**5. COVID-19 and its symptoms of mental disruption**

The emotional and psychological effects of COVID-19 outbreak ranged from biological factors like the neurotropic effects of SARS-CoV-2 (causative agent of COVID-19) and involvement of limbic system along with its psychological factors of fear, discomfort, uncertainty, anger, addiction, socioeconomic issues of isolation, xenophobia, stigma, domestic-violence, loss of livelihoods and constraint of open spaces. Global studies have established COVID-19 to be increasingly associated with neuropsychiatric manifestations such as delirium, anxiety, depressive disorders, insomnia and incidences of increased self-harm. Meanwhile, COVID-19 itself can progress to neurological and mental complications like delirium, stroke, cerebrovascular accidents, seizures and agitation that can have added psychiatric associations. Further on, those with pre-existing psychiatric conditions might be at increased risk of COVID infection due to lack of supervision and inadequate compliance to many precautionary measures [16]. The emotional outcome of subjects who were quarantined compared to those who were not, shows presence of acute stress disorder, anxiety, irritability, insomnia, boredom, poor concentration and performance, post-traumatic stress disorder (PTSD) and nervousness. Other psychological reactions reported during mass quarantine were generalized fear, collective hysteria and pervasive community anxiety. These symptoms are typically associated with disease outbreaks and escalation of new cases, together with inadequate anxiety provoking information provided by the media [15]. Reports of people emptying supermarkets and panic buying was indicative of their escalated levels of anxiety [4]. Anxiety may be related to sensorial deprivation and pervasive loneliness initially in the form of insomnia and later progressing to depression and PTSD. Moreover, other health measures get compromised in presence of abnormally elevated anxiety. The butterfly effect of increased anxiety and depression could also lead to a global increase in chronic illnesses including heart-disease-related deaths as people diagnosed with depression are up to five-times more likely to die within six months of having had a heart attack than those without depression [17]. Factors associated with a greater psychological vulnerability seem to be more important than factors associated with the risk of infection in predicting mental health consequences of the pandemic. Furthermore, symptoms of the infection, such as fever, myalgia, hypoxia and cough, as well as adverse effects of treatment, such as insomnia caused by corticosteroids, led to feelings of fear of contracting COVID-19 causing worsening of anxiety and mental distress. As mental and physical health are equally important and closely connected, a sound state of mental health plays a crucial role in people's ability to maintain good physical health. **Table 1** shows the various research conducted globally to study the impact of COVID -19 on mental health.

Zhao et al. highlighted that even close contacts of people with COVID-19 experienced distress and prolonged mental health consequences including severe depression and chronic fatigue in the post-COVID period in a study comprising 1169 close contacts. The study revealed that old age, heavy financial loss and perception of poor health were significantly associated with depression in them while the cause of fatigue reported




#### **Table 1.**

*Various studies conducted across globe depicting adverse impacts of COVID-19 on mental health.*

was frequent use of mass media [33]. Among the varied corollaries of the pandemic, one among them was diametrically opposite incidences of both alcohol abuse as well as alcohol withdrawal symptoms in different circumstances due to sudden lockdown. The migrant labourers who represent 4.7% of the global labour workforce along with refugees, having limited access to healthcare, living in overcrowded environments, working in marginalized sectors and lacking workplace and social protection were the worst sufferers of pandemic and economic shutdown [16]. Researches depict that people working on site, within lower income bracket, job loss and households with children under the age of 18 yrs. were more likely to report negative mental health outcome in form of anxiety, stress or depression [34]. Lack of authentic information, dissatisfaction with fulfillment of basic needs, poor sleep quality, ambiguity about SARS-CoV-2 and a relatively lower confidence in health care fraternity could be the stipulated reason for ongoing extreme stress.
