Anxiety disorders: The hidden threat for Latin American countries in times of COVID-19

July 13, 2020

More than 11 million people worldwide are suffering from COVID-19 (Worldometer, July 4, 2020). The global spread is halting economies with a stronger impact in Latin American countries who were already struggling with limited health services, a broad informal market, and high unemployment rates. In these countries, households suffer persistent worries about their health, economic uncertainty, and rigid social isolation, some of the stressors that can lead to mental health diseases.

The COVID-19 affects not only individuals’ physical wellbeing but also their mental health. According to Sher (2020), COVID-19 was found to be associated with mental diseases like anxiety, depression, distress, sleep disturbances, and even suicide. These illnesses surge when individuals fear for the wellbeing of family members, friends, or work stability (American Psychiatric Association, 2020). The abrupt disturbance caused by COVID-19 is affecting every aspect of people’s lives and could become a catalyst for anxiety disorders with unknow future repercussions in every dimension of society.

Occasional anxiety is normal and even a healthy mechanism in our lives that lead us to prepare for future potential threats (real or not). However, when anxiety leads to inaction and does not dissolve over time, it incapacitates individual perceptions leading to a mental disorder (National Institute of Mental Health). There are several types of anxiety disorders, but they can be grouped into three classes: (i). Anxiety disorders when someone is suffering from excessive feelings of real or perceived threat or worry about a future risk; (ii). Obsessive-compulsive and related disorders when someone is suffering from obsessive/intrusive thoughts (e.g., excessive fear for not being clean, leading to obsessive behaviors like washing their hands more than regularly), and (iii). Trauma and stressor-related disorders when someone faced a traumatic or stressful life event like the loss of a loved one (Anxiety organization, 2020).

The repercussions of COVID-19 in the mental health of Latin American people, for instance, can be inferred from data from past pandemics of infectious diseases that found people suffering from high-anxiety due to several stressors that increased feelings of worry and concern (Schoch-Spana from the Johns Hopkins School of Public Health, 2020). In the context of COVID-19, several are the stressors causing feelings of uncertainty, worry, and fear in large populations. For instance, individuals at home with symptoms of respiratory illnesses, such as coughing and sneezing, can suffer from anxiety due to the uncertainty and fear of having COVID-19. The mild symptoms of COVID-19 are similar to many other diseases, such as the cold or the common flu. Similarly, even people in recovery from the virus can still have to deal with anxiety through constant worry and fear since the long-term effects of the virus in their physical health are unknown, and they fear to transmit the coronavirus to their loved ones unintentionally.

For instance, in Peru, severe lockdowns (the people can only leave their homes for specific activities) were unexpectedly implemented, which halted social activities for many communities. These policies started in March, and most Peruvians still under social isolation. This limited socialization with friends and family members, challenging the most basic form of human interaction and affecting people of all ages with different mental and physical needs. At the same time, people were requested to adopt new and more rigid daily routines, such as cleaning their hands regularly and using a mask. Home-schooling in large families was also suddenly adopted, causing family members to adopt new roles and responsibilities without training and limited resources (e.g., older brothers became teachers of their younger while parents become workers and caretakers of ill-elders and children). For single moms, there is no other option but to assume all these overwhelming duties simultaneously.

Moreover, the scenario of distress in Latin American families is exacerbated due to limited economic resources. Families already struggling to cope with new overwhelming routines are also facing the challenges of living in economies with incumbent market-informality. In Peru, the lockdowns to protect people from COVID-19 also caused a severe economic impact and a rise in unemployment in the informal market, which comprises 70% of employment. Moreover, thousands of people living in Lima's poor neighborhoods named "conos" depend on daily incomes to live, and most of them work in small informal businesses that had to be closed due to the lockdowns. For decades, for parents in this neighborhood, the main concern was to provide food once a day to their families. With COVID-19, the subsistence concern worsened since priorities to buy essential health protection to every family member raised. In some conos, access to water for the new norm of constant hand cleaning in times of COVID-19 is a challenge. Unfortunately, the hopes for a scenario of the economic recovery for these families are distant and uncertain since cases of COVID-19 are still on the rise.

Additionally, Peruvian middle-class families with stable employment and access to resources must face a constant wave of contradicting news. While the source of mental distresses in the most impoverished communities involves more immediate matters, the middle-class is divided by news outlets and social media with contradicting information about the severity of the pandemic, further increasing uncertainty and thus anxiety. Sometimes ignorance is better than disinformation. Currently, the USA is the first in the rank of deaths from COVID-19, and in second, we have Brazil, two countries with large populations. However, countries with small populations like Peru and Chile are ranked in fifth and sixth place, followed by Mexico in the ninth position (Worldometer, 2020). This reality comprises another source of anxiety, even for families that did not lose a loved one, the awareness of being in a disease hotspot country with limited health infrastructure, expensive COVID-19 treatments, and limited financial resources has been severely impacting their mental and well-being. For example, young adults are worried about not being able to cover the cost treatment of older parents while older parents worry about their children getting the virus or losing their jobs. Unlike developed nations, in Latin American countries, medical equipment is scarce, and national hospitals have no ICU capacity to attend COVID-19 patients properly. In 2019, hospitals in Brazil registered nearly 1.05 ICU beds per 100,000 inhabitants, while in Peru, it was registered 0.58 ICU beds per 100,0000 people (Statista, 2020).

Misleading information from Social Media is also playing a role in increasing anxiety disorders in Latin American populations. For most people living in lockdown, popular social media like Facebook and YouTube have become the primary sources of information about COVID-19. For most Spanish speakers, information is limited to the available in their native language, so the national and local news are the most common sources of information. At the beginning of the pandemic, governments in Latin America failed to provide accurate information about the COVID-19 and respond to critical citizens' inquiries about why to adopt social isolation. The lack of comprehensive and time-sensitive information from the governments was fulfilled by misleading, incomplete, or false news from social media. For instance, harmful and, in some cases, deadly auto-medication was being encouraged by some politicians in Brazil, or with news about unproven scientific natural remedies to cure COVID-19. In countries with a large indigenous population, like Peru and Brazil, the lack of information about the virus in native languages (e.g., Quechua, Aymara, or Guarani) also becomes a cause of uncertainty anxiety and virus contagion.

Therefore, several stressors are affecting the mental health of Latin Americans in times of COVID-19 with, yet, unforeseen consequences. In the meanwhile, governments can encourage their populations to follow guidelines to cope with mental distress. That is why it is relevant to support the WHO guidelines to deal with mental health, such as (a). keep yourself informed about COVID-19 but using trustworthy national, local, or international sources like the WHO website. (b) maintain a daily routine. It is recommended that people living in social isolation made a schedule and followed it. It can be distributed between times for telecommuting, practice personal hygiene, workout, eat healthy meet, and time to relax. Also, give space to your family members to relax. (c). minimize news feeds, limit to one or two times a day to watch, read, or listen to information that makes you feel nervous or anxious. (d). Maintain social contact with people close to you by phone or using online tools. People need to remember that being physically isolated does not mean being socially isolated. (e). Limit the amount of alcohol or do not drink alcohol at all and avoid the use of drugs for dealing with fear, boredom, anxiety, or social isolation. 

Finally, it is critical to comprehend that reasonable levels of anxiety can play a positive role since as with any emotion, it can prepare individuals for a change in behavior, and if properly guided (by our leaders), can lead to individuals adopting individual and collective protection behaviors (e.g., use mask and practice social distancing). In contrast, high or lower anxiety could cause someone to suffer from obsessive feelings of worry about contagion and remain utterly isolated, threatening their life or avoiding using masks or social distancing to become a source of virus spread. In any case, Latin American governments have the critical role of informing their populations about mental diseases and how families can cope with mental illnesses in times of COVID-19. Governments need to take responsibility, accept the severity of the pandemic, and make sure to properly inform the population with accessible material for every citizen respecting each community's demographics.

REFERENCES

  1. Jovanovic, T. (n/d). "What is Anxiety?".
  2. Johns Hopkins Bloomberg School of Public Health. (2020). "Mental Health in the COVID-19 Pandemic: How to Cope in a Crisis".
  3. American Psychiatric Association. (n/a). "What Is Mental Illness?".
  4. Worldometer. (2020). "Coronavirus Cases". https://www.worldometers.info/coronavirus/#countries.
  5. National Institute of Mental Health. (n/d). "Anxiety Disorders".
  6. World Health Organization. (2020). "Mental health & COVID-19".
  7. World Health Organization. (2020). "Coping with Stress during the 2019-nCOV outbreak".

About Author(s)

marthapalomino's picture
Martha Rosario Palomino Coila
Martha Rosario is a Ph.D. in Education and an MS. in Management, major in Health Services Management. Currently, she is a professor at the School of Social Work at the Universidad Nacional del Altiplano in Peru.
marthapalomino's picture
Martha Rosario Palomino Coila
Martha Rosario is a Ph.D. in Education and an MS. in Management, major in Health Services Management. Currently, she is a professor at the School of Social Work at the Universidad Nacional del Altiplano in Peru.
marilununezp's picture
Marilu Nuñez Palomino
Marilu Nuñez is a graduate student of Public and International Affairs with a major in International Political Economy at the University of Pittsburgh. She has a Master's Degree in Accounting for the FEA-USP in Brazil. Currently, she is doing research on International Trade and Mental Health in the Americas.