World Mental Health Day

By Dr. Sameer Malhotra in Mental Health And Behavioural Sciences

Nov 07 , 2020 | 7 min read

We are living in challenging times. The 21st century has witnessed growing materialism, consumerism, competitions, change in lifestyle, increased pace of life, impact of media and gadgets, change in family structure and dynamics, and associated stress. On one hand, there are increasing distractions and demands on an individual and on the other shrinking support systems. Impatience, Excessive grudges, substance /drug and alcohol dependence,   focus on getting rather than giving, time pressures, less sharing and caring , difficulties in maintaining work life balance, over dependence on technology, decreasing human contact have all contributed to poor quality of life and relationships, dissatisfaction, distress, disharmony, frustration and dysfunction. 

Alongside, the uncertainty and the impact on health/ life and economics associated with the COVID -19 pandemic has led to significant stress. The world is not only going through a physical impact of COVID -19 but is also simultaneously going through the emotional/ mental impact of the pandemic. 

In its endeavour to understand the effects of the pandemic on the mind health of our population, the Department of Mental Health & Behavioural Sciences at Max Hospital Saket under the guidance of Dr Sameer Malhotra conducted 2 web based surveys, one on adults and the other on adolescents

The COVID 19 pandemic has posed significant challenges. It has stirred the world scientifically, emotionally and spiritually. 

It has defined a new way of life with limited needs, some discipline and need to introspect. It has given some time to nature to heal itself. 

It has checked the super fast pace of life, the greed to get more and more, the superficial approach, the meaningless race that we were getting driven into. It has given us time to reconsider our priorities individually and collectively as a society, to create and develop strong family bonds, to feel greatness of Nature and gratitude towards all that it has offered. COVID pandemic and associated needful restrictions in lifestyle have impacted the mental health of people. The role of healthy coping abilities becomes all the more relevant during this phase.  Not only do the emotional experiences, emotional expressions/reactions, and associated behavioural symptoms impact the individual, they also impact the family members, and society at large.
Negative emotional expressions and behaviour can lead to altercations and negative home environment, marital discord, family discord which can intern breed psychiatric disorders, poorly reflect on the quality of life and predispose one to aggressive and suicidal behaviour.

The studies highlight a need for emotional, academic accommodations (including reduction in volume/ chapters), occupational (stability of employment, relaxation in working hours) and financial support mechanisms (relaxation in taxation, relaxation in the amounts and duration of payment of bills (electricity, water), check on price rise, positive role of insurance companies to be able to provide adequate coverage in spirit) to help ease the burden perceived during this testing time.

The mind and body are known to be strongly interlinked. Significant stress impacts both the mind as well as the body. Significant emotional distress is known to be linked to significant disturbance in the immune system predisposing one to the risk of infection. Negative mindset can negatively impact the ways of handling stressful situations and associated outcomes.

There is a need to encourage the development of healthy coping mechanisms and holistic wellness through community mental health programmes across age groups and socio-economic strata.

There is a need for promoting, regularly conducting and expanding mental health programs across educational Institutions aimed at sensitization of students, teachers, parents and administration.

There is a need for strengthening value-based education using the ‘caring-concern and sharing’ approach to help develop healthy coping abilities. The focus of education should be centred on defining constructive meaning and purpose to one's life, development of healthy personal goals and objectives , with relative ease of pursuing a meaningful and constructive career . This shall help in adding meaning and purpose to one's life.

Further there is a need to expand mental health programmes across public and private sector organizations to help in sensitization towards mental health needs, prevention of psychiatric ailments, for early conflict resolution and early recognition and treatment of psychiatric ailment without the fear of being stigmatized.

There is also a need to develop and nurture healthy coping abilities, problem solving approach, sense of empathy, gratitude and concern for others.  Encouraging healthy physical activity, sports, mindfulness, yoga, meditation, association with nature, and healthy lifestyle (healthy nutrition and sleep wake cycle), healthy communication shall be helpful in building mental health.

There is a need to develop and nurture empathy and an attitude of gratitude and need to adequately reward service providers including medical and paramedical services, sanitary workers, teachers, and other essential workers and service providers.

The studies highlight the need to cater to mental health needs alongside the physical concerns arising out of the pandemic. The same needs to be catered through a well integrated sensitive approach.

This year the theme for the World Mental Health Day rightfully emphasises the need for and importance of Mental Health for All: Greater investment - Greater Access so as to reach out to Everyone, Everywhere. As no person and no society is immune to mind related problems. 

With approximately ‪1/5th of the world's population residing in India addressing mental health needs would be important to make a global impact in reducing the burden experienced by the individual and the family,  and society at large towards psychiatric problems.

Over the last few decades there has been an increase in suicide rate among population. In 2016 suicide accounted for the most common cause of mortality in the age 15- 40 years.

According to WHO, 8,00,000 people die from suicide every year. The age standardized suicide in India for women is  16.4 per 1 lac population and 25.8 per 1 lac for men. According to the National Crime Records Bureau, a total of 1,39,123 suicides were reported in 2019 in India.

Suicide is a preventable cause of death, it is associated with risk factors like marital and family disharmony, relationship stress/break-ups,  significant financial stress, loneliness, lack of social support systems, feeling isolated and hopeless, significant depression and anxiety symptoms, significant feelings of insecurity and major psychiatric disorders like mood disorders (major depression, bipolar disorder), obsessive compulsive disorder, psychotic disorders; alcohol and other substance use disorders, personality inadequacies, inability to control one’s impulses, lack of concern and support available from family and social network and lack of meaning an purpose towards life.

Over a period the society has witnessed a shift from community living/ joint family set up to nuclear families and subsequently individual living, staying away from family for long duration in isolation to pursue educational or career opportunities, increase in the aging population without the comfort/ security of their children staying with them, growing materialism, consumerism and unhealthy competition have added to insecurities in one’s life and vulnerability towards psychiatric problems.

The study on adults covering over a thousand participants from across the country revealed that over half were going through significant anxiety symptoms and over 1/4th had significant depressive symptoms. Approx. 10% of those depressed had frequent suicidal thoughts. Over 50% were worried  about health of family and self, and over 40% were worried wrt financial issues , significant number were also worried about future uncertainty.  Over half  of the participants were spending 1-8 hours per day on consuming news related to COVID-19. The common coping strategies used included : staying connected to friends and family (reported by 77% participants), indoor hobbies and constructive activities (reported by 2/3rd ), Spending some time in mindfulness and meditation (1/3rd) .

The study on adolescents (aged 15-19 yrs) covered over 200 participants, mostly from urban settings. Approximately over half of the participants were residing with family members in the vulnerable age group wrt to COVID-19 (i.e., <5 year of age, >65 years of age). Approximately 87% of the adolescents had sufficient knowledge about COVID and related precautions. Over 90% of 

the adolescents were majorly concerned about the safety and well-being of themselves and their family, 63.3% were also concerned about the future of COVID-19 and environment, 54.5% (over half) were concerned regarding their education/career and 27.8% (over 1/4 th) were concerned regarding finances.Approximately 1/6 th did not participate in household chores. Of the over 93%. Adolescents who were currently attending online educational classes , majority (60.1% ) were concerned about excess screen time, about half (49.4% ) were concerned about reduced understanding due to technical errors and 41.1% were concerned about their change in motivation.Approx. 46.8% of the adolescents were in favor of reduction in the amount of course work, 12% were in favor of extension of study year and 26% in the favor of both post lockdown.

57% of the participants were stressed about college and career opportunities post COVID-19 and about 4.5% believed that COVID-19 influenced their choice of career.

Contd findings of adolescent study: • 71.8% reported disturbed sleep wake cycle and 58% reported a change in their eating habits.

• 53.5% reported decline in exercising, however 49% reported pursuing more hobbies.

• 61.8% respondents reported an increase in use of social media, 39.5% reported an increase in online gaming and 76.6% had an increase in time spent on their mobile phones.

• 47.8% reported engaging in self-counseling and self-talk during COVID.34.2% of them felt withdrawn from studies more than usual

Try to build resilience through healthy lifestyle ( healthy balanced diet, regular exercise, regular healthy sleep-wake schedule) , positive self help skills, engaging in constructive hobbies, developing a positive helpful attitude, living mindfully and taking difficulties as challenges with a sportsman spirit. Try to understand, recognise and help the one”s in distress and don’t shy away from seeking timely professional help. Remember most of the psychiatric problems are treatable.