Abstract
Coronavirus disease 2019 (COVID-19) is caused by SARS-CoV-2, a newly emergent coronavirus, that was first reported in Wuhan, China, in December 2019. The COVID-19 pandemic has impacted 216 countries, areas or territories globally and infected 9.8 million people including 495,388 deaths by the last count of 28th June, 2020 (World Health Organization, 2020). In Bangladesh, the first three known cases of COVID-19 were reported by the country’s Institute of Epidemiology, Disease Control and Research (IEDCR) on the 8th of March 2020 (Islam, Ferdous, et al., 2020). Since then, this emergent disease has been increasing swiftly in the densely populated country of Bangladesh and has turned into a major public health concern there as in other countries. More than 137,500 confirmed cases have reported in Bangladesh with 1,738 fatalities by 28th June, 2020 (Institute of Epidemiology Disease Control and Research, 2020). To reduce the spread of COVID-19, a public holiday was declared by the Government of Bangladesh on March 26 (Islam, Ferdous, et al., 2020). This public holiday involved schools, colleges, universities and other institutions remaining closed until the situation is under better control. This uncertain situation has disrupted many individuals’ daily routines and habits, which may harm their mental health and place them at risk for developing posttraumatic stress disorder (PTSD) (Boyraz & Legros, 2020), a condition that includes intrusive memories, avoidance behaviours, irritability and emotional numbing.
Home quarantines, social isolation and travel restrictions during the COVID-19 outbreak are likely to impact many people’s mental health. During spatial distancing and home quarantines, individuals may experience boredom, stress, anxiety, anger, loneliness and other feelings (Boyraz & Legros, 2020). Loneliness and social isolation may increase the likelihood of early death, with some studies suggesting its impact is more harmful than obesity and similar to tobacco smoking (American Psychiatric Association, 2019). Outbreaks like the COVID-19 pandemic have potential for psychological contagion, and which may generate widespread fear, anxiety, depression, PSTD and other psychiatric disorders, and these may be exacerbated by stigmatisation of affected individuals as well as their relatives, caretakers and residents in infected areas (Mak et al., 2009). As PTSD and other psychiatric disorders exert a substantial burden on individuals and society (Boyraz & Legros, 2020; Liu et al., 2020), early detection and intervention are important during and following major outbreaks like the COVID-19 pandemic.
Individuals who have been infected with the SARS-CoV-2 virus may develop COVID-19 or infect others. These experiences can be traumatic for them and people close to them, including families, friends and caretakers (Boyraz & Legros, 2020). Others may experience trauma from the environment that the COVID-19 pandemic has created, one that may limit social interactions, generate feelings of isolation, and lead to disruption in daily lives and routines (e.g. financial losses, job losses, housing problems and lack of support) (Boyraz & Legros, 2020). Having customary contact with individuals who experience serious manifestations of COVID-19 or die may be particularly traumatic.
Following the 2003 SARS outbreak in China, high levels of PTSD symptoms were noted. One study revealed that among medical staff working in the 2003 SARS outbreak in China, 10% had high levels of PTSD symptoms (Wu et al., 2005). Likewise, another study found that PTSD was the most prevalent long-term mental disorder, followed by depressive disorder, among SARS survivors in Hong Kong (Mak et al., 2009). This study also reported that one-fourth of the patients had PTSD and that the prevalence of PTSD in the 30 months following the SARS outbreak was 47.8% (Mak et al., 2009). A more recent study in China reported that the prevalence of posttraumatic stress symptoms in the hardest-hit areas was 7% after a month of the COVID-19 outbreak (Liu et al., 2020).
In Bangladesh, there has been no study of PTSD during the COVID-19 outbreak. However, a recent study conducted from March 29 to April 06, 2020 (early in the outbreak) reported high estimates of panic (79.6%) and generalised anxiety (37.3%) among Bangladeshi people in the community (Islam, Ferdous et al., 2020). Furthermore, another study conducted among Bangladeshi university students reported high prevalence estimates of depression (62.9%), anxiety (63.6%) and stress (58.6%) (Islam, Sujan, et al., 2020). As such, the environment appears extremely conducive for people to be experiencing PTSD. Furthermore, as Boyraz and Legros (2020) suggested that low-income populations were at particular risk for developing PTSD, Bangladesh with its dense population and middle income may experience more trauma than some other well-developed countries. Additionally, Bangladesh may be particularly impacted as its 20.5% of individuals are estimated to live below the poverty line (Bangladesh Bureau of Statistics, 2019). Furthermore, the impact of the COVID-19 pandemic may be exacerbated in Bangladesh by other recent events such as cyclone ‘Amphan’ (The New York Times, 2020). Research is needed to investigate PTSD and related concerns during and following the pandemic. Information may help inform early interventions, supportive programmes, policies, and practices to help protect individuals from developing and experiencing PSTD. Some general behaviours may help promote mental health and resilience during the COVID-19 pandemic and these may include (i) employing preventative measures to cope with COVID-19-related concerns, (ii) staying connected with friends and family members, (iii) engaging in regular physical exercise, (iv) getting enough sleep, (v) avoiding alcohol and drug use, (vi) using digital technologies in a balanced manner and, (vii) getting professional help for mental health concerns and stress. Mental health researchers, practitioners and those working in professions in which trauma exposure is common should promote awareness of PTSD through online counselling, campaigns, social media and other manners during the COVID-19 pandemic.
