Impacts of COVID-19 Pandemic on Mental Health in Malaysia: A Single Thread of Hope
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MJP Online Early 01-05-20
BRIEF COMMUNICATION
Impacts of COVID-19 Pandemic on Mental Health in Malaysia:
A Single Thread of Hope
Hemavathi Shanmugam, Johan Ariff Juhari, Pritiss Nair,
Chow Soon Ken, Ng Chong Guan
Department of Psychological Medicine, Faculty of Medicine,
University of Malaya, Kuala Lumpur, Malaysia
Abstract
Introduction: The COVID-19 pandemic is a catastrophic occurrence that has
not been seen since the Spanish Flu. Recent researches mainly focused on the
adverse effects of COVID-19 pandemic on mental health. Objective: This
article examines both the negative and unexpected helpful changes which the
pandemic has on mental health in the Malaysian population. Results: We
expect to see an upsurge in anxiety disorders, posttraumatic stress disorders,
obsessive-compulsive disorders and aversive social effects of isolation. On the
other hand, we could also postulate that improvement could be achieved in
compliance and supervision of medication, strengthening of the family
support and reduction in substance-related psychiatric disorders. Conclusion:
By understanding both deleterious and potentially favourable effects of a
global disaster such as the COVID-19 pandemic, mental health professionals
could be better equipped in facing such events.
Keywords: COVID-19, Pandemic, Impact, Mental Health
Introduction Negative Impacts
COVID-19 pandemic is spreading all around The World Health Organization (WHO) [4]
the world. Many countries in the world, and public health officials all around the
including Malaysia, are experiencing a crisis world are calling upon all individuals to
– one which could stir up tremendous practice social distancing - be it avoiding
mortality and morbidity. Contemporaneous large crowded areas, mass gatherings or to
researches and reviews have focused on the have any close contact with at-risk
physical impacts of COVID-19 pandemic [1, individuals to prevent the virus’s spread.
2, 3]. However, while dealing with such an However, this is at odds with the very nature
enormous challenge, the potential mental of humans as social creatures. The existence
hazard brought upon by the pandemic could of human beings has always revolved
be disastrous. around the connectivity to others, as people
have evolved in such a way, that they seek
for human connection and affection [5, 6].MJP Online Early 01-05-20
Thus, social distancing not only tests the data in Malaysia regarding mental health
capacity for human co-operation, but it also impacts of COVID-19.
brings about various mental health
implications such as fear, anxiety, grief and Government’s measure: such as movement
depression. A meta-analysis in 2015 that control order (MCO), not only limits one’s
was reported by a psychologist, Julianne movement outside and social activities, but
Holt-Lunstad and her colleagues from one’s job status is jeopardized as well.
Brigham Young University concluded that Numerous non-essential businesses are
the risk of mortality is increased to 29% in forced to come to a halt. Financial
individuals who suffered from chronic social difficulties quickly set in – and many groups
isolation [7]. of the population especially those in the B-
40 and M-40 category, have already lost
Fear and anxiety towards COVID-19 could their source of income or are in the verge of
potentially be overwhelming and hence termination. Despite the government’s
heighten the mental stress towards oneself stimulus packages that were developed to
and society. This fear and anxiety are aid the financial burden faced by many
compounded by social distancing as citizens in Malaysia, many small and
individuals want the best of both worlds medium enterprises (SME) in Malaysia, can
which is to be connected, yet to not contract no longer sustain the financial burden that is
the ongoing coronavirus infection. brooding and has been resorting to cutting
Undeniably, social distancing minimizes wages, reduce the number of employees as
social contact and thus aids to decelerate the well as providing unpaid leaves indefinitely
spread of COVID-19. However, social due to blooming uncertainty of the country's
distancing could disrupt the social rhythm, economic status. Losing a job brings in
by depriving one's regular coping feelings of uncertainty and insecurity -
mechanisms with stress – hence putting which eventually disrupts mental health,
mental health at stake. leading to feelings of anxiety and depression.
According to the Malaysian Mental
According to the American Psychiatric Healthcare Performance in 2016, mental
Association (APA), about 62% of disorders were estimated to be responsible
Americans are suffering from symptoms of for 8.6% of total DALY's [10]. With the
anxiety, which is related to COVID-19 and ongoing COVID-19 pandemic, one can only
59% feels that the virus is greatly impacting expect these figures to rise dramatically. The
their day-to-day lives [8)]. Qiu et al, 2020 financial burden hitting the population in
conducted a nationwide large-scale survey Malaysia could further escalate with
of psychological distress in the general individuals coping by drinking alcohol and
population of China during the tumultuous taking illicit substances which then give
time of the COVID-19 epidemic [9]. The further rise to multiple other disorders such
survey found those who are vulnerable for as alcohol use disorder and so on.
psychological distress includes female,
young adults who obtain information from Pandemics may also negatively impact the
social media which triggers stress, the poor and vulnerable populations, and
elderly who are at higher risk for mortality especially patients with serious mental
and migrant workers affected by the illness [11]. People with preexisting mental
economic crisis. There is however limited illnesses suffer a greater risk of relapses,
owing to fear, anxiety and social rhythmMJP Online Early 01-05-20
disruption. Furthermore, social distancing Unexpected Helpful Impacts
forces an individual to stay at home for an
extensive period. If the individual is already Interestingly, COVID-19 pandemic might
living in a preexisting toxic home have a potentially favourable impact on
environment, spending more time at home mental health in the Malaysian setting. Due
could be extremely stressful. The Women’s to the MCO and hence movement
Aid Organisation and Talian Kasih reported restrictions outside of the house, families
an increment of 44% and 57% respectively tend to stay at home. Family’s supervision
in contacts after the government-issued of medications potentially become more
Movement Control Order (MCO), for which available and regular – hence there are fewer
domestic abuse is one of the reasons cited relapses for psychiatric conditions. MCO
[12]. A patient who suffers from post- could also bring the family together,
traumatic stress disorder (PTSD) due to past enabling a chance for bonding. The
family trauma, staying with the family with improvement in familial bonding could, in
more contact at home could mean disaster. turn, improve family support, which is vital
Another example is people who have a pre- in the face of crisis: such as COVID-19
existing condition known as obsessive- pandemic. Family support is cardinal and
compulsive disorder (OCD). This group of therapeutic especially for patients with
people, who have contamination OCD, mental illness [14], by fulfilling their
potentially already suffers from the physical, emotional and spiritual needs.
compulsion of frequently and repeatedly
washing their hands. The COVID-19 Besides, family support could as well
pandemic then creates a blurry line between improve the outcome in substance-related
safety and compulsion. psychiatric illnesses [15]. With the
enforcement of MCO, family support could
Besides the general population, health care be enhanced. Family is expected to be at
workers on the front line are also at risk of home and potentially acts as vital overseers -
developing psychological distress while by supervising and monitoring individuals
managing patients with COVID-19. A study from using substances. Besides, MCO could
in China by Lai J et al in 2020, found that, provide a chance for substance users to bond
among 1,257 healthcare workers working with their family, and hence possibly helps
with COVID-19 patients in China, 50.4% in fulfilling their psychological need of
reported symptoms of depression, 44.6% relatedness. Gloria H. Y. Chan in 2019,
symptoms of anxiety, 34% insomnia, and found that: one's psychological need for
71.5% reported distress [13]. Front-liners connectedness serves as an important
are afraid of disease transmission to their determinant for substance use [16]. If their
family members, felt exhausted with long psychological need for relatedness is
working hours especially due to lack of fulfilled, the ultimate coping mechanism of
adequate protective gear. Some of them also using drugs could as well be diminished –
had a sense of guilt as they could not do and hence resulting in an overall reduction
enough for their patients and watched the substance-related psychiatric disorders.
patients deteriorated without their family Furthermore, the MCO comes with
members by their side. heightened security and numerousMJP Online Early 01-05-20
roadblocks. Tightened security could before this – and possibly finding a new
potentially make substance use and balance between work, family and personal
trafficking less accessible. As a result, life. T. S. Sathyanarayana et al in 2010,
substance use and its related psychiatric pointed out that: work, family and personal
conditions are less prominent too. The life should be complementary and not
Police DiRaja of Malaysia in a recent press conflicting with each other [21]. Decent
statement in March 2020 reported that since family happiness and personal life are
the starting of the MCO, crime rates around especially key dimensions of a successful
Kuala Lumpur has seen a 48% dip. career. Art of balancing between these
dimensions is no easy task. However, the
Additionally, MCO enables a break from the pandemic and resultant MCO potentially
hectic schedule of work and studying. For allow people to attempt - to learn to attain a
certain individuals, whose work and study newfound balance in work and life.
serve as major stressors, the MCO provides
a much-needed break from the stressful Conclusion
daily routine – thus less psychiatric relapses
and psychological distress may occur. It is intriguing yet crucial to learn about the
Carolyn S. Dewa in 2007, found that chronic psychological impact – both negative and
work stress could worsen the outcome of potentially favourable ones. Some of the
patients with psychiatric illness [17]. Hence, major issues to ponder: did the theme of
MCO could provide a long-awaited rest for psychological distress change due to the
those who suffered chronic stress from work pandemic? For example, in patients with
– and thus providing a favourable outcome n anxiety, do the symptoms of anxiety change
mental health. Furthermore, staying at home to fear instead due to the COVID-19
longer potentially enables more home- pandemic? More targeted and structured
cooked food and a healthier diet regime. research on mental health implications
Dinan et al. in 2018 found correlations should be studied in Malaysia. This is to
between a healthy diet and mental health develop a better understanding of the
[18]. For example, a higher amount of paradigm of the pandemic and to tailor an
dietary vegetables and fruits is associated individualized treatment and prevention of
with increased levels of reported happiness mental health complications due to COVID-
and mental health [19]. 19 pandemic.
In addition to food and rest, MCO Some of the preventive measures proposed
drastically slows down the pace of life. by Xiang et al, 2020 are, forming a
People could gain more time and multidisciplinary team which consist of
opportunities to think about the meaning of psychiatrists, clinical psychologists and
life. According to Huguelet P. et al in 2016, other supporting staffs [22]. Secondly,
spirituality and meaning in life are important communication should be concise, clear and
determinants of recovery for patients with accurately updated from time to time. Lastly,
psychiatric disorders [20]. In the face of an secure services such as usage of electronic
unprecedented global crisis, while being devices are important to provide
equipped with more time, people could psychological support [22]. Druss, 2020 also
explore, or re-explore about the meaning of emphasized the importance of continuation
life. People might have a chance to learn to of mental health services for patients with
appreciate things which were overlooked severe mental illness via methods such asMJP Online Early 01-05-20
telepsychiatry [11]. Furthermore, education Zhu, Lin-ling Cheng, Feng Ye, Shi-
regarding mental illness is also crucial to yue Li, Jin-ping Zheng, Nuo-fu
reduce stigma and encourage more people to Zhang, Nan-shan Zhong, Jian-xing
come forward to seek treatment for the He. Comorbidity and its impact on
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experience following COVID-19 pandemic. China: A Nationwide Analysis.
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precipitants for relapses – in aiming to work [4] World Health Organization (2020,
together for the betterment of mental health. March 31) Coronavirus disease
(COVID-19) advice for the public.
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Corresponding Author
Ng Chong Guan
Department of Psychological Medicine,
Faculty of Medicine, Lembah Pantai,
50603, Kuala Lumpur,
Malaysia
Email: chong_guan@um.edu.myYou can also read
