Open access peer-reviewed chapter

# Vulnerable Groups and COVID-19 Pandemic; How Appropriate Are Psychosocial Responses?

Written By

Amir Moghanibashi-Mansourieh

Submitted: January 30th, 2021Reviewed: June 7th, 2021Published: July 1st, 2021

DOI: 10.5772/intechopen.98762

From the Edited Volume

## Anxiety, Uncertainty, and Resilience During the Pandemic Period

Edited by Fabio Gabrielli and Floriana Irtelli

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## Abstract

Covid-19 pandemic has had adverse health, economic and social consequences on different communities, groups and individuals. Vulnerable groups are more likely to contract the infection and suffer from mental disorders particularly anxiety due to lack of access to health and social resources, lower income and less awareness etc. In this chapter, in addition to a description of the psychological and social conditions of vulnerable groups including women, children, the elderly, and minority groups during the pandemic, the factors influencing the success of psychosocial interventions provided for these groups and the weak points and upcoming challenges will be addressed. Finally, the conclusion will offer some recommendation for coping with the future circumstances.

### Keywords

• psychosocial interventions
• vulnerable groups
• COVID-19
• anxiety
• pandemic
• mental health
• social support
• inequality

## 1. Introduction

Beyond the tragic story of human death, this crisis has left many problems on other aspects of human life. Governments now face a dual challenge: on the one hand, they have to deal with an epidemic crisis in the field of health, and at the same time, they have to respond to its economic and social effects.

Developed economies have made attempts to mitigate some of the socio-economic effects of widespread closures, including measures such as tax refund delays, increased payments, subsidies to workers, compensation, and the provision of double unemployment insurance. Less developed countries have fewer tools to manage the effects of COVID-19 pandemic, and they are not only facing an economic crisis, but also a systemic human development crisis [1].

### 2.6 How mental health care systems responded to the COVID-19 crisis

Mental health systems have faced unprecedented challenges during the pandemic. A recent survey by the WHO found that COVID-19 disrupted or halted mental health services in 93% of the world while demand for receiving mental health interventions increased. The survey conducted in 130 countries highlights the disruptions of mental health services for vulnerable people in psychotherapy, reduction of major harms, retention in drug addiction treatment and emergency services. It also reports that providing personal medicine and crisis support during COVID-19 is much more difficult in large mental health institutions than in the community, which increases the risk of inequality of care for people with psychosocial and intellectual disabilities [31, 32].

To overcome the disruptions of service provision of mental, neurological and substance use disorders (MNS), most countries (70%) initiated telemedicine for replacement in personal counseling, 67.7% hotlines for mental health and mental support, 65.4% special measures to prevent and control the infection. In mental health services, while 44.6% of health care providers trained COVID-19 within basic psychological skills, discharged 44.6% of the patients or transferred them to other health facilities, 33.1% provided in-house communication services or community and 20.8% hired counselors [32].

Internet services, smartphones, and the advent of fifth-generation cellular phone networks have enabled mental health professionals and health officials to provide online mental health services during the outbreak of Covid-19 pneumonia [33]. According to some studies, online psychological interventions, including online cognitive-behavioral therapy (CBT) have been effective for disorders such as depression, anxiety, and insomnia disorders (e.g., through WeChat) [34]. There have also been several artificial intelligence programs used as interventions in psychological crises during the pandemic, including the Three Holes Rescue program, which monitors people at risk of suicide by analyzing messages sent to them on Weibo and, when necessary, alarms to volunteer psychologists and psychiatrists to carry out necessary and urgent interventions. These interventions can improve the quality and efficacy of emergency interventions. Countries such as the United Kingdom and the United States have also conducted various studies to address methods such as reducing health anxiety for psychological interventions in times of crisis against public health emergencies [35].

Cognitive-behavioral patterns (CBTs) show that excessive health anxiety can be alleviated by targeting maladaptive beliefs and behaviors. Controlled randomized trials have also indicated that CBT is beneficial for people suffering from excessive anxiety during a pandemic. Book therapy is another promising and sometimes useful intervention that requires further evaluation in randomized controlled trials.

The psychological distress caused by the pandemic may disappear without intervention, just as the emotional effects of other stressors may disappear over time. Instances of disorders that cause clinical attention include major depressive disorder (MDD), post-traumatic stress disorder due to the loss of loved ones or other traumatic events, and general anxiety disorder (GAD), which may cause or be caused due to a pandemic. Such people may be referred for cognitive-behavioral therapy or treatment with certain medications [36, 37].

It is also important to point out the restrictions that exist and need to be removed: first, vulnerable groups may have limited access to smartphones and the Internet. Second, online emergency interventions are effective and cost-effective, which are key for critical times, but it is emphasized that online interventions cannot be a permanent alternative to face-to-face treatment.

At the level of health care policies, it seems vital to ensure transparency of communication between authorities and the public (including service users) and to provide clear ways to protect mental health from the challenges posed by pandemics and the impact of social initiatives and isolation. As complexity paradigm indicates health is non-linear attribute but congruent with the values of social justice, participation, and empowerment [38, 39]. In addition, from a methodological and theoretical standpoint, complexity conveys a holistic, contextual and transdisciplinary approach, and health promotion tends to put emphasis on ecology and interdisciplinary action. Thus, it is recommended that healthcare system planning encompasses interventions with dynamic, contextual and community-based nature [40]. Finally, it is time for countries to respond to mental health services (under chronic capital shortages) by increasing budgets and staff capacity, especially given the predicted increasing pressure on national and international mental health services in the near future.

### 2.7 Social stigma

In areas related to health and hygiene, social notoriety is the negative relationship between (with) a person or group of people who have certain characteristics or diseases. At the time of an outbreak, this notoriety may mean labeling people, stereotyping and discriminating behaviors against them, or experiencing a loss of social dignity due to an association with a particular illness [38]. Anxiety caused by lockdowns, many unknowns around COVID-19 and fear of contracting the infection has risen stigma in communities. This results in more serious health problems and more difficulties in controlling the spread of Covid-19 [41].

According to the World Health Organization, the negative relation can be faced by people who may:

• be in contact with the virus (e.g., those with Covid-19 symptoms, or who tested positive, or is close to someone who has)

• be from countries where the virus originated or are considered “hot spots”

• be overlooked by public health guidance in some way [42].

COVID-19 social stigma is often corresponding to fear and willingness to protect those close to us. However, the impacts of social stigma are very harmful. It can enhance feelings of guilt and anxiety and can worsen loneliness and mood problems for those with COVID-19 [43]. Additionally, the anxiety and fear of being stigmatized against, may cause two dangerous clinical and public health consequences: delayed referral of symptomatic patients to healthcare services and under-detection of the infected. A delayed diagnosis has been corresponding to more severe disease, mostly in the elderly and in vulnerable people, while a delayed notification of an infected person may facilitate the rapid spread of Covid-19 in the community [41].

## 3. Conclusion

Mental health is a development issue. There is a correlation between mental health and growth which one affects the other. Developmental areas, such as education, employment, economic resources, emergency responses, and human rights, affect mental health. At the same time, people with mental health concerns are often lost or actively excluded from developmental programs. Therefore, it is very important to improve the ground for the development of communities and also to address the issues of people with mental health concerns on development interventions. Governments, civil society, bilateral development agencies, research institutes, and others should make conscious efforts to reach out to people with psychosocial disabilities.

There is a need to create user-friendly resources that hide mental health and reduce stigma around it. Community participation in expressing their needs and designing and implementing interventions is vital. There were many cases during the epidemic, in which it was the support of the community and neighborhoods that helped people overcome the challenges they faced. Involvement in the community ensures the improvement of the whole community. Finally, there is a need to invest in building effective mental and social health infrastructure. It is time to invest in building human resources and enhancing existing capacity. These resources and services, if created consciously, can survive beyond the epidemic and continue to serve as a vital resource for societies.

## Conflict of interest

The author declares no conflict of interest.

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Written By

Amir Moghanibashi-Mansourieh

Submitted: January 30th, 2021Reviewed: June 7th, 2021Published: July 1st, 2021