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and Health Implications of COVID-19 Comorbidity-Related Complications in the African States: Recent Developments in Counseling and Therapeutic Options",doi:"10.5772/intechopen.104546",slug:"a-scoping-analysis-of-the-psychosocial-and-health-implications-of-covid-19-comorbidity-related-compl",body:'There is no health without mental health. Mental health is important at every stage of life, from childhood and adolescence through adulthood to senescence. However, the upsurge of Coronavirus (COVID-19) as a global burden in 2019 in Wuhan, China, its high mortality rate and attendant stressors, such as lock-downs, self-isolation and quarantines, infection fears, inadequate information, job and financial losses, stigma, and discrimination, among others have contributed significantly to the increase of negative psycho-social and mental health disorders globally. Since the WHO’s declaration of the outbreak of coronavirus disease as a Public Health Emergency of International Concern (PHEIC) and a pandemic between 30th January and 11th March 2020, there had held six different International Health Regulations (IHR) Emergency Committee meetings (third to ninth) for COVID-19 in Geneva. The meetings were specifically held on 30 April 2020, 31 July 2020, 29 October 2020, 14 January 2021, 15 April 2021, 14 July 2021, and 22 October 2021. During each of these committee meetings, it was concluded that the pandemic constitutes a major PHEIC.
The physical burden associated with COVID-19 included symptoms such as mild to moderate respiratory illnesses characterized by fever, dry cough, tiredness, difficulty breathing or shortness of breath, and loss of the ability to smell and taste. Between 31st December 2019 and the week 492,021, five out of 316,017 COVID-19-related deaths and 270,327,277 cases have been recorded in line with the applied case definitions and testing strategies of affected countries. The total number of cases recorded in the global community and the EU/EEA are probably an underestimate of the true number of cases and deaths, due to various degrees of under-ascertainment and under-reporting. Between 9th and 16th December 2021, there had been no changes made to the following ECDC variant classification—
The COVID-19 pandemic has not only disrupted and altered lives in Africa but a surge in depressive cases, public anxieties, worries [1], and increased risk of mental health symptoms and disorders among vulnerable populations, such as unemployed adults, youth, the elderly, and frontline healthcare workers [2]. Its impact in the Democratic Republic of the Congo (DRC) was complicated by the recent Ebola virus disease (EVD) outbreak reported on 8 October 2021, in Butsili Health Area in the Beni Health Zone, North Kivu Province, even though it has been officially declared over on 16 December 2021. In total, eight confirmed and three probable EVD cases, including nine deaths (six among the confirmed cases), were reported since the start of the outbreak (8 October 2021).
Although the WHO and the US CDC have been detecting and characterizing new variants and providing updates to healthcare workers, the public and global partners on the spread and effects of COVID-19 on patients with noncommunicable diseases and co-morbid ailments, Corser [3] posit that the impact of COVID-19 on the mental health of individuals is an unfolding urgent crisis. Additionally, epidemiology and virologic evidence suggest that COVID-19 and its subsequent deadly variants have been associated with mental and neurological manifestations, including delirium or encephalopathy, agitation, acute cerebrovascular disease (including ischaemic and hemorrhagic stroke), meningoencephalitis, impaired sense of smell or taste, anxiety, depression, and sleep problems. WHO [4] found that out of 775 adults, studied in the United States, 55% believed that COVID-19 had dangerous effects on their mental health, while 71% felt agitated about the negative impacts of isolation on their mental health. Pappa, Ntella, Giannakas, Giannakoulis, Papoutsi, and Katsaounou [5] also associated personality changes consistent with depression with COVID-19-induced encephalopathy. Zhang and Ma [6] reported that symptoms of depression, anxiety, fear, stress, and insomnia, increased during the pandemic.
Toward the end of 2020, the emergence of specific variants of the COVID-19 pandemic that constitute a greater significant risk to global public health led to the listing of specific Variants of Interest (VOIs) and Variants of Concern (VOCs). This classification aided the prioritization of global health monitoring, research, and ongoing response to the pandemic. According to the SIG Variant classification scheme, the following are the four main classes of SARS-CoV-2 variants (see Table 1).
The alpha, gamma, and beta variants continue to be monitored but are spreading at much lower levels in the U.S.
The WHO’s label of COVID-19 Variants | Pango lineage• | GISAID clade | Next strain clade | Additional amino acid changes monitored d° | Earliest documented samples | Date of designation |
---|---|---|---|---|---|---|
Alpha | B.1.1.7 | GRY | 20I (V1) | +S:484 K + S:452R | The United Kingdom, Sep-2020 | 18-Dec-2020 |
Beta | B.1.351 | GH/501Y. V2 | 20H (V2) | +S: L18F | South Africa, May-2020 | 18-Dec-2020 |
Gamma | P.1 | GR/501Y. V3 | 20 J (V3) | +S:681H | Brazil, Nov-2020 | 11-Jan-2021 |
Delta | B.1.617.2 | G/478 K.V1 | 21A, 21I, 21 J + S:417 N | +S:484 K | India, Oct-2020 | VOI: 4-Apr-2021 VOC: 11-May-2021 |
Omicron* | B.1.1.529 | GRA 21 K, 21 L 21 M | +R346K | Multiple countries, Nov-2021 | VUM: 24-Nov-2021 | VOC: 26-Nov-2021 |
Variants of COVID-19.
All variants of COVID-19 can cause severe disease or death. While data on these complications may be available in the global north and south, there is a paucity of literature in most African States.
The upsurge of Coronavirus as a global pandemic and its attendant gender-related socio-economic problems have sparked up depression, sadism, suicidal ideation, and all manner of psychiatric ailments across the globe. The pandemic that claims millions of lives both recorded and unrecorded deaths created a new wave of mental ill-health and vicarious trauma even for clinicians attending to COVID-19 patients.
The prevalence of these illnesses and traumatic experiences among clinicians and significant persons attending to the sick or those who have lost loved ones to the pandemic is yet to be determined. The policy strategies deployed for containing the spread of the pandemic increased unemployment, financial insecurity, and poverty. It also had grave impacts on mental health by increasing social isolation and loneliness that have been strongly associated with anxiety, depression, self-harm, suicide attempts, and emotional problems across the lifespan. The effect of social (or physical) distancing measures affects mental health within a syndemics approach through interacting socio-demographic forces (eg, aging, rising inequality) and health conditions (eg, chronic diseases and obesity) that yield resultant comorbidities.
More so, the World Health Organization in its new Mental Health Atlas report identified the growing need for mental health support and a worldwide failure to provide people with the mental health services needed during the COVID-19 pandemic. In a policy brief on COVID-19, the United Nations also mandated the need to provide high-quality data on the psychological impacts of the COVID-19 pandemic [8].
The purpose of this study is to examine the psychosocial and health implications of COVID-19 Comorbidity-Related Complications among selected vulnerable groups in the African States, identify which sub-groups are most vulnerable to psychological distress, identify the risk and protective factors associated with this population’s mental health, and to highlight recent developments in counseling and therapeutic options.
The study contributes to informing where mental health interventions, together with organizational and systemic efforts to support this population’s mental health could be focussed in an effort to support psychological well-being.
What are the COVID-19-related mental health theories?
Are there existing policies or plans for managing mental health issues associated with COVID-19 in Africa?
What is the prevalence of the mental health consequences of COVID-19 containment measures, socio-demographic forces, and other health conditions for vulnerable groups?
How can the mental health consequences of the COVID-19 containment measures, socio-demographic forces, and other health conditions among vulnerable groups be mitigated in Africa?
What are the basic psychosocial counseling principles for COVID-19 positive patients and other significant persons?
To address the stated research questions and objectives, the study adopts a desk review of the literature. The desk review of literature includes scoping existing online records, scientific articles, and reports published in English on the pandemic, related comorbidities, and mental health between 2000 and 2021. All scientific articles were obtained from the online database, while country and continent-specific reports and preprint articles were abstracted using google scholar.
According to WHO [9], mental health is a state of well-being during which the individual realizes his or her own abilities, has the capacity to cope with the normal stresses of life, works productively and fruitfully, and makes meaningful contributions to his or her community. In other words, mental health is not just the absence of mental illness, but the presence of well-being. Cohan and Cole [10] and Ilesanmi and Eboiyehi [11] asserted that disasters have complex, multi-faceted, and long-lasting mental health implications for the people who experience them and vicarious trauma effects on their caregivers. Maths, Nirmala, Moirangthem, and Kumar [12] reported that the prevalence of mental health problems in populations affected by disasters was two to three times higher than that of the general population.
Sturgeon [13] posits that the determinants of mental health and well-being during the pandemic are both psychological and social factors. The psychological factors encompass emotions (e.g., anger, guilt, and grief), thought processes (e.g., hopelessnesses, helplessness associated with the pandemic), beliefs (e.g., about the outbreak, its attribution, and those affected by it), and so on. The social factors entail access to family and community networks during the COVID-19 quarantine, economic factors, stigma and discrimination, cultural practices, and so on. Both psychological and social factors interact with each other to influence the mental health and well-being of individuals during the pandemic.
Consequently, the general theoretical mental health assumption related to COVID-19 and its associated comorbidities as well as the containment measures (quarantine) is that undue distress, a sense of loss, and impairment to social and occupational functioning can stem from losing direct social contacts, loved ones, employment, sources of income, educational opportunities, recreation, freedoms, and social supports. This can be worsened by the gripping fears and anxieties of its morbidity, mortality, and efficacy of high transmission. These anxieties include constant fears of getting infected and passing the infection to friends, families, and coworkers, as well as fear of survival when infected. The development of this mental stress is an emergency needing mental health response. Nearly 20 months into the global health crisis, the pandemic fatigue worsened by the resurgence of more deadly variants is contributing to and creating risks of mental distress of losing jobs, keeping families safe, or the sweeping uncertainty of the future.
Gallagher and Wetherell [14] classified the mental health implications of COVID-19 and its associated comorbidities as peritraumatic stress occurring during or immediately following infection. Biello [15] highlighted the following characteristics of pre-trauma in the current global pandemic scenario as including:
Since Africa recorded its first COVID-19 case in Egypt on 14 February 2020, a significant number of countries have reported cases in capital cities and multiple provinces. As of 2020, out of the WHO’s 194-Member States, only 51% had mental health policies or plans that are in line with international and regional human rights instruments. More so, only 52% met the target relating to mental health promotion and prevention programs, and these are way short of the 80% target. The only 2020 target met was a reduction in the rate of suicide by 10%, but even then, only 35 countries had a stand-alone prevention strategy, policy, or plan.
In compliance with the WHO’s Mental Health Policy Action Plan (2013–2020) that aimed at preventing mental disorders; providing care; enhancing recovery; promoting mental well-being and human rights, as well as reducing the mortality, morbidity, and disability of persons with mental disorders, the following are the existing MHP in African nations:
The mental health impact of disasters usually outlasts their physical impact, thus indicating that the elevated mental health impacts of COVID-19 will continue well beyond the outbreak of the pandemic. The vicarious trauma of the pandemic on clinicians and other health care providers during outbreaks may last up to three years after an outbreak. According to Carfì, Bernabei, and Landi [20], reports from viral outbreaks in earlier centuries, including the deadly “Spanish Flu” pandemic of 1918–1920, describe an increased incidence of neuropsychiatric symptoms such as insomnia, anxiety, depression, mania, psychosis, and suicidality. They also claimed that the full impact of COVID-19 on mental health may be known for several years, but it is likely to be significant—and potentially chronic in some patients globally.
However, Panchal et al. [21] noted that about four in 10 adults had symptoms of anxiety or depressive disorder prior to the onset of the pandemic between January to June 2019 in the U.S. The Mental Health America (MHA) [22] reported surging rates of depression, anxiety, and other mental health problems because of COVID-19 among the people accessing their online mental health screening services. MHA observed a slight increase in the demand for mental health care between January and April 2020, a sharp spike around May and June of the same year. The MHA report also noted that screenings for anxiety (406%) and depression (457%) in June 2020 were greater than those in January. There was also a spike in the percentage of people diagnosed as “at-risk” for psychosis during the onset of the lockdown and self-isolation in May 2020. This continued to rise in June to more than four times the number in January. A six-fold increase was noted for those considering suicide or self-harm. The MHA [22] observation was confirmed by A KFF Health Tracking Poll in the US around July 2020 to 2021 on the mental health impacts of COVID-19 among adults that showed difficulty sleeping (36%), eating (32%), increases in alcohol consumption or substance use (12%), and worsening chronic conditions (12%), due to worry and stress over the coronavirus.
These have been worsened by the enforcement of the containment measures, including restriction of movements and self-isolation procedures, which led to increasingly negative and poor mental health outcomes. For many, this has been compounded by job loss and loss of income. In the US, more than half of young adults (ages 18–24) captured by the KFF study reported symptoms of anxiety and/or depressive disorder (56%). While the majority of these had suicidal thoughts (26% vs. 11%) during the pandemic, there were further concerns around poor mental health and well-being for children and their parents, particularly mothers, as many experienced challenges with school closures and lack of childcare. Panchal, Kamal, Orgera, Cox, Garfield, Hamel, and Chidambaram [21] claimed that women with children are more likely to report symptoms of anxiety and/or depressive disorder than men with children (49% vs. 40%).
Panchal et al. [21] further reported that Non-Hispanic Black adults (48%) and Hispanic or Latino adults (46%) are more likely to report symptoms of anxiety and/or depressive disorder than Non-Hispanic White adults (41%) resulting from the pandemic in the US. They also reported that some of the mental health-related challenges experienced by many essential workers include a greater risk of contracting the coronavirus, symptoms of anxiety or depressive disorder (42% vs. 30%), starting or increasing substance use (25% vs. 11%), and suicidal thoughts (22% vs. 8%) than other workers during the pandemic compared to nonessential workers.
MHA [22] posited that the social consequences of the pandemic, rather than the threats of sickness or death, are the major causes of stress among persons using the screening tools. Factors identified as the major cause of depression and anxiety (73%), past trauma (46%), or relationship problems (44%) were loneliness and isolation among girls/women between 11 to 25 years of age.
In the UK, a British Medical Association survey conducted during the pandemic showed that 45% of UK doctors suffered depression, anxiety, stress, burnout, or other mental health conditions relating to, or made worse by, the COVID-19 crisis [23].
In India, the socio-economic and mental health of marginalized communities were disproportionately impacted by the pandemic [24]. Balaji and Patel [25] observed mental health difficulties among women, children, young people, sexual minorities, and people with pre-existing mental health conditions and substance use disorders. In spite of this information, Duggal et al. [26] claimed that there exists a lack of empirical data on the mental health impact of the pandemic on marginalized communities and their needs in India. In a meta-analysis of 31 studies conducted in China, Deng et al. [27] reported that the prevalence of depression among persons diagnosed with COVID-19 was 45%, anxiety was 47%, and sleep disturbances were 34%. Also, the Chinese, Singaporean and Australian governments have identified the psychological side effects of COVID-19 and the long-term impacts of isolation which could cause more harm than the pandemic itself [28, 29, 30].
Zeroing in on the African States, the experience of the disease, breakdown of social support, loss of loved ones, and stigmatization could trigger short-term mental health problems among affected persons and their families, while factors such as economic losses (job and income losses) can potentially trigger long-term mental health problems. Some of the COVID-19-related fears, worries, and anxieties may be borne out of lack of knowledge, rumors, and misinformation, while its associated mental health care has become one of the most neglected areas of health. Frissa and Dessalegn [31] predicted that the impact on mental health will be immense in sub-Saharan Africa due to their weak health care systems. They also hinted that patients with COVID-19 and other illnesses along with significant persons around them consistently experienced post-traumatic stress disorders, anxiety, depression, and insomnia. They further reported that the uptake of mental health care services is generally low in the region while individuals in some communities rely solely on social resources. This was further compounded by poor digital literacy, low smartphone penetration, limited internet connection, and weak expertise in online mental health service delivery even among clinicians and psychotherapists. While the majority of those who need mental health care do not have access to services, receive little or no treatment at all.
The COVID-19-related mental health treatment gap is thus higher in African nations. Consequently, the need to protect individual socio-cultural coping and resilience mechanisms is very critical in the continent, most especially the sub-Saharan African region.
The MTL status of some of the African states shows that:
Consequently, the pandemic has heightened individual vulnerability to financial insecurity, unemployment, and fear, which have been identified as risk factors for poor mental health among Nigerians [2]. The pandemic amplified existing vulnerabilities, inequalities, societal divides, fragility, instability, and threats to social cohesion and peace processes [38]. Currently, a lot of Nigerians are facing psychological distress that can lead to burnout, depression, anxiety disorders, sleep disorders, and other illnesses due to the absence of protective factors, such as employment, educational engagement, physical exercise, and access to health services during the lockdown [38].
In spite of the fact that mental health challenges are huge across the nation, Nigeria has no clearly defined mental health-related allocated budget. The allocation for health in the entire 2016 National Budget was only 3.65% out of which about 3.3% was barely earmarked for mental health and more than 90% of this amount went to institution-based services provided through eight stand-alone mental hospitals [39].
Another major challenge is the lack of a social welfare package for addressing the mental health needs of the socially marginalized and neglected groups in Nigeria, most especially women, children, the elderly, the homeless, and the very poor. These groups of people are vulnerable to different risk factors associated with mental disorders and also exhibit poor health help-seeking behavior [39]. More than 70% of these categories of patients with mental health problems/disorders in Nigeria seek unorthodox interventions before orthodox care [39].
Vulnerability to the negative psychological impact of the current pandemic varies among different populations across the continent. In post-apartheid South Africa, for instance, even though mental health services have been decentralized and integrated into primary health care, there still remain service gaps within and between provinces, especially in the rural areas [47] According to Jaguga and Kwobah [48], even though preventive and medical actions are critical to the containment of the pandemic, emergency psychological crisis interventions (EPCI) are required for the mitigations of the mental health consequences of the pandemic among affected populations by and other vulnerable groups such as pediatric patients, pregnant women, mothers, older people, PLWDs, other marginalized groups with suspected or confirmed cases and frontline workers. The direct EPCI may be utilized for COVID-19 patients, while the indirect EPCI is employed for their relatives, caregivers, and health care professionals. Forms of Emergency Psychological Crisis Interventions (EPCI) could entail both digital and preventive virtual mental health services aimed at addressing scale and limiting the exposure of patients to COVID-19 at health facilities. Psychological counseling, digital mental health education, and communication materials may be delivered for those in need and shared through Facebook, Twitter, Whatsapp, and other commonly used social media platforms.
There is also the need to proactively identify high-risk groups early on and provide them with targeted interventions. This may be done through research and deployment of artificial intelligence to proactively identify posts on social media from people who are in crisis and likely to commit suicide. Such vulnerable persons may be reached through different types of virtual psychotherapeutic mechanisms, including video-conferencing, the conduct of cognitive-behavioral and mindfulness-based smartphone therapies, and chess-edutainment [49, 50]. Most African nations, especially Nigeria, Ghana, South Africa, and Kenya, already have a telecommunications density exceeding 100%, which serves as a veritable tool for the implementation of mobile psycho-therapeutic care and services. Existing digital psycho-therapeutic clinical care across Africa include Wazi in Kenya, PsyndUp in Nigeria, MindIT in Ghana, and the MEGA project in South Africa and Zambia. There could also be the provision of several mental health hotlines and online therapy services for COVID-19 pandemic emotionally distressed people.
The following vulnerable groups within the larger population in all African nations are particularly needing EPCI and support:
To mitigate the mental health consequences of COVID-19 in Cameroon among these vulnerable groups, including those living in the hard to reach rural communities, the government (Cameroon’s Ministry of Public Health) in collaboration with WHO and the Red Cross initiated the following strategic actions:
An assessment of the psychological care during the COVID-19 response.
Provision of remote medical and psychological support to vulnerable communities, including older people and those with comorbidities: This was provided in partnership with the German Agency for International Cooperation and iDocta Africa
The UN Population Fund and Uni-Psy et Bien-Être have also set up psychological support for pregnant and breastfeeding women including their families, as well as caregivers.
Engagement of key stakeholders in the reduction of the mental health impact of COVID-19 among different populations
The strategies adopted in Uganda include:
The psychosocial counseling principles for understanding and addressing the mental health needs of individuals who are awaiting results of COVID-19 tests confirmed COVID-19 individuals, health care workers working in COVID isolation hospitals and their family members from a nonjudgmental and empathic attitude include:
Psychotherapeutic approaches that could be deployed for COVID-19 affected persons are approaches in response to disasters, including psychological debriefing, psychological first aid, cognitive-behavioral approaches, crisis intervention, screening and triage models, problem-solving interventions, rumor control, and conflict mitigation [55].
Clinical, counseling, psychotherapeutic and rehabilitation options for special and vulnerable populations, such as pediatric patients, pregnant women, mothers, older people, PLWDs, and other marginalized groups with suspected or confirmed cases, as well as reporting and grief counseling of COVID-19-related death. However, there is also no known coordinated and multidisciplinary continuum of clinical, counseling, and psychotherapy COVID-19 care pathways for symptomatic and asymptomatic patients and their families in the African States. Hence, there was a need for this study that attempts to run a scoping analysis of existing literature on the psychosocial and health implications of COVID-19 Comorbidity-Related Complications for vulnerable persons in developing societies.
The short- and long-term mental health implications of the COVID-19 pandemic are far-reaching for clinicians and the significant persons or survivors, especially among those at risk of new or exacerbated psychological illness and those facing barriers to accessing care.
Although the global community is in the vaccination phase against COVID-19, however, many people are refusing to be vaccinated due to fear or uncertainty, and the need for vaccinated people to continue taking existing precautions to mitigate the outbreak. Thereby compounding the psychological and mental health distress of the pandemic. It may also result in an increase in alcohol consumption, drug dependency and abuse, deaths due to suicide, and despair. It is, therefore, important for policymakers to continue to discuss further actions to alleviate the burdens of the COVID-19 pandemic.
Globally, the mental health status of vulnerable persons and clinicians has become more acute during the COVID-19 pandemic, while the targets for effective leadership and governance for mental health, provision of mental health services in community-based settings, mental health promotion and prevention, and strengthening of information systems, are far from being attained.
The following are recommendations on organizational measures, policies, and systemic changes needed to address the challenges of prevention, treatment, and education of Africans going forwards on their mental health:
Preventive and treatment interventions for mental health symptoms;
Arts-based and Life-skills Therapeutic Interventions and Recreational activities, such as outdoor exercises.
Need for the prevention of mental disorders and prioritization of mental health as a public health concern;
Need for the attainment of universal access to mental care;
Increase in mental health funding through direct budgetary allocation and integration of mental health into primary care;
There is an increasing need to accelerate the scale-up of investment in mental health and to scale up the quality of mental health services that are aligned with COVID-19 pandemic-related needs.
African nations need a documented mental health policy to tackle the menace in the country noting that the prevalence is one in four individuals. The policy should be formulated to cover a long period of about 5–10 years. It should be an initiative of the government and, the higher the level of government involvement, the higher its chances of success. The policy document will provide a framework and also give priority to the treatment. It will help to develop mental health services in a coordinated and systematic manner. It will help to identify key stakeholders and allow different stakeholders to reach an agreement. People with mental health disorders need equity and should not be discriminated against on the basis of their mental illnesses.
Mental health services should be integrated into other health care services at all levels instead of stand-alone facilities.
There is an urgent need for local governments to invest more in Primary Healthcare Centres (PHCs) as the entry point of other health care systems.
There is also the need to fund young psychiatry practitioners’ interest in research geared toward the development and advancement of mental health delivery in Nigeria.
The study acknowledges the contributions of the Centre for Gender, Health, and Social Rehabilitation, Ile-Ife, Nigeria for providing the needed facilities for the conduct of this research within its existing resources. However, the researchers obtained no funding support from any organization or institutions in the implementation of this study.
IntechOpen books and journals are available online by accessing all published content on a chapter/article level.
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