Who is ‘high-risk’ in the ongoing mental health pandemic?
COVID-19 is affecting mental health across the world, but some key populations are hit hardest
by Catherine Cove
With over 24 lakh total cases of COVID-19 worldwide and over 30,000 in India, the spread of COVID-19 has had far reaching consequences on collective health and wellbeing. In order to curb the spread of the pandemic, many countries are instituting lockdowns, shelter-in-place orders, and other social distancing measures. In India, the government instituted a nation-wide lockdown on March 24th, which has been extended to stay in effect until early May. The fear, uncertainty and devastation of a pandemic coupled with economic insecurity and lifestyle changes caused by these restrictions has led to widespread mental health concerns at a global level.
Studies have shown that anxiety, depression, post traumatic stress disorder, substance use, and domestic violence are all positively correlated with the presence of a large scale disaster . Early reports indicate that the COVID-19 crisis is no exception to this trend. While the mental health effects of COVID-19 impact a wide range of individuals across cultures and circumstances, there are particular groups who are more susceptible to these effects and for whom greater care must be provided.
Frontline health workers
Many have likened working on the COVID-19 response to working in the aftermath of a natural disaster or a war zone. Workers are forced to witness scenes of devastation and the human cost of the disease firsthand, while being acutely aware that their job puts them at higher risk of contracting the virus themselves.
The fast-paced environment of working in a healthcare system in the time of a pandemic often does not allow sufficient time for workers to pay adequate attention to their own mental health concerns and risks.
Another element of the pandemic that adds to the strain on healthcare workers is the uncertainty of the timeline. Unlike working in the aftermath of a natural disaster, fighting against COVID-19 comes with an increasingly uncertain timeline: There is little clarity as to when this crisis will conclude or temporarily stall, which leaves frontline workers to continue their work without an end in sight. All of these factors contribute to a stressful and uncertain reality for frontline workers, exacerbating mental health concerns for a critically important group.
Pandemics, like natural disasters and other crises, have a way of disproportionately affecting the most vulnerable in our society. When it comes to the mental health impact of COVID-19, the result is no different. Marginalised and stigmatised groups often face increased discrimination and stigma in addition to having more limited access to healthcare and social support. This crippling combination leads to poorer physical and mental health outcomes among these groups.
The transgender community is one example of a marginalised group that has been forced to bear a disproportionate burden during the COVID-19 pandemic. Before the pandemic struck, transgender individuals often did not have the same access to healthcare as cisgender individuals, and faced discrimination within the healthcare system which further deterred them from seeking care . The spread of COVID-19 in India will only increase the severity of these exclusions. The presence of stigma and discrimination will have a range of potent effects during the pandemic, with mental health challenges among marginalised groups being just one of them.
Individuals exposed to domestic violence
Reports from several countries have affirmed that the restrictions imposed to stem the spread of COVID-19 have led to a rise in domestic violence. Spikes in calls to domestic violence hotlines have strongly coincided with the start of lockdown periods . In India as well as other countries, lockdowns have created a set of circumstances that enable abusers to exert control over their victims: Those at risk of domestic violence find themselves subject to growing isolation from support systems, increased surveillance by their abusers, and escalating physical and psychological violence. Due to the urgency of curbing the spread of COVID-19, adequate provisions to support domestic abuse victims were not developed in parallel with lockdown provisions. The result is that many survivors have limited or no places to turn to for support and safety.
While mental health concerns have been increasing among the general population since the start of the COVID-19 pandemic, it is critical to identify and recognise the groups whose mental health is particularly vulnerable during this period. For different reasons, frontline workers, marginalised groups, and victims of domestic violence face severe physical and psychological threats as the virus spreads throughout India. In order to take action to address mental health at this time, plans and policies must be developed keeping the needs and realities of these groups at the forefront. How society’s most vulnerable members fare during this period will be the true test of the efficacy of our response.
Catherine Cove is a Technical Specialist working on public health, health financing, and program evaluation at Swasti Health Catalyst
 Galea, S, Merchant, R, and Lurie, N. The Mental Health Consequences of COVID-19 and Physical Distancing: The Need for Prevention and Early Intervention. JAMA Intern Med. Published online April 10, 2020.
 Swarupa Deb. Living on the Edge: COVID-19 Adds to Distress and Discrimination of Indian Transgender Communities. Health and Human Rights Journal. 2020.
 Amanda Taub. A New Covid-19 Crisis: Domestic Abuse Rises Worldwide. New York Times. April 14, 2020.