: this is how long the Flood and the temptation of Christ lasted. The emergence of quarantines in Medieval Europe is surprising: the infectious theory did not exist at that time. A calamity of this magnitude could only have caused the wrath of a god angry with sinners. Divine punishment, by all accounts, spread through the miasms of the air, and the technology for the formation of these disease-causing air principles has been widely discussed. According to one version, the culprit was the Etna volcano in Sicily - it was through this island that the plague got to Europe. The Centers for Disease Control and Prevention (CDC) defines quarantine as “separating and restricting movement of the people who have been exposed to a contagious disease to see if they then become ill». The infectious diseases have not only affected the physical health but also the psychological wellbeing of people [2]. Materials and methods A systematic literature search was carried out to identify relevant studies: 9 studies were identified and included in the review, including 5 qualitative, 2 quantitative, and 2 mixed method studies. Results For us, social psychologists, as well as doctors, this is the most important issue. There is a large number of studies that have examined this problem during and after epidemics. It has been found tout hat quarantine can be a factor of an acute stress [3] that can support mental health under such circumstances (Asmundson & Taylor, 2020) with symptoms of anxiety, depression, and posttraumatic stress disorder being the most often reported in general (Brooks et al., 2020; Chew et al., 2020). Outbreaks of infectious diseases (COVID-19 and others) may be associated with depression, anxiety, guilt, grief, stigma, and post-traumatic stress (Brooks et al., 2020; Chew, Wei, Vasoo, Chua, & Sim, 2020; Lau et al., 2005) In research, Hawryluck et al. (2004) found out that people who were quarantined during SARS reported a high level of psychological distress. Clearly, being social is a human tendency that facilitates social interaction, and thus, psychological distress results (Usher et al. 2020). Van Bortel et al. (2016), and Kumar and Nayar (2020) have suggested that issues of mental health should be considered and also addressed to as anxiety, stress, fear, trauma, helplessness and other psychological issues are experienced during a pandemic [4]. Self-isolation also affects the psychological health of people and can cause post-traumatic stress. Comparison of PTSD symptoms in parents and quarantined children with those who were not quarantined found that mean PTSD scores were four times higher in children who were quarantined than those who were not in quarantine. About 28% (27 of 98) of the parents quarantined in this study reported sufficient symptoms to warrant a diagnosis of trauma-related mental disorder, compared with 6% (17 of 299) of the parents who were not quarantined [5]. The results highlight the need for tailored interventions that offer parents effective strategies in dealing with stigma through social support and self-esteem. Increased anxiety levels and fear are attributed to a sense of personal vulnerability, rapidly changing prevention guidelines, the separation from friends. The coronavirus outbreak has led people to engage in social distancing as a critical way to contain the spread of the illness. We are faced with a completely different kind of fear, previously unknown and not lived by us, this is the fear of a pandemic and quarantine. The isolation imposed by quarantine frequently leaves people feeling that they have no control over the situation Uncertainty triggered by the rumors may drive them even more anxious, fear and self-stigmatization. To be particular, mental health pressure originated from multiple populations, such as older adults, medical staff, and youngsters, have invoked the specific exploration of various studies. The fear of COVID-19 is also related to its novelty and the lack of faith in the health care system is likely to fuel fears about the consequences of becoming infected. The fear and mental health pressure at some points can lead to self-stigmatization. The term stigma dates back to the Greeks, who cut or burned marks into the skin of criminals, slaves, and traitors in order to identify them as tainted or immoral people who should be avoided. Today, stigma is not merely a physical mark, an attribute that results in widespread social disapproval -a discrediting social difference that yields a “spoiled social identity…”, stigma is a mark (attribute) that links a person to undesirable characteristics (stereotypes). Stigma is an attribute that conveys devalued stereotypes. Stigma is a general aspect of social life that complicates everyday microlevel, stigmatized “at least in some connections and in some phases of life” [5]. Erving Goffman’s early elaboration of the concept, psychological and social psychological research has considered how stigma operates at the microlevel, restricting the well-being of stigmatized individuals. More recently, sociologists have considered the macro-level dimensions of stigma, illuminating its structural causes, population-level consequences, and collective responses [6]. Stigma occurs in social interactions. Patrick W. Corrigan, Kosyluk, K. A. and Watson, A. S. added the stigmatized group’s perspective to Goffman‘s model review of the stigma reduction literature and argue for approaches involving a targeted, local, credible, and continuous contact with stigmatized people as a means of reducing public stigma (Corrigan & Watson, 2002), (Corrigan, P. W., & Kosyluk, K. A., 2013), (Corrigan, P. W., Kosyluk, K. A., & Rüsch, N., 2013) [7-9]. The origin of stigmatization lies in the cognitive representations that people hold regarding those who possess the stigmatized condition. These cognitive representations or features of a stigmatized condition can trigger negative emotional and behavioral reactions (Dijker & Koomen, 2003; Weiner, Perry, & Magnusson, 1988). High levels of perceived severity evoke both anxiety and sympathy on the part of people (Crandall & Moriarty, 1995; Feldman & Crandall, 2007; Van Alphen, Dijker, Bos, Van den Borne & Curfs, 2012). Like public stigma, self-stigma has cognitive, affective, and behavioral components (Mak & Cheung, 2008) and operates at both the explicit аnd at the implicit levels (Rusch, Corrigan, Todd, & Bodenhausen, 2011). Public stigma impacts the self in through internalized stigma, which is the reduction of self-worth and accompanying psychological distress (Herek, 2007, 2009). In medicine, this term was used to denote “a conspicuous symptom of the disease” [10]. An interesting research of neuroscience has much to offer stigma researchers and examines the processes, underlying stigmatisation in the brain, of various forms of stigma at the more implicit level (Amodio, 2010; Dovidio, Pearson, & Orr, 2008) [11]. The stigmatization of people with mental illnesses has been recognized by international agencies such as the World Health Organization and the World Psychiatric Association as an important public health and human rights problem. The analysis of the literary sources on the problem of stigmatization allows us to conclude that the problem of stigmatization is relevant for a variety of social categories. The results highlight the need for tailored interventions that offer parents some effective strategies in dealing with stigma through social support and self-esteem. For any type of stigma, its owners go through a similar experience - the experience of a person, not the same as other “normal» people. While each circumstance is unique, looking at past events can provide a look into the psychological impact that quarantines may have. Between 2002 and 2004, more than 15,000 people in Toronto voluntarily went into quarantine due to exposure to severe acute respiratory syndrome (SARS). All of those surveyed reported they felt isolated while in the quarantine as a result of the lack of social and physical contact with others. People felt cut off from the rest of the world because they were unable to do normal activities [12]. Stigma can also create a mental distress following quarantine. The study found out that 29% felt other people avoiding them after they had been in the quarantine [3]. The science community has an important role to play in preventing and stopping stigma surrounding people. Discussion The level of stigma associated with COVID-19 is based on three main factors: -it is a disease that is new and that still contains a lot of unknown facts; -we are often afraid of the unknown; -it is easy to associate that fear with ‘others’. Stigma can undermine social cohesion and prompt possible social isolation of groups, which might contribute to a situation where the virus is more, not less, likely to spread. This can result in more severe health problems and difficulties controlling a disease outbreak [13]. Stigma predicts a psychological distress and a lower quality of life. Stigma can: -drive people to conceal the illness to avoid discrimination; -prevent people from seeking health care immediately; -discourage them from adopting healthy behaviours [13]. The stigmas of mental illness are of two kinds. The first is social stigma when others hang a psychiatric label on a person and begin to prejudice him. The second type is self-stigmatization. It is a person's reaction to his own mental illness and the status of the mentally ill in society. The research on depression stigma is needed to gain more insight into the underlying construct and to reduce the level of stigma in the community. Stigma can also be “subtle” and arise as nonverbal expressions of discomfort (e.g., a lack of an eye contact) (Goffman, 1963). Goffman’s main contribution was “that he recognized commonality across a wide variety of social stigmas and illustrated how each one is dynamically interwoven into the fabric of social interaction. He also acknowledged that stigma represents a dilemma for the nonstigmatized who interact with and are sometimes related to people with a stigmatized condition” [7, 14]. The research on depression stigma is needed to gain more insight into the underlying construct and to reduce the level of stigma in the community. In recent years, stigma has been recognized by the science community, makers and organizations as an important public health issue and several initiatives and interventions have been developed for reducing stigma in society [15]. The World Health Organization (WHO) compares depression to an epidemic that has engulfed all of humanity: depression has already come out on top in the world among the causes of absenteeism, and on the second place among the diseases leading to disability [16]. According to the WHO forecasts, in 2020 depression will come out on top in the world among all diseases, overtaking today's leaders - infectious and cardiovascular diseases. Even today, it is the most common disease that women suffer from. Only the coronavirus pandemic is able to delay this forecast for some time. According to various sources, in Russia, from 5 to 15% of the population suffer from depression, and this figure, according to experts' forecasts, will grow. Moreover, 50 years ago, the number of cases was 10 times less [16]. Women fall ill with depression twice as often as men (20-26% versus 8-12%, respectively). The findings of empirical studies sampled with 1257 Chinese heath care workers demonstrated that women (nurses, and frontline doctors in Wuhan) were more affected by depression, anxiety, insomnia, and distress than men(Lai et al., 2020) [17]. One of the most common theories is that the rise of the Internet use has directly or indirectly resulted in a host of mental health problems. Self-stigmatization can significantly affect feelings of shame and lead to poorer treatment outcomes. Fear and self-stigmatization in both long-term and brief periods of isolation and loneliness can have negative consequences on both physical and mental well-being. Self-stigma reflects the social and psychological impact of possessing stigma. It includes both the apprehension of being exposed to stigmatization and the potential internalization of the negative beliefs and feelings associated with the stigmatized condition [13]. The results of our research highlight the need for tailored interventions that offer parents effective strategies in dealing with stigma through social support and self-esteem [10]. The stress and coping theory is commonly used as a framework for an empirical investigation of caregiving experiences. Per this theory, an appraisal, or the evaluation of the negative/positive aspects of a stressor, mediates one’s reaction to the stressor. One of the components of an appraisal is salience, or how much an experience stands out as prominent or important. In the study by Muralidharan A, Lucksted A, Medoff D, Fang LJ, Dixon L. the stigma measure focused on frequency of family members’ thoughts about stigma-related experiences, such as hiding their relative’s mental illness or not knowing how to explain it to others. Importantly, this measure does not examine how often family members experienced stigma-related stressors, only how salient such stressors were [18]. The salience of stigma-related experiences was inversely related to general family functioning, but unrelated to family problem-solving or incendiary communication. The general family functioning scale includes several items related to mutual provision of an emotional support and acceptance (e.g., “We confide in each other,” and “During a crisis, we turn to each other for support”). The importance of experiences associated with a stigma was inversely related to the overall functioning of the family, but was not related to solving family problems or incendiary communication. The general scale of family functioning includes several items related to mutual provision of an emotional support and acceptance (for example, “We trust each other” and “During a crisis, we turn to each other for support”). The extended quarantine brought psychosocial stressors to children and adolescents, such as fears of infection, tediousness, annoyance, lack of an in-person contact with peers and teachers, of which the Chinese government should raise the awareness (Wang, Zhang, Zhao, Zhang, & Jiang, 2020) [19]. The Chinese universities have resorted to supporting risk management, which consists of raising medical supplies, carrying out specialized medical research, conducting innovative online teaching, and providing psychological assistance, which have abstracted the devastating impact on psychology (Wang, Cheng, Yue, & McAleer, 2020) [19]. Conclusion During a quarantine, taking care of your mental health is essential more than ever, as one needs to remain calm, not stressed, and promote a positive well-being. Mental health and resilience on personality of isolation can all play a role in ability to cope with a quarantine. To examine the unique contribution of the salience of stigma-related experiences: a discrimination stigma, a disclosure stigma, and a positive aspect stigma, perceived stigmatization and individuals' experiences of depressive symptoms, self-esteem, and resilience. Studies have shown that beyond public and self-stigma, a stigma can also impact family members. Media is an important vector for public messaging that may lead to a stigma (both negative and positive). Both the content and the way of reporting seem to play important roles. Prompt and accurate information to ease the psychological stress deserves attention (Ioannidis, 2020). In our opinion, we all need to be intentional and thoughtful when communicating on social media showing supportive behaviors around the new coronavirus disease (COVID-19). Misinformation is spreading more quickly than the current outbreak of the new coronavirus. This contributes to negative effects including stigmatization. Stigma and fear around communicable diseases hamper the response. It is necessary to continue the research and to examine the unique contribution of the salience of stigma-related experiences: a discrimination stigma, a disclosure stigma, and a positive aspect stigma, perceived stigmatization and individuals' experiences of depressive symptoms, self-esteem, and resilience [20]. A mental illness stigma is a potent source of distress for a personality, families and an important target of social services. We focus on the prominent role of the civil society in the prevention of stigma and mental health. Some of the brightest among them are non-profit organizations that take part in solving almost all social problems [21]. Since the beginning of the coronavirus pandemic, hundreds of thousands of Red Cross volunteers have been working in Europe and other continents (Red Cross), the activities of which are related to providing psychological assistance to victims [22]. Doctors Without Borders is channeling aid to all countries hardest hit by the coronavirus and is strengthening an infection control through its own programs [23]. Studies of infectious disease outbreaks in general can provide a basis for understanding the potential impact of COVID-19. The pandemic has made demands for services, including medical services [24]. The impact of long-term exposure to stigma requires a deeper understanding of the mental health processes of stigmatisation. The research on the interrelatedness of different manifestations of stigma benefited from the collaboration between different disciplines. Although the social psychological research on stigma reduction is growing, many stigma researches of the mental health processes lack a sound theory and methodology. Comprehensive and detailed evaluations of stigma reduction interventions and, in particular, of their respective components are therefore warranted of the mental health processes. Кnowledge of both shared and unique stigma mechanisms can inform the development of strategies designed to reduce psychological and physical health disparities.

About the authors

T. P. Lipai

Minsk City Institute for the Development of Education

Email: lipai@tut.by

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