Two years on, Covid-19 has taken a severe toll on the mental health of youngsters and psychologists

In March 2020, the World Health Organization declared Covid-19 a global pandemic leading countries to announce lockdowns and take precautionary measures to curb the spread of the virus.

With new variants, such as Delta and Omicron, spreading rapidly and resulting in high mortality rates, Covid-19 or Covid-19-induced state measures (severe lockdowns) took a severe physical, emotional or psychological toll on many.

The rapid global spread of the virus exacerbated mental health concerns across all age groups and social structures, particularly affecting frontline workers, including psychologists and psychiatrists.

The psychological and physical consequences of the pandemic manifested in people’s lives from the extensive changes observed in how society functions. The public health crisis hit individuals economically, with some experiencing unemployment while most – more than 80% in India – reporting a sharp decline in household incomes. Vulnerable groups were reduced to a single meal a day and suffered the worst.

For the more privileged population, the overnight virtual shift of education and service-sector driven operations led to increased feelings of isolation, loneliness, burnout, anxiety, stress and other mental health complications.

During a study from December to February by the Centre for New Economics Studies at OP Jindal University, the research team spoke to doctors, psychiatrists, psychologists, counsellors, and other mental health experts. The purpose of this long, interview-led ethnographic study was to understand the extent to which the pandemic affected the social, physical and emotional development of children and adolescents, and more importantly, how it affected the personal and professional lives of psychiatrists and mental health experts.

According to the United Nations Children’s Fund, or Unicef, there are 2.2 billion children across the world, making up 28% of the global population. Those left out of schools due to shutdowns and forced to adapt to “remote schooling” faced serious challenges.

For most groups, the pandemic aggravated survival concerns amidst an environment of heightened uncertainty. Psychologists and psychiatrists the team spoke to explained how it is difficult to accept the personal consequences of their work on their own lives. This is because of the perception that “psychologists should know how to deal with this”, making it more difficult to speak out about their problems.

They argued that while extensive research, surveys and studies have been conducted to understand how the pandemic affected, for example, the lives of frontline workers and nurses, limited studies or academic discussions focus on the mental health of children and psychologists or psychiatrists.

Children, adolescents

According to the American Psychological Association, “anxiety” is defined as an emotion that is characterised by feelings of worried thoughts, physical changes and tension. The recent months have seen significant cross-sectional research carried out to investigate how Covid-19 and lockdowns affected “children” and the “youth”.

The findings demonstrate that the type and degree of this impact remains influenced by several risk factors, including: developmental age, educational status, pre-existing mental health conditions, and the prolonged experience of being in quarantine because of an infection or a fear of infection.

Even though the rate of Covid-19 infection among young children and adolescents was relatively low during the first few waves, the stress they were under made their mental state extremely sensitive

Based on the research team’s interactions with experts, it was observed that children and adolescents, compared to adults, have increased or prolonged adverse mental health implications, especially during the pandemic. These implications vary depending upon factors including age, socio-economic status, special needs, pre-existing mental health problems, and familial problems.

According to Unicef, more than one in every seven adolescents between the ages of 10 and 19 suffers from a mental health concern, such as anxiety, autism, bipolar disorder, conduct disorder, eating disorders, depression, and intellectual disability and others.

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Before the lockdown, schools were a medium for children and teenagers to interact with their peer groups and mentors. However, over 91% of the world’s student population was negatively affected due to the disruptions in education, physical activity and socialisation opportunities.

Children and adolescents, who are confined to their homes, experienced uncertainty and worry and developed anxiety and stress. The absence of a structured schooling environment has wreaked havoc on their daily routine, increased boredom, and led to a lack of ideas for engaging in academic and extracurricular activities.

“We did get a lot of children affected due to schools being closed or shut down. There was a lot of distress and anxiety in them, and in the pre-schoolers we found a lot of oppositional defiant behaviours [or ODDs],” said Dr Desiree Saimbi.

Oppositional defiant behaviours are diagnosed as a disorder in children that is marked by “defiant” and “disobedient behavior” to authority figures. Its causes are less known but it is likely that it involves a combination of genetic and environmental factors.

Moreover, it was observed that children or young adults from abusive households often found their schools and universities as spaces to escape from the reality at home. Schools, especially in rural areas, also provided children with meals, health services and essential supplies such as menstrual hygiene products in a few areas.

The midday meal scheme, which has played a significant role in increasing enrolment and improving school attendance in many parts of rural and urban India, has also had broader, positive consequences as it is one of the most important measures in ensuring children’s nutritional security.

According to reported data, the midday meal scheme served 9.17 crore students in 11.35 lakh schools across the country in 2018-19. Further, adolescent girls from low-income houses depend on the school-based supply of menstrual products. Due to the restrictions on mobility during the lockdown, there was a sharp decline in the production and distribution of these supplies.

In an essay published during the first wave of Covid-19, a few of us had anticipated that some of these issues, such as nutritional security, would be aggravated during the prolonged lockdown period.

Based on conversations with experts, it was observed that several young children between six to 12 years of age were diagnosed with Attention Deficit Hyperactive Disorder, or ADHD. These children find it difficult to gather and interpret social and environmental cues and struggle to remain in confined spaces, which drives up their levels of hyperactivity along with increased impulses.

Research suggests that almost 46,000 adolescents die by suicide each year. Further, during the pandemic, it was observed that adolescents between 13-19 years of age were diagnosed with several emotional and behavioural disturbances, with many suffering from suicidal ideation.

“Adolescents between the age group 17-19 years, struggle with making decisions regarding their future such as the profession they should pursue. They also face learning problems such as not being able to retain for longer durations thus leading to poor academic grades.”

— Dr Payal Chhoker, clinical psychologist

Research also indicates that several pre-existing and underlying mental disorders were amplified during the lockdown period. For example, there was an increase in Obsessive Compulsive Disorder, or OCD, among children and adolescents. A common symptom of an individual with OCD is hoarding and fear of contamination.

Washing hands was one of the major precautionary measures to be followed with the outbreak of the pandemic. According to the World Health Organization, to reduce the risk of contracting the virus, one had to wash their hands “six times a day”. Such guidelines reaffirmed the beliefs of those diagnosed with OCD and worsened their symptoms.

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Mental health professionals

The burden of Covid-19 was shared by frontline and medical workers as well mental health professionals. Along with the overwhelming changes in working environments across the world, the pandemic led many to seek mental healthcare, causing an increased need for psychiatry services and urgent calls for the provision of mental healthcare.

With a lack of essential resources and guidelines, a shift to the virtual, and implementation of safety measures, psychiatrists had to adapt to changing needs from the confines of their homes.

While imparting mental health services to patients, the consequences of the pandemic such as insomnia, stress, anxiety, loneliness, burnout and grief did not spared clinicians either. However, the conflict between providing mental health support and considering their personal and emotional needs was one of the many challenges professionals grappled with.

Psychiatry services rapidly transitioning to the virtual mode blurred lines between professionalism and personal life. Working from home with an increased demand for mental health services, but no similar rise in income, disrupted the work schedule of many psychologists.

Long working hours, accompanied by the pandemic’s emotional and financial repercussions made it taxing to provide care. Additionally, private practitioners and self-employed psychologists faced immense trouble in maintaining a steady flow of income and ensuring job security due to the shift to digital platforms.

“There is a misconception wherein psychologists are considered mental health professionals first and then as human beings capable of experiencing negativity.”

— Dr Shrishti Sharma, a New Delhi-based psychologist

Providing psychological service requires being non-judgemental, unbiased and clear-headed to prevent personal traumas from interfering in extending support. This led to a dilemma between choosing self-care or providing support to patients. Striking a work-life balance in such cases is essential as the mental health of psychologists can often affect a session with a patient.

Although prioritising one’s own health is essential to maintain good patient-doctor relationships, it can often lead to the emergence of a moral injury. These moral conflicts are defined by negative emotions, such as shame or guilt, that surface by taking work absences, self-isolation or turning down patients to prevent overwhelming office hours and mental strain. This led to a dilemma that caused mental health professionals to take on more than they could handle, leading to burnout and further guilt of being unproductive.

With the intersection of office and personal environments during the pandemic, the emotional detachment from the experiences shared during a session was also a task for mental health professionals. Furthermore, the shared weight of “negativity” experienced by populations worldwide burdened psychologists, making it difficult to prevent the mental baggage of a session with a patient from affecting their personal lives.

Even though experienced during the early phases of the pandemic when individuals were beginning to adjust to drastic global changes, drawing professional boundaries has had positive emotional and mental implications for psychologists. Going forward, psychologists are being encouraged to maintain a healthy approach to self-care, validating personal experiences outside of work, and implementing strategies of coping with the unavoidable effects of the pandemic.

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Summing up

Though young children and adolescents have a low risk of Covid-19 infection, the stress they undergo makes them vulnerable. Children suffer from the detrimental consequences on educational, psychological and developmental progress due to confinement measures such as the shutdowns of schools and other activities for a long period. They also grapple with loneliness, worry and uncertainty.

Further, children and adolescents diagnosed with mental illnesses are not comfortable with sudden changes in their surroundings. As a result, there may be an increase in the number of symptoms and behavioural issues. Access to mental health treatments for children and adolescents has to be improved by leveraging face-to-face as well as digital platforms.

Psychologists have described the pandemic as an “emotional journey” with feelings of happiness at times but sadness, frustration, boredom, rage, embarrassment, and anxiety at others. Many of them complained about a lack of energy and “psychological reserves”, putting them at risk of low productivity and exhaustion. Some mental health professionals have had direct experiences with the catastrophic effects of the virus or have witnessed it affect others.

In contrast, others have not yet had the time or space to absorb these events, resulting in a primary or secondary proxy traumatic response. The pandemic has also been an opportunity for psychologists to make a beneficial contribution to society in various ways.

However, it has to be recognised that while psychologists, amongst many professions, specialise in ways to study the human mind and behaviour, they have not been completely immune to the devastating effects of the Covid-19 pandemic. Undertaking efforts to improve the systemic and individual wellbeing of psychologists will also safeguard and sustain society’s health in the long run.

This is the first of a two-part series of essays from a recent study undertaken by the Visual Storyboard Team of Centre for New Economics Studies, Jindal School of Liberal Arts and Humanities. More information about the Visual Storyboard Team’s work can be found on their website.

Deepanshu Mohan is Associate Professor of Economics and Director, Centre for New Economics Studies, Jindal School of Liberal Arts and Humanities, OP Jindal Global University. Ada Nagar is Senior Research Assistant with CNES. Jignesh Mistry is Senior Research Analyst and Visual Storyboard Team Lead at CNES. Vanshika Mittal is Senior Research Analyst and Visual Storyboard Co-Team Lead at CNES. Rajan Mishra is a Video Editor with the Visual Storyboard Team at CNES and works at Amity University, Lucknow. Mohd Rameez is Senior Research Analyst at CNES. Tavleen Kaur, Isha Khurana, Ruhi Nadkarni are Research Assistants with CNES.