**4.5 Mental health in specific groups in the COVID-19 pandemic context**

During the COVID-19 pandemic, individuals at age extremes (children and the elderly) also suffer an impact on their mental health. Social isolation by COVID-19 pandemic in elderly people has been associated with increased depression and suicidality, as well as to increased pro-inflammatory and decreased anti-viral immune responses. Virtual solutions may be less comfortable for children and the elderly [15], who may also have limited access to internet services and smartphones to enter in mental health services online. Also, the current mass quarantines and restrictions to public transport make it more difficult for them to acquire medicine from previous psychiatric pathologies, which is common in this age range [18].

Some suggestions for managing mental health in institutionalized elderly people include establishing a contingency plan and strategies to deal with more serious psychiatric symptoms; maintaining transparency and trust with employees that prioritize equity and well-being with adequate training and personal protective equipment; ensuring care for the mental health of family members; reassuring them about feelings of fear, sadness and anxiety; and promoting a healthy climate of communication and empathy [44].

In the case of children, stressful and potentially traumatic situations, such as illness and hospitalization, can trigger the emergence of unusual behaviors, such as sucking finger, enuresis, or desire to sleep with parents. Therefore, encouraging the maintenance of routine and creative activities, such as painting, drawing or playing with family members, is essential to reduce psychological impacts. In the event of hospitalization, children should be maintained with constant contact and communication with the family and belongings that fulfill the function of emotional connection. No one should lie about their diagnosis and treatment, making it clear that the child is not to blame for being sick, providing an open communication channel for them [16].

As for young people in universities, the Chinese, mainly, were denied entry in many countries. They face discrimination and isolation in some countries due to being deemed as potential COVID-19 carriers, consequently, such students are at risk of hate crimes, especially when individuals consider them contagious. This situation can lead to mental health problems, such as denial, stress, anxiety, and fear [12].

Refugees and international migrant workers have a higher burden of common mental disorders (*e.g.* depression) and a lower quality of life than local populations. Many domestic workers cannot obtain masks from pharmacies because they must stay with employers and adhere to government-recommended self-quarantine [17]. Severe risk factors for COVID-19 are common for mental disorders in this population: overcrowding, disruption of sewage disposal, poor standards of hygiene, poor nutrition, negligible sanitation, and lack of access to shelter, health care, public services and safety [19, 45–48].
