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COVID-19 pandemic-related anxiety in teenagers

Article  in  Indian Journal of Psychiatry · January 2020


DOI: 10.4103/psychiatry.IndianJPsychiatry_327_20

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Swapnajeet Sahoo Ruchita Shah


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Kasturba Medical College, Manipal Academy of Higher Access this article online
Education, Manipal, Karnataka, India. Quick Response Code
E-mail: shahulameen@yahoo.com Website:
www.indianjpsychiatry.org
Submitted: 09-Apr-2020, Revised: 16-Apr-2020,
Accepted: 17-Apr-2020, Published: 15-May-2020
REFERENCE DOI:
10.4103/psychiatry.IndianJPsychiatry_321_20
1. Eysenbach G. Improving the quality of Web surveys: The checklist for
reporting results of internet E-surveys (CHERRIES). J Med Internet Res
2004;6:e34.

This is an open access journal, and articles are distributed under the terms of How to cite this article: Ameen S, Praharaj SK. Problems
the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, in using WhatsApp groups for survey research. Indian J
which allows others to remix, tweak, and build upon the work non-commercially, Psychiatry 2020;62:327-8.
as long as appropriate credit is given and the new creations are licensed under © 2020 Indian Journal of Psychiatry | Published by Wolters Kluwer - Medknow
the identical terms.

COVID-19 pandemic-related anxiety in teenagers

Sir, Teenagers and children are special groups of the population


who have different “psyche.” More specifically, the
The COVID-19 outbreak since December 2019 and its adolescents/teenagers tend to experience emotions more
subsequent transformation into a pandemic had affected intensely. Having teenagers confined to their homes with
persons from every age group, and children and adolescents 24/7 parental attention/supervision can create a great
are not immune to it.[1] Although the mortality rate and degree of irritation as they are not used to such situations.
severity of COVID-19 are relatively low in young people, all Moreover, teenagers find it quite difficult to practice
the infection control measures and preventive strategies are social distancing. Children and adolescents are finding
equally important to this special population of “teenagers” it quite difficult to make sense of what’s happening in
like all other age groups. Moreover, teenagers and children the world, and they have their inherent suggestibility to
are considered to be hidden carriers of COVID-19 in recent follow the rumors/myths being forwarded in social media
Chinese studies conducted on COVID-19 close contacts.[2] platforms related to COVID-19 transmission/ precautions
Therefore, more precautions have to be taken by this special measures.[6] All these can also lead to excessive worrying,
population. fear, and anxiety about contracting the infection and can
create a sense of panic among teenagers. In this regard,
As the COVID-19 infection speeded to spread to >200 various health organizations/institutes have laid down
countries in <3 months of its outbreak, the World Health tips/advice to manage stress and anxiety in children and
Organization (WHO) and the National authorities across adolescents.[6-8] In this report, we present an 18-year-old girl
the world had taken several multiple steps for containment who presented with severe symptoms of anxiety- related
of the spread of infection. Some of these strategies include to COVID-19 infection and highlight the issues related to
the closure of schools, colleges and other educational teenagers in COVID-19 Pandemic.
institutions, shopping malls, promotion of hand hygiene,
and social distancing. Some of the countries, including An 18-year-old-female, from the urban background with
India, have adapted “lockdown” across the country to no past or family history of mental illness presented to
contain the spread of infection. While these measures are emergency services with symptoms of anxiety for 1 week.
of the utmost necessity to tackle the spread of infection, Exploration of history revealed that after the Nationwide
these measures have created a sense of “panic” in the “lockdown” was declared since March 24, 2020, she was
general public.[3,4] Further, several messages/videos are confined to her home, would mostly be hooked up to the
being circulated in the social media platforms regarding news channels about COVID-19 updates throughout the
several modes of transmission of COVID-19 infection. day. She would be following up various news channels and
Further, the news agencies/newspapers/some real-time videos in the social media platforms about how the lives of
COVID-19 tracker websites repeatedly provide real-time people have been affected in different Western countries and
updates about the number of cases infected and died due in China, how the infected persons were dying and family
to COVID-19.[5] members were unable to help their infected relatives/near

328 Indian Journal of Psychiatry Volume 62, Issue 3, May-June 2020


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Letters to Editor

ones, how the health-care workers were getting affected, related to COVID-19 and encourage distraction to tackle
etc. Over the period of 4–5 days of this routine, she started with their kids anxiety. More specific awareness programs
remaining worried that everyone on the Earth is going to focusing on this subgroup of the population are essential
get infected and die. These worries were associated with to decrease the prevailing anxiety among teenagers and
autonomic symptoms of anxiety such as palpitations, children.
feeling restlessness, and dryness of the mouth. After 4–5
days, started to avoid the news and social media, but if Declaration of patient consent
she would accidentally hear anything about COVID-19 The authors certify that they have obtained all appropriate
infection, her anxiety would increase further, which was patient consent forms. In the form the patient(s) has/have
now associated with intense palpitations, breathlessness, given his/her/their consent for his/her/their images and
sweating, tremors, tingling sensations in the body, nausea, other clinical information to be reported in the journal. The
and feeling of impending doom. These episodes would be patients understand that their names and initials will not
followed by intense crying spells. The frequency of these be published and due efforts will be made to conceal their
episodes would be 3–4 times/day, and she had to be calmed identity, but anonymity cannot be guaranteed.
down by family members. Resultantly, she was not able to
sleep, her appetite decreased, and she would mostly remain Financial support and sponsorship
worried about her own health and that of family members. Nil.
She was brought to our emergency, after one such episode.
She was diagnosed with anxiety disorder (not otherwise Conflicts of interest
specified) and managed with tablet clonazepam 0.5 mg There are no conflicts of interest.
and with supportive psychotherapy sessions. She was
psychoeducated regarding anxiety leading to the autonomic
symptoms and was taught relaxation exercises. She was Swapnajeet Sahoo, Seema Rani, Ruchita Shah,
followed up on telephonically and with these interventions, Ajay Pal Singh, Aseem Mehra, Sandeep Grover
she showed improvement in her symptoms over the next Department of Psychiatry, Postgraduate Institute of Medical
few days. Education and Research, Chandigarh, India.
E‑mail: drsandeepg2002@yahoo.com
This case description of the 18-year-old adolescent female
Submitted: 11-Apr-2020, Revised: 14-Apr-2020,
highlights the impact of the COVID-19 crisis over this special Accepted: 17-Apr-2020, Published: 15-May-2020
group of population. It further explains how the excessive REFERENCES
use of social media and telecommunication materials can
affect the mental well-being of teenagers and can lead to 1. Coronavirus Age, Sex, Demographics (COVID-19) – Worldometer.
excessive worry and subsequent severe anxiety symptoms. Available from: https://www.worldometers.info/coronavirus/coronavirus-
age-sex-demographics/. [Last accessed on 2020 Apr 10].
Various websites/health institutes/child and adolescent 2. Hu Z, Song C, Xu C, Jin G, Chen Y, Xu X, et al. Clinical characteristics
psychiatric societies/UNICEF and the WHO in their websites of 24 asymptomatic infections with COVID-19 screened among close
contacts in Nanjing, China. Sci China Life Sci 2020;63:706-11.
have focused on several techniques/tips to be taken care 3. Nigam C, Kumar A. Covid-19 Pandemic: Depression, Anxiety Go Viral as
of while dealing with teenagers during this COVID-19 Nation Observes Lockdown. India Today; 2020. Available from: https://
www.indiatoday.in/mail-today/story/covid-19-pandemic-depression-
pandemic.[9,10] Some of which are making them aware anxiety-viral-nations-observes-lockdown-1659774-2020-03-26. [Last
of the current situation about COVID-19, giving proper accessed on 2020 Apr 09].
information about how to protect themselves, promoting 4. 7 Reasons Why it’s Hard to Control Your Coronavirus Anxiety. STAT; 2020.
Available from: https://www.statnews.com/2020/03/12/why-coronavirus-
hand hygiene and social distancing, preparing a daily routine anxiety-hard-to-control/. [Last accessed on 2020 Apr 09].
of their activities, limiting exposure to social media and 5. COVID-19 News Making You Anxious? Listen to Expert Tips on How to Stay
Calm. CNA Lifestyle. Available from: https://cnalifestyle.channelnewsasia.
news channels, and validating their disappointment about com/wellness/anxious-depressed-covid-19-expert-tips-on-how-to-stay-
missing their schools/colleges/sports/ birthday parties, calm-12583238. [Last accessed on 2020 Apr 10].
etc., encouraging healthy habits, promoting remote/online 6. How to Talk to Your Anxious Child or Teen about Coronavirus. Available
from: https://adaa.org/learn-from-us/from-the-experts/blog-posts/
schooling/classes.[11,12] More specifically, the Centre for consumer/how-talk-your-anxious-child-or-teen-about. [Last accessed on
Disease Control and Prevention had advised the parents and 2020 Apr 10].
7. Damour L. 5 Ways to Help Teens Manage Anxiety about the Coronavirus.
caregivers should be available to listen to the concerns of The New York Times; 2020. Available from: https://www.nytimes.
their teenagers and children and reassure them, avoiding com/2020/03/11/well/family/coronavirus-teenagers-anxiety.html. [Last
accessed on 2020 Apr 10].
language that might blame others and lead to stigma, paying 8. Children and Adolescents. Norwegian Institute of Public Health. Available
attention to what the children and teenagers see or hear from: https://www.fhi.no/en/op/novel-coronavirus-facts-advice/facts-and-
on television/radio or online, and providing minimal but general-advice/advice-and-information-for-children-and-adolescents/.
[Last accessed on 2020 Apr 10].
accurate and genuine information.[12] Further, it has been 9. Concerns for the Mental Health of Children and Adolescents during the
seen that anxious parents are more likely to make their Coronavirus Pandemic – ESCAP. Available from: https://www.escap.eu/
index/coronavirus-and-mental-health/. [Last accessed on 2020 Apr 10].
children and teenagers more anxious. Therefore, parents 10. COVID-19: IFRC, UNICEF and WHO Issue Guidance to Protect Children
and caregivers should try to manage their own anxiety and Support Safe School Operations. Available from: https://www.who.

Indian Journal of Psychiatry Volume 62, Issue 3, May-June 2020 329


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Letters to Editor

int/news-room/detail/10-03-2020-covid-19-ifrc-unicef-and-who-issue- Access this article online


guidance-to-protect-children-and-support-safe-school-operations. [Last
accessed on 2020 Apr 10]. Quick Response Code
11. Institute CM is the Editorial Director of the CM. Supporting Teenagers and Website:
Young Adults during the Coronavirus Crisis. Child Mind Institute. Available www.indianjpsychiatry.org
from: https://childmind.org/article/supporting-teenagers-and-young-
adults-during-the-coronavirus-crisis/. [Last accessed on 2020 Apr 10].
12. CDC. Coronavirus Disease 2019 (COVID-19). Center Disease Control
Prevention; 2020. Available from: https://www.cdc.gov/coronavirus/2019- DOI:
ncov/daily-life-coping/talking-with-children.html. [Last accessed on 10.4103/psychiatry.IndianJPsychiatry_327_20
2020 Apr 10].

This is an open access journal, and articles are distributed under the terms of
the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, How to cite this article: Sahoo S, Rani S, Shah R, Singh AP,
which allows others to remix, tweak, and build upon the work non-commercially, Mehra A, Grover S. COVID-19 pandemic-related anxiety in
as long as appropriate credit is given and the new creations are licensed under
the identical terms.
teenagers. Indian J Psychiatry 2020;62:328-30.
© 2020 Indian Journal of Psychiatry | Published by Wolters Kluwer - Medknow
For reprints contact: reprints@medknow.com

The psychology behind response of people in wake of the COVID‑19


pandemic in India

Sir, The most commonly observed response was denial of the


illness, with patients escaping from isolation wards even
The emergence of corona virus pandemic has given rise to after testing positive, defying precautions, engaging in
an atmosphere of uncertainty. Thanks to the internet and social interaction, and hiding their illness. They appear
information technology, we are being updated continuously overconfident of their own self and in condition of denial.
about the havoc it is causing‑ country‑ and state‑wise statistics Similar finding has been reported by a Norwegian study[2]
of cases and fatalities, people left shelter‑less or quarantined on a potential influenza pandemic where major proportions
and what not. The governments are toiling hard to manage of people minimized the perceived mortality risk. The
the situation, bringing in regulations, arrangements, and stages of grief as given by Kubler‑Ross[3] states “Denial”
policies. Our over‑burdened health sector is rifled with as the first stage of grief; characterized by disbelief and
providing adequate health care, morbidity and mortality, protest. The other stages are anger, bargaining, depression,
racing for a cure and a vaccine. Health‑care professionals have and acceptance; stages are usually overlapping and a fluid
been reported to be struggling with concerning issues ‑ lack process that varies from person to person. The instance of
of proper protective equipment in isolation wards, violence a patient committing suicide after being informed about
from patients’ guardians, threat of being evicted from their suffering from a viral infection (not coronavirus) can be
homes for fear of community spread, amidst the most fearful exemplified as cognitive distortion of “catastrophizing” of
threat of getting infected while on their jobs. A plethora of the outcome of his condition.[4]
misinformation about the disease and the statistics, circulating
over social media, has created mass misconceptions, anxiety Following steady increase in cases amidst widespread
and stigma, leading to ignoring precautionary directives, lockdown, reported instances of resistance and violence
discrimination, and marginalization. The phenomenon of against law enforcement and medical personnel, exemplify
“Misinfodemics” ‑ i.e., the spread of a particular health manifestation of “anger.” Masses partially cutting down
condition or illness, facilitated by viral misinformation[1] ‑ is social mingling and migrants in different locations starting
widely observable in the people’s reactions. As the off for long journeys on foot to reach their home amidst
imposition of “lockdown” in numerous countries has given lockdown, is akin to “bargaining.” With recognition of the
way to collective economic crisis, exacerbation of aberrant insufficiency of resources, finances, health care, isolation
reactions is to be expected. A very irksome response that is shelters, and the resultant agony and angst while in social
being encountered is the aversion of public to abide by safety isolation is similar to the stage of “depression.”
regulations, rejection to observe precautions stipulated
for their own good, even to the point of being aggressive The rise of hateful behavior toward police and medical
and resistive to medical help. The epidemiological process personnel and ethnic discriminatory behavior can be
of the pandemic can be conceptualized to be reflected in attributed to Freud’s neurotic defense of “Displacement.”[3]
human’s thoughts, behaviors, and emotional responses. Here Trauma of the pandemic that threatened one’s survival
is an attempt to discuss about the psychology behind these causes affective investment in another object purporting
responses. to solve the conflict. The catastrophic pandemic also

330 Indian Journal of Psychiatry Volume 62, Issue 3, May-June 2020

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