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Covid-19: Mental health consequences of pandemic need urgent research, paper advises

BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1515 (Published 16 April 2020) Cite this as: BMJ 2020;369:m1515

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Frequent suicide incidences by in-ward patients indicate mental stress is a real issue at Indian COVID-care centers

Dear Editor,
Suicide incidences by in-ward COVID-19 patients have been frequently reported from Indian COVID-care centers (1). These incidences indicated mental stress in COVID-19 patients is a real issue at these centers and needs to be addressed (2). Multiple patients specific and health system-related factors could have contributed to these suicide incidences. The COVID-19 pandemic has put tremendous pressure on hospitals and healthcare workers (HCWs) which may have affected the quality of the patient care and access to the individual patients. There has been a lot of social stigma and apprehension of life loss associated with COVID-19 which can make the patients unduly stressed (3). In some COVID-19 patient new onset of psychiatric symptoms also has been reported (4); disease-induced anxiety, sleep deprivation, physical weakness, and depression may be contributory causes for the patient suicides (5). No direct human contact (without personal protective covering) in hospital wards also may be a contributor to the mental stress in the COVID-19 patients. Additionally, owing to the high risk of contracting the viral infection, to a certain extent hesitation by HCWs to provide affectionate care to the COVID-19 patients is understandable.
Regular mental counseling of the in-ward COVID-19 patients may make them feel cared thus can reduce their apprehension. Some patients may truly require therapeutic management of their psychiatric symptoms which can be screened out during counseling. As death risk in younger age patients and those without co-morbidities is very low, providing the patients with correct information about their personal health status and limited life risk may also reduce their anxiety. As the risk of contracting viral infection and shortage of medical staffs may be a real challenge for providing direct mental counseling, using virtual facilities and telepathy for this seem feasible options hence should be availed to in-ward COVID-19 patients.

References
1. Another Covid-19 patient dies by suicide in Patna AIIMS | Deccan Herald [Internet]. [cited 2020 Jul 31]. Available from: https://www.deccanherald.com/national/east-and-northeast/another-covid-1...
2. Suicide case highlights importance of counselling for COVID-19 patients - The Hindu [Internet]. [cited 2020 Jul 31]. Available from: https://www.thehindu.com/news/national/karnataka/suicide-case-highlights...
3. Banerjee D. How COVID-19 is overwhelming our mental health. Nat India Retrieved March. 2020;26(March):2020.
4. Varatharaj A, Thomas N, Ellul MA, Davies NWS, Pollak TA, Tenorio EL, et al. Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study. The Lancet Psychiatry [Internet]. 2020 Jun [cited 2020 Jul 15];0(0). Available from: www.thelancet.com/
5. Montemurro N. The emotional impact of COVID-19: From medical staff to common people. Brain, Behavior, and Immunity. Academic Press Inc.; 2020.

Competing interests: No competing interests

31 July 2020
Ashutosh Kumar
Assistant Professor
Department of Anatomy, All India Institute of Medical Sciences (AIIMS), Patna, India
Patna, Bihar, India