When coronavirus cases were reported in December 2019, the disease outbreak led to a state of emergency in some countries to protect their citizens. Apart from the state of emergency declaration, other less drastic measures focused on movement restrictions to curb the spread of the disease using criteria such as self-isolation, quarantine, and lockdowns. The elderly population faces the highest mortality risk, which makes them the most vulnerable people. Quarantine is associated with numerous psychological impacts that disproportionately affect senior citizens. Some of the negative psychological impacts include depression, post-traumatic stress disorder, and anger (Brooks et al., 2020). This paper discusses the impact of quarantine on the mental health of senior citizens focusing on depression and includes an analysis of available data regarding the same.
Quarantine is defined as the separation and restriction of movement for individuals who have possibly been come into contact with a highly contagious disease to reduce the risk of spreading the disease. Quarantine is an unpleasant experience for people since they are separated from their loved ones and face the uncertainty of the disease status. Additionally, individuals in quarantine also lose their freedom and get bored, which might have unpleasant effects. One of the direst consequences is suicide and the development of mental health issues such as anxiety and depression (Brooks et al., 2020). Despite efforts by various government agencies to make quarantine as safe and comfortable as possible, psychological costs are challenging to offset, such as depression.
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The World Health Organization (WHO) recommended the performance of rapid reviews to collect data about the psychological effects of quarantine on various populations. Upon the performance of a review, Brooks et al. (2020) found that there was a high incidence of symptoms of psychological distress and disorder among people who had been quarantined. 9% of the study population exhibited high depressive symptoms three years after quarantine. Though there have been numerous efforts to curb the occurrence of depression among people in quarantine, one of the chief limitations is that the psychological well-being and psychological needs of people under quarantine differ from those of the general population (Huremović, 2019). Therefore, mental health care for senior citizens under quarantine has to be tailored to suit their specific needs based on the circumstances.
Data Analysis
Outcomes
The chief goals described in Healthy People (2020) target the reduction of major depressive episodes for adults older than 18 years and the increase of the proportion of adults aged 18 years and older with mental illness who receive treatment.
According to the data gathered from Healthy People 2020, one of the outcomes indicates that younger people between 18-24 exhibit the highest rates of depression compared to other age groups. The rate of occurrence of depression among this population has steadily decreased over the past eight years. The prevalence of depression decreases with increasing age, with the lowest rates recorded for people 85 years and older. Gathered data shows that there are some age disparities between the young and senior citizens, though the disparities differ from the data generated, as shown in the table below. Data generated indicated that senior citizens were more vulnerable to depression than younger adults, which differs from the described outcomes.
Figure 1. Age Disparities in Adults with Major Depression Episodes ("Healthy People 2020 |", 2020).
Li et al. (2020) performed a study to determine the incidence of depression associated with COVID-19. A 20.4% prevalence of depression was recorded. The prevalence of depression was dependent on the amount of time spent on COVID-19 related news each day. For people who spent less than five minutes each day on COVID-19 related news, the prevalence of depression was 17.8%, while those who spent more than one hour had a prevalence of 27.9%. According to the data, disparities in the prevalence of depression resulted from time spent on COVID-19 related news and not based on age.
Based on Healthy People (2020) data, older adults exhibit higher rates of treatment of mental illnesses such as depression in comparison to younger adults. Adults aged between 18-24 years have the lowest treatment rates, while those aged between 55 and 64 have the highest treatment rates. The age disparities are described in the table below.
Figure 2. Age Disparities in Adults with Mental Illnesses Who Receive Treatment ("Healthy People 2020 |", 2020).
There are three psychosocial stressors involved in the development of depression in senior citizens. Senior citizens worry about the possibility of themselves and their loved ones being infected. Home quarantine also causes a great deal of inconvenience to their daily lives and routine, thus contributing to the development of depression. Another stressor associated with the onset and development of depression is the financial burden caused by quarantine (Li et al., 2020).
Weaknesses and Strengths of Senior Citizens
Weaknesses
Older people are vulnerable to developing mental health and behavioral issues when exposed to disasters or emergencies. Consequently, various professional organizations mobilized geriatric mental healthcare teams to coordinate psychosocial support for senior citizens. One of the chief reasons why senior citizens are more vulnerable is that they have little awareness and limited access to information about disease outbreaks. Limited awareness triggers excessive worrying. On the other hand, it could also cause obliviousness to warnings. Strict security measures also result in the prevention of social activities, while lockdown rules in nursing homes prevent face-to-face communication with family and friends. Therefore, social participation and engagement of senior citizens are drastically reduced (Wang et al., 2020).
Community crises wreak havoc on senior citizens' mental health due to various factors that make the population more vulnerable. These factors act as weaknesses among the community. One such factor is the perception that senior citizens have regarding control. They actively seek information to attain an impression of control in an attempt to eliminate the fear of the unknown. As a result, they end up developing high anxiety. In cases where senior citizens get inaccurate information or misinformation, they get a distorted perception of the risk and develop an extreme fear of the unknown. Additionally, senior citizens may panic, which promotes stigmatization, marginalization, and scapegoats. Therefore, addressing mental health issues such as depression becomes challenging, dampening efforts to improve mental health in the community (Sujatha & Rajashekar, 2020).
Strengths
Senior citizens exhibit a high capacity for resilience and adaptability to various circumstances, such as the challenges that accompany quarantine. They are capable of deliberately cultivating resilience, healthy coping strategies, well-being, and mindfulness. They have developed various coping mechanisms over the years, that place them in a better position to handle multiple stressors that might lead to depression (Sujatha & Rajashekar, 2020). Various stressors applicable to senior citizens include a lack of supplies, frustration, infection fears, lengthened quarantine duration, stigma, and financial loss (Brooks et al., 2020).
Areas that Require Improvement
The numerous reviews performed on mental health issues among senior citizens under quarantine indicate the need to implement early intervention measures that target the enhancement of psychological health among the community. Another area that requires improvement is the provision of psychosocial support to senior citizens as a means to reduce depression incidences. Some of the early intervention measures include psychological crisis intervention (PCI) and psychological first aid (PFA). These tools provide psychosocial support, thus mitigating distress and providing emergency management to support emotionally overwhelmed senior citizens. They help in giving them a sense of safety and comfort (Sujatha & Rajashekar, 2020).
Another area that requires improvement is in the dissemination of relevant empirical and scientific information about disease prevalence, prevention, control, and treatment for senior citizens to related medical teams, law enforcement agencies, patients, and their caregivers or family members. Such information can be disseminated in the form of manuals that are available in various native languages. Providing adequate and accurate information negates conspiracy theories and false claims that lead to the perception that the disease is unbreakable, unstoppable, and unbeatable. This perception exacerbates symptoms of distress and mental composure among senior citizens (Sujatha & Rajashekar, 2020).
Due to the quarantine rules, senior citizens can barely leave their homes for clinical-based depression care management. Therefore, depression intervention measures should focus on home-based depression care management. Effective home-based depression care management includes active screening for depression using telecommunication services. These services can also be utilized to set measurement-based outcomes, educate patients on depression management, and maintain optimum mental health status.
Conclusion
Quarantine conditions lead to an increase in the occurrence of depression among older adults aged above 65 years. Loss of freedom, boredom, limited supplies, and news exposure about COVID-19 are some of the stressors associated with depression. Data gathered shows that the prevalence of depression in younger adults is higher than that of older adults. In contrast, data generated shows that the incidence of depression is higher among older adults. Older adults are more vulnerable to developing depression due to misinformation or the lack of adequate, and accurate information, which causes anxiety and depression. There needs to be more research to assess the lower prevalence of depression among older adults, yet they are the most vulnerable to depression under quarantine.
References
Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely, S., Greenberg, N., & Rubin, G. J. (2020). The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The Lancet . https://doi.org/10.1016/S0140-6736(20)30460-8
Healthy People 2020 | . Healthypeople.gov. (2020). Retrieved 6 July 2020, from http://www.healthypeople.gov/.
Huremović, D. (2019). Mental health of quarantine and isolation. In Psychiatry of Pandemics (pp. 95-118). Springer, Cham.
Li, J., Yang, Z., Qiu, H., Wang, Y., Jian, L., Ji, J., & Li, K. (2020). Anxiety and depression among general population in China at the peak of the COVID‐19 epidemic. World Psychiatry , 19 (2), 249. 10.1002/wps.20758
Sujatha, M., & Rajashekar, C. (2020). Psychological health of Senior Citizen during Corona Virus disease 2019-A Social Work Response. Mukt Shabd , IX (VI), 1-8. Retrieved 5 July 2020, from http://shabdbooks.com/gallery/157-june2020.pdf.
Wang, H., Li, T., Gauthier, S., Yu, E., Tang, Y., Barbarino, P., & Yu, X. (2020). Coronavirus epidemic and geriatric mental healthcare in China: how a coordinated response by professional organizations helped older adults during an unprecedented crisis. International Psychogeriatrics , 1-4. https://doi.org/10.1017/S1041610220000551
