**1. Introduction**

The development of the coronavirus disease 2019 (COVID-19) epidemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, triggered a global scenario of socio-economic catastrophe and psychological anguish. Many psychological problems and essential mental health consequences, including stress, anxiety, depression, frustration, uncertainty during the COVID-19 outbreak, emerged progressively.

In response to this dire circumstance, specific public policies were introduced by governments globally. These measures include self-quarantine, isolation, and social distancing. Implementing these policies caused the closure of educational institutes, offices, workplaces, public places, and social gathering restrictions. People were advised to stay at home and follow advice proposed by the WHO to protect

themselves and others from the spread of COVID- 19. The strict self-quarantine order (lockdown) has kept the entire population in selected jurisdictions in isolation, with a significant impact on people's life [1]. Although social activities have been restricted in most countries, almost all non-essential individual movements were prohibited due to quarantine, while the local hospitals received suddenly thousands of critically ill COVID-19 patients and were forced to implement their emergency protocols.

In this context, the general population and most of the front-line healthcare workers became vulnerable to the emotional impact of COVID-19 infection due to both the pandemic and its consequences worldwide. The modern society, in which everyone can travel and communicate quickly, has seldom been subjected to the present social isolation and constraints associated with feelings of dissatisfaction and uncertainty. This unusual scenario surrounding the COVID-19 epidemic illustrates that people are fundamentally and emotionally unprepared for the negative impacts of biological disasters, which immediately highlight how everyone may be vulnerable and helpless.

There is a constant update about the disease available on news channels and over the Internet, highlighting the number of individuals affected and deaths due to COVID-19. Also, inadequate knowledge and overwhelming news may contribute to fear and anxiety among the public. People at large may experience disappointment, irritability, and boredom under isolation measures [2]. The communication technologies' facilities and transmission of inaccurate or sensational information may increase unacceptable social reactions such as aggression and rage [3].

The psychological reactions to the COVID-19 pandemic may vary from panic behavior or collective hysteria to pervasive feelings of hopelessness and desperation associated with adverse outcomes, including suicidal behavior [4]. Significantly, other health measures may be compromised by abnormally elevated anxiety. According to the social role invested, the security measures adopted in managing the pandemic had different consequences on individuals. Suspected and confirmed COVID-19 cases are likely to experience anxiety, loneliness, depression, denial, insomnia, and fear [5]. Health authorities' strict quarantine policy and mandatory contact tracing policy may lead to social rejection, discrimination, financial loss, and stigmatization. Medical health workers are first-line fighters treating patients with COVID-19. They are a unique subset of exposed individuals as they are equipped with the resources and knowledge to address the dangers imposed by a pandemic. Despite this, they are not impervious to the detrimental impact of the pandemic on their psychological health and behavior. During the challenging times of a pandemic, healthcare workers, the most exposed group, are vulnerable to psychological challenges. Every day, they face a high risk of being infected and are exposed to prolonged and distressing work shifts to meet health requirements. This has placed healthcare workers around the world in an unprecedented situation.

This epidemic, as well as the public health measures put in place to slow it down, has drastically altered people's lifestyles and is believed to pose a threat to their physical and mental health. This significant health catastrophe is impacting numerous countries, with high rates of transmission and death, and extensive outbreaks and mortality are linked to negative mental health consequences.

#### **2. Fear**

Strasner (1987) defined fear as "an emotional reaction (rational or irrational) to an object (animate or inanimate) or event that is associated with increased risk of

*Mental Impact of COVID-19 – Fear, Stress, Anxiety, Depression and Sequels DOI: http://dx.doi.org/10.5772/intechopen.102754*

danger and also unpleasantness, agitation and a desire to hide, flee or seek protection." Phobia, on the other hand, is characterized by intense, severe, and persistent fear. Such fears lead to persistent efforts to avoid (flee) the source of distress, often by undertaking a number of "safety behaviors". As a new infection with the potential for loss of life, COVID-19 has provoked legitimate fears. However, in a minority of subjects, this has also led to extreme restrictions, which could be characterized as "coronaphobia" [6]. Adequate communication that engenders a realistic appraisal of the risks, along with clear statements of behaviors that can reduce transmission, have been effective to control these fears, while also preventing viral transmission.

#### **2.1 Fear among patient population**

SARS-CoV2 infected patients experienced a high degree of fear stemming from uncertainity of illness outcome, inability to communicate with family members, lack of complete knowledge of the disease process and the stigma associated with being infected with the virus. Morever, the fear of isolation, discrimination and stigmatization was also noted in this group [7]. Those patients suspected to have SARS-CoV2 infection are also prey to the terror of having the disease, advancement of disease, precariousness of healthcare delivery and quarantine as per government regulations. Besides, even patients suffering from other illnesses displayed features of trepidation of inability to receive proper treatment due to overwhelmed healthcare resources. Patients with chronic diseases like diabetes, TB, and heart failure, for example, were found to avoid seeking medical treatment because they were afraid of contracting the illness from others in a healthcare facility, adding to fear of contagion. The type of chronic disease is a significant predictor of fear with higher levels noted among those diagnosed with autoimmune diseases or receiving immunosuppressants [8].

#### **2.2 Fear among HCW population**

Despite being the highest risk exposure group, healthcare workers have been found to experience less fear compared to the patient population as well as the general public. In a study conducted in India it was observed that a mere 18.3% healthcare workers reported of fear of contracting the infection. Most healthcare workers displayed concern and fear of transmitting the infection to their families and loved ones, especially to their children and the elderly [9]. Higher levels of fear were present in lab technicians, X-ray technicians and nurses while physicians were found to have the lowest level of fear. A possible explanation of this is that technicians and nurse have more exposure to contracting the illness during sampling, testing and medication of patients [10]. Non-medical healthcare workers were assessed to have lowest fear quotient juxtaposed to medical healthcare workers who are usually in direct contact with SARS-CoV2 infected patients and have a better understanding of the disease and its mortality [11]. Alike patients, healthcare workers are not immune to the fear of social marginalization. Assault on doctors, eviction of resident physicians from their rented houses, and fear of infection from healthcare workers have all been reported [12, 13]. These factors alongwith the shortage of sufficient protective equipment, absence of effective therapy and the virus's high infectivity rate might possibly play a role in their fearfulness of coronavirus pandemic. The presence of fear among HCWs poses a significant threat to their psychological adjustment skills and impede delivery of optimum care to patients.
