25-year-old Harshitha couldn't stop thinking about her grandmother who passed away and her father's ordeal at the hospital amid Covid. Recurring images of hospitals overflowing with patients, scrambling for oxygen cylinders gripped her. "This fear is crippling," she said.
As her dreams intensified and became more frequent, and started taking a toll on her day-to-day activities, she knew she had to seek professional medical help. It was then evident that she had Post-Traumatic Stress Disorder or PTSD.
"Earlier, PTSD was used particularly used in the context of war victims, concentration camp survivors, Tsunami survivors or those who've had near-death experience," Dr Sameer Malhotra, Director and Head - Department of Mental health ad Behavioral Sciences, Max Hospital, Delhi, said.
But we live in unprecedented times. Covid has turned our every day lives on its head and brought with it an array mental health challenges. While anxiety, depression have been plaguing many, for some who have experienced extreme events due to COVID, PTSD has been debilitating.
What Is PTSD? How Is It Relevant Amid COVID?
According to the National Institute of Mental health, PTSD is a disorder that develops in some people who have experienced a shocking, scary, or dangerous event.
"It occurs when there is some severe and serious threat to one's own life or somebody very close to you, or if you have witnessed somebody losing his or her life. It is near death experience, which is the catch phrase for PTSD," Dr Sandeep Vohra, Senior Consultant, Mental Health & Psychiatry, Indraprastha Apollo Hospitals, Delhi, said.
None of us are experiencing the impact of the pandemic like the frontline healthcare workers and thus the incidence of PTSD is higher among them.
However, the general population is not devoid of the prolonged trauma and are susceptible to PTSD too.
But when we talk about PTSD among general population, the trauma has to be of significant magnitude…over and above, in normal mind capacity to cope, Dr Malhotra said.
Due to Covid, PTSD is likely to be more prevalent in people who have either been hospitalised with severe illness, if on ventilators, in those who have had a near-death experience or if they have seen a loved one die, Dr Vohra said.
It is also based on duration and the degree of stress.
In Covid survivors, who are hospitalised and put on steroids as part of treatment protocol, there are instances where people have developed steroid-induced psychosis and ICU psychosis, Dr Malhotra said.
"The patients reach a stage where they are not oriented in time, place and person and at times start hallucinating….these things do get worse if they're on steroids."
This condition is called delirium, when you’re disoriented, he added.
Adjustment issues, grief can be seen in people who have lost their family members to COVID because of shortage of oxygen or despite the best of medical treatment services.
"For them, to absorb the fact that a family member is no longer physically present with them is tough. All of a sudden, life has changed," Dr Malhotra said. There is also associated guilt.
What Are the Symptoms of PTSD?
The symptoms usually begin early, within three months of the traumatic incident, but sometimes they begin years later too.
However, the symptoms should last more than a month and be severe enough to interfere with relationships or work to be considered PTSD.
Other Psychological Consequences of COVID
While, PTSD has been on the rise, the undercurrent is of significant anxiety and depression in the general population, Dr Malhotra said.
"These are unprecedented times. This is obviously something which has created a lot of uncertainty and thus, shaken the very foundations of your survival instinct. This has created a lot of conflict within"
In a nationwide study conducted last year, during the first wave of Covid, 55 percent of adults in the general population qualified for a significant anxiety disorder, Dr Malhotra said.
"About 27 percent, which means more than one in four, met the criteria for clinical syndrome of depression, requiring treatment."
The general stressors can affect depending on the degree of stress as per the surroundings of an individual and their own coping mechanism and support system, Dr Vohra said.
"According to my observation, some of the people who are very friendly or have an outgoing lifestyle, they have been badly affected," he added.
The psychological consequences can be worse for those with an anxious temperament, who have health-related anxieties, Dr Malhotra said.
“People who do a lot of surfing on the internet with respect to health parameters or people that have an obsessive bent of mind, they're more vulnerable.”
How Can We Cope?
What are the interventions to help individuals whose mental health has been disturbed by COVID?
The family should provide all the support possible and a healing environment to for the person, Dr Vohra said.
Try to open communication channels.
Don't make the person feel isolated.
Be there for the person, but don't probe into what happened.
Refrain from giving undue suggestions.
Keep the person engaged.
Listen empathetically.
Make sure the person is eating, sleeping well
Make sure drugs are avoided.
It is important for the person going through the trauma to speak about the issues and seek professional help if the problems are not resolved.
While several studies have examined the stressors and effect of Covid on mental health, more time is needed to understand the consequences, Dr Vohra said.
But with the pandemic pushing all of us to a breaking point at some point or the other, the awareness on PTSD is relevant for everyone, so that people can reach out for help without any stigma.
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