Human disasters come in all shapes and sizes including wars, terrorist violence, natural events,

economic recessions and depressions as well as infection. As a species more fragile than we often allow,
humans would be expected to adversely react to these types of disasters in terms of mental ill health
and possibly suicidal behaviour leading to increased demands on the Mental Health services. This
narrative historical paper examines relevant studies into how previous disasters affected mental health
and suicidal behaviour. The characteristics of what is known of the current Covid-19 disease are
analysed and compared to other types of disasters with a view to gaining some insight into what we
might expect. Of all the types of disasters, economic recession appears most toxic. Mitigating the worst
effects of recession appears to be protective. Particularly vulnerable groups are identified in whom we
might expect an increase in suicidal behaviour.

War, terrorist attacks, natural catastrophes, economic recessions and depressions, and infection are all
examples of human calamities. Humans, as a more vulnerable species than we often admit, are likely to
react negatively to these types of calamities in terms of mental ill health and possibly suicidal behavior,
resulting in increasing demands on Mental Health services. This narrative historical article looks at
studies that look at how prior disasters affected mental health and suicidal behavior. The current Covid-
19 disease's features are analyzed and compared to other types of disasters in order to acquire some
insight into what we could expect. Economic recession looks to be the most dangerous sort of calamity.
(Patrick Devitt, 2020)

COVID-19 and mental health: preserving humanity, maintaining sanity, and promoting health

Rajiv Tandon

Asian journal of psychiatry 51, 102256, 2020

As the COVID-19 pandemic rages on, the enormous magnitude of the devastation that it has wreaked
across the world is becoming apparent. Experts are now predicting a “tsunami of psychiatric illness”,
with the Secretary-General of the United Nations (Guterres, 2020), the Director-General of the World
Health Organization (Ghebreyesus, 2020), and the President-Elect of the World Psychiatry Association
(DeSousa et al., 2020) calling attention to this impending mental health crisis. Although definitive
information is lacking, rates of suicide, substance use disorders, domestic abuse, anxiety and depressive
disorders are already reported to be increasing around the world.

As the COVID-19 outbreak continues, the enormity of the havoc it has caused around the world
becomes clear. Experts are now predicting a "tsunami of psychiatric illness," with the Secretary-General
of the United Nations (Guterres, 2020), the Director-General of the World Health Organization
(Ghebreyesus, 2020), and the President-Elect of the World Psychiatry Association (DeSousa et al., 2020)
all expressing concern about the impending mental health crisis. Although definitive data is missing,
global rates of suicide, substance use disorders, domestic abuse, anxiety and depression illnesses are
already on the rise. (Rajiv Tandon, 2020)

National Center for Biotechnology Information (nih.gov)

The impact of the COVID-19 pandemic on suicide rates

Leo Sher

QJM: An International Journal of Medicine 113 (10), 707-712, 2020

Multiple lines of evidence indicate that the coronavirus disease 2019 (COVID-19) pandemic has
profound psychological and social effects. The psychological sequelae of the pandemic will probably
persist for months and years to come. Studies indicate that the COVID-19 pandemic is associated with
distress, anxiety, fear of contagion, depression and insomnia in the general population and among
healthcare professionals. Social isolation, anxiety, fear of contagion, uncertainty, chronic stress and
economic difficulties may lead to the development or exacerbation of depressive, anxiety, substance use
and other psychiatric disorders in vulnerable populations including individuals with pre-existing
psychiatric disorders and people who reside in high COVID-19 prevalence areas. Stress-related
psychiatric conditions including mood and substance use disorders are associated with suicidal behavior.
COVID-19 survivors may also be at elevated suicide risk. The COVID-19 crisis may increase suicide rates
during and after the pandemic. Mental health consequences of the COVID-19 crisis including suicidal
behavior are likely to be present for a long time and peak later than the actual pandemic. To reduce
suicides during the COVID-19 crisis, it is imperative to decrease stress, anxiety, fears and loneliness in
the general population. There should be traditional and social media campaigns to promote mental
health and reduce distress. Active outreach is necessary, especially for people with a history of
psychiatric disorders, COVID-19 survivors and older adults. Research studies are needed of how mental
health consequences can be mitigated during and after the COVID-19 pandemic.

Multiple lines of evidence suggest that the coronavirus disease 2019 (COVID-19) pandemic is having a
significant psychological and societal impact. The psychological consequences of the epidemic will most
likely last for months or years. According to studies, the COVID-19 pandemic is linked to distress, worry,
fear of contagion, depression, and insomnia in the general public as well as among healthcare
professionals. Social isolation, anxiety, fear of contagion, uncertainty, chronic stress, and economic
difficulties may lead to the development or exacerbation of depressive, anxiety, substance use, and
other psychiatric disorders in vulnerable populations, such as those with pre-existing psychiatric
disorders and those living in high COVID-19 prevalence areas. Suicidal conduct is linked to stress-related
mental diseases such as mood and substance use disorders. COVID-19 survivors may also be at
increased risk of mental health problems. Suicide rates may rise during and after the COVID-19
outbreak. The COVID-19 crisis's mental health implications, including suicidal behavior, are anticipated
to last for a long period and climax later than the actual pandemic. To reduce suicides during the COVID-
19 crisis, it is critical to lessen general population stress, worry, worries, and loneliness. Traditional and
social media efforts should be launched to promote mental health and alleviate distress. Active outreach
is required, particularly for those with a history of psychiatric illnesses, COVID-19 survivors, and the
elderly. There is a need for research into how the mental health impacts of the COVID-19 epidemic
might be reduced. (Leo Sher, 2020)
National Center for Biotechnology Information (nih.gov)

Research locale

NEW

https://www.sciencedirect.com/science/article/pii/S0165032720326495

The 2019 coronavirus disease (COVID-19) pandemic poses a threat to societies’ mental health. This
study examined the prevalence of psychiatric symptoms and identified the factors contributing to
psychological impact in the Philippines.

During the early phase of the pandemic in the Philippines, one-fourth of respondents reported
moderate-to-severe anxiety and one-sixth reported moderate-to-severe depression and psychological
impact. The factors identified can be used to devise effective psychological support strategies.

This survey was conducted in the first month that COVID-19 was declared a pandemic and enhanced
community quarantine was implemented in the Philippines. To our knowledge, this was the first study
that examined the psychological impact of COVID-19 to the general population in the country. During
this time, 16.3% of the respondents reported moderate to severe psychological impact; 16.9% of the
respondents reported moderate to severe depressive symptoms; 28.8% reported moderate to severe
anxiety symptoms; and 13.4% reported moderate to severe stress signals.

However, these levels were lower than the rates reported by Salari et al. (2020) which were 33.7%,
31.9% and 29.6% for depression, anxiety, and stress respectively. In China, the majority reported worse
psychological impact with overall mean IES-R scores more than 24 points, indicating the presence of
post-traumatic stress disorder symptoms (Wang et al., 2020a; Wang et al., 2020b). Different populations
in the world have been experiencing pandemic fear which can worsen feelings of anxiety that can lead
to mental health disorders. Previous experiences of outbreaks like those caused by SARS, Ebola, and
MERS-CoV contribute to heightening the impact of the present pandemic.

The study shows that females are more affected than males. The less educated, single people, children
and adolescents, those who have no children reported high levels of stress, anxiety, depression and
psychological impact. These subgroups, considered at greater risk for adverse psychological outcomes
during a public health crisis, may be experiencing low social and emotional support, increased perceived
threat to well-being and feelings of fear, isolation and uncertainty (Perrin et al., 2009).

The students reported greater psychological impact as well as more depressive, anxiety and stress
symptoms compared to those who are employed. The results were comparable to reports among the
Chinese students (Wang et al., 2020b). Contributing factors include effects on daily life and routine,
academic delays, and perhaps reduced social support (Cao et al., 2020).

During pandemics, healthcare workers are at the front lines. They are subjected to long working hours,
risk of infection, shortages of protective equipment, loneliness, exhaustion and separation from families
(Kang et al., 2020). They are at a significant risk of adverse mental health outcomes. However, our study
shows that HCPs had lower levels of psychological impact, and symptoms of stress and depression than
non-HCPs, comparable to the survey done among health care workers in Singapore (Tan et al., 2020).
This can be due to their strong sense of duty and ability to adapt to crisis. It can also be because the
survey was done during the early parts of the pandemic when cases were still low and the health care
system was not yet overwhelmed. As the pandemic ensues, mental health policies are needed to
support our HCPs and other front-line workers.

In this study, most respondents rated their current health status as good. They feel that they are less
likely to contract COVID-19 and more likely to survive the infection if they do get infected. They were
also confident of their own doctors’ abilities. These perceptions seemed to be protective against adverse
mental health state. It was reported that almost half of the respondents had at least one physical
symptom within the last two weeks, but only 5% had a recent visit with their doctors for consultation.
This disparity between symptoms suggestive of COVID-19 and health-seeking behavior may be due to
factors like physical limitations caused by community quarantine, closed outpatient clinics, fear of
getting infected in hospitals, and lack of public transportation. The presence of any of these symptoms
and consequent imposed quarantine by a health authority was associated with psychological distress as
also found among the Chinese population (Wang et al., 2020a). In severe instances where presence of
symptoms cause social discrimination and avoidance, or lack of basic needs cause hopelessness, the
more vulnerable individuals commit suicide (Garger, 2020; Mamun and Griffiths, 2020; Rajkumar, 2020a;
Sher, 2020).

In the Philippines where universal health care is not yet fully implemented, the 60% of respondents who
had medical health coverage had less anxiety symptoms as compared to those who had none. The
government's health aid through the Philippine Health Insurance Corporation (2020) which assured to
cover the full cost of COVID-19 hospitalization to its members may have had a positive effect on the
public's mental health.

During the initial phase of the lockdowns in the Philippines, majority of the respondents spent an
average of 0-9 hours on social media to derive information and news. Those who had access and were
satisfied to updated information experienced less psychological impact and lower levels of stress,
anxiety and depression. Still many express the need for additional and up-to-date information. They
were showing signs of anxiety and moderate psychological impact which may lead to “headline stress
disorder” (Dong and Zeng, 2020). Shared information that is relevant and unambiguous may alleviate
panic and stress (Hiremath et al., 2020). A more consistent public education is needed to decrease
uncertainties that are associated with more emotional reactions.

It appeared that those who practice hand hygiene and wear face masks as precautionary measures have
protective effects on psychological status. Wearing a face mask is generally recognized to prevent a sick
person from transmitting the virus while also protecting the wearer from getting infected. At the time of
the survey, many establishments have imposed a “no mask-no entry” policy.

The restriction in social mobility to control the pandemic is stressful as it prevents face-to-face
connections and traditional social interactions (Zhang et al., 2020). Those who can go out like the
workers who provide essential services exhibited less symptoms of anxiety and depression compared to
those who stay 20 to 24 hours at home. Those who exhibit COVID-related symptoms or potential
contacts of COVID were isolated and separated from loved ones.

The imposed quarantine as seen in previous outbreaks has associated negative psychological effects
that may be linked to fears of having the infection and spreading it to family members; frustration and
boredom from being isolated; duration of uncertainty and scarcity of basic supplies (Brooks et al., 2020).
While isolation may be a necessary preventive measure, adequate information, opening lines of
communication and provision of essential supplies to those confined may improve psychosocial
outcomes (Brooks et al., 2020).

The present study has some limitations. First, the survey was done online and administered in the
English language. Majority of respondents were well educated with access to the internet. Second, the
snowball sampling strategy was initiated within the social network of academicians and healthcare
professionals and may not be representative of the general population. Third, the survey was rolled in
the early phase of the pandemic and the psychological outcomes may change over the course of the
public health crisis.

During the early phase of the COVID-19 pandemic in the Philippines, one-fourth of the respondents
reported moderate-to-severe anxiety, one-seventh reported moderate-to-severe stress levels and one-
sixth reported moderate-to-severe depression and psychological impact of the outbreak. Female
gender, youth age of 12-21 years, single status, students, presence of specific physical symptoms (i.e.,
headache, cough, chills), recent imposed quarantine by a health authority, prolonged stay at home, poor
self-reported health status, feeling of too much unnecessary worry has been made about COVID-19,
concerns about family members getting sick, and feeling of being discriminated by other countries were
associated with a greater psychological impact of the pandemic and higher levels of stress, anxiety and
depression.
Timely and accurate health information, having children older than 16 years old, perception of good
health status and confidence in their own health care providers were associated with lesser
psychological impact of the pandemic and lower levels of stress, anxiety and depression. The findings of
this study can be used to frame appropriate psychological interventions to avert occurrence of mental
health problems preventing psychological crisis.
The 2019 coronavirus disease (COVID-19) pandemic threatens the mental
health of societies. This study looked at the incidence of psychiatric
symptoms and the factors that contribute to psychological distress in
the Philippines.
This survey was conducted in the Philippines during the first month
after COVID-19 was declared a pandemic and increased community
quarantine was instituted. This was, to the best of our knowledge, the
first study that looked at the psychological impact of COVID-19 on the
general public in the country. During this time, 16.3% of respondents
experienced moderate to severe psychological impact, 16.9% moderate to
severe depressive symptoms, 28.8% moderate to severe anxiety symptoms,
and 13.4% moderate to severe stress signals.These values, however,
were lower than those reported by Salari (2020), which were 33.7%,
31.9%, and 29.6% for depression, anxiety, and stress, respectively.
According to the study, females are more affected than males. Less
educated individuals, singles, children and adolescents, and those
without children reported high levels of stress, anxiety, despair, and
psychological effect. These subgroups, who are thought to be more
vulnerable to negative psychological consequences during a public
health crisis, may be facing a lack of social and emotional support,
an elevated perceived threat to their well-being, and emotions of
fear, loneliness, and uncertainty (Perrin, 2009).
In the Philippines, where universal health care is not yet fully
implemented, 60% of respondents with medical health coverage reported
fewer anxiety symptoms than those without. The government's health
assistance program, the Philippine Health Insurance Corporation
(2020), which promised to cover the full cost of COVID-19
hospitalization for its members, may have had a positive impact on the
public's mental health.
During the initial phase of the Philippines' lockdowns, the majority
of respondents spent an average of 0-9 hours on social media seeking
information and news. Those who had access to and were satisfied with
current knowledge had less psychological impact and lower levels of
stress, anxiety, and sadness. Many people still express a desire for
more up-to-date information. They had anxiety and a mild psychological
impact, which could develop to "headline stress disorder" (Dong and
Zeng, 2020). Relevant and unambiguous information shared may help to
reduce worry and to reduce the uncertainties that are associated with
stronger emotional reactions, more consistent public education is
required.
The restriction on social mobility imposed to combat the pandemic is
unpleasant since it prevents face-to-face interactions and typical
social relationships. Those who can go out, such as professionals who
offer critical services, showed less anxiety and sadness symptoms than
those who stayed at home for 20 to 24 hours. Those who exhibit COVID-
related symptoms or who are prospective COVID contacts were segregated
and separated from their loved ones.
The imposed quarantine, as seen in previous outbreaks, has been linked
to negative psychological effects, which may be linked to fears of
contracting the infection and spreading it to family members;
frustration and boredom from being isolated; duration of uncertainty;
and scarcity of basic supplies (Brooks, R.K. Webster, L.E. Smith, L.
Woodland, S. Wessely, N. Greenberg, G.J. Rubin, 2020). While isolation
may be a necessary preventive measure, providing enough information,
opening channels of communication, and providing required resources to
individuals who are confined may enhance psychosocial outcomes (Brooks
et al., 2020).
According by Michael L. Teeab, Cherica A. Teec, Joseph P. Anlacand,
Katrina Joy G. Aligamd, Patrick Wincy C. Reyese, Vipat Kuruchitthamf,
Roger C. Hog, (2020)During the early stages of the COVID-19 pandemic
in the Philippines, one-fourth of respondents experienced moderate-to-
severe anxiety, one-seventh moderate-to-severe stress levels, and one-
sixth moderate-to-severe depression and psychological impact of the
outbreak. Female gender, youth age 12-21 years, single status,
students, presence of specific physical symptoms (i.e., headache,
cough, chills), recent quarantine imposed by a health authority,
prolonged stay at home, poor self-reported health status, feeling of
too much unnecessary worry about COVID-19, concerns about family
members getting sick, and feeling of discrimination by other countries
were all associated with a greater psychological impact of the
pandemicTimely and accurate health information, having children over
the age of 16, impression of good health status, and confidence in
their own health care providers were all associated with reduced
psychological impact and lower levels of stress, anxiety, and
depression. The findings of this study can be used to develop
appropriate psychological interventions to avoid the emergence of
mental health disorders.
https://www.cambridge.org/core/journals/international-psychogeriatrics/article/covid19-and-mental-
health-of-older-adults-in-the-philippines-a-perspective-from-a-developing-country/
CE99711179336AD47C3BDA6C981BEAB4