With the emergence of the first cases of COVID-19, this disease seemed to be something far from Costa Rica. When the first case in the country was confirmed on March 6th, 2020, many people believed that it would all be a matter of months, and that they would soon resume the usual activities, meetings with friends, family celebrations, they would return to face-to-face work and, therefore, Hence, the economy would stabilize.
But the truth is that this disease came to affect and modify the dynamics of families, different social groups and work environments. In fact, the way it is shared with other people has changed; many people lost jobs, many fell ill and, on the other hand, many loved ones were lost. Therefore, if we weave a little finer, an impact is evident in the most intimate fibers of the mental well-being of each one of us.
Worldwide, according to WHO statistics, 1 in 5 people who had COVID-19 have faced, for the first time, a diagnosis of clinical pictures of anxiety, depression or insomnia. Likewise, suicidal thoughts have increased between 8% and 10%, especially in young adults, and the mental health of people living in the most unfavorable socioeconomic situations has worsened.
Therefore, mental health impairment cannot be medicated or addressed solely through biomedical care. As mentioned by González, H. and Pérez, M. (2014), the existence of mental disorders or the affectation of people is not denied, but, usually, the clinical culture and its corresponding treatments, both pharmacological and psychological, prevail.
In this sense, comprehensive care is required, covering social, economic, biological, environmental and political needs related to mental health. In other words, the social determinants of health must be considered; that is, all those “circumstances in which people are born, grow, work, live and age, including the broader set of forces and systems that influence the conditions of daily life”.
According to Cénat, J. et al (2021), aspects such as anxiety, stress associated with the risk of being infected, the death of loved ones, the infection of loved ones, containment and isolation measures, loneliness, physical and emotional fatigue, job loss, financial insecurity, poverty, excessive consumption of information, and the vulnerability of certain disadvantaged groups are potential risk factors that can contribute to developing mental health problems such as anxiety, depression, insomnia, somatization, social phobia, post-traumatic stress disorder, obsessive-compulsive disorder, self-harm, suicidal ideas and inappropriate behaviors.
In order to show this affectation more closely, different people were asked about their experiences in the pandemic and how this has influenced their well-being.
“This has affected me; I tested positive for nexus, and I must have been taking good care of myself in my own home and sharing the bathroom with my family. Because it is a small house and with so many people, there is no space or conditions. I reached a state of fear and anxiety at the last level. I spent many nights without sleep and that made me feel weak. And even though I can go out now, I panic”. (43-year-old man, who fell ill with COVID-19).
Similarly, it was also mentioned that:
“I am not afraid of the disease. Fortunately, my family has not gotten sick. But I have felt very lonely. You feel sad and that affects your mind; not being able to see my children and grandchildren, nor being able to celebrate dates like Christmas or Mother’s Day, makes me live alone”. (An adult woman, over 79 years old).
“I have had many feelings of anguish and fear due to contagion, but the labor issue was quite complicated for me. I was left without work because of the pandemic, and I went through a roller coaster of emotions, sadness, uncertainty, anger and even frustration”. (A 31-year-old woman, unemployed).
Through these comments, the complexity and multi-causality in the mental affectation of the population is evidenced. If the respective governments and their health systems focus only on the care of the pandemic, understand the people who get sick and their physical affectation, any effort will not be enough. In this sense, it is relevant to go further. This also implies generating strategies and public policies in which coordinated inter-institutional work is reinforced, and in which a vision of health from the social dimension prevails.
Likewise, aspects such as social class, purchasing power, the structuring of families, the psychosocial environment in which a person develops, support networks, humanitarian aid, support to vulnerable or susceptible population to illness must be considered. Due to COVID-19, housing conditions (that is, overcrowded conditions or informal settlements), access to food, employment policies, among many others.
Finally, although efforts have been made in the country such as, for example, the creation of telephone lines to request support, call centers of the different schools of psychology or the College of Professionals in Psychology, and subsidies that allow people to have greater peace of mind, it is also necessary to visualize and act on the mental health of all people in their respective contexts (this includes women, the elderly, children, health professionals, people living in poverty, etc.), risk factors prior to the pandemic, social dynamics, accessibility and social inequality, thus generating actions of health and inter-institutional management that range from disease prevention to health protection itself.