**4. The effects on adult psychological health**

It is obvious that the current pandemic process will bring some drastic changes in human life such as reshaping of the economic and social system in the context of the transition to remote working systems [80]. It is also thought that the immediate effects of the pandemic period will be apparent in economical indicators in terms of visibility, followed by social and psychological issues depending on both economic and other factors [81]. It is argued that these problems will differ according to age groups, and in general, problems such as stress, anxiety, lowered motivation [3], fear at night, insomnia, pessimism and isolation from social environments, and demoralization, temporary memory loss, and irritability in some people can be observed [82]. Individuals may project their psychological problems on their families and private lives [81]. From this perspective, a sociological crisis may appear as a result of individuals projecting their problems on the family and then to the society since sudden changes in daily life can evolve into a social trauma [83].

Daily lifestyles and many routines of adults such as their relations with their environment, the way they go to work, and their social activities have been changed due to the epidemic. This phenomenon shows the extent of a crisis like the COVID-19 pandemic as well as challenges encountered by the adults in adapting to the new lifestyle. These changes, along with social isolation, have led to a dramatic surge of stress and anxiety in individuals. On the other hand, there are some uncertainties in social life that cause individuals to be afraid and panic. It can be argued that these uncertainties are primarily about how the epidemic is transmitted, how long it will end, whether a treatment or effective vaccine will be found, and how business and working life will be shaped in the future [84]. It is believed that the COVID-19 Pandemic may cause significant mental problems in individuals in the long term, and therefore it is important to address the psychological problems of individuals arising from the pandemic [3].

On the other hand, the pandemic process has also affected working patterns, requiring the use of the remote working system usually from home. However, remote working system can be perceived as normal by those individuals who are socially isolated or who have introverted +personality traits. This may also pose a problem for those individuals who are apt to using technological devices. However, for those sociable individuals with extroverted personality traits, this situation can actually pose a problem [3].

A report (2020) released by Inter-Agency Standing Committee (IASC) categorized the reactions of employed or unemployed adults to the epidemic crisis in the following [3];


It is clear that the mental reactions shown during the epidemic range from experiencing extreme fear to being indifferent. Therefore, it is plausible to contend that the responses to the epidemic are variable [8]. Given the reactions of employed adults to the crisis, it is seen that these reactions generally differ from each other in terms of mental and behavioral characteristics [8]. Considering the psychological status of adults [85], who work at risky conditions in the healthcare system for the benefit of society, it is seen that they also experience mental problems such as stress, anxiety, low motivation [3] in the lead, being afraid at night, insomnia, pessimism and being isolated from social environments while some may also suffer from moodiness, temporary memory loss, and irritability [82]. Therefore, it is considered important to create a safe and healthy working environment for the adults working in healthcare and to meet the psychological support needs of individuals with impaired mental health [86].

On the other hand, it can be suggested that the unemployed adults are negatively affected in terms of psychological resilience during the epidemic as much as those employed [87]. In this period, it is thought that parents who take care of their children at home are affected negatively from the epidemic both physically and psychologically as much as those employed. For instance, insomnia, muscle pain and joint problems and a constant state of fear and anxiety can be observed in parents. Considering that such a continuous state of fear and panic at home can have an adverse effect on children, it can be argued that the reactions of adults to the crisis are vitally important [88]. Now that it seems inevitable that adults who spend almost all of the day in isolation at home, they project their disrupted emotions on their children [89].

It is stated that the psychological resilience levels of adults who suffer from high levels of depression and anxiety and do not take adequate precautions against the epidemic are significantly lower than others. It is believed that the main reason lies in the fact that they feel insecure because of not taking measures. On the other hand, it is obvious that the psychological resilience of adults who have low depression and anxiety levels and take the necessary precautions against the epidemic is significantly high [90]. In addition, obsessive behaviors such as frequent hand washing can be observed in individuals with extremely high sensitivity to the epidemic. The major reason for this situation is thought to be the need for individuals to feel safe [91]. Living under the continuous threat of death can elicit feelings of helplessness and trauma in some adults. Psychological studies on natural disasters conclude that societies will experience emotional distress and therefore will be negatively affected psychologically. Particularly the economic crisis and the accompanying uncertainties may trigger suicidal thoughts [92].

Other studies have reported that patients with or suspected of being infected with COVID-19 exhibit intense emotional and behavioral responses such as fear, boredom, loneliness, anxiety, insomnia, or anger [42, 93]. Such responses have been associated with disorders such as panic and post-traumatic stress disorder, psychotic and paranoid symptoms, and even suicidal behavior [94]. These symptoms may be more prevalent especially among the quarantined patients [42]. Even in patients with conventional flu symptoms, stress and fear may emerge due to its similarity to COVID-19, creating psychological distress [95]. Despite the relatively

#### *Perspective Chapter: Psychological Effects of COVID-19 Pandemic DOI: http://dx.doi.org/10.5772/intechopen.101498*

low number of suspected cases, the majority of cases showing asymptomatic or mild symptoms, and the low mortality rate of the epidemic, the psychological effects of the epidemic can be much more serious [96].

In a study conducted in China on the COVID-19 epidemic, a high rate of generalized anxiety disorder and sleep quality problems are observed in the population. The anxiety disorders are found to be more prevalent in those younger than 35 years, particularly those who pay too much attention to the agenda on the epidemic [97]. In a study by Ho et al., it is stated that the failure of planned travel plans, social distance, continuous exposure to information about the epidemic from the media, and panic about meeting the household needs trigger anxiety and depression all over the world [98]. In another study conducted in China, the indirect traumatization levels of the society are found to be higher than the nurses working in the field [99]. In another survey, symptoms of post-traumatic stress disorder are observed among the participants in the first period after the outbreak. The same surveys are administered four weeks later and although the symptoms of post-traumatic stress disorder are decreased, it is revealed that this decrease was not clinically significant and the symptoms were severe. In the same study, moderate to severe levels of stress, anxiety, and depression are determined in the first evaluation, and it is observed that the same severe psychological distress persist in the evaluation made four weeks later [100]. According to a study conducted in Turkey, it is found that participants show significantly high levels of somatization, anxiety, phobic anxiety, obsessive–compulsive disorder, depression, hostility, and anger after COVID-19 [101]. In addition, when the pre- and post-coronavirus symptom scores are compared, it is determined that women differ significantly in all symptoms, indicating that they are much more affected psychologically by the coronavirus [101].

In addition, it is reported that the psychological symptoms of those who are anxious about their health and fear contracting the disease before COVID-19 have worsened considerably during the epidemic period. On the other hand, individuals with pre-epidemic obsessive–compulsive disorder (OCD) may be the most affected group by the epidemic due to obsession of contamination, hygiene compulsion, suspicion obsession, and control compulsion. The increase in symptoms, stress and disease anxiety in OCD patients due to the epidemic seem to be quite challenging [102]. In a large-scale study in China, 53.8% of the respondents reported the negative impact of the epidemic on their psychology as moderate or severe. 16.5% of them reported that they experienced moderate and severe depressive symptoms. 28.8% of them reported moderate and severe anxiety symptoms, and 8.1% experienced moderate and severe stress. 84.7% of them spent 20–24 hours a day at home while 75.2% of them were seriously worried about their family members. Variables such as being female, studying, experiencing physical symptoms like cold, dizziness and muscle pain, and evaluating the health status as poor were associated with experiencing more stress, anxiety and depression. It has been stated that obtaining epidemic-specific health information such as treatment protocols in the country and the number of appropriate beds in local hospitals, paying attention to hand hygiene, and taking precautions by wearing masks reduce the possible negative psychological effects of the epidemic [100]. In addition to the patients diagnosed with or suspected of having COVID-19, psychological disorders may also be observed in their families and close contacts. It has been stated that this may cause mass hysteria as the number of cases increases [42, 103, 104].
