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		<title>Effects of  COVID-19 pandemic on mental health</title>
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		<pubDate>Mon, 12 Oct 2020 04:30:22 +0000</pubDate>
				<category><![CDATA[Articles]]></category>
		<category><![CDATA[Covid 19]]></category>
		<category><![CDATA[Psychology]]></category>
		<category><![CDATA[Research Paper]]></category>
		<category><![CDATA[Anxiety disorders]]></category>
		<category><![CDATA[depression]]></category>
		<category><![CDATA[Effects of COVID-19 on mental health]]></category>
		<category><![CDATA[Schizophrenia]]></category>
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					<description><![CDATA[<p>Effects of  COVID-19 pandemic on mental health have a lasting effect on their overall well-being. This may vary from a panic behaviour or collective hysteria to pervasive feelings of hopelessness and desperation with negative outcomes including suicidal behavior. The World Health Organization (WHO) declared the outbreak of a new coronavirus  disease, COVID-19, to be a</p>
<p>The post <a href="https://healthvision.in/effects-of-covid-19-pandemic-on-mental-health/">Effects of  COVID-19 pandemic on mental health</a> appeared first on <a href="https://healthvision.in">Health Vision</a>.</p>
]]></description>
										<content:encoded><![CDATA[<p style="text-align: justify;"><span style="color: #ff0000;"><b>Effects of  COVID-19 pandemic on mental health <span style="font-weight: 400;"><strong>have a lasting effect on their overall well-being. This may vary from a panic behaviour or collective hysteria to pervasive feelings of hopelessness and desperation with negative outcomes including suicidal behavior. </strong></span></b></span></p>
<p style="text-align: justify;"><span style="font-weight: 400;"><img fetchpriority="high" decoding="async" class=" wp-image-13243 alignright" src="https://healthvision.in/wp-content/uploads/2020/10/Mental-health-300x193.png" alt="Mental-health" width="333" height="214" srcset="https://healthvision.in/wp-content/uploads/2020/10/Mental-health-300x193.png 300w, https://healthvision.in/wp-content/uploads/2020/10/Mental-health-768x494.png 768w, https://healthvision.in/wp-content/uploads/2020/10/Mental-health.png 900w" sizes="(max-width: 333px) 100vw, 333px" />The World Health Organization (WHO) declared the outbreak of a new coronavirus  disease, COVID-19, to be a Public Health Emergency of International Concern.  In March 2020, WHO made the assessment that COVID-19 can be characterized as a pandemic. <strong>COVID-19 pandemic not only affected physical health, but also mental health and well-being.</strong> The current pandemic is changing priorities for the general population, but it is also challenging the agenda of health professionals, including that of psychiatrists and other mental health professionals . </span></p>
<p style="text-align: justify;"><span style="font-weight: 400;">The current situation is causing mental health problems such as <strong>stress, anxiety, depressive symptoms, insomnia, denial, anger and fear. </strong></span><span style="font-weight: 400;">The main aim of research is to study the effect of mental health due to covid-19 pandemic.</span><span style="font-weight: 400;"> These mental health problems not only affect attention, understanding and decision-making capacity of medical workers, which could hinder the fight against COVID-19, but they could also <strong>have a lasting effect on their overall well-being . </strong></span></p>
<p style="text-align: justify;"><span style="font-weight: 400;">The psychological reactions to COVID-19 pandemic on population  may vary from a panic behavior or collective hysteria to pervasive feelings of hopelessness and desperation which are associated with negative outcomes including suicidal behavior. Importantly, other health measures may be compromised by abnormally elevated anxiety.</span></p>
<p style="text-align: justify;"><span style="color: #ff0000;"><b>Method:</b></span></p>
<p style="text-align: justify;"><span style="font-weight: 400;">This paper aims to review the latest papers referring to the effect of pandemic on mental health by using an online questionnaire method. A  survey was conducted through a google form link shared on various social media . <strong>It was conducted from 19 september 2020 to 24  September 2020.</strong> The population of the world who agreed to participate in study were included by a simple random method . Populations aged 18 years or more were included in this survey . </span></p>
<p style="text-align: justify;"><span style="color: #ff0000;"><strong>Study Tools:</strong></span></p>
<p style="text-align: justify;"><span style="font-weight: 400;"><img decoding="async" class=" wp-image-13245 alignright" src="https://healthvision.in/wp-content/uploads/2020/10/depression-and-anxiety-300x215.jpg" alt="depression-and-anxiety" width="405" height="290" srcset="https://healthvision.in/wp-content/uploads/2020/10/depression-and-anxiety-300x215.jpg 300w, https://healthvision.in/wp-content/uploads/2020/10/depression-and-anxiety.jpg 727w" sizes="(max-width: 405px) 100vw, 405px" />The online questionnaire consists of socio-demographic characteristics including name,age,gender,email,occupation and name of country. </span><span style="font-weight: 400;">On receiving and clicking the link the participants will be directed to information about the study and informed consent . After they agreed to participate in the survey they filled up details .</span></p>
<p style="text-align: justify;"><span style="font-weight: 400;"> Then the set of several questions will appear consecutively in which the participants will answer. </span><span style="font-weight: 400;">This study was conducted among 301 people in the world and response came from India ,USA ,  London , Canada, Australia and  Kenya. </span><span style="font-weight: 400;">Out of them ,</span></p>
<p style="text-align: justify;"><span style="font-weight: 400;">2<strong>55 (84.71%)  people were from India, </strong></span><strong>26 (8.6%) people were from the USA, </strong><strong>10 (3.32%) people were from Canada,  </strong><strong>5 (1.66%) people were from Australia,  </strong><strong>3 (0.99%) people were from London, and </strong><strong>2 (0.66%) people were from Kenya. </strong>Out of 301 participants , 152 (50.49%) were male and 149 (49.5%) were female.</p>
<p style="text-align: justify;"><span style="color: #ff0000;"><b>Age</b></span></p>
<p style="text-align: justify;"><span style="font-weight: 400;">Total 12 questions were conducted in an online survey and options were based on everyday , very often , sometimes and not at all .</span></p>
<p style="text-align: justify;"><span style="font-weight: 400;">The covid-19 pandemic is by definition, a significant threat to humanity. The pandemic is straining our healthcare and economic system in ways that are significant and obvious .</span></p>
<p style="text-align: justify;"><span style="font-weight: 400;">Following psychological signs are observed :</span></p>
<p style="text-align: justify;"><span style="color: #ff0000;"><b>Uncontrollable fear</b></span></p>
<p style="text-align: justify;"><span style="font-weight: 400;">This is commonly one of the most frequent psychological reaction to pandemics. Several existing studies demonstrated that those who have been exposed to the risk of infection may develop pervasive fears about their health, worries to infect others and fear infecting family members.</span></p>
<p style="text-align: justify;"><span style="color: #ff0000;"><b>Frustration and irritation </b></span></p>
<p style="text-align: justify;"><span style="font-weight: 400;"><strong>Distress, boredom, social isolation and frustration are directly related to confinement, abnormally reduced social/physical contact with others, and loss of usual habits.</strong> As per report  frustration and pervasive irritation seem to derive from the inhibition from daily activities, interruption of social necessities, not taking part in social networking activities.</span></p>
<p style="text-align: justify;"><span style="color: #ff0000;"><b>Loneliness</b></span></p>
<p style="text-align: justify;"><span style="font-weight: 400;">Pervasive loneliness may be significantly associated with increased depression and suicidal behavior.Pervasive loneliness may be significantly associated with increased depression and suicidal behavior.</span></p>
<p style="text-align: justify;"><span style="color: #ff0000;"><b>Insomnia</b></span></p>
<p style="text-align: justify;"><span style="font-weight: 400;">Due to stressful life, impaired sleep and circadian rhythms at a time when healthy sleep is particularly important to cope adaptively with this crisis uncertainty about the future.</span></p>
<p style="text-align: justify;"><span style="font-weight: 400;">The above symptoms if left untreated can result into various chronic mental disorders :</span></p>
<p style="text-align: justify;"><span style="color: #ff0000;"><b>1) Schizophrenia :</b></span></p>
<p style="text-align: justify;"><span style="font-weight: 400;"><img decoding="async" class=" wp-image-13246 alignright" src="https://healthvision.in/wp-content/uploads/2020/10/schizophrenia-mechanism-300x225.jpg" alt="schizophrenia-mechanism" width="375" height="281" srcset="https://healthvision.in/wp-content/uploads/2020/10/schizophrenia-mechanism-300x225.jpg 300w, https://healthvision.in/wp-content/uploads/2020/10/schizophrenia-mechanism.jpg 640w" sizes="(max-width: 375px) 100vw, 375px" /><strong>Schizophrenia is a chronic brain disorder</strong> that affects less than one percent of the U.S. population. When schizophrenia is active, symptoms can include delusions, hallucinations, disorganized speech, trouble with thinking and lack of motivation. However, with treatment, most symptoms of schizophrenia will greatly improve and the likelihood of a recurrence can be diminished.</span></p>
<p style="text-align: justify;"><span style="font-weight: 400;">While there is no cure for schizophrenia, research is leading to innovative and safer treatments. Experts also are unraveling the causes of the disease by studying genetics, conducting behavioral research, and using advanced imaging to look at the brain’s structure and function. These approaches hold the promise of new, and more effective therapies.</span></p>
<p style="text-align: justify;"><span style="color: #ff0000;"><b>2) Anxiety : </b></span></p>
<p style="text-align: justify;"><span style="font-weight: 400;">      </span><span style="font-weight: 400;">  </span><span style="font-weight: 400;">Everyone feels anxious now and then.Occasional anxiety is OK. But anxiety disorders are different. They are a group of mental illnesses that cause constant and overwhelming anxiety and fear.  The excessive anxiety can make you avoid work, school, family get-togethers, and other social situations that might trigger or worsen your symptoms. </span></p>
<p style="text-align: justify;"><span style="color: #ff0000;"><b>Types of Anxiety disorders</b></span></p>
<p style="text-align: justify;"><span style="font-weight: 400;">There are several types of anxiety disorders:</span></p>
<ol style="text-align: justify;">
<li style="font-weight: 400;"><span style="font-weight: 400;">Generalized anxiety disorder </span></li>
<li style="font-weight: 400;"><span style="font-weight: 400;">Panic disorder </span></li>
<li style="font-weight: 400;"><span style="font-weight: 400;">Specific phobias</span></li>
<li style="font-weight: 400;"><span style="font-weight: 400;">Separation anxiety</span></li>
<li style="font-weight: 400;"><span style="font-weight: 400;">Medication-induced anxiety disorder</span></li>
</ol>
<p style="text-align: justify;"><span style="color: #ff0000;"><b>3) Depression</b></span></p>
<p><img decoding="async" class="alignright wp-image-13247 " src="https://healthvision.in/wp-content/uploads/2020/10/depression-blog-300x154.jpg" alt="depression" width="382" height="196" srcset="https://healthvision.in/wp-content/uploads/2020/10/depression-blog-300x154.jpg 300w, https://healthvision.in/wp-content/uploads/2020/10/depression-blog.jpg 500w" sizes="(max-width: 382px) 100vw, 382px" /></p>
<p style="text-align: justify;"><span style="font-weight: 400;"><strong>Depression (major depressive disorder) is a common and serious medical illness that negatively affects how you feel, the way you think and how you act.</strong> Fortunately, it is also treatable. Depression causes feelings of sadness and/or a loss of interest in activities once enjoyed. It can lead to a variety of emotional and physical problems and can decrease a person’s ability to function at work and at home.</span></p>
<p style="text-align: justify;"><strong>Depression symptoms can vary from mild to severe and can include:</strong></p>
<ul style="text-align: justify;">
<li style="font-weight: 400;"><span style="font-weight: 400;">Feeling sad or having a depressed mood</span></li>
<li style="font-weight: 400;"><span style="font-weight: 400;">Loss of interest or pleasure in activities once enjoyed</span></li>
<li style="font-weight: 400;"><span style="font-weight: 400;">Changes in appetite — weight loss or gain unrelated to dieting</span></li>
<li style="font-weight: 400;"><span style="font-weight: 400;">Trouble sleeping or sleeping too much</span></li>
<li style="font-weight: 400;"><span style="font-weight: 400;">Loss of energy or increased fatigue</span></li>
<li style="font-weight: 400;"><span style="font-weight: 400;">Increase in purposeless physical activity (e.g., hand-wringing or pacing) or slowed movements and speech (actions observable by others)</span></li>
<li style="font-weight: 400;"><span style="font-weight: 400;">Feeling worthless or guilty</span></li>
<li style="font-weight: 400;"><span style="font-weight: 400;">Difficulty thinking, concentrating or making decisions</span></li>
<li style="font-weight: 400;"><span style="font-weight: 400;">Thoughts of death or suicide</span></li>
</ul>
<p style="text-align: justify;"><span style="font-weight: 400;">Symptoms must last at least two weeks for a diagnosis of depression.</span></p>
<p style="text-align: justify;"><span style="color: #ff0000;"><b>4) Bipolar disorder :</b></span></p>
<p style="text-align: justify;"><span style="font-weight: 400;"> Bipolar disorders are brain disorders that cause changes in a person’s mood, energy and ability to function. Bipolar disorder is a category that includes three different conditions — bipolar I, bipolar II and cyclothymic disorder.</span></p>
<p style="text-align: justify;"><span style="font-weight: 400;">People with bipolar disorders have extreme and intense emotional states that occur at distinct times, called mood episodes. These mood episodes are categorized as manic, hypomanic or depressive. People with bipolar disorders generally have periods of normal mood as well. Bipolar disorders can be treated, and people with these illnesses can lead full and productive lives.</span></p>
<p style="text-align: justify;"><span style="color: #ff0000;"><b>Psychological approaches</b></span></p>
<p style="text-align: justify;"><span style="font-weight: 400;"><img decoding="async" class=" wp-image-13249 alignright" src="https://healthvision.in/wp-content/uploads/2020/10/symptoms-of-mania-380311_final-237f247e10ae42508e8ca3410453ad81-300x200.png" alt="symptoms-of-mania-" width="332" height="221" />The coronavirus disease 2019 (COVID-19) pandemic will cause an extraordinary stressor to patients and health care systems across the globe and people with serious mental illnesses should be provided truthful information about strategies related with the medical treatment for COVID-19. It will also be important to deal with the psychological and social dimensions of this epidemic for patients. </span></p>
<p style="text-align: justify;"><span style="font-weight: 400;">Psychiatrists can play an essential role in supporting the well-being of those affected and their families and crucial interventions can be related with the education about the common adverse psychological costs and encouraging health-promoting behaviours, the facilitation of problem solving and finally the empowerment of the patients, their families and health-care providers.</span></p>
<p style="text-align: justify;"><span style="color: #ff0000;"><strong>Characteristics of studies reporting psychological parameters</strong></span></p>
<table>
<tbody>
<tr>
<td><b>Region of university</b></td>
<td><b>Author</b></td>
<td><b>Year of publication</b></td>
<td><b>Type of paper</b></td>
<td><b>Sample size</b></td>
</tr>
<tr>
<td><span style="font-weight: 400;">Rollins School of Public Health, Emory University, Atlanta, Georgia, USA</span></td>
<td><span style="font-weight: 400;">Druss BG</span></td>
<td><span style="font-weight: 400;">2020</span></td>
<td><span style="font-weight: 400;">Viewpoint</span></td>
<td><span style="font-weight: 400;">0</span></td>
</tr>
<tr>
<td><span style="font-weight: 400;">Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore 560029, India</span></td>
<td><span style="font-weight: 400;">Banerjee D</span></td>
<td><span style="font-weight: 400;">2020</span></td>
<td><span style="font-weight: 400;">Letter</span></td>
<td><span style="font-weight: 400;">0</span></td>
</tr>
</tbody>
</table>
<table>
<tbody>
<tr>
<td><span style="font-weight: 400;">School of Epidemiology and Public Health, Child and Adolescent Psychiatry, University of Ottawa, Ottawa, Ontario, Canada</span></td>
<td><span style="font-weight: 400;">Gardner W</span></td>
<td><span style="font-weight: 400;">2020</span></td>
<td><span style="font-weight: 400;">Viewpoint</span></td>
<td><span style="font-weight: 400;">0</span></td>
</tr>
<tr>
<td><span style="font-weight: 400;">Neurology and Physical Medicine and Rehabilitation and Chief of Pain Medicine, Johns Hopkins School of Medicine, USA</span></td>
<td><span style="font-weight: 400;">Cohen S</span></td>
<td><span style="font-weight: 400;">2020</span></td>
<td><span style="font-weight: 400;">Recommendation and guidelines</span></td>
<td><span style="font-weight: 400;">0</span></td>
</tr>
</tbody>
</table>
<table>
<tbody>
<tr>
<td><span style="font-weight: 400;">Metro South Addiction and Mental Health Service, Brisbane, Australia</span></td>
<td><span style="font-weight: 400;">Dan Siskind</span></td>
<td><span style="font-weight: 400;">2020</span></td>
<td><span style="font-weight: 400;">Paper for clinician with recommendations</span></td>
<td><span style="font-weight: 400;">0</span></td>
</tr>
<tr>
<td><span style="font-weight: 400;">Centre for Behavioural Science and Applied Psychology, Sheffield Hallam University, UK</span></td>
<td><span style="font-weight: 400;">Arden MA</span></td>
<td><span style="font-weight: 400;">2020</span></td>
<td><span style="font-weight: 400;">Letter</span></td>
<td><span style="font-weight: 400;">0</span></td>
</tr>
</tbody>
</table>
<p style="text-align: justify;"><span style="color: #ff0000;"><b>Psychological Impact On Other Countries</b></span></p>
<p style="text-align: justify;"><span style="font-weight: 400;">In the USA, the crisis has highlighted the extent of interconnectedness of their institutions, including medical, public health, political, economic, and educational. The current pandemic clearly underscores the global nature of their lives today and the limited constructs of nationality, religion, and political leanings in the face of a common threat. They cannot fully anticipate the long-lasting effects of this pandemic on our societies. </span></p>
<p style="text-align: justify;"><span style="font-weight: 400;">There they have seen telemedicine set up at record speed to meet the needs of patients. Regulatory barriers to reach many patients were brought down almost overnight. They can use more platforms and cross state lines to deliver care, which are important changes that help us reach as many patients as possible. They are collectively experiencing a stressor that affects segments of the population in different ways. </span></p>
<p style="text-align: justify;"><span style="color: #ff0000;"><strong>Pandemia and social psychiatry</strong></span></p>
<p style="text-align: justify;"><span style="font-weight: 400;"><img decoding="async" class=" wp-image-13248 alignright" src="https://healthvision.in/wp-content/uploads/2020/10/copingwithcovid19tips_160074_1-300x168.png" alt="copingwithcovid19tips" width="371" height="208" srcset="https://healthvision.in/wp-content/uploads/2020/10/copingwithcovid19tips_160074_1-300x168.png 300w, https://healthvision.in/wp-content/uploads/2020/10/copingwithcovid19tips_160074_1-1024x572.png 1024w, https://healthvision.in/wp-content/uploads/2020/10/copingwithcovid19tips_160074_1-768x429.png 768w, https://healthvision.in/wp-content/uploads/2020/10/copingwithcovid19tips_160074_1.png 1200w" sizes="(max-width: 371px) 100vw, 371px" />With the advent of the COVID-19 pandemic, stigma and xenophobia have become major elements of the public discourse and a regrettable, but everyday reality. We have been witnessing increased antagonism toward specific groups with high infection rates that in turn has led to patients presenting with both enacted and felt stigma and associated increased anxiety and depression. <strong>Combining the stigma associated with mental illness with the stigma now shown toward certain COVID-positive patients may lead to double stigma,</strong> a barrier to psychiatric treatment adherence with resultant increased morbidity. Reducing stigma requires both national and international interventions. </span></p>
<p style="text-align: justify;"><span style="color: #ff0000;"><b>Result of the survey:</b></span></p>
<p style="text-align: justify;"><span style="font-weight: 400;">From above survey , following result have been obtained:</span></p>
<p style="text-align: justify;"><span style="font-weight: 400;"><strong>1. There are 22% of people who daily suffer from uncontrolled fear</strong> due to covid-19. 53% have sometimes fear of covid -19.</span></p>
<p style="text-align: justify;"><span style="font-weight: 400;"><strong>2. There are 50% people who are daily concerned</strong> about their and their family’s health and safety.</span></p>
<p style="text-align: justify;"><span style="font-weight: 400;"><strong>3. There were less changes found in the sleep pattern</strong> of people due to this covid-19 pandemic.</span></p>
<p style="text-align: justify;"><span style="font-weight: 400;"><strong>4. Less than 75% of  people are losing their interest</strong> in the academic activities.</span></p>
<p style="text-align: justify;"><span style="font-weight: 400;"><strong>5.</strong> As 18-25 years participants were more so there were  34%  not applicable for this category   and <strong>rest people sometimes were  concerned  about their financial condition.</strong></span></p>
<p style="text-align: justify;"><span style="font-weight: 400;"><strong>6.</strong> From the above graph less than <strong>60% people suffer from loneliness and frustration.</strong></span></p>
<p style="text-align: justify;"><span style="font-weight: 400;">7. There were more than 60% people who <strong>got angry on small things due to the pandemic conditions.</strong></span></p>
<p style="text-align: justify;"><span style="font-weight: 400;">8. From the survey we concluded that <strong>there was a mild change in appetite of people.</strong></span></p>
<p style="text-align: justify;"><span style="font-weight: 400;">9. There were <strong>70% people scared due to watching news and reading newspapers</strong> regarding covid information.</span></p>
<p style="text-align: justify;"><span style="font-weight: 400;">10. Due to covid-19 we have found that more than <strong>60% people suffered from lack of concentration.</strong></span></p>
<p style="text-align: justify;"><span style="font-weight: 400;"><strong>11. 9% of people were having suicidal thoughts</strong> which should be taken care of and work for it as soon as possible.</span></p>
<p style="text-align: justify;"><span style="color: #ff0000;"><b>Conclusion</b></span></p>
<p style="text-align: justify;"><span style="font-weight: 400;">From this survey we found that there is a mild to moderate effect on  mental health due to covid-19 pandemic. </span><span style="font-weight: 400;">Implementing community-based strategies to support resilience and psychologically vulnerable individuals during the COVID-19 crisis is fundamental for any community.  </span><span style="font-weight: 400;">To cope up with covid-19 pandemic people are trying best to take care of mental health by thinking positive, accepting current situation and doing meditation. </span></p>
<p style="text-align: justify;"><span style="font-weight: 400;">Even they are trying to keep in touch with friends and relatives , taking care of family and keeping busy with different activities.The psychological impact of fear and anxiety induced by the rapid spread of pandemic needs to be clearly recognized as a public health priority for both authorities and policy makers who should <strong>rapidly adopt clear behavioral strategies to reduce the burden of disease and the dramatic mental health consequences of this outbreak.</strong></span></p>
<div>
<p><span style="color: #ff0000;"><strong><img decoding="async" class="alignnone wp-image-13241" src="https://healthvision.in/wp-content/uploads/2020/10/Krishani-Patel-and-Vishani-Patel-300x197.jpg" alt="Krishani-Patel-and-Vishani-Patel" width="326" height="214" srcset="https://healthvision.in/wp-content/uploads/2020/10/Krishani-Patel-and-Vishani-Patel-300x197.jpg 300w, https://healthvision.in/wp-content/uploads/2020/10/Krishani-Patel-and-Vishani-Patel-768x504.jpg 768w, https://healthvision.in/wp-content/uploads/2020/10/Krishani-Patel-and-Vishani-Patel.jpg 852w" sizes="(max-width: 326px) 100vw, 326px" /></strong></span></p>
<p><span style="color: #ff0000;"><strong>Krishani Patel-(L)</strong></span><br />
<strong>2nd year MBBS student</strong><br />
<strong>AMCMET medical college , ahmedabad </strong></p>
<p><span style="color: #ff0000;"><strong>Vishani Patel-(R)</strong></span><br />
<strong>3rd year MBBS student</strong><br />
<strong>GMERS Medical college, Patan.</strong></p>
</div>
<p style="text-align: justify;"><span style="color: #ff0000;"><b>References</b></span></p>
<p style="text-align: justify;"><span style="font-weight: 400;">1  WHO. Coronavirus disease (COVID-19) pandemic. WHO emergencies (Internet). Geneva, Switherzland, Updated 6 Mar 2020 Available at: </span><a href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports"><span style="font-weight: 400;">https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports</span></a><span style="font-weight: 400;">.</span></p>
<p style="text-align: justify;"><span style="font-weight: 400;">2  WHO. Coronavirus disease 2019 (COVID-19) Situation Report-70 (Internet). Geneva, Switherland, Updated 19-30 March 2020. </span><a href="https://www.who.int/publications-detail/covid-19-operational-guidance-formaintaining-essential-health-services-during-an-outbreak"><span style="font-weight: 400;">https://www.who.int/publications-detail/covid-19-operational-guidance-formaintaining-essential-health-services-during-an-outbreak</span></a><span style="font-weight: 400;">.</span></p>
<p style="text-align: justify;"><span style="font-weight: 400;">3  Fiorillo A, Gorwood P. The consequences of the COVID-19 pandemic on mental health and implications for clinical practice. Eur Psychiatry 2020;63:e32.</span></p>
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<p style="text-align: justify;"><span style="font-weight: 400;">5 Barbisch D , Koenig KL, Shih</span> <span style="font-weight: 400;">FY.</span> <span style="font-weight: 400;">Is there a case for quarantine? Perspectives from to Ebola. </span><i><span style="font-weight: 400;">Disaster Med Public Health Prep</span></i> <span style="font-weight: 400;">2015</span> <span style="font-weight: 400;">; 9</span> <span style="font-weight: 400;">:547–53.</span></p>
<p style="text-align: justify;"><span style="font-weight: 400;">6 Rubin GJ, Wessely S. Coronavirus: the psychological effects of quarantining a city. </span><i><span style="font-weight: 400;">BMJ Opinion</span></i><span style="font-weight: 400;"> 2020; 368:m313.</span></p>
<p style="text-align: justify;"><span style="font-weight: 400;">7 Jones, N. M., Thompson, R. R., Dunkel Schetter, C., Silver, R. C. (2017). Distress and rumor exposure on social media during a campus lockdown. Proceedings of the National Academy of Sciences of the United States of America, 114, 11663–11668. <a href="https://doi.org/10.1073/pnas.1708518114">https://doi.org/10.1073/pnas.1708518114</a></span></p>
<p style="text-align: justify;"><span style="font-weight: 400;">8 Kang, L., Li, Y., Hu, S., Chen, M., Yang, C., Yang, B. (2020). The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus. The Lancet Psychiatry, 7, E14.</span></p>
<p style="text-align: justify;"><span style="font-weight: 400;">9 The outbreak ofCOVID-19 coronavirus and its impact on global mental health</span></p>
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<p style="text-align: justify;"><span style="font-weight: 400;"> </span><span style="font-weight: 400;">11 Banerjee D. The COVID-19 outbreak: cucial role the psychiatrists can play. Asian J Psychiatr 2020;50:102014.</span></p>
<p style="text-align: justify;"><span style="font-weight: 400;"> </span><span style="font-weight: 400;">12  Freeman MP. COVID-19 from a psychiatry perspective: meeting the challenges. J Clin Psychiatry 2020;81:20ed13358.</span></p>
<p style="text-align: justify;"><span style="font-weight: 400;"> </span><span style="font-weight: 400;">13 Bai</span> <span style="font-weight: 400;">Y</span><span style="font-weight: 400;"> , Lin C-C , Lin C-Y , Chen J-Y , Chue C-M , Chou P. </span><span style="font-weight: 400;">Survey of stress reactions among health care workers involved with the SARS outbreak</span><span style="font-weight: 400;">. </span><i><span style="font-weight: 400;">Psychiatr Serv</span></i> <span style="font-weight: 400;">2004</span><span style="font-weight: 400;">; </span><span style="font-weight: 400;">55</span><span style="font-weight: 400;">:</span><span style="font-weight: 400;">1055</span><span style="font-weight: 400;">–</span><span style="font-weight: 400;">7</span><span style="font-weight: 400;">.</span></p>
<p style="text-align: justify;"><span style="font-weight: 400;">14  Reynolds DL , Garay JR , Deamond SL , Moran MK , Gold W , Styra R. Understanding, compliance and psychological impact of the SARS quarantine experience. </span><i><span style="font-weight: 400;">Epidemiol Infect</span></i><span style="font-weight: 400;"> 2008; 136:997–1007.</span></p>
<p style="text-align: justify;"><span style="font-weight: 400;">15  Hawryluck L , Gold WL , Robinson S , Pogorski S , Galea S , Styra R. SARS control and psychological effects of quarantine, Toronto, Canada. </span><i><span style="font-weight: 400;">Emerg Infect Dis</span></i><span style="font-weight: 400;"> 2004; 10:1206–12.</span></p>
<p style="text-align: justify;"><span style="font-weight: 400;">16  DiGiovanni C , Conley J , Chiu D , Zaborski J. Factors influencing compliance with quarantine in Toronto during the 2003 SARS outbreak. </span><i><span style="font-weight: 400;">Biosecur Bioterror</span></i><span style="font-weight: 400;"> 2004; 2:265–72.</span></p>
<p style="text-align: justify;"><span style="font-weight: 400;">17 Cava MA , Fay KE , Beanlands HJ , McCay EA , Wignall R. The experience of quarantine for individuals affected by SARS in Toronto. </span><i><span style="font-weight: 400;">Public Health Nurs</span></i><span style="font-weight: 400;"> 2005; 22:398–406.</span></p>
<p style="text-align: justify;"><span style="font-weight: 400;">18 Jeong H , Yim HW , Song Y-J , Ki M , Min JA , Cho J , et al.  Mental health status of people isolated due to Middle East respiratory syndrome. Epidemiol Health 2016; 38:e2016048.</span></p>
<p style="text-align: justify;"><span style="font-weight: 400;">19 Desclaux A , Badji D , Ndione AG , Sow K. Accepted monitoring or endured quarantine? Ebola contacts’ perceptions in Senegal. </span><i><span style="font-weight: 400;">Soc Sci Med</span></i><span style="font-weight: 400;"> 2017; 178:38–45.</span></p>
<p style="text-align: justify;"><span style="font-weight: 400;">20 Braunack-Mayer A , Tooher R , Collins JE , Street JM , Marshall H. Understanding the school community’s response to school closures during the H1N1 2009 influenza pandemic. </span><i><span style="font-weight: 400;">BMC Public Health</span></i><span style="font-weight: 400;"> 2013; 13:344.</span></p>
<p style="text-align: justify;"><span style="font-weight: 400;">21 Amerio A , Bianchi D , Santi F , Costantini L , Odone A , Signorelli C , et al.  Covid-19 pandemic impact on mental health: a web-based cross-sectional survey on a sample of Italian general practitioners. <i>Acta Biomed</i> 2020; 91:83–8.</span></p>
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