Handling children in COVID wards: A narrative experience and suggestions for providing psychological support

Psychoanalysis of COVID-19 Patient Narratives: A Descriptive Study

Background and Objectives: COVID-19 patients are a psychologically vulnerable patient group who suffer from both physical symptoms and psychological problems. The present study is a psychoanalytic investigation of COVID-19 patients utilizing Lacan's desire theory. We aimed to explore the manner in which patients' desire is presented in their lived experience narratives and sought to discover factors which directly impacted on this process. Materials and Methods: In-depth semi-structural interviews were conducted with 36 COVID-19 patients in China. During each interview, participants narrated their lived experiences of COVID-19 infection. Emotions, metaphors, and behaviors in patient narratives were collated as the main points for psychoanalysis. Results: Our findings demonstrated that the desire for being a healthy person made patients emotionally sensitive to the social environment. Anxiety and obsessive behaviors emerged in the process, which reveals their desire for that which they lack. Furthermore, public fear with respect to COVID-19 was somehow converted to psychological pressure on COVID-19 patients. Thus, these patients attempted to "de-identify" their identity as "patients". Positive responses of COVID-19 patients to the external world included admiring medical personnel, government, and country, while negative responses included interpersonal conflicts or complaints about discrimination. Following the rules of the Other, COVID-19 patients were influenced by the Other's desire in constructing their own image of a healthy person. Conclusions: This study revealed COVID-19 patients' psychological need to rid themselves of the identity of "patient" at the individual and social level. Our findings have clinical implications in helping COVID-19 patients to reshape their identity and to live a normal life.

A Qualitative Inquiry of Parents' Observations of Their Children's Mental Health Needs During the COVID-19 Pandemic

Given that children and adolescents are at critical periods of development, they may be particularly vulnerable to the effects of the COVID-19 pandemic. Using a descriptive phenomenological approach, 71 parents' observations of their child's mental health difficulties were explored. Parents sought out treatment because their children were experiencing significant distress. Data used were transcribed from baseline questionnaires and therapy summaries. Data analysis revealed three themes: emotion regulation difficulties, hypervigilance, and despair. The search for strategies and tailored interventions to help mitigate the potential harmful and long-term mental health impacts of the pandemic should be at the forefront of research and clinical practice.

Impact of lockdown due to COVID-19 pandemic in changes of prevalence of predictive psychiatric disorders among children and adolescents in Bangladesh

Lockdown, isolation, quarantine and social distancing are proved to be only effective measures to prevent and tackle COVID-19 till date. Unfortunately, these measures have caused physical, economical and mental health problems. Children and adolescents are not immune to the adverse mental health effect due to the new changes. Research around the globe shows children and adolescents are suffering from an increased number of depressive symptoms, clinginess, inattention, irritability and worry. This cross-sectional online-based survey type study was aimed to get a snapshot of the prevalence of predictive psychiatric disorders in the child and adolescent population in Bangladesh before and during lockdown. Validated Bangla parent version of Strengths and Difficulties Questionnaire was used to assess the psychopathology among subjects. Total sample was 552 aged from 4-17 years. Boy-girl ratio was 1.3:1. Prevalence of any predictive psychiatric disorder before lockdown was 20.5 % and within lockdown was 39.7 % and the difference was highly significant (P < 0.001). Prevalence of emotional, conduct disorder and hyperactivity were also increased significantly during the lockdown period than before. Conduct disorder and hyperactivity were more prevalent among boys both before and within lockdown. In contrast, prevalence of emotional disorder was higher among girls before lockdown but within the lockdown period, the boy-girl prevalence was almost the same. This study shows the new extreme measures to tackle COVID-19 has a disaster impact on mental health of children and adolescents. Subsequent studies and support should be developed to prevent conditions getting worse.

Children and COVID19: Understanding impact on the growth trajectory of an evolving generation

The COVID19 pandemic has forced the world to be closed in a shell. It has affected large population worldwide, but studies regarding its effect on children very limited. The majority of the children, who may not be able to grasp the entire emergency, are at a bigger risk with other problems lurking behind the attack of SARS-CoV-2 virus. The risk of infection in children was 1.3%, 1.5%, and 1.7% of total confirmed COVID-19 cases in China, Italy and United States respectively which is less compared to 2003 epidemic of severe acute respiratory syndrome (SARS), when 5-7% of the positive cases were children, with no deaths reported while another recent multinational multicentric study from Europe which included 582 PCR (polymerase chain reaction) confirmed children of 0-18 year of age, provide deeper and generalize incite about clinical effects of COVID19 infection in children. According to this study 25% children have some pre-existing illness and 8% required ICU (intensive care unit) admission with 0.69% case fatality among all infected children. Common risk factor for serious illness as per this study are younger age, male sex and pre-existing underlying chronic medical condition. However, we need to be more concerned about possible implications of indirect and parallel psychosocial and mental health damage due to closure of schools, being in confinement and lack of peer interaction due to COVID19 related lockdown and other containment measures. The effects can range from mood swings, depression, anxiety symptoms to Post Traumatic Stress Disorder, while no meaningful impact on COVID19 related mortality reduction is evident with school closure measures. The objective of this paper is to look at both the positive & negative effects in children due to COVID19 related indirect effects following lockdown and other containment measures. There is a need to gear up in advance with psychological strategies to deal with it post the pandemic by involving all stakeholders (parents, teachers, paediatricians, psychologists, psychiatrists, psychiatric social workers, counsellors), proposing an integrated approach to help the children to overcome the pandemic aftermath.