Dual Diagnosis: Open Access Open Access

Short Communication

Dear Editor-in-Chief

Following the outbreak of COVID-19, mental and spiritual disorders have increased among patients due to patients' spiritual beliefs and destiny oriented attitudes toward disasters. Insufficient spiritual facilities in low-and middle-income countries (LMICs) and the high workload of health care providers, has reduced the possibility of patients spiritual rehabilitation. Treating the patients with mental disorders as well as people affected by COVID-19 without considering their spiritual beliefs can weak the level of their spiritual health and thus, make them more vulnerable to future pandemics.

Disasters, either man-made or natural, raise the stress level and lead to long-term consequences (Cherry et al., 2018). According to the Emergency Events Database classification of disasters, the COVID-19 outbreak in 2019 places in the natural disasters category, biological subgroup, and epidemic main type (EM-DAT, 2020). The effects of the COVID-19 pandemic including the social distancing, home-quarantine, reduction of social connections and family income, as well as listening to devastating news about deaths and burial of the victims have led to a rise in stress, anxiety, and fear (Rajkumar, 2020). Accordingly, people affected by COVID-19 are more susceptible to anxiety and depression, compared to healthy people, by 8.3% and 14.6%, respectively. One of the reasons for this difference in the proportion is the lack of psychological support and rehabilitation of the victims (Lei et al., 2020). World Health Organization defines rehabilitation as a set of interventions designed to optimize the performance and reduce disability among the people suffering from health problems (WHO, 2017). Post-disaster rehabilitation covers physical, mental, social, economic and spiritual types. In this line, spiritual rehabilitation comprises of the actions that assist individuals or families to use their spiritual beliefs as a source of power, hope, and healing (Ardalan, Latifi, Sohrabizadeh & Rajaie, 2014). Among the different aspects of rehabilitation, spiritual rehabilitation has not been considered yet in the disaster research context and it is incorrectly considered as mental rehabilitation interventions. For instance, based on our field observations in Iran, a girl who had lost her mother because of COVID-19 was furious and devastated because she was mad at God and believed that her mother was a woman of faith and prayed all the time and loved God, why did God take her away? On the other hand, belief in religious determinism and destiny is common among some communities when it comes to disasters. Such belief can lead these people to believe in God's will as the source of COVID-19, intending to reveal divine power to the people who have forgotten about god. Research on the attitudes towards disasters, showed that most of the affected people believed Tsunami as an Act of God, by which God wants to test human's patience. For the COVID-19 patients who affiliate their illness my think it as God's punishment or abandoning; then spiritual counseling can be necessary for the rehabilitation of affected communities. Spiritual beliefs of the patients are significant considerations, of which spiritual rehabilitation can be effective for providing spiritual care for COVID-19 patients by clergy is essential (Hall, 2020).

On the other hand, the medical staff, particularly in the LMICs doesn’t have the opportunity of involving in spiritual care; Counseling due to the lack of spiritual facilities and infrastructure in the hospitals as well as struggling with various problems such as lack of resources, high workload, insufficient personal protection equipment and being far from their families. It is necessary to care spiritual rehabilitation independently along with other aspects of rehabilitation at the time of COVID-19 pandemic. It is important to note that spiritual rehabilitation needs to align with the culture, religious beliefs, and values of the communities. It can then cover all people living in the affected society; including different religious minorities and secular beliefs. The people who are affected by the COVID-19 pandemic require the spiritual rehabilitation, of which needs to be implemented by trained experts in order to prevent patients’ susceptibility to the potential psychosocial consequences. The purpose and meaning of life will change forever among the individuals who have low spiritual health, making them more susceptible to the potential future disasters. Accordingly, authors are pronounced the necessity of spiritual rehabilitation during COVID-19 pandemic.