With the declaration of the COVID-19 pandemic and cries for social distancing ringing out loud across social media, the news of the Coronavirus outbreak has adversely impacted the emotional and mental health of individuals.

Two deaths by suicide, allegedly linked to the pandemic, have been reported in India. In what was though to be “the first death by suicide anywhere in the world linked to the coronavirus outbreak”, a 50-year-old man died by suicide after becoming convinced that he had contracted the virus and would invariably infect his family members.

According to the deceased’s son, his father would continuously watch coronavirus-related videos circulating online.

On March 18, a 35-year-old man, suspected to be a coronavirus patient, died by suicide at Safdarjung Hospital. Fears surrounding the fast-spreading contagion are thus, raising concerns of mental well-being, globally.

Stress and anxiety levels have witnessed a marked increase across the world. The World Health Organisation (WHO) has also acknowledged the rising stress among the population, publishing an advisory on “mental and psychosocial well-being during COVID-19 outbreak.”

In India too, there has been an increase in general stress levels, anxiety and frequency of panic attacks. Pragya Lodha, Program Director at The MINDS Foundation, told The Citizen that while there are no official statistics to quote yet, the coronavirus pandemic has led to an estimated 20-30% rise in cases. The MINDS Foundation is an organisation that works at the grassroots to eliminate the stigma surrounding mental illness through education, training and providing cost-effective, quality care.

The virus outbreak has resulted in individuals experiencing anxiety for one’s health, worrying about recovery, “extra precautious behaviour” and “hypochondrial reactions”, Lodha stated. With health experts prescribing precautionary self-isolation to prevent community transmission of the virus, people are also experiencing a “fear of social isolation, being lonely, financial lockdown, constraints at home and general lock down... accompanied by feelings of low”, Lodha said.

A study on the psychological impacts of quarantine, published in the medical journal, The Lancet, suggests various negative effects such as symptoms of post-traumatic stress, confusion and anger. Some of the stressors the study highlights include fears of infection, a longer quarantine duration, frustration, boredom, inadequate information, lack of supplies, financial loss and stigma.

Lodha stated that under quarantine, “one may feel disconnected and alone”. “People used to having a routine and used to working do worry and feel restless with a sudden standstill in their routine. People have also worried over financial crunching with the lockdown.” Many experience a restlessness with their life coming to a standstill, she said.

One of the primary fears associated with the outbreak, that is also leading to an increase in anxiety among the population, is the possibility of being a carrier and inadvertently infecting one’s family members and others in close contact.

Safia (name changed) told The Citizen that the thought of becoming an asymptomatic carrier of the virus and infecting her immuno-compromised father (above 60 years of age) has led to many bouts of anxiety. “If I were to cause it for him, then I just wouldn't be able to live with myself,” she said.

Safia has been experiencing high levels of anxiety for the past few weeks. As “the numbers got worse and the cries for social distancing got stronger”, Safia’s anxiety reached a peak this Monday. The build-up of having to ask for work-from-home and anticipating an “irrational response” contributed to her rising stress.

“I went out on the weekend, and then I began reading a lot. I suddenly felt very guilty that I hadn’t been staying at home—I had been going to work, I had been going out,” Safia said.

“Till then, my response was, why stay at home? By that logic you will just be at home for the next six months. But as I started reading up, I couldn't stop thinking about it, and then couldn't sleep. I began feeling extremely anxious. I think the lack of sleep contributed to it,” she told The Citizen.

With the “overload of information, there is also this blurry grey area of disinformation”, Safia stated. This flow of constant information often creates a state of panic among the population. To combat this, Lodha highlighted the importance of seeking and forwarding trusted information, such as “from government sources rather than just WhatsApp forwards”. “One must spread only the correct information known about COVID 19 rather than creating a panic about the same,” she said.

While the WHO guidelines suggest, ”Minimize watching, reading or listening to news that causes you to feel anxious or distressed”, Safia stated that this was not an option for her as she works at a news organisation. “I work in the news, so it's very hard to not read about more coronavirus news.”

Safia said that everyone’s response to her has been to tell her to “Calm down”. “But, it’s not easy to calm down… If being paranoid will lead me to be cautious, so be it,” she said.

Deleting social media applications such as Instagram and attempting to work on non-coronavirus related work projects are all ways in which Safia attempted to manage her anxiety levels. However, what has helped her the most has been staying at home.

“Being at home definitely helps because I'm not constantly worrying about whether my hands are clean, how I'm going to commute. Resigning myself to home and actually practising isolation and social distancing not only makes me feel a little more in control of myself and my family, but also this larger idea of flattening the curve and setting a precedent and just having less carriers—that being me—out there,” she said.

“It has to be understood that self quarantine may have to be done for protective reasons, for self and others,” Lodha told The Citizen.

For persons who have been diagnosed with mental health conditions before, self-isolation can be a cause of great concern. “Though one may feel further inflicted and may dwell in negative affect and overthinking, peers and family should provide constant support in all ways possible,” Lodha stated.

Further, with the increase in “anxiety and low moods”, anti-anxiety and antidepressant medication have been serving as “helpful emergency treatments”, Lodha said. There has also been a spike in online therapy, according to Lodha. “Online sessions have been a solace to many and have definitely been a resort in times of social isolation.”

To deal with the fears surrounding the COVID-19 pandemic and the negative effects of social isolation, Lodha suggested keeping in touch with one’s family and friends to help ease the stress. Sticking to one’s routine while at home and finding time to invest in hobbies and personal learning can be useful ways to tackle one’s anxiety.

Lodha further emphasised the importance of seeking professional help in case one is experiencing an increase in stress and anxiety.