The Covid-19 pandemic impact on community mental health

The impact of the pandemic is felt by people all over the world. This is caused by stigmatization, discrimination, positive experiences of Covid, and disruption of social support. The purpose of this systematic literature review was to find out the psychological impact during the pandemic on the community. This systematic literature review was compiled by searching for articles from 2020 to 2021 contained in health databases from several journals such as Elsevier, BMC, Index, Cambridge University Press, Dove Press, and Wiley which was performed electronically. The inclusion criteria included in this study were focusing on the impact of the Covid-19 pandemic and mental health. From 20 articles, it was shown that psychological factors also played an important role in adherence to preventive measures in public health (such as vaccination) and how people deal with the threat of this virus infection with good health protocols. A person with a low level of education had a risk of being prone to depression and anxiety. This was because if someone with a high level of education had extensive knowledge about virus transmission so that they were better able to protect and cope with the anxiety and depression. Theoretically, the implication of this study is to enrich insight related to the impact of the Covid-19 pandemic on community mental health. While practically, this study might empower the community to maintain a healthy lifestyle during the pandemic that can prevent mental disorders. We hope this study will also empower stakeholders to create a policy that works in facilitating mental health assistant during the pandemic, especially for the Covid-19 patients in the community.


Introduction
The Covid-19 pandemic that has lasted for more than a year leaves a huge impact on all aspects of life. One of the impacts is the mental health of the community. The impact of the pandemic is felt by people all over the world. This is caused by stigmatization, discrimination, positive experiences of Covid, and disruption of social support, these are included in short-term mental health disorders. In addition, losing a job due to the pandemic also causes long-term mental health problems. Mental health is influenced by environmental factors and the current situation, where the pandemic has caused the situation to change drastically from usual, today's society is forced to be able to deal with pressures that occur from the social, economic, educational, and cultural sides [1].
Health is a state of physical, mental, and social well-being. This understanding implies that physical, mental, and social health are in balance. The pandemic, which is still ongoing and not sure * corresponding: putri.rosalia96@gmail.com when it will end, has had a huge impact on people's lives, both physically and mentally. The massive issue of Covid-19 in all media at the beginning of the pandemic has caused confusion, fear, anxiety, anxiety, and panic among the public. The number of deaths due to Covid-19 is increasing anxiety. The act of self-isolation, work from home, online learning systems cause obstacles in social interaction in society which in turn causes increasing frustration and stress for students, college students, and office workers [2].
The pandemic also has a negative impact on the economy. Many companies have closed and laid off their employees. The number of unemployed increased in all regions, the feeling of anxiety about how the family's financial fate was felt by workers who became the backbone of the family. These workers feel confusion, anxiety, frustration, fear, feelings of helplessness and can even trigger insomnia [3]. Starting to feel inferior because they have no income.
Teenagers and children who have to follow the online learning system feel bored and constrained because they cannot interact with their friends. Children and adolescents who are in the process of growing and developing need self-appreciation through a series of interactive activities with their friends, tutors, school teachers, dance coaches in the studio, or coaches of the sports they are involved in. The pandemic that requires restrictions on activities outside the house has changed the interaction patterns of these children and adolescents [3]. This will cause feelings of laziness, boredom, and constraint which in turn will trigger stress. Women who play an important role in every household also feel the impact of the pandemic on their mental health. These mothers feel anxious and afraid of contracting the virus, worried about the financial fate of the family when their husbands are also affected by layoffs. How to manage family finances, how to still provide nutritious food for family members in the middle of an economic problem, how to keep family health guaranteed. Not to mention the fear of thinking that if you catch the virus you have to self-isolate or worse if you have to be treated in a hospital and when you return home you will be ostracized by friends, relatives, and neighbors. This confusion, anxiety, fear, feeling of helplessness, boredom, feeling of restraint and low self-esteem are pieces of evidence that the pandemic has caused mental health problems in all levels of society. However, not everyone can manage the level of stress and anxiety they are facing. For those who cannot manage anxiety, it will result in mental disorders that will greatly interfere with daily activities. Therefore, special attention is needed so that all people can go through this Pandemic without mental health problems [4]. The purpose of this systematic literature review was to find out the psychological impact during the pandemic on the community, especially the occurrence of mental health disorders in the community so that this impact could be anticipated as early as possible.

Methods
This systematic literature review was compiled by searching for articles from 2020 to 2021 contained in health databases from several sources such as Elsevier, BioMed Central (BMC), Cambridge University Press, Dove Press, and Wiley. The inclusion criteria included in this study were focused on the impact of the Covid-19 pandemic and mental health, which were divided into three groups: children, adults, and Covid-19 patients. Articles searching was done by using keywords: Covid-19, mental health, mental illness, societal level effect, Covid-19 patients, insomnia, anxiety, stigmatization, and fear. While for the Indonesian article we used databased from E-resources Perpusnas and LIPI. The keyword used was: Covid-19, stres psikologis, remaja, dewasa, anak-anak, dan kecemasan, dan gangguan mental. Each article was screened by its title and abstract.
Based on the references obtained, the research or studies included in this paper meet the criteria as followed: (1) Studies focusing on general public health (e.g. Children, adults, and Covid-19 patients).
(2) Articles focusing on the effect of Covid- 19 towards mental health disorders, social and government support for this mental health issue during the pandemic. (3) Including studies from countries across the world. (4) The article is written in English and Indonesian From the total of 60 articles that were obtained, only 20 articles met the inclusion criteria, and the other 40 articles were excluded, including 5 articles with abstracts only without providing full papers.

Results
A systematic literature review study of 20 articles showed that the current state of the pandemic could have an impact on people's mental health. Among them appear the impact of post-traumatic stress symptoms including anxiety, confusion, and anger. Broadly speaking, the psychological impact felt by Covid-19 patients and the wider community in the form of feelings of depression, stress, and anxiety. The impact of this community's mental health mostly begins with stress, worries and fears, then causes conflicts in the family and the environment.
The pandemic also has an impact on the incidence of insomnia in the community and worsens the symptoms of patients who have been diagnosed with insomnia. This happened because of people's fear of the Covid-19 disease and there were many changes in their daily routines during the pandemic. There is a lot of pressure that is felt during a pandemic, where fear and anxiety occur not only for yourself but for those closest to you; there are those who feel changes in sleeping patterns and changes in eating patterns, feeling depressed and having difficulty concentrating, this situation arises because of limited mobilization and being constantly at home, especially children, resulting in psychotic disorders.
From several studies, it was stated that women and the younger generation were at higher risk of anxiety and depression compared to men and older people, this was based on research in China during the pandemic. However, according to the World Health Organization (2020) survey in 2020, the number of depression increased in the elderly because it was accompanied by various comorbidities. Psychological factors also played an important role in adherence to preventive measures in public health (such as vaccination) and how people deal with the threat of this virus infection with good health protocols. A person with a low level of education had a risk of being prone to depression and anxiety. This was because if someone with a high level of education had extensive knowledge about virus transmission so that they were better able to protect and cope with the anxiety and depression, so that depression and anxiety were at lower levels.
In addition, someone who had received information about the virus from articles and journals or even from social media sources would reduce the level of depression and anxiety of course by presenting readers who can be trusted in conveying information. The peak of psychological reactions included maladaptive behavior, emotional distress, and defensive responses. Kristen.R Choi predicted that there was a risk that the outbreak would create a "second wave pandemic" of mental health crisis in the health system and society. Thus, the public health response must be comprehensive to the pandemic, which includes (a) attention to the psychological aspects of hospitalization for patients, families, and staff affected by Covid-19; (b) emergency psychiatric patient care planning if the hospital is overwhelmed with Covid-19 patients; and (c) innovation to provide mental health care in the community while social distancing is required and health system resources are being strained. According to Agus Kusnayat et al, in terms of the world of education, it had quite an impact on the mental health of students, where learning conditions suddenly had to change from face-to-face to an online system resulting in students objecting to the tasks given by the teacher which results in the stress level of students increasing by 60%. If this was allowed to continue, it would be fatal in the mental development of students [9].

Discussions
During the last twenty years, diseases caused by viruses that continue to emerge cannot be denied this has become a serious problem for health. The latest disease caused by a virus, namely the covid-19 virus, which initially appeared in the city of Wuhan that is the largest metropolitan area in the Hubei Province of China, and spread rapidly to other countries became a pandemic. This virus that attack the respiratory tract was originally classified as pneumonia of unknown etiology, this case was first reported to WHO on 31 December 2019 [6]. The impact of the pandemic has certainly caused anxiety. This condition is a normal reaction toward a threatening and unexpected situation such as the pandemic. Stress during the pandemic can occur due to changes in concentration, irritability, lack of productivity. To suppress the spread of the virus, various countries also implement a system quickly. Due to these policies many people experience psychological effects that increase stress symptoms, the severity of stress symptoms also differs depending on the duration and period of negativity, feelings of loneliness, excessive fear and stigmatization [6].
The impact of the pandemic on mental health in each population is different depending on how to prevent and treat the problems they experienced. In the United States, it is stated that 45% of adults experience anxiety and stress, this number continues to increase, followed by exposure to the virus. Also in the UK, about 33% of people experience high levels of anxiety during the pandemic. Meanwhile, in Italy, based on survey results, the percentage of post-traumatic syndrome reached 37%, 21% stress, 20% severe anxiety, 17% depressive symptoms and 7% insomnia [2]. The current pandemic gives a significant threat to public health including the impact of mental health on society.

The impact on childrens
This pandemic condition gives children the feeling of boredom and stress because they are constantly at home, where children's daily routines usually play outside the house with their friends [4]. Millions of children have been adversely affected by the pandemic, the greatest impact being felt in low socio-economic populations. Of course the impact is felt in terms of positive impacts and negative impacts. The positive impact on the stage of child development where children can learn new skills, develop self-ability, increase self-confidence. Cultivating great awareness regarding unknown diseases and improve health. Parental support is very important in providing a good understanding of behavior that can maintain personal safety and the safety of others. Developing relationships and a sense of empathy in family interactions to become closer, form bonds of love and affection and develop a sense of loyalty toward surrounding people [7].
The negative impacts felt by children include the impact on education, during the pandemic, face-toface learning at school has been shifted to online. This gave a serious impact on children's education such as decreasing quality of knowledge, learning does not take place effectively, interference with internet network access, a fear of slow learning to the next stage, related to health problems, lack of physical activity outside the room, lack of nutritional intake, susceptible to various health disorders. Changes in aggressive behavior more easily such as irritability, frustration, and anxiety. Addiction to social media and internet access increases the risk of child exploitation [7]. Kusnayat et al. [8] in their research found a close relationship between online learning system and the mental attitude of the students participating in the class. Around 60.5% of students from universities who are the object of research were ready to adapt to online lectures, although there were some who found it difficult to use the applications used as many as 32.5% but around 47.5% were not ready to adapt. This condition would create psychological pressure for students. Survey data showed 59.5% objected toward assignments given by lecturers which resulted in increased stress levels for students so that they had difficulty to sleep. If this continues, it would be fatal in the psychological development of students, the impact would be study failure or drop out and other things that are more severe [9].
In teenagers, which is a period of transition from children to adults where this period is marked by the occurrence of emotional and behavioral development as well as biological, psychological and social changes [18]. In this group of age, interaction with peers doing various activities outside the home is very popular and plays an important role in the process of self-actualization and is a characteristic of teenagers identity. During this pandemic period where large-scale social restrictions (LSSR) are imposed, it is certainly very disturbing for teenagers because they cannot interact with their peers anymore. The implementation of LSSR, social distancing, online school system causes teenagers to feel isolated, restricted, bored, anxious, and sad. Sudden loss of activities outside the house with peers such as school, sports activities, art activities can result in the emergence of depressive symptoms in teenagers which of course will result in disruption of mental health [18].

The impact on adults
Sudarsana et al. [1] in his book mentioned that there were positive and negative psychological impacts on society during this pandemic. The positive psychological impacts of some individuals include having positive experiences such as feeling proud when they find ways to overcome pressure and survive during the pandemic, the community also shows an act of sacrifice and cooperation with one another in facing this pandemic condition so that they can feel the goods that comes from helping others. While the negative psychological effects can include post-traumatic stress symptoms including anxiety, confusion, and anger [1]. According to Brook et al (2020) there are several impacts of the pandemic on community psychology in the form of post traumatic stress disorder (PTSD) such as anxiety, confusion, fear, frustration, feeling helpless, insomnia [11]. The high mortality rate in the community, the implementation of social restrictions in an area has triggered depression, anxiety, excessive fear to changes in people's sleep patterns. All these things that happen will worsen the physical and mental state of the community [16].
Rifani et al 2020 in their research on 50 samples related to emotional and mood instability during the pandemic, this is the main factor causing individual mental disorders during the pandemic. A healthy mental state is closely related to physical health conditions. During the pandemic in Indonesia, there was a 20% increase in the number of mental disorders (Tugurejo Hospital Semarang from Ratih Widayati Sp.KJ) quoted from JAWA POS Radar Semarang, 2020: 10. The increase in the number of patients was the majority of the causative factors, among others, were the layoffs and people with mental disorders due to the pressure of too long to undergo a quarantine period at home then lead to conflicts in the family such as domestic violence or even divorce. Based on the results of the questionnaire, many respondents felt fear, either fear of the news that appears in the media or fear of social conflicts that occured during the pandemic. News related to the pandemic certainly has an impact on people's emotions and moods, one of which is feelings of worry which are then followed by feelings of fear. However, with many opportunities to gather with family during quarantine at home, it is enough to have a positive impact on mental health, namely feelings of pleasure, because we have the opportunity to support each other in the difficult times they are going through [2]. According to Setyaningrum & Amildha (2020) the massive layoffs that occurred in Malang City were the biggest factor in the occurrence of anxiety and stress in the people of Malang City which resulted in disturbances both to psychological conditions and to the mental health of the people of Malang City [19]. A Survey of Family Resilience in the Pandemic Period conducted by the Bogor Agricultural University (IPB) showed that for married women, the most common psychological disorders experienced during the pandemic were anxiety and restlessness, sadness and difficulty in concentrating [20].
Yulia (2020) in a review article Insomnia during the Covid-19 Pandemic not only had an impact on physical health, but also had an impact on mental health, which would affect the quality of individual sleep pattern and even cause insomnia or worsen existing insomnia symptoms. Fear and anxiety about being infected with Covid-19 can affect people's sleep quality and sleep patterns. Isolation at home during the pandemic has also changed people's daily routine habits. This irregular schedule of activity and rest will affect the circadian rhythm of society. Therefore, it is necessary to intervene in preventing and overcoming insomnia and reducing insomnia symptoms in the community during the pandemic [3]. Ilpaj et al [4] in a literature review Analysis of the effect of the Covid-19 death rate on the mental health of people in Indonesia stated that the large number of people who were infected and people die because of the Covid-19 will have a major impact on mental health. This is illustrated because the majority of people in isolation in their own condition can cause a person to be in an uncomfortable situation. Government regulations regarding social distancing obligations also create emotional distance between family, friends, friends, or people in places of worship who can support each other. Furthermore, with the feelings of loneliness and isolation can increase the suicide rate. In addition to excessive fear and anxiety disorders and changes in sleeping patterns, eating patterns, feeling depressed and having difficulty concentrating, there is also an increased risk of drug and alcohol abuse. People who are in a state of excessive stress and anxiety can stimulate the individual to consume alcohol and drugs, this bad habit must be stopped immediately, because it will interfere with the physical and mental health of the individual [4].
Rosyanti et al (2020) stated that quarantine taken by individuals and communities would have negative psychological impacts such as stress symptoms. The severity of symptoms depends on the duration and extent of quarantine, feelings of loneliness, fear to be infected, inadequate information, and stigma on more vulnerable groups including psychiatric disorders, health workers, and people with low socio-economic status [7]. Cullen et al (2021) in Commentary Mental health in the Covid-19 pandemic, It is known that psychology is a factor that plays an important role in community compliance with public health efforts (such as vaccinations) and health protocols, this is an important issue in efforts to control any infectious disease, including Covid-19. Psychological symptoms that have emerged in the middle of the pandemic include maladaptive behaviors, emotional distress, and defensive responses. People who are prone to psychological problems are especially at risk. A study on 1210 respondents from 194 cities in China in January and February 2020 noted that 54% of respondents reported the psychological impact of Covid-19 with moderate or severe symptoms; 29% reported moderate to severe anxiety symptoms; and 17% reported moderate to severe depressive symptoms. Despite the possibility of bias, it was a very high proportion that some people were likely to be at greater risk [9].
The elderly group is also vulnerable to the negative impacts of the pandemic. The elderly are prone to be infected by the Covid-19 due to the degenerative process that occurs in the elderly and causes a decrease in body resistance. In general, the elderly already have comorbidities such as hypertension, diabetes mellitus, heart disease so that the elderly are very vulnerable to be infected. Anxiety about the spread of the Covid-19 has a bad influence on the strength and physical health of these elderly people [20].

The impact on Covid-19 patients
Sudarsana et al. [1] in his book stated that the impact of mental health on Covid-19 patients could be in the form of psychological disorders such as feelings of depression, stress, and anxiety. This impact was referred to as a stressor. These stressors are divided into two, namely [1]: 1. Stressor during quarantine Quarantine duration for 14 days can lead to increased mental disorders, especially PTSD (Post Traumatic Stress Disorder), avoidant behavior, and anxiety. Like the other people, they also experience fear where there is a fear that the infection they experience will infect others. This fear mostly occurs in pregnant women and those with children. In addition, there is also frustration and boredom due to them stopping their daily routines and reducing physical and social contact with other people, as well as feeling isolated from the outside world. Covid-19 patients also feel worried about the supply of their basic needs such as food, drinks, clothing, or other accommodation, including medicines to personal protective equipment, plus related 5 E3S Web of Conferences 340, 05006 (2022) https://doi.org/10.1051/e3sconf/202234005006 The 13 th AIWEST-DR 2021 information from the government which is inadequate both in quantity and quality. The information includes guidelines for steps in efforts to overcome Covid-19, the level of risk, and the purpose of quarantine. This inadequate information is one of the predictors of the onset of PTSD symptoms.

Post-quarantine stressor
After the quarantine is completed, the next postquarantine stressor will occur including financial stressors, namely a decrease or loss of income sources, especially for workers with low income levels. This can be a trigger factor for the emergence of mental health disorders such as the risk of anger and anxiety as well as the development of socioeconomic distress in the months after quarantine. In addition, stigmatization also occurs, which is a negative characteristic attached to a person's personality due to the influence of his environment according to Ministry of National Education (2008). Stigma refers to people who are quarantined, so that people are treated differently, avoided, not invited to social events, considered scary and dangerous, infectious, and criticized.
Rosyanti et al (2020) stated that quarantine could exacerbate pre-existing conditions such as depression, anxiety, and post-traumatic stress disorder. In addition, the risk of disease transmission might increase the fear of contamination in patients with obsessive-compulsive disorder and hypochondria, or individuals with a history of paranoia. Although quarantine protect against the spread of the Covid-19, their isolation process creates psychosocial stress that can trigger or worsen mental health disorders [5]. In addition, stigma has begun to emerge in the community towards Covid-19, such as discrimination against sufferers and families of Covid-19 sufferers and rejection. People are afraid to be infected by the Covid-19 so many people stay away from them and isolate the sufferers and their families. This certainly adds a mental burden to the sufferer where the sufferer feels sad, feels alone, feels afraid of transmitting the disease to others [16]. Stigma that is formed in society can cause people to hide illness to avoid discrimination, prevent people from seeking immediate health care and prevent people from adopting healthy behaviors. Such a huge effect of the stigma on the sufferers. Covid-19 sufferers, who should receive moral support from their family and community in order to recover quickly, actually get an additional mental burden that can worsen the patient's condition [16].

Strategies for maintaining mental health during the pandemic
Maintaining mental health must actually involve efforts that can be made to survive stress and can be used as a reference in maintaining mental health during the Covid-19 pandemic as follows: [1,4,8,9] 1. Taking selfcare to maintain immune system and emotional state. 2. Seeking social support such as communicating online with family and friends can provide a feeling of social support for each other during isolation. 3. Helping others by giving goods according to the needs of others and praying for them. 4. Limiting yourself to access to social media, it is not uncommon for news on social media to become a source of anxiety. Therefore, we must be wise in receiving information, choose official and trusted sources of information from the government. 5. Focus on things that can be controlled. 6 Kristen et al (2020) stated that the threat of a second wave pandemic of mental health crises must be addressed as part of a comprehensive public health response to Covid-19. Evidence suggested that survivors of ICU care were at high risk for posttraumatic stress disorder, depression, sleep disturbances, poor quality of life, and cognitive dysfunction. Collaboration among health system leaders from hospitals and community mental health systems must be done to ensure the safety and continuity of care for individuals experiencing mental health crises. In addition, the health system should offer support mechanisms for mental health services including interventions for patients and families (e.g., providing trauma-information ICU care, providing mental health and education resources after discharge, supporting virtual visits) and for staff (e.g., work mental occupational health resources, support for illness and family leave, ensuring adequate staff, and a safe practice environment with adequate personal protective equipment. Various innovations should be developed in the community such as the Telehealth model (including insurance coverage for telehealth), adequate drug supply, increased mental health training for officers [5]. Stuijfzand et al. [10] mentioned that social predictors in the context of a pandemic, namely organizational support and family/friend support could serve as protective factors from mental health disorders, social isolation could have an impact on poorer mental health.

Conclusion
The current Covid-19 pandemic has a huge impact on mental health of the community and health providers. This was related to stress reactions that include changes in concentration, anxiety, insomnia, reduced productivity, and interpersonal conflicts. Health providers has also experienced more severe mental disorders due to separation from family, abnormal situations, increased exposure, fear of Covid-19 transmission, feelings of failure to handle a poor prognosis, inadequate technical facilities such as personal protective equipments and other equipments used to treat the patients. In addition, women, children, and the elderly were also at high risk for mental health disorders during the pandemic. To prevent mental health disorders in the long term, appropriate interventions and approaches are needed to restore concerns about personal health, excessive fear of being infected with covid-19 and anxiety about transmitting the virus to family or others. Strategies for maintaining mental health during the pandemic are needed by applying many positive activities in daily routine. In addition, comperehensive cooperation between public health and other stakeholders are important in creating innovative strategies to prevent worsen mental health disorder among public during the pandemic.