By: Retna Mustika Indah
The outbreak of coronavirus disease 2019 (COVID-19), which started in China in December 2019, has proliferated in other Europe, America, Australia, Africa, and Asian countries, including Indonesia. In addition to endangering human health and consequently causing deaths, COVID-19 imposes irreversible psychological impacts on human societies. It is natural for individuals to feel fear, sadness, and anxiety during a crisis. Indeed, fear of the virus is spreading even faster than the virus itself. In this COVID-19 conjuncture, people can be fearful about becoming ill and dying, losing livelihoods and loved ones, and being socially excluded. People who test positive for COVID-19 must cope with anxiety about their condition, physical discomfort, separation from loved ones, isolation, and possible stigma. Those who have loved ones affected by COVID-19 are facing worry and separation.1 Many people worldwide are suffering from loss of livelihoods and opportunities. Some people turn to alcohol, drugs, and potentially addictive behaviors such as gaming, shopping online, internet, or eating disorders.2-7 Domestic violence has increased. Finally, people experiencing the death of a family member due to COVID-19 may not have the opportunity to be physically present in their last moments or to hold a proper funeral ceremony, which may disrupt the grieving process.8 At the press conference of The 5th ASEAN Health Ministers Meeting (AHMM) on May 2022, The Director for Mental Health, Ministry of Health Republic of Indonesia, highlighted that this COVID-19 pandemic had increased the prevalence of mental health disorders to 1-2 fold compared to before the pandemic, and affected various groups of the population.9 In many pandemic episodes, the general population and the healthcare workers who are more at risk for infection and transmission also present similar psychological distress.10-12 Frontline workers such as doctors, nurses, and ambulance drivers, are exposed to additional stress during the COVID-19 pandemic. They experience stigmatization, higher demands during work, and fear of spreading COVID-19 to their families, not to mention the physical strain they have to endure while wearing protective equipment and the physical isolation to which they have to submit themselves to protect their families.
It cannot be denied that many countries have no adequate healthcare system and infrastructure to deal with the pandemic situation.13, 14 The shortage of healthcare workers is aggravated by high mortality among those treating COVID-19 patients15, resulting in higher work-load and longer working hours for the remaining personnel, especially when the number of COVID-19 patients continues to increase. Moreover, similar to other countries, there is a lack of personal protective equipment (PPE) for healthcare workers on duty. This shortage is worsened by the public’s panic buying and stockpiling of medical-grade PPE.13, 14 Other than that, the number of hospitals, bed capacities, and supporting facilities to treat COVID-19 patients, such as negative pressure wards and Intensive Care Unit rooms, are lacking and also not evenly distributed in Indonesia.13 The lack of facilities puts healthcare workers in a difficult position, where they must decide to whom treatments should be given.16 The abovementioned issues might explain why healthcare workers in Indonesia are more prone to adverse mental health symptoms than the general population.
Several interventions have been implemented to support the healthcare workers in minimizing the impact of the COVID-19 pandemic on their mental health. Some focus areas, such as training the healthcare workers and strengthening the logistics and supply chain, should be prioritized and require a relentless commitment. Knowledge regarding the infection causing the pandemic and its prevention was deemed important to reduce the worries of healthcare workers.17 Updated information, including infection guidelines, hospital procedures, and even operation of common medical protective equipment should be well provided and reachable. Online platforms that are growing rapidly nowadays make it more possible to achieve this goal. After taking serious attention to the infrastructure and facility, psychosocial intervention might play important role in supporting the mental health of healthcare workers. Lesson learned from the previous pandemic; psychosocial training can improve resilience to pandemic-related stress.18, 19 Mental health consultants or peer group support and offered assistance to healthcare workers may help the healthcare workers to adapt to the stresses created by the epidemic.17 Some cases might require therapy and rehabilitation, however, studies found that Cognitive Behavioural Therapy20-22 and music therapy23 were effective to relieve specific mental symptoms such as stress, depression, PTSD, anxiety, behavioral changes, or psychotic symptoms.
Besides the psychosocial intervention, organizational support during the pandemic is important. One effective support to create better environments during the pandemic is an adjustment of working hours.24 Some hospital staff in several cities with a high burden of COVID-19 in Indonesia work for 2 weeks and have the following week off. Some local governments even provided accommodation for the health workers during the peak of the COVID-19 cases. These policies were implemented to prevent transmission from healthcare workers to their environment. Reorganizing the area in the hospital to provide space for healthcare workers to relax, shower, receive emotional support, and reenergize with snacks and beverages is expected by the employees since they are exposed to the stress of using the full protective equipment and dealing with the mortality and emergence of COVID-19 patients.
Taking care of the mental health of healthcare workers directly affects their ability to fully serve their patients. We should take this moment to strengthen our healthcare system, especially mental health services. In the near future, it will be mandatory to establish psycho-logical treatment guidelines and launch the program to improve psychological resilience among healthcare workers. Finally, all the programs put in place so far faced resistance on the part of healthcare workers in admitting psychological difficulties. We believe online promotion and awareness campaigns to minimize psychological stigma should also be implemented in both the planning and the execution phases of a psychological intervention program.
- Gentry SV, Thomas-Meyer M, Tyrrell CSB, Mavrodaris A, Williams R, Wallbank S, et al. What are the mental health impacts of epidemics on relatives of people affected, and relatives of healthcare workers: What interventions are available to support them? A systematic review and narrative synthesis. Comprehensive psychiatry. 2022;113:152288.
- Siste K, Hanafi E, Sen LT, Christian H, Adrian, Siswidiani LP, et al. The Impact of Physical Distancing and Associated Factors Towards Internet Addiction Among Adults in Indonesia During COVID-19 Pandemic: A Nationwide Web-Based Study. Frontiers in psychiatry. 2020;11.
- Sun Y, Li Y, Bao Y, Meng S, Sun Y, Schumann G, et al. Brief Report: Increased Addictive Internet and Substance Use Behavior During the COVID-19 Pandemic in China. The American journal on addictions. 2020;29(4):268-70.
- Bonny-Noach H, Gold D. Addictive behaviors and craving during the COVID-19 pandemic of people who have recovered from substance use disorder. Journal of addictive diseases. 2021;39(2):257-64.
- Panno A, Carbone GA, Massullo C, Farina B, Imperatori C. COVID-19 Related Distress Is Associated With Alcohol Problems, Social Media and Food Addiction Symptoms: Insights From the Italian Experience During the Lockdown. Frontiers in psychiatry. 2020;11.
- Gecaite-Stonciene J, Saudargiene A, Pranckeviciene A, Liaugaudaite V, Griskova-Bulanova I, Simkute D, et al. Impulsivity Mediates Associations Between Problematic Internet Use, Anxiety, and Depressive Symptoms in Stu-dents: A Cross-Sectional COVID-19 Study. Frontiers in psychiatry. 2021;12.
- Hanafi E, Siste K, Limawan AP, Sen LT, Christian H, Murtani BJ, et al. Alcohol- and Cigarette-Use Related Behaviors During Quarantine and Physical Distancing Amid COVID-19 in Indonesia. Frontiers in psychiatry. 2021;12.
- Cardoso É AO, Silva B, Santos JHD, Lotério LDS, Accoroni AG, Santos MAD. The effect of suppressing funeral rituals during the COVID-19 pandemic on bereaved families. Revista latino-americana de enfermagem. 2020;28:e3361.
- Ministry of Health RoI. Pandemi COVID-19 Memperparah Kondisi Kesehatan Jiwa Masyarakat. 2022.
- Sitanggang FP, Wirawan GBS, Wirawan IMA, Lesmana CBJ, Januraga PP. Determinants of mental health and practice behaviors of general practitioners during COVID-19 pan-demic in Bali, Indonesia: a cross-sectional study. Risk Management and Healthcare Policy. 2021;14:2055.
- Fathiariani L, Nassimbwa J. Investigating the burden of mental distress among nurses at a provincial COVID-19 referral hospital in Indonesia: a cross-sectional study. BMC nursing. 2021;20(1):1-8.
- Syamlan AT, Salamah S, Alkaff FF, Prayudi YE, Kamil M, Irzaldy A, et al. Mental health and health-related quality of life among healthcare workers in Indonesia during the COVID-19 pandemic: a cross-sectional study. BMJ open. 2022;12(4):e057963.
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- Mahendradhata Y, Andayani N, Hasri ET, Arifi MD, Siahaan RGM, Solikha DA, et al. The Capacity of the Indonesian Healthcare System to Respond to COVID-19. Frontiers in public health. 2021;9:649819.
- Wirawan GBS, Januraga PP. Correlation of Demographics, Healthcare Availability, and COVID-19 Outcome: Indonesian Ecological Study. Frontiers in public health. 2021;9:605290.
- Emanuel EJ, Persad G, Upshur R, Thome B, Parker M, Glick-man A, et al. Fair Allocation of Scarce Medical Resources in the Time of Covid-19. The New England journal of medicine. 2020;382(21):2049-55.
- Chen R, Chou K-R, Huang Y-J, Wang T-S, Liu S-Y, Ho L-Y. Effects of a SARS prevention programme in Taiwan on nursing staff’s anxiety, depression and sleep quality: A longitudinal survey. International Journal of Nursing Studies. 2006;43(2):215-25.
- Maunder RG, Lancee WJ, Mae R, Vincent L, Peladeau N, Beduz MA, et al. Computer-assisted resilience training to prepare healthcare workers for pandemic influenza: a randomized trial of the optimal dose of training. BMC Health Services Research. 2010;10(1):72.
- Aiello A, Khayeri MY-E, Raja S, Peladeau N, Romano D, Leszcz M, et al. Resilience Training for Hospital Workers in Anticipation of an Influenza Pandemic. Journal of Continuing Education in the Health Professions. 2011;31(1):15-20.
- Waterman S, Hunter ECM, Cole CL, Evans LJ, Greenberg N, Rubin GJ, et al. Training peers to treat Ebola centre work-ers with anxiety and depression in Sierra Leone. International Journal of Social Psychiatry. 2018;64(2):156-65.
- Geoffroy PA, Le Goanvic V, Sabbagh O, Richoux C, Wein-stein A, Dufayet G, et al. Psychological Support System for Hospital Workers During the Covid-19 Outbreak: Rapid Design and Implementation of the Covid-Psy Hotline. Frontiers in psychiatry. 2020;11.
- Ping NPT, Shoesmith WD, James S, Nor Hadi NM, Yau EKB, Lin LJ. Ultra Brief Psychological Interventions for COVID-19 Pandemic: Introduction of a Locally-Adapted Brief Intervention for Mental Health and Psychosocial Support Ser-vice. The Malaysian journal of medical sciences : MJMS. 2020;27(2):51-6.
- Giordano F, Scarlata E, Baroni M, Gentile E, Puntillo F, Brienza N, et al. Receptive music therapy to reduce stress and improve wellbeing in Italian clinical staff involved in COVID-19 pandemic: A preliminary study. The Arts in Psychotherapy. 2020;70:101688.
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