This document discusses the impacts of COVID-19 on mental health based on a presentation by Sarita Neupane. It outlines that the pandemic has caused increased rates of mental health issues like depression, anxiety, insomnia and substance abuse both in the general population and among healthcare workers. Nationwide surveys in China and Nepal found about 30-50% of respondents experienced psychological distress during the pandemic. Vulnerable groups like children, elderly, and those with pre-existing conditions are particularly at risk. The document also discusses WHO guidelines for addressing acute and long-term mental health effects during and after the pandemic.

1. IMPACTS OF COVID-19 ON MENTAL HEALTH
Presented by:
Sarita Neupane
Little Buddha College of Health Science

2. Prepared by:
Sarita Neupane
Time: 45 minutes

3. Outline of presentation
● Objective of presentation
● Overview of COVID-19
● Introduction of Mental Health
● Effects of COVID on Mental Health
● Data of mental health during the pandemic
● WHO guidelines for Mental health
● Conclusion

4. Objective of presentation
● To overview the situation of COVID -19
● To discuss about the Mental health during the pandemic
● To discuss the National and international scenario of the impacts of COVID-
19 in Mental Health
● Education,COVID-19 and Mental Health
● Consequences of COVID-19 on Mental Health
● To explain about the WHO guidelines on Mental Health during COVID-19.

5. Overview of COVID-19
● A novel coronavirus named severe acute respiratory
coronavirus 2 (SARS-CoV-2) was first identified in a seafood
market in Wuhan City, Hubei Province in China, at the end of
2019
● The contagious respiratory illness caused by this novel
coronavirus is called coronavirus disease 2019 or, in short,
COVID-19
● From February, COVID-19 cases soared across most of
Europe, the United States, Australia, Asia and on to Africa.
● Until now, the novel coronavirus continues to wreak havoc on
daily life around the globe, affecting …..countries, infecting
……...and killing …….people (until……….; Worldometer,
2020

6. Mental Health

7. Mental Health
State of well-being in which the individual:
✔ Realizes his/her own abilities
✔ Cope with normal stress of life
✔ Can work productively and
✔ Able to make a contribution to community
Mental Illness
Any disease or condition that affects way a person
thinks, feels, behaves and ability to relate to others
and to surroundings

10. Introduction
● COVID-19 pandemic is turning out to be a major
stressor for most of the humanity. Never has such an
event affected so many individuals all across the globe.
● The initial focus is necessarily on the physical
consequences of the infection.
● There is recognition that the significant psychological
consequences emerging out of this catastrophe need to
be addressed.
● The mental health issues began emerging almost
immediately after the WHO declared COVID-19 a
Public Health Emergency of International Concern in
January 2020.

11. ★ There are many factors which make the healthcare providers
vulnerable to mental distress such as high risk of contracting the
infection, heavy workload, inadequate protection against
contamination, frustration and poor social support as well as feeling
of isolation from the general public.
★ A nationwide survey of China found that almost one-third of the general
public have experienced certain psychological distress due to COVID-19

12. Effects of COVID on Mental Health
★ The general population is also at the high risk of mental distress.
★ An online survey performed among 4872 participants from 31
provinces of China during the first week of February 2020 found that
almost half, i.e. 48.3 % (95% CI: 46.9%-49.7%) of the participants
had experienced depression and 22.6% (95%CI: 21.4%-23.8%) of the
participants had a certain level of anxiety, which were positively
associated with frequent exposure to social media during the COVID-
19.

13. Global scenario of COVID-19 prevalence with mental health status
Source : Data comes from "The Impact of COVID-19 on College Student Well-being," a survey conducted by the Healthy
Minds Network and the American College Health Association.

14. Source: https://www.weforum.org/agenda/2020/05/what-risks-does-covid-19-pose-to-society-in-the-long-term/

15. Source : https://www.weforum.org/agenda/2020/05/united-nations-global-mental-health-crisis-covid19-
pandemic/

17. Source: https://cmha.ca/news/warning-signs-more-canadians-thinking-about-suicide-during-
pandemic

18. Harm and types of suicide
● According to Emile Durkheim, the term suicide is
applied to all cases of death resulting directly or
indirectly from a positive or negative act of the victim,
which he/she knows will produce this result (Pickering
& Walford, 2011).
● Durkheim identifies three different types of suicide
which are,
egoistic
suicide
anomic suicide
fatalistic
suicide.

19. Egoistic
suicide
• Egoistic suicide is seen as stemming from the absence of social integration. It is
committed by individuals who are social outcast and see themselves as being alone or
an outsider.
• These individuals are unable to find their own place in society and have problems
adjusting to groups. They received little and no social care. Suicide is seen as a solution
for them to free themselves from loneliness or excessive individuation.
Anomic
suicide
• Anomic suicide is caused by the lack of social regulation and it occurs during high levels
of stress and frustration. Anomic suicide stems from sudden and unexpected changes in
situations. For example, when individuals suffer extreme financial loss, the
disappointment and stress that individuals face may drive them towards committing
suicide as a means of escape.
Fatalistic
Suicide
• Fatalistic suicide occurs when individuals are kept under tight regulation. These
individuals are placed under extreme rules or high expectations are set upon them, which
removes a person’s sense of self or individuality. Slavery and persecution are examples of
fatalistic suicide where individuals may feel that they are destined by fate to be in such
conditions and choose suicide as the only means of escaping such conditions. In South
Korea, celebrities are being put under strict regulations.

20. Public health importance of Suicide
● The economic and human cost of suicidal behavior
to individuals, families, communities and society
makes suicide a serious public health problem
around the world.
● Suicide is estimated to contribute more than 2% to
the global burden of disease by the year 2020.
● Suicide is a multifaceted problem and hence suicide
prevention programs should also be
multidimensional.
● Collaboration, coordination, cooperation and
commitment are needed to develop and
implement a national plan, which is cost-effective,
appropriate and relevant to the needs of the
community.
● In Nepal, suicide prevention is more of a social and
public health objective than a traditional exercise in
the mental health sector.

21. Status of Mental Health during COVID-19 in nepal
❏ According to the Nepal police a total 2218 people committed the sucide
during nationwide lockdown.
❏ 20 people committed sucide per day during nationwide lockdown in Nepal.
❏ But the health export exclaim that the number could be higher as several
sucide attempt are not reported to authority concern.
❏ Before the pandemic the number of the sucide cause was an average of 400
per month or 13 death per day.
❏ The investigation by the expert found a combination of depression,
domestic violence, financial worries,and reduce access to health care service
are primary cause of sucide.

22. Status of Nepal during lockdown
❏ A media survey was conducted during the time
of lockdown between April 23 to May 3 by
Transcultural Psychosocial Organization (TPO)
to study the social impact of COVID-19.
❏ Almost 50 percent of the participants reported
having at least one psychosocial problem,
whereas, 32 percent reported having two or
more psychosocial problems ranging from
restlessness, fearfulness, anxiety, worry and
sadness.

23. Contd...
❏ People are consuming alcohol as a
coping mechanism, which has
further added to the existing mental
and physiological distress. This has
led to numerous death accounted for
alcohol poisoning and the cases of
domestic violence and abuse.
❏ The Women’s Rehabilitation Center
(WOREC) a national organization
of Nepal recorded that, during the
time of lockdown form 24 March
2020 to 9 May 2020, there have
been 231 reported cases of
violence against women and girls at
24 districts of Nepal . Source: ????

24. ❏ The World Health Organization (WHO)
2016 estimates that the crude suicide rate
for Nepal stands at 8.8 suicides per
100,000 populations.
❏ At the time of lockdown from 24 March
to June 6, 2020, in 74 days of lockdown
it has been estimated that the suicidal rate
has been increased by 20 percent as
1,200 cases of suicide throughout the
country has been reported.
❏ This illustrates almost 17 lives have been
lost per day due to suicide during the
period of lockdown.

26. Source:https://myrepublica.nagariknetwork.com/

27. COVID, Education and Mental Health
❏ As of April 8, 2020, schools have been
suspended nationwide in 188 countries,
according to UNESCO.
❏ Over 90% of enrolled learners (1·5 billion
young people) worldwide are now out of
education.
❏ The UNESCO Director-General Audrey
Azoulay warned that “the global scale and
speed of the current educational disruption is
unparalleled”.

28. Impact on a student’s mental health
❏ Students experience reduced motivation toward
studies, increased pressures to learn independently,
abandonment of daily routines, and potentially higher
rates of dropout as direct consequences of these
measures.
❏ Thus, by increasing academic stressors in a population
with heightened pre-existing stress levels and a
potentially reduced ability to rely on typical coping
strategies – such as family who themselves may be
experiencing heightened distress – the COVID-19
pandemic has placed an unprecedented mental health
burden on students, which urgently requires further
examination and immediate intervention.

29. Virtual class and its
consequences in Nepal
❏ The Government of Nepal though has decided to
introduce a digital education system to continue
the teaching learning process, and this has further
burdened parents with the load of school fees and online internet fees.
❏ It is further stressful for parents with a low income who have to struggle for daily
wages and do not have proper internet access, as it compromises the learning needs of
their children.
❏ Parents have found themselves trying to educate bored, distressed children from home with
marginal support from school authorities; meanwhile, children and young adults have been
unable to continue the educational and social development which they would normally
receive in a school setting.

31. Phases of Mental Health Issues
Mental health issues noted in biological disaster zones including
COVID-19 can be classified as:
Acute phase - during
the outbreak (
approximately 2-6
months)
Long term phase -
after the control of
the outbreak (>6
months )

32. Phases of Mental health of COVID-19
a. Acute phase (during the outbreak):
● Issues to be dealt with include
immediate mental health impacts such
as
○ Fear,
○ Denial,
○ Anxiety,
○ Insomnia,
○ dissociative symptoms,
○ suicidal ideas/attempts,
○ substance withdrawal and
○ relapse of pre-existing mental health
problems.
b. Long -term phase(after the control
of the outbreak):
● Issues commonly presenting include:
○ Grief
○ Survivors guilt
○ Depression
○ Substance use
○ Relapses of pre-existing mental
illness
○ PTSD
○ Somatization disorder

33. Vulnerable Population
● Children
● Senior citizens
● Pregnant women
● Person with disability
● Homeless individuals
● Poor social support and lower economic status
● Life threatening chronic medical conditions like
cancer,chronic renal
failure,Asthna/COPD,immuno compromised
patients
● History of severe mental illness and wandering
mentalli ill

34. Common Stressors
➢ The rising death toll in various parts of the world is creating a sense of panic.
➢ Survival guilt among those who suffered from the illness.and might have
infected others.
➢ The prospect of losing employment and sources of income facing losses and
even horrific specter of closing down of the business
➢ Inability to pay room rent

35. Contd….
➢ Not being able to place food on the table
daily
➢ Infodemic:the overabundance of
misinformation about the Coronavirus,
especially on social media
➢ Social distancing has become a major
stressor for the youngsters
➢ Mental health issues surrounding food:
inability to buy groceries, vegetables,fish,
meat, eggs,and dairy products

36. Other Mental Health problems due to COVID
Anxiety Disorder
Generalized Anxiety Disorder
Panic disorder Phobias Obsessive Compulsive
Disorder(OCD)

37. Anxiety disorder
● Many forms of Anxiety disorders are
expected in the aftermath of COVID-
19.
● The emergence of these symptoms can
occur even during lockdowns periods
due to fear/anticipation of an infection.
Generalized Anxiety Disorders
● It is characterized by excessive
worrying and persistent free-floating
anxiety

38. Panic disorder
● It is characterized by recurrent
unexpected attacks of severe anxiety
(panic attacks) that reach a peak within
a few minutes and last for a few more
minutes.
● This is associated fear of having more
attacks (anticipatory anxiety) of
avoidance of triggers of panic attack.

39. Phobias
● Most commonly certain people can
excessively develop fear of crowds in the
wake of COVID-19 ( DUE TO FEAR OF
INFECTION).
● In certain cases,if there is excessive
avoidance of crowds to the point of being
housebound it is called agoraphobia.
● In all these phobic states, anxiety
symptoms are triggered only in particular
situations and are accompanied by strong
avoidance of the situations that trigger
fears.

40. Obsessive compulsive disorder (OCD)
● OCD is also expected to increase in the
aftermath of COVID-19.
● To ensure that subjects reduce transmission of
infection,they have been bombarded with public
health message to wash repeatedly to reduce
contamination.
● Subject with OCD also experience repetitive
thoughts that they are
contaminated(contamination obsessions) and
wash repeatedly to reduce anxiety
(compulsion).

41. Severe Mental illness
● In individuals already suffering from such
conditions, there could be a relapse or worsening.
● Common symptoms:
➢ Unexplained irritability/aggressive behaviour
➢ Talking or smiling to self
➢ Suspiciousness
➢ Hearing voices when nobody is
around(hallucination)
➢ False beliefs(delusions)
➢ Poor self-care

42. Effects of COVID on Mental Health

44. Common Worries during COVID-19
Falling ill & Dying
fear of being infected
Mistaken by COVID
19
Avoiding to
seek Health
facilities
Powerlessness
Helplessness
Boredom & Loneliness
Relieving
Traumatic events,
Previous
epidemics
Fear
Indecisiveness
OR Problematic
Behavior
Cognitive Difficulties

51. WHO guidelines for Mental Health

54. Conclusion
● COVID-19 pandemic is turning out to be a major cause of mental health for
most of the humanity.
● Combination of depression, domestic violence, financial worries, and reduce
access to health care service are primary cause of suicide during the
pandemic in Nepal.
● Education and its effect on the mental health of the students have been the
major problem in most of the countries.
● Stay connected with others while practicing physical distancing can be the
better coping mechanism for stress.

55. References
My republic , Retrieved from https://myrepublica.nagariknetwork.com/news/author/880
Mental Health Concern during COVID-19 Pandemic in Nepal, Retrieved from
https://www.researchgate.net/publication/342690766_Mental_Health_Concern_during_COVID-
19_Pandemic_in_Nepal
WHO guidelines on mental health, Retrived from
https://www.who.int/publications/guidelines/mental_health/en/
Corona update of Nepal , Retrieved from
https://www.worldometers.info/coronavirus/country/nepal
Education,COVID-19 and Mental Health
https://www.thelancet.com/journals/lanchi/article/PIIS2352-4642(20)30109-7/fulltext
https://www.healtheuropa.eu/covid-19-and-mental-health-at-work-and-school/102085/