Research Article

Effect of COVID-19 on the Mental Health of People in South Asia

Muhammad Abubakar1, Labeeba Tahreem Asif2, Muhammad Aftab Ahmad3, Muhammad

Ahmad4, Laraib Zahid5, Mahnoor Farooq6, Naila Bajwa7
(1-8)
Department of community Medicine King Edward Medical University/ MHL, Pakistan

ABSTRACT:
Background: Covid-19 is a pandemic that affected people all over the world. Due to Covid-19, people
were socially inactive and isolated. This segregation created an alarming increase in mental health
problems.
Objective: To determine the effect of contagious virus on the mental health of people in South
Asia.
Methods This is a systematic review that uses the preferred reporting items for systematic
reviews and meta-analysis that is (PRISMA) guidelines We conducted this systemic review
including the articles related to covid 19 and mental health from 2020 to 2030..
Result: The stress prevalence was found to be in a range of 10 to 49%.The range for moderate
to severe anxiety happened to occur to be 15 to 52% during the pandemic era. An increased
depression prevalence ranging from 13 to 60%, was observed. Fear of getting COVID-19 has
been shown to be elevated by 32%. Elevated risk for suicidal tendencies was associated with
above mentioned factors and was seen to be increased by 10%.Insomnia prevalence seems to
have escalated to 15 to 50% and the most common age group affected was children.
Conclusion: The review shows that psychological symptoms such as insomnia, anxiety,
depression, and stress are related to isolation due to the lockdown, increased social media usage,
misleading information, and uncertainty.

Key Words: COVID-19, Pandemic, Mental Health, South Asia

INTRODUCTION:

Almost all South Asian countries were

T he epidemic of COVID-19 has

affected more than 5 billion people, and it
regularly notified of the number of COVID-
19 cases, but there was too little focus on
mental health problems that people were
facing due to this deadly epidemic (10).
resulted in the death of millions of people (1). Numerous studies and electronic media
The cause of covid 19 is a new contagion content have called attention to the sharp
virus. It was first linked in Wuhan, China. hike in mental health issues in Bangladesh,
This complaint spread from person to person Maldives, India, Nepal, Pakistan, and Sri
in a very rapid and devastating manner (2). Lanka (11).
The incubation period of the contagion may
be from one to fourteen days. At least one- The deadly covid 19 spread all over the
third of the infected people don’t show the world and caused mental health problems
symptoms (3). among people of all age groups. The main
purpose of this study is to review all
The World Health Organization has exceptional works done on the mental health
proclaimed this complaint as the sixth of people suffering from COVID-19 to
worldwide health crisis and labeled it as an spotlight this serious issue on the state level.
epidemic on the 11th of March 2020 (4). A
variety of social media sites are used as a
tool to raise awareness among people about
this disease (5). Many kinds of guidelines are The rationale of this study is to discuss the
suggested by experts to check the spread of effects of this novel virus on the mental
this novel corona virus (6). health of people in South Asia And to
address their mental health issues that are
Home isolation and social distancing, the creating hindrance in performing their
main measures taken to help the normal day to day activities.
accumulation of covid 19, resulted in mental
health problems like anxiety, depression,
and wakefulness. Social isolation affects
mental health significantly. (7). A recent study
in the USA claimed that one in every five
cases of covid 19 has mental health
problems, and people post-COVID-19 have
serious mental issues (8). Various types of
research are conducted worldwide that serve
as a tool to encourage the government to
raise public education programs to alter the
attitude of people toward this disease (9)
METHODS

We have followed the PRISMA guidelines for this Exclusion Criteria:

systemic review. The exclusion criteria includes that the studies that were
Search Strategy: not meeting our criteria were excluded and the article.
We used the keywords mental health problem “OR’’ that don’t meet our titles are excluded. Articles which
mental health issues ‘’AND’’ covid-19 ‘’OR’’ were not written in English are excluded.
coronavirus ‘’AND’’ South Asia. We conducted this Screening Process:
systemic review, including the articles related to 182 citations were identified through the database. After
COVID-19 and mental health from 2020 and 2023 removing 9 similar, we take the titles and abstracts of
These articles were obtained from three electronic 173 citations using the previously defined criteria. After
databases, namely, PubMed, and Google Scholar. the primary process, 26 studies were chosen by us for
The search was limited to articles published in the review. 14 articles that do not meet the criteria were
English language. removed. Finally, the left 12 articles are used in this
Inclusion Criteria: review. A Prisma flow diagram is shown below
The inclusion criteria includes the articles which were
published between 2020 and 2023 written in English are
included in this research. All the genders are included in
this research. People of age group 20 to 50 years are
included in this research.
Figure 1: Prisma flow diagram: PRISMA flowchart showing the selection of studies (PRISMA, Preferred Reporting Items
for Systematic Reviews and Meta-Analysis

Data Extraction
We perform the data extraction from the included articles with respect to quantity of the article and its
characteristics in accordance with the main aim of this review. This includes details such as author, year
of publication, country, type of article, age, and mental issues identified. The articles which were
selected were subjected to the next phase, and we read the whole text. We used Microsoft Excel
software for data extraction and synthesis, and the data extraction table is shown in Table 2

Characteristics of the studies included

A overview of the included studies is shown in Table 1.The number of studies that were conducted in in
India were 4, in china there are 2 ,in Pakistan there is 1,in Switzerland there is 1 and others that were
also shown. Nine studies put focus on the prevalence estimates of anxiety, stress, & depression as well
as their associated factors, while the left over studies put stress on depression, stress, fear, insomnia,
social pressure, and suicidal tendencies.

Table: 1 Summary of selected 12 studies:

No. Author and Title Country Type of Reference Mental issues identified
Year of article
 publication

1. Mukhtar S. Psychological Pakistan Systematic (1) Psychological crisis

Health during the Review
2020 coronavirus Social pressure and stigm
complaint 2019
epidemic
outbreak

2. Hussain Prevalence of USA A (22) Depression Anxiety

MM. anxiety & systematic
depression in analysis Suicidal behavior
2021 South Asia and meta-
during covid 19 analysis

3. Sun Y. Comparison of China Systematic (23) Depression anxiety

mental health review and
2023 symptoms before meta-
& during the analysis
covid 19
pandemic
4. Banerjeee Impact of covid India Systematic (17) Depression anxiety fear
D. 19 pandemic on and
Psychosocial advocacy
2020 Health and review
wellbeing in
South Asian
countries

5. Stephen X. Scientific London Meta (18) Anxiety depression

Zhang evidence on analysis
mental health in
2021 key regions
under the covid
19 pandemic
meta-analytic
evidence from
China, eastern
Europe, Latin
America, South
Asia, Southeast
Asia, Spain

6. Chandu VC. Measuring the India Review (21) Fear depression acute s
impact of covid article
2020 19 on mental
health a scoping
review of the
existing scales
7. Balakrishan Covid-19 India Systematic (12) Depression anxiety str
V. depression and review
its risk factors in meta-
2022 Asia Pacific analysis

8. KS Ng. Covid 19 India Systematic (20) Mental health

prevalence and review
2022 its risk factors in
South East Asia

9. Mahmud S. The global Switzerland Systematic (15) Depression anxiety str

prevalence of review
2022 depression meta-
anxiety stress analysis
insomnia during
covid 19
pandemic

10. Panchal U. The impact of Europe Systematic (14) Depression anxiety str
covid 19 review
2021 lockdown on
children and
adolescents
11. Pappa S. Systemic review China Systematic (19) Insomnia anxiety depres
MD and meta- review and
analysis of the meta-
2022 mental health analysis
symptoms during
covid 19
pandemic in
Southeast Asia

12. Tanha AF. A review of Bangladesh Systematic (16) Sleep disturbances fear m
common mental review
2022 health problems
in the general
population
during the covid
19 pandemic in
South Asia
Figure 2: PIE CHART SHOWNING POST COVID MENTAL HEALTH PROBLEMS

Post Covid prevalence of stress, anxiety, depression:

depression,fear, suicidal tendencies and
Stress: The stress prevalence was found to be in a occupations such as health care workers.
range of 10 to 49%. Age and gender are considerable
variable factors. The main thing that created stressful Fear: Fear of getting COVID-19 has been shown to
condition for people is the spread of wrong be elevated by 32%. People were terrified of being in
information about the virus casualties and the fake social events. People started to live lonely and that
news about shortage of health care instrument and creates fear and depression.
other things.
Suicidal tendencies: Elevated risk for suicidal
Anxiety: The range for moderate to severe anxiety tendencies was associated with above mentioned
happened to occur to be 15 to 52% during the factors.
pandemic era. The anxiety related to covid is more
common among South Asian community Insomnia: The most common age group affected was
children. Insomnia is the product of depression and
Depression: An increased depression prevalence anxiety.
ranging from 13 to 60%, was observed and most
common associations were with older age and

Figure: Forest Plot Showing post-covid Mental Health Problems

issues like stress, depression, anxiety, fear, insomnia,

and suicidal tendencies. These psychological issues
COVID-19 struck the world in 2019. Along with were emerging at an alarming rate, particularly in
other devastating effects on the human body, it also South Asian countries. These issues were worsened
affects the mental health of people around the globe. due to a low number of psychiatrists and
Governments enforced lockdowns that resulted in the psychologists in South Asian countries, and people
separation of people socially. During this terrible had to suffer a lot. Many researches were conducted
pandemic, people were on their own to cope with in South Asian countries. We have included 12
mental health problems. The social isolation faced by studies in our systematic review. A study conducted
people due to this pandemic resulted in psychological in China claimed that post-COVID prevalence of
depression and insomnia was 20.1% and 18.2%. It and 46.92% from mild to severe on the scale of
also showed that suicidal tendencies were increased severity (26) A study was conducted on the mental
in vulnerable individuals. Furthermore, people with health of COVID-19 survivors. It depicted that most
poor socioeconomic status are more likely to suffer of the people who fell prey to COVID-19 had mild
from mental health problems (24). Another study was kind of depression. An alarming level of post-trauma
conducted in India, which showed that work stress was noticed in post-patients (27). In Pakistan,
environment stress was linked with a 46% augment research conducted on mothers who were staying
in the cases of depression and anxiety combined. In with their children with the virus shows an increased
this study, there was an alarming rise in the incidence of mental health issues like sleep
symptoms of depression and anxiety among Indian deprivation, anxiety, and stress. (28)
healthcare professionals during the post-pandemic
time (25). A study was conducted on the impacts of covid-19
pandemic on 150 HCWs. Overall, 80.7% of HCVs
A study conducted In Bangladesh involving students suffered from depression, and 50.3% faced stress of
at colleges and different universities also highlighted various kinds. All these studies highlighted the post-
mental health issues among students. The prevalence COVID mental health crisis on a global level (29).
of stress, anxiety, and depression was 28.5%, 33.3%,

Limitations:

Several limitations were identified in this systematic particularly in South Asian countries, as they face
review. Firstly, most of the studies were based on different challenges to deal with, as described above.
online surveys that included samples from urban This review highlights the importance of mental
people having access to the Internet .Moreover, health issues like depression, anxiety, stress, suicide,
different studies evaluated different issues, with most self-harm, and anger due to their increased
of them focusing on anxiety and depression, thus prevalence even after the pandemic is over. The
limiting the knowledge about sleep problems and symptoms are related to isolation due to the
insomnia. Also, these studies were conducted in lockdown, increased social media use, misleading
different countries at different times, and some information, and uncertainty. Lack of mental health
countries, like Afghanistan, had very few studies. So, care during the pandemic also contributed to the
mental health issues in South Asian countries because psychological crisis as the number of psychologists
of this dangerous virus should be studied carefully. and psychiatrists is alarmingly low in South Asian
countries. This research can help to identify the major
Conclusion: problems after COVID-19 to facilitate the concerned
authorities about planning and dealing with these
The devastating effects of this deadly virus on the issues of interest.
mental health of people have become significant,
 Conflict of interest.

In this systematic review, there is no conflict of interest

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