Asian Journal of Psychiatry 51 (2020) 102127
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Asian Journal of Psychiatry
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Letter to the Editor
Pakistanis’ mental health during the COVID-19
Through this correspondence, I aim to highlight the secondary
crisis-in-making which is mental health and psychosocial issues which
mark the need for psychological crisis intervention during COVID-19
outbreak. Mental health and wellbeing are substantial foundations of
healthcare and thus identification and mitigation of these issues is vital
for healthy psychosocial functioning of individuals and community.
This paper identifies potential mental health issues and proposes to
adopt behavior modification to adapt with the quarantine, social isola-
tion and social distancing. Pakistan should introduce psychological
crisis intervention program (see Mukhtar, 2020). Pakistan (7025 con-
firmed cases) contracted coronavirus (COVID-19 – Coronavirus Disease
2019) through the arrival of overseas Pakistani (students, zaireen,
visitors and pilgrims) from other geographical locations to Pakistan.
Pakistan’s (fifth most populous country) basic family unit is extended-
consanguine family system with multiple generations living together
and thus in collectivistic culture such as this practicing social distancing
poses a challenge on mental health of all family members. Community-
dwellers depend on social support through family interaction and cul-
tural activities to keep feelings of loneliness, negative emotions and
psychological distress at bay. People could experience fear of death,
fear of getting oneself or their family infected, anxiety, anger, depres-
sive symptoms, and other mental health concerns during this pandemic
outbreak (Rana et al., 2020).
Many factors are contributing in the affected mental health, psy-
chosocial functioning, wellbeing, psychological and emotional welfare
including uncertainty of this novel illness, unpredictability of the new
risk including the self-isolation, social-distancing, and quarantine) im-
paired social functioning, interpersonal issues, perpetuating emotional
and behavioral disorders, precipitating psychological problems, pre-
disposing mental health issues, and tendency of easily getting affected
from traumatic events. Healthcare conditions in Pakistan are exacer-
bating on daily basis and thus controlling the disease would require
holistic comprehensive management on both physical and mental
healthcare situation (Mukhtar, 2020). COVID-19 pandemic outbreak
could have negative impact on psychological and mental health of
people, for instance psychological distress, mental health issues, grief,
shame, helplessness, hopelessness, posttraumatic symptoms, substance
abuse, panic attacks, stress, anxiety, depression, loneliness, ambiva-
lence, fear, anger, stigma and worry towards socioeconomic status
(Mukhtar, 2020).
Mental health refers to the state of wellbeing in which individuals
realizes their own ability to cope with normal life stressors and pro-
ductively work to contribute in their own community (WHO, 2005).
Mental health constitute a six element psychological perspective which
includes a) self-acceptance, b) meaning in life, c) autonomy, d) healthy
relations with others, e) environmental mastery, and f) personal
growth.
Coronavirus pandemic outbreak which consolidated social-distan-
cing and self-isolation has challenged all the aspects of mental health,
https://doi.org/10.1016/j.ajp.2020.102127
Received 11 April 2020; Received in revised form 17 April 2020; Accepted 18 April 2020
1876-2018/ © 2020 Elsevier B.V. All rights reserved.
T
wellbeing, emotional health, psychological and social wellness at the
collective level (Mukhtar, 2020). Interpersonal issues including do-
mestic violence, abuse, trauma, negative emotions, unhealthy relations
and family environment, financial instability, poverty, poor health and
other factors in addition to coronavirus has exacerbated the wellbeing
of all individuals making them question their self-acceptance, meaning
in life, and relationships with others. Restricted movement resulting
from lockdown could make people question their autonomy and en-
vironmental mastery. And all in all challenges the personal growth and
compromising mental health of general public (Lima et al., 2020; Shi
and Hall, 2020).
The mental health issues have become secondary major health
concerns globally prevalent in individuals to variable extents. People
are experiencing anxiety, anger, confusion and posttraumatic symptoms
during the self-isolation and quarantine (Banerjee, 2020). Healthcare
professionals are doing meticulous job in protecting the nation from
this catastrophic event (Rana et al., 2020), however, for effective
treatment of infected individuals and their families’ mental states
should be monitored as well.
Communities could adopt behavior modification to adapt with the
Coronavirus’s adverse outcomes by reframing the situation to improve
mental health through: mindfulness, personal growth, building resi-
lience, coping strategies, health problem solving, cultivating positive
emotions, and curbing negative emotions through behavior modifica-
tion. Adopting new behaviors such as mindfulness of hand-washing,
healthy diet, physical activity; practicing introspection, meditation and
minimalism; learning new skills of sketching, musical instruments,
dancing; acquiring new languages; procuring knowledge of books, and
podcasts; accumulating influential videos, series, movies, games, and
music; and expressing gratitude through introspection and mindfulness
– these activities could bring resilience, coping, wellbeing, gratitude,
mindfulness and adapting and adjusting with the new changes outcome
of coronavirus outbreak.
Psychiatrists, experienced and trained mental health practitioners,
and counselling psychologists could provide empirically-evidence based
perspectives on misinfodemics (rumors, conspiracy theories, myths,
superstitions, misinformation, disinformation and false information),
normalize communities about the mental health issues, optimize mental
health availabilities through internet platforms, and empower in-
dividuals and communities through mental healthcare.
Government of Pakistan should incorporate psychological inter-
ventions as part of healthcare system in the context of public health
emergency. Pakistan should introduce psychological crisis intervention
program (see Mukhtar, 2020) to timely, effectively and efficiently mi-
tigate the psychosocial and mental health impact of COVID-19. There is
a paucity of research on the mental health factors prevalent in Pakistan
during the COVID-19 pandemic outbreak so this commentary marks the
preliminary suggestion to evaluate the impact of coronavirus outbreak
on mental health in Pakistan. Government of Pakistan should
Letter to the Editor Asian Journal of Psychiatry 51 (2020) 102127

strengthen personnel, optimize institutional good governance and offer J. Psychiatry 102014. https://doi.org/10.1016/j.ajp.2020.102014.
advanced trainings and degrees in the field of counselling psychology Lima, et al., 2020. The emotional impact of Coronavirus 2019-nCoV (new Coronavirus
disease). Asian J. Psychiatry 287, 112915. https://doi.org/10.1016/j.psychres.2020.
and mental health. 112915.
Mukhtar, S., 2020. Mental health and psychosocial aspects of coronavirus outbreak in
Financial disclosure Pakistan: psychological intervention for public mental health crisis. Asian J.
Psychiatry. https://doi.org/10.1016/j.ajp.2020.102069.
Rana, W., Mukhtar, S., Mukhtar, S., 2020. Mental health of medical workers in Pakistan
The author declares no financial disclosure related to the submis- during the pandemic COVID-19 outbreak. Asian J. Psychiatry 51, 102080. https://
sion. doi.org/10.1016/j.ajp.2020.102080.
Shi, Wei, Hall, Brian J., 2020. What can we do for people exposed to multiple traumatic
events during the coronavirus pandemic? Asian J. Psychiatry 102065. https://doi.
Declaration of Competing Interest org/10.1016/j.ajp.2020.102065.
World Health Organization, 2005. Promoting Mental Health: Concepts, Emerging
Evidence, Practice. WHO.
The author declares no conflicts of interest.
Sonia Mukhtar
Acknowledgment
University of Management and Technology, Lahore, Pakistan
E-mail address: sonia.mukhtar12@gmail.com.
None.

References

Banerjee, D., 2020. The COVID-19 outbreak: crucial role the psychiatrists can play. Asian