The Cause of Mental Health Problem Among Urban Residents During the COVID-19 Outbreak: Implication for information Communication

Background

Currently, it is a common experience that seeing people gaze at several other having disorganized thought, showing unhappy face, glancing towards other with the suspicion and avoiding to meet others on the streets during the day and night hours. As this happens, it is easier to understand that these peoples are staying away from others and avoiding social interaction, want to be alone, boredom and engaged in the extended thought; they are having a certain kind of psychological disorder; could be linked to the mental health of the community.

Many scholars have proposed the possible links between social distancing and the mental health of the general public. For example, a study conducted by (Fiorillo & Gorwood, 2020; Williams et al., 2020) identified social distancing and social isolation as has had to have a considerable negative impact on the mental health of the public. Social distancing and isolation will increase the probability of fear, anxiety symptoms, loneliness, depressed mood, and psychological distress (Carvalho Aguiar Melo & de Sousa Soares, 2020) and contribute to frustration, boredom, low mood, potentially depression and anxiety might also arise from the fear of contagion and inadequate clarity around social distancing guidelines (Venkatesh & Edirappuli, 2020).

In addition to social distancing, studies showed several contributing risk factors to mental health, which are sometimes opposing and other times harmonizing. For instance, a literature review conducted in Germany on Challenges and burden of the Coronavirus 2019 (COVID-19) pandemic for child and adolescent mental health revealed that isolation, contact restrictions, and economic shutdown impose a complete change to the psychosocial environment are the major factor contributing to mental health problem of the public and, anxiety, lack of peer contact and reduced opportunities for stress regulation was the main concerns of the review (Fegert et al., 2020). Furthermore, parental mental illness, domestic violence, and child maltreatment were also identified as the potential cause of the mental health problem of the public (Fegert et al., 2020). In this study, mental health problem was found to have been caused by policy-related and personal issues such as tight discipline policies to the guideline.

On the other hand, another study conducted in Israel showed that cause of mental health problem in the public was identified as a result of elevated psychological distress due to background illness, fear of contracting COVID-19 from a patient, and a higher subjective overload; rather than policy-related issues (Shacham et al., 2020). Yet another review conducted in Australia (Usher et al., 2020), indicated that mental health problem is associated with fear, panic, and discrimination. Moreover, World Health Organization (WHO, 2020), pointed out that mental health problems might be attributed to news reports. That is, news that disseminates misinformation with untrusted sources and Social Media can create a conducive environment for the development of abnormal behavior related to mental health with the mental health problem of the public. These different findings clearly show that there are wide divergences in the causes of mental health problems, and these variations in cause stem from the differences in location, culture, and contexts of the participant.

From an extensive standpoint, however, public mental health causes are closely linked with many factors including living style, culture, economic status, lack of physical contact, social distancing, unemployment, and losing the loved one. Not only these but other factors like social displacement (disproportionally experience the impacts of the pandemic due to their weakened social support structures), bleak socioeconomic prospects, unequal access to healthcare and social services, precarious housing, tenuous living and working conditions, vulnerability to misinformation, risks of exploitation and abuse also among the contributing factors.

In the Ethiopian context, the researcher believes that the problem of mental health during COVID-19 is felt by many people from different walks of life though it is seldom researched. Therefore, this research was aimed at investigating the causes of mental health problems during the COVID-19 epidemic in Bahir Dar City Administration.

Statement of the Problem

In Ethiopia mental health issue is understood as one of the most common and leading non-communicable diseases in the country (WHO, 2015), highlighting the country need to urgently increase investment in services for mental health or risk a massive increase in mental health conditions in the coming months due to COVID-19 pandemic (WHO, 2020).

According to the WHO (2020), the impact of the pandemic on people’s mental health is already extremely concerning, and social isolation, fear of contagion, and loss of family members is compounded by the distress caused by loss of income and often employment. Due to the pandemic, people are working from home are exposed to specific psychosocial risks, such as isolation, blurred boundaries between work and family, increased risk of domestic violence, and the fear of losing the job, pay cuts, lay-offs, and reduced benefits make many workers question their future. Job insecurity, economic loss, loss of family, fear of contracting the contagion, and unemployment can have a severe impact on mental health (International Labour Organisation, 2020).

A study conducted across the World by (Płomecka et al., 2020), highlights a significant impact of the COVID-19 pandemic at a regional and worldwide level on the mental health of individuals and elucidates prominent associations with their demographics, history of psychiatric disease risk factors, household conditions, personality traits, and attitude towards COVID-19. In this study gender, pre-existing psychiatric condition, and prior exposure to trauma was identified as notable risk factors contributing to the mental health problem. In the other study conducted in the UK, the mental health problem is worsened by 8.1% on average as a result of the pandemic and by much more for young adults and for women which are groups that already had lower levels of mental health before COVID-19. Furthermore, inequalities in mental health have been increased by the pandemic (Banks, n.d.).

The other study conducted in the UK by (Williams et al., 2020), indicated that COVID-19 had a significant contribution to the mental health of the public. In the study, the finding indicated that practical social and economic losses such as the loss of (in-person) social interaction, loss of income, and loss of structure and routine led to psychological and emotional ‘losses. The COVID-19 pandemic is associated with mild stressful events among the participant of the study (Zhang & Ma, 2020). Isolation and quarantine (more extreme forms of social distancing) have precipitated depression and anxiety, might have similar effects as confined people are detached from their loved ones, deprived of personal liberties, and devoid of purpose owing to altered routine and livelihood, can contribute to frustration, boredom, low mood, and potentially depression (Venkatesh & Edirappuli, 2020). Anxiety might arise from fear of contagion and inadequate clarity around social distancing guidelines, often made worse by less reliable media sources heightening confusion and fear-mongering could the major contributor to the mental health of the public (Venkatesh & Edirappuli, 2020).

Despite these facts, per day case is raising and the country registered 31, 336 on the date of the start of data collection. The public is getting panic and the issue of mental health problems is seldom researched. So that cause of mental health problems needs to be addressed to inform the policymakers and health professional to take corrective measures before the problem got serious. Based on this background, the researcher aspires to study the cause of mental health problems during the COVID-19 pandemic in the Bahir Dar City Administration. To identify the cause of mental health problem in the city the researcher wants to answer the following research questions;

What are the causes of mental health problems in Bahir Dar City Administration during the COVID-19 pandemic?

Methodology

Communities are facing different kinds of problems these days due to COVID-19 pandemic. Among the many kinds of problems, mental health is becoming more and more difficult to tackle due to its diversified causes. The purpose of this study was therefore to investigate the causes of a mental health problem as perceived by residents, and professionals working on the issue. Thus, data was gathered from residents, mental health professionals, and medical doctors who are working with COVID-19 cases.

To gather relevant data, 10 residents of which five are those who have had the experience of forced quarantine were selected using snowball sampling methods and the remaining five were taken from the public, were selected using purposive sampling methods and 10 mental health professional (five psychologists and psychiatrists were selected useing purposive sampling technique and five medical doctors those are engaged in providing medical treatments for COVID-19 patients were purposefully selected.

The mental health professionals identified those who were forcefully guaranteed and a medical doctor was also identified those rehabilitated from COVID-19 infections. The resident was selected by the researcher. The data was collected between August 17 to 20/2020. During the interview period, all the government policy was followed including social distancing. Ethical clearance was obtained from the regional health bureau and informed consent was also provided to the participant of the study.

The data used in the study were collected through an interview. The interviews were so in-depth that several probing questions were asked following the participants' responses. The data collected was analyzed and interpreted through qualitative descriptions and narratives. Finally, conclusions were drawn.

Results

As data were gathered from residents, those who had the experience of forced quarantine, recovered COVID- 19 patients, psychologists, psychiatrists, and medical doctors, the results are treated for whole and separately for the groups by grouping the participant into two as residents and professionals.

The study reveals a high prevalence of risk factors associated with mental health problems among urban residents due to the COVID – 19 pandemic. Furthermore, the study confirmed that the general population; those who have contracted the virus and recovered, and those who experienced forced quarantine were felt that they have a high risk of having mental health problems. The result of the study is comparable to the study conducted by (Braquehais et al., 2020; Jia et al., 2020; Otu et al., 2020). For instance, a study conducted in the united kingdom by (Jia et al., 2020) states that the mean score for depression, stress, and anxiety which is a risk factor for mental health-related to COVID – 19 exceeded significantly the population norms. Furthermore, (Braquehais et al., 2020) indicated that mental health problems experienced are not limited to infected persons but also extend to frontline workers and community members alike.

Causes of Mental Health Problem Among the Residents

The data from residents, those who had the experience of forced quarantine, and recovered COVID-19 patients were not easily accessed. This is because the participants did not like to be interviewed and particularly those were recovered does not want to be leveled “COVID-19 recovered”. After an extended period of discussion, they participated in the interview.

From the in-depth interviews conducted with residents, those who had the experience of forced quarantine and recovered COVID-19 patients. The findings of the study reveal that the causes of the mental health problem are related to social, economic, and psychological. Social distancing, forced quarantine, stigma and discrimination social disintegration, reduced social interaction, lack of freedom of movement, social isolation and misinformation was classified as a social cause of mental health problem, economic loses, economic deprivation of families, having lost their businesses and jobs, pay cuts, lay-offs, job security, and reduced benefits was taken as economic cause. Furthermore, getting infected, the raise of the death related to COVID-19 triggered stress, stress due to the COVID information, and thought of death is the risk for mental health problems. This is a surprise as most of the findings of the cause of mental health in other countries disclosed that it is related to the finding reported in this study (Carvalho Aguiar Melo & de Sousa Soares, 2020; Płomecka et al., 2020; Venkatesh & Edirappuli, 2020; Williams et al., 2020; Zhang & Ma, 2020).

Resemblance appeared due to the similarity of the case and most of the events felt in Ethiopia were also similarly considered in the other nation. As the government guideline and the current economic circumstance across the globe put the public in the same scenarios, understood the problem in the same way irrespective of culture and geographical locations. Because they are placed in strict government guidelines of social distancing, isolation, quarantine, stigma, economic loss, and a perceived thought of contracting the infection, believe of being dead and being discriminated if I contracted the virus. One resident, for instance, reported:

… I know that the community will discriminate and isolate me from the social issue even if I respected the guideline and followed the rules after I contracted and recovered from COVID – 19 viruses, this puts me in a difficult position and lead me and might develop some kind of psychological problems. Therefore, I try to avoid social issues living by myself and is one of the major problems that I am wondering and lost my sleep for several days.

Causes of Mental Health Problem for Mental Health Professional

Most professionals reported that social and psychological factor as a major cause of mental health problem among the public such as social distancing, forced quarantine, stigma and discrimination, social disintegration, reduced social interaction, lack of freedom of movement, social isolation, and misinformation, getting infected by the virus, the raise of the death related to COVID-19 triggered stress, stress due to the COVID information and thought of death is the risk for mental health problems. This appears to have the potential to lead the residents to develop further undesirable psychological problems which lead them to a mental health problem.

Psychologists, Psychiatrists, and medical doctors attribute the cause of mental health problems among the public to residents themselves, pre-existing psychiatric conditions, prior exposure to suffering, misinformation, and their communities. They reported that stigma and discrimination by the residents regarding rehabilitated patients might put negative thought among the remaining residents which contributes to the mental health problems.

A substantial number of professionals also believe that the social setting in which the rehabilitated individuals are living contributes a lot to a mental health problem. These days, culture, the social value of supporting during disaster events has been non-existent due to the virus so that it makes the social integration of recovered patients into the community, could hurt the remaining residents. They are sources of stress and ultimately the cause of mental health problems among the residents.

Does Difference exist Among the Urban Residents?

Form the in-depth interviews with these residents and professionals, it is also identified that female residents were more venerable to stress and anxiety and ultimately to the mental health problems. The global study conducted by (Płomecka et al., 2020), indicated that females were more prone to the risk factor than their counterpart, that could contribute to mental health problems. Moreover, the study conducted by (Jia et al., 2020), indicated that women are more prone to risk factors than their male counterparts. The result of the study further confirmed that mental health problems showed a substantial difference in the different age groups. Particularly, adult populations were identified as more disposed to risk factors to a mental health problem as the result of the COVID – 19 pandemics. This finding is incomparable with the study conducted in the united kingdom by (Jia et al., 2020) indicating that mental health problem is more common on those identified as a young individual.

Conclusions

The following conclusions are drawn from the results.

Mental health problems are related to social, psychological, and economic factors.

Recommendations

Based on the above findings, the subsequent recommendations are suggested:

The government and policymakers should communicate information regarding the cause of mental health problem to the general public;