In this qualitative study, 27 IDIs were conducted, between May and June 2020, with a variety of community members including, young adults, middle-age adults, and older adults of both genders. Data collection was ceased once saturation was achieved. Out of total 30 participants, (n=27) were agreed to participate in the study. The demographic information for the IDIs participants are illustrated in Table 2.
Based on the data collection and thematic analysis, three overarching themes were identified (I) Impact of COVID-19 on mental health of the general communities; (II) Current coping mechanisms to adapt to the new reality; and (III) Recommendations to address mental health of communities. The themes and categories are presented in Table 3.
Themes 1: Impact of COVID-19 on mental health of the general communities
Increased anxiety and fear:
Community members shared that the perceived uncertainty associated with COVID-19 has created stress and fear among individuals. Few community people verbalized that explaining and dealing with children’s question about the current outbreak has further added anxiety in these difficult times. Some community people shared their concerns that closure of school has led to disruption in learning of children which may have induced anxiety among parents. These all worries and fears have led to a sense of unpredictability about the future, and life after pandemic. Highlighting these points, a respondent stated:
“Obviously there is so much uncertainty about the future … when this will end? How many people will die? How world will look after this pandemic?”(IDI-16)
Another fear that community people stated was the lack of adherence to precautionary measures, which may result in rapid transmission of virus leading to increase number of cases and loss of lives. Some participants also expressed that being more meticulous in complying with all safety measures against COVID-19 has raised their frustration and stress level. Similar thought is discussed by a respondent:
“Even if you go to the grocery shop you need to be extra careful about wearing masks, maintaining distance, cleaning hands … which add to the stress...On the other hand, other people are not following any measures which can eventually get us into trouble”. (IDI-20)
While, some community members pointed out that they are frightened or scared because currently there is no treatment or vaccine against COVID-19 to control its rapid transmission. Few community individuals also shared that irrespective of disease exposure, they experience dread and anxiety from falling sick and tend to feel false symptoms of disease within them as one participant verbalized:
“If you get little flu or a sneeze, it strikes your mind towardsCOVID-19 symptoms. Even on little body ache…one feels like having COVID-19 symptoms”. (IDI-19)
Further, some community members related their fear and anxiety with their risk of getting infection from workplace and transmitting it to their families, particularly elderly, children or people with compromised immune function. Some community people also voiced their concern that many private hospitals have been unable to accept and manage new COVID-19 patients which also induce a panic situation among community members. Expressing similar concerns, a participant revealed:
“I am scared about my family … My father is a chronic kidney patient; his immunity is very low. There is a fear that if he will get infected …Will there be any space in the hospital. Further, how he would go through the entire process as he is already immune-compromised.... So, there is a fear of losing my father or losing any other family member” (IDI-25)
Financial hardship amid COVID-19 affecting psychological health:
Many community members mentioned that the current pandemic has affected the global economy which will undoubtedly lead to financial losses impacting individuals financially, mostly daily wages workers. Dialogue with the community people indicated that their business is either on hold or concluded due to which individuals face difficulty in making their ends meet. Some of the community individuals also revealed that they faced layoffs or salary deductions in these challenging times. This has eventually affected the economic conditions of the family and they stated that they will have to start over again to get settled in their lives. Highlighting these points, a respondent stated:
“We have a garment shop and we thought to earn well in Ramadan. But due to COVID-19, the shop was totally closed and we were not able to earn even during the peak time. It seems that we would have to wait for a year to get back to the normal routine”. (IDI-17)
Moreover, the financial hardships related with pandemic has translated into widespread emotional distress and increased risk for psychiatric condition. Similar, comments on the experience of mental distress is discussed by a participant:
“Many people have lost their jobs…no money to buy grocery and to run house…These people are suffering from anxiety, and depression. I have heard that few people have attempted suicide because they have no money to survive in this world” (IDI-5)
Restrictions to routine religious practices affecting mental health:
A number of mass prayers and gatherings in religious places are prohibited that was the source of internal satisfaction and get-together for many individuals, resulting in mental sufferings among community people. Community members verbalized that they used to spend their quality time in the prayer hall to gain strength and positive energy. Highlighting this point, a respondent verbalized
“I miss my prayer hall (Jamat Khana). Closure of prayer hall has been very difficult as there is feeling of incompleteness and dissatisfaction” (IDI-11)
During interviews, many community members also gave insight regarding traditional burial and funeral practices that has been halted due to COVID-19. They shared their concerns that burial practices such as ritual wash (ghusl), shrouding/covering the body (kafan), and funeral prayers could not be performed for the deceased in the current situation. Further, they shared that they are unable to counsel and provide moral support to the bereaved family members. This has heightened their fear and anxiety level and they are scared of dying in this way. This point was illustrated by a respondent who stated:
“I have observed that ritual wash is not given to the death body because of the current situation. I don’t want to die like this. I believe burial practices and rituals are so much necessary for the deceased. (IDI-11)
Effects of media on emotions:
Community members mentioned that there is no source of entertainment because all types of media are currently displaying information related to COVID-19 pandemic. Majority of the community members shared that they are uncertain about the source and authenticity of information provided by the media. Highlighting this view, a participant expressed:
“Media has a negative effect. News headlines appearing in red color make us aggressive and anxious as red color affects our brain area. Moreover, there are many political issues in our state due to which media news is unauthentic and I don’t rely on it” (IDI-17)
Many individuals shared that the repeated media exposure about COVID-19 has enhanced their psychological distress. They are overwhelmed with misinformation and rumors which impaired their concentration and daily functioning. During the interviews, a community participant shared:
“Media has negatively affected us. Media such as news channel has a devastated impact on everyone particularly senior citizens who are at home. If I talk about my mother in law, she keeps on watching news and that has disturbed her so much. She is not coming out of this trauma (COVID-19)….. She is not even coming out of her bed or not even meeting anyone due to the influence of media” (IDI-4)
Some community people notified that media can work positively on a larger scale to nurture community well-being but unfortunately no such direction has been witnessed from their end. Many community members reported that they are avoiding mass media use to promote their mental wellbeing and to remain mentally stable. Highlighting this view a participant expressed:
“I don’t watch news on media otherwise I will suffer from depression. It is important that we don’t watch news and take care of ourselves” (IDI-14)
Effects of social isolation on temperament, feelings and emotions:
Community members highlighted that major repercussion of the COVID-19 outbreak is restriction on socialization. The lack of social interaction has substantially influenced the behavior of people. This is evident by greater psychological distress in the form of anxiety, anger and irritability that results in increase disputes and domestic violence within the families. Similar feelings revealed by the participant:
“Physical connection has been broken down from relatives and friends. Overall, everyone has become irritable even on minor issues because one cannot go out, vent out their feelings, and meet friends. This has resulted in disputes within the family on small concerns”. (IDI-2)
Few people also expressed that working from home is another challenge as you have to show 24/7 availability. This has increased their burden and caused agitation as they find difficultly in balancing their work and home life together. Some participant also verbalized that their fears and increased agitation have resulted in sleep disruptions and restlessness. Highlighting this view a participant expressed:
“Work from home is another stressful thing for me in this pandemic because there is no time limit. Usually, after office hours we are not responsible for any task or to respond back…But now days we have to show our availability every time… even on weekends”. (IDI-2)
Theme 2: Current coping mechanisms to adapt to the new reality
Getting closer to God amid COVID-19
A fundamental element in adjusting with these detrimental circumstances is coping. Each individual in the community found their own coping mechanism to deal with COVID-19 pandemic. Majority of the community members shared that in the midst of these challenging times they have come closer to God by spending more time in praying and being connected with supreme power. Few community individuals also expressed that religion and faith give them strength, and hope to manage current stressful situation. Highlighting this thought a participant discussed:
“People should come closer to their religion. If they will timely perform their prayers then it will automatically reduce more than half of their stress and anxiety” (IDI-22)
Connecting with community members, friends, and relatives:
Social-isolation is an unusual experience for an individual however, supportive environment by the family play a crucial role to cope during the outbreak. Community members shared that lock down and social distancing has positive aspects as well; as families spend more time together. Spending quality time with family and relatives can bring sense of ease and comfort. Further, during these unprecedented times, many families reported use of online technologies to interact with other relatives and friends. Expressing similar thoughts, a participant verbalized:
“In these times, families should get united …..Positive point is that people, who were unable to spend time with their family, are now spending quality time with family. Due to COVID-19, we are sitting together, avoiding mobile phones and doing table talk. BeforeCOVID-19, I was connected with the world. But I had no idea what is happening at my home. COVID-19 has brought this positive change in life” (IDI-17)
Resetting lives amid COVID-19:
Some of the respondents verbalized that setting up a daily routine like indulging in house-hold chores (cleaning and cooking) helped them to spend their time productively. Others highlighted that they spent time on hobbies such as, reading, writing, listening to music, and singing, photography, playing indoor games, performing home workouts (exercises and yoga) to stay active and motivated. While, some of the individuals utilized their time effectively in distance learning courses and gaining new skills. A participant shared:
“Now a day, I am doing a lot of activities with my daughter. We are doing art work (painting) and learning new kinds of painting. I and my daughter have also learnt baking in this lock down period. Other than that, we are playing different games such as Ludo to keep ourselves busy” (IDI-3)
Participating in mental health programs:
During these difficult times when there is deluge of information on COVID-19, community members stated that there is need to divert their minds by planning strategies and programs that promote their mental wellbeing. Some community people shared that in order to overcome anxiety, fear and stress in this pandemic, mental health programs are initiated by some community leaders and volunteers. These programs were reported to be useful as they guide people to cope in a positive way and are very helpful for those who are depressed and anxious. Highlighting these views a community participant verbalized:
“Last Sunday, I attended a psychologist session on “Mindfulness journey to a peace full life”, organized by my community. It was a very good program that guided us on how to be positive. The session focused on issue of anxiety and stress in this pandemic situation. The session helped in developing a sense of optimism and broadening horizon of our perceptions. These different types of sessions are running in our community which are very helpful for us to cope in present time” (IDI-5)
Theme 3: Recommendations to address mental health of communities
Assessing mental health needs of communities
Some community members shared that mental health issues are considered as a taboo in our society and people usually avoid talking about it. In that regard, community people pointed out that it is fundamental to assess the mental health needs of the community to plan and design appropriate mental health services. Alongside some community members mentioned that these mental health programs will also be beneficial for the COVID-19 patients and their family members. Highlighting these points, a respondent stated:
“I believe that if there will be any survey or study conducted to understand the effects ofCOVID-19on general population … The results of the survey will certainly reveal that COVID-19 has more effects on mental health as compared to physiology of a person. Therefore, government should conduct the survey and identify the house holds that have mental health issues and should send flyers or brochures that help them in coping” (IDI-15)
Delivering remote mental health interventions for elderly:
Most of the community members expressed that the long term impact of the pandemic would be stressful for every individual particularly elders who are vulnerable given their weaker immune systems. Some community members conveyed that the current pandemic has called upon great transformation in terms of delivering of remote mental health services via using basic technologies such as the telephone, SMS and radio. However, there is lack of opportunities to monitor psychosocial needs of elders and deliver support to them.
“There are different mental health programs and sessions which are organized by our Jamati institutions. But, we are not providing any mental health session for our mass population that is our senior citizens or elder people”. (IDI-2)
Role of government to support mental health of communities:
During interview, community members notified that the government is only providing awareness about COVID-19 and are not focusing on the psychological needs of the community members. Few community individuals also mentioned that no funding is allocated by the government to tackle the mental health challenges of the community in this outbreak. In this context, many community people recommended the need of quality mental health services from the government at national and provincial level. Expressing similar views, a participant mentioned:
“Government is not considering mental health issues. Government should start mental health programs which could include online counseling sessions or programs that could lighten the moods of general population. They can also raise mental health awareness via talk shows or through any other activity…government can use media to raise awareness and conduct mental health programs” (IDI-7)