Toys chained to a railing in a courtyard of a nursery school in Bergamo city, Italy. Photo was taken in April 2020, as nurseries, schools and many other activities came to a halt. ©UNICEF/UNI324961/Diffidenti
Article by WeWorld
THE THREE MAIN STRESSORS
It is well known that pandemics, natural disasters or other crisis events can pose a significant threat to our mental health. In the current scenario, there are three main factors that can cause psychological distress or even more serious diseases: i) the pandemic, ii) the lockdown measures, iii) and the new phenomenon known as infodemic (Biondi and Iannitelli, 2020).
i) The pandemic constitutes a stressor because it involves the threat of being infected, with the risk of developing a potentially mortal disease and infecting loved ones;
ii) The lockdown measures bring with them a new condition of isolation, social distancing and suppression of a “normal” life routine;
iii) The infodemic, a neologism coined by the WHO[1] to indicate the overload due to the excess of – often contradictory – information about the pandemic, can make people feel lost, causing panic and high stress.
These stressors can entail severe emotional discomfort, being related to highly traumatic and exceptional events, but also to a change in habits. Quarantine and more generally social isolation produce physiological and social changes, such as alteration of sleep-wake rhythm, physical activity, nutrition, exposure to sunlight. These are all elements that can directly impact our emotional brain and disrupt it. In Italy, this was particularly true for children. They had to undergo restrictive measures and school closures, for a total of 97 days for the school year 2019/2020, whereas for 2020/2021 there have been intermittent closures. Nevertheless, it is important to distinguish between adaptive reactions – related to the ability of human beings to adapt to and live with new situations and conditions, the so-called "adaptive plasticity" – and the development of real pathologies such as insomnia, eating disorders, anxiety, self-harm, depression, etc. (Biondi and Iannitelli, 2020). The first are more common and may turn into positive adaptation; the latter may need specific treatment. Early evidence indicates that women, young people, those suffering from sleep disorders, those with pre-existing precarious state of health, or those with relatives affected by Covid-19 are at major risk of developing severe mental health problems[2] (Humanitas, 2021).
THE EFFECTS OF COVID-19 ON THE MENTAL HEALTH OF CHILDREN LIVING IN ITALY
Globally, the WHO (2021) reports that there are at least 10% of children and 20% of adolescents at risk of developing mental disorders. In recent months, many studies conducted in Italy confirmed the psychological discomfort experienced by children and adolescents. During the pandemic 16.5% of the Italian population showed symptoms of depression, but among the youngest this percentage rises to 34.7% (Fondazione Italia in Salute, 2021). According to a survey conducted by Humanitas (2021), people between the age of 12 and 24 have been most affected psychologically, especially young students who were deeply influenced by the prolonged school closures and distance learning. Another study by the Gaslini Children’s Hospital (2021) showed that 60-70% of the general pediatric population developed a malaise that could result in sleep disorders, irritability and difficulty in concentrating among children, while in adolescents anxiety and depression prevail. During the first lockdown, Italy had assisted to a minor request for help[3], but with the second wave of autumn 2020, a 30% increase in psychiatric admissions for self-harm and suicide attempts has been recorded. 65% of the children who have been hospitalized since October 2020 have attempted suicide or practiced a marked self-harm. Then eating disorders exploded, with a rise in requests for help of 28% only for anorexia cases (Il Sole 24 Ore, 2021). The situation is also particularly at risk for those under-18s coming from socio-economic hardship. In Italy the probability of falling ill with depression doubles among low-income people and threefold among the unemployed. Today the unemployed constitute 10% of the population, but some estimates predict an increase to 17% for 2021. Economic discomfort can trigger psychological malaise, as also attests the significant increase in sales of psychopharmaceuticals recorded in recent months (Pharmastar, 2021).
HOW WEWORLD DEALT WITH THE ISSUE OF MENTAL HEALTH
WeWorld is an Italian independent organization committed for nearly 50 years to guaranteeing the rights of women and children in 27 countries. When the pandemic broke out in 2020, WeWorld projects had to be re-adapted to tackle this crisis and guarantee the well-being of children and adolescents, including their mental health. The following give examples of meaningful practices and results WeWorld carried out and collected in this field.
SYRIA WeWorld has been providing humanitarian assistance since 2014, focusing its action in Aleppo and Deir-ez-Zor. As part of WeWorld strategy to respond to Covid-19, our Education Team conducted phone calls during school closures – between April and May 2020 – to families with children enrolled in Self Learning Program (SLP). Through these calls, WeWorld wanted to spread reliable information and good practices to face health risks and psycho-social consequences on vulnerable children due to the pandemic and to the consequent schools’ closure and home isolation. 503 out of 1,403 target families were provided with information and tips[4] on how to support their children in facing education and emotional/mental challenges during isolation and school closures.
TANZANIA Since 2012, WeWorld has been working to promote and improve an inclusive and friendly environment for quality education in public schools. For the KITE II project[5] WeWorld is working in collaboration with the government in 10 public primary schools, in Dar es Salaam. As part of WeWorld strategy to respond to Covid-19[6], a research (KAP survey[7]) was conducted through phone calls during school closure between the 27 of May and the 8 of June, 2020. The results of the survey showed that children had experienced psychosocial distress due to social restrictions, increased fears and worries of contracting Covid-19 and being hospitalized; fear of not having access to food; fear of not being able to go back to school and, at the same time, fear of getting sick while returning to school.
MOZAMBIQUE WeWorld has been operating since 2000 in many areas of the country and is currently conducting permanent action in the fields of education, food security, agroecology and Disaster Risk Reduction (DRR). WeWorld is currently working in Cabo Delgado with two Education in Emergencies Projects: “Oficina de Arte (ODA)”, aiming at supporting pupils and teachers with Psychosocial Support (PSS) activities in Pemba, and “Support to education during Covid-19 pandemic in Pemba”, funded by Unicef. To better understand and respond to the effects of the pandemic on children’s mental health, WeWorld designed a program for the children of the three project communities. The program envisaged the creation of community and home-based and school-based artistic-educational laboratories[8] to promote children well-being and social cohesion. Overall, in 2020 WeWorld organized almost 15 sessions of Oficina de Arte with the participation of 776 children. The sessions aimed at creating moments of learning and leisure but also of joy and social re-integration for the most vulnerable children; exploring levels of movement coordination, creativity, concentration and tactile stimulation; contributing to the psychosocial well-being of the children, as well as to family integration; creating a safe physical and mental space that could be recreational, educational and socially reintegrative for the children. In the end, the project proved to be successful and both the children and their families expressed great satisfaction.
References
Biondi M., Iannitelli A., (2020), Covid-19 and stress in the pandemic: sanity is not statistical, in Rivista di Psichiatria, Vol. 55, n. 3, https://www.rivistadipsichiatria.it/archivio/3382/articoli/33567/
Fondazione Italia in Salute (2021), Gli italiani e il Covid-19, https://formatresearch.com/2021/04/15/fondazione-italia-in-salute-gli-italiani-e-il-covid-19-impatto-socio-sanitario-comportamenti-e-atteggiamenti-verso-i-vaccini/
Humanitas (2021), Covid-19, attenzione anche alla dimensione psicologica, https://www.humanitas-care.it/news/covid-19-attenzione-anche-alla-dimensione-psicologica/
Il Sole 24 Ore (2021), Il neuropsichiatra: “Il Covid è stato un detonatore, tra i ragazzi è boom di ricoveri”, https://www.ilsole24ore.com/art/il-neuropsichiatra-il-covid-e-stato-detonatore-i-ragazzi-e-boom-ricoveri-AEdWQOC
Pharmastar (2021), Covid-19, la pandemia infetta anche la mente, https://www.pharmastar.it/news/covid19/covid-19-la-pandemia-infetta-anche-la-mente-1-milione-di-nuovi-casi-di-disagio-mentale--34464
WHO (2020), Promoting well-being of children and adolescents during the pandemic, https://www.who.int/docs/default-source/mca-documents/8w-1-dr-nazneen.pdf?sfvrsn=232a486d_2
[1] https://www.who.int/health-topics/infodemic#tab=tab_1
[2] Various factors associated with mental health problems may depend on age, sex, marital status, education, employment, income, place of residence, close contacts with people who have contracted the virus, physical comorbidity and mental health problems, exposure to news related to Covid-19, etc. (Humanitas, 2021).
[3] This resistance was due both to resistance to go to the hospital and because stress was lived in a less intense way.
[4] Parenting tips were previously elaborated by WeWorld Education Team, based on standard awareness material made available and ready-to-use by international agencies and national relevant actors.
[5] The project focuses on 3 main issues: quality education, inclusive education and child protection.
[6] It should be noticed that, starting from the end of 2020, the effects of the pandemic in Tanzania were not so much manifested since the government refused to disclose any data about new cases or death tolls related to Covid-19.
[7] The survey was built on 3 different levels of inquiry: demography, Knowledge, Attitude and Practice (KAP survey) and school assessment. A total of 395 phone surveys were conducted in 2 different school districts: Kinondoni, with 178 respondents, and Temeke (217 respondents). The survey parents (69.6%) of the sample), children (19.7%) and members of the school community (10.7%).
[8] The team of artists and activists of the Oficina de Arte project was trained at the Provincial Direction of Education on protective strategies and on how to identify children with special needs (learning difficulties, disability, etc. ) and cases at risk of psycho-social distress , both in school and out of school.