|Year : 2021 | Volume
| Issue : 2 | Page : 117-121
Comparison of demographic profile and psychological problems related to coronavirus disease 2019 outbreak among the general public (18 years and above) in a Northern State of India: A web-based cross-sectional survey
Jaison Joseph1, Bharat Pareek2, Sandeep Grover3, Sunita Sharma4, Biji P Varkey5, Tamanna Sehrawat1, Sarita Kumari1, Seema Parjapat1, Sapna Saini1
1 Department of Psychiatric Nursing, College of Nursing, Pt. B.D. Sharma University of Health Sciences, Rohtak, Haryana, India
2 Vice-Principal, Saraswati Nursing Institute, Kurali, Punjab, India
3 Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
4 Department of Psychiatric Nursing, National Institute of Nursing Education, Postgraduate Institute of Medical Education and Research, Chandigarh, India
5 Department of Neurology, Pt. B.D. Sharma University of Health Sciences, PGIMS, Rohtak, Haryana, India
|Date of Submission||23-Jan-2021|
|Date of Acceptance||15-Nov-2021|
|Date of Web Publication||02-Feb-2022|
College of Nursing, Department of Psychiatric Nursing, Pt. B.D. Sharma University of Health Sciences, Rohtak - 124 001, Haryana
Source of Support: None, Conflict of Interest: None
Background: The psychological impact of the general public during a pandemic is complex and incompletely understood. There is a dearth of studies reporting the psychological problems in the general public during the coronavirus disease 2019 (COVID-19) crisis in India, including a comparison as per demographic profile. Materials and Methods: An online survey was conducted from April 17, to May 1, 2020 using the principles of the snowball recruiting technique. The psychological problems of the potential study subjects were evaluated using the Hindi version of the Patient Health Questionnaire-4 (PHQ-4) scale. There were a total of 1826 responses, out of which 391 were excluded from the analysis. Results: The mean age of the subjects was 41.95 years (Median = 50, SD = 19.05, range: 18–86 years) and around 45% of respondents were with an age range of 18–39 years. The mean and standard deviation of the PHQ-4 was 1.81 (2.34), and the overall prevalence of psychological problems was 30% as per the cutoff of PHQ-4. The estimates of anxiety and depression among study subjects were 11% (158/1435) and 16.1% (232/1435), respectively. Younger age, female gender, unmarried, and rural residential status were significantly associated with increased psychological problems in this setting. Conclusion: The psychological response to the COVID-19 varies with sociodemographic status, and about one-third of the people reported having psychological problems in the early phase of the COVID-19 pandemic in this setting. There is a need to expand the mental health services to each stratum of the society with a focus to provide personalized care as per the sociodemographic profile.
Keywords: Coronavirus disease 2019, general public, India, psychological problems, survey
|How to cite this article:|
Joseph J, Pareek B, Grover S, Sharma S, Varkey BP, Sehrawat T, Kumari S, Parjapat S, Saini S. Comparison of demographic profile and psychological problems related to coronavirus disease 2019 outbreak among the general public (18 years and above) in a Northern State of India: A web-based cross-sectional survey. J Mental Health Hum Behav 2021;26:117-21
|How to cite this URL:|
Joseph J, Pareek B, Grover S, Sharma S, Varkey BP, Sehrawat T, Kumari S, Parjapat S, Saini S. Comparison of demographic profile and psychological problems related to coronavirus disease 2019 outbreak among the general public (18 years and above) in a Northern State of India: A web-based cross-sectional survey. J Mental Health Hum Behav [serial online] 2021 [cited 2022 Dec 9];26:117-21. Available from: https://www.jmhhb.org/text.asp?2021/26/2/117/337163
| Introduction|| |
The World Health Organization declared coronavirus disease (COVID-19) outbreak as an international public health emergency on January 30, 2020. The disease, first reported from China in December 2019, continues to surge through the continents including Asia affecting many countries. There is a long-lasting psychosocial consequence related to the pandemic due to disease-related fear and anxiety, social isolation, and the overloaded information on social media and elsewhere.
The rampant and unpredictable spreading of the information related to the global pandemic has been causing negative mental health impacts such as panic episodes, anxiety, and depression due to the overloaded information obtained through mass media and social networking sites. The stigma related to the COVID-19 will also indirectly increases disease transmission as a stigmatized community tends to hide important health problems and is reluctant for a medical consultation. The imposed quarantine related to the COVID-19 outbreak can result in psychological problems such as anxiety, depression due to financial losses, unavailability of essentials, and perceived uncertainty about disease progression through the media hype.
The psychosocial impact of the general public during a pandemic is complex and incompletely understood. It is very important to understand the myriad of psychosocial issues and negative mental health consequences of the pandemic. At the individual level, epidemics are associated with a wide range of psychiatric comorbidities including anxiety, panic, depression, and trauma-related disorders. Over concerned public may have nonrealistic panic anxiety related to the essential and emergency services related to routine life which may end in psychiatric morbidity. Apart from physical suffering, the consequences of the so-called “coronaphobia” on the mental health and well-being of people at various developmental stages can hamper social stability. The psychological response to the COVID-19-associated quarantine may vary as per the developmental period of life. For instance, the impact on the elderly might be different from adolescents or adults. Although the mental health concerns of COVID-19 warrant attention in the Indian context, there is a dearth of studies reporting the prevalence of depression and anxiety among the general public during the COVID-19 crisis in India, including a comparison as per demographic profile. In this background, we evaluated psychological responses to the COVID-19 outbreak among the general public of Haryana, a northern state of India using a validated screening questionnaire.
| Materials and Methods|| |
A cross-sectional survey design was decided, and data were collected using free software Google Forms. The investigators invited all Indian citizens ≥18 years residing in the state of Haryana from April 17, 2020 to May 1, 2020. The subjects who refuse to give consent for a web-based survey and did not have access to fill the Google forms were excluded. Potential respondents were invited through a text message through social networking media using the principle of snowball recruiting technique. The enrollment to the study was on a first-come, first-served basis, and the participation was completely voluntary and noncommercial. The study has been approved by the Institutional Ethics Committee at Pt. BDS UHS, Rohtak. Participants were allowed to terminate the survey at any time they desired. Participants were asked to fill the Hindi version of the research questionnaires. The basic information of the subjects included information about age, gender, marital status, educational qualifications, occupation, residential status, and current living status.
The potential respondents were Hindi-speaking general public. Considering the nature of the pandemic, drafting a specific questionnaire was not feasible to check the various dimensions of psychological problems. Therefore, we used the Hindi version of the Patient Health Questionnaire-4 (PHQ-4) scale available from the developer's official website https://www.phqscreeners.com/select-screener. PHQ-4 consists of four questions, each question has a set of responses, whose score ranges from minimum 0 to maximum 3. The total score is determined by adding together the scores of each of the four items. The following cut-offs were used to understand the severity of anxiety and depression:- normal (0–2), mild (3–5), moderate (6–8), and severe (9–12).
There were a total of 1826 responses, out of which 391 were excluded from the analysis. The exclusion was based on the following aspects: Incomplete response in any of the desired items (n = 180), respondents from outside of the Haryana (n = 147), and duplicate items (n = 64). The final analysis was done on the rest of the 1435 respondents.
Data were analyzed using Statistical Package for the Social Sciences (IBM SPSS Statistics 22.0). The comparisons of the categorical variables were done by Pearson's Chi-square test (or Fisher's exact test, where the expected number of frequency in a cell is less than 5). For continuous variables, analysis of variance was used.
| Results|| |
The mean age of the subjects was 41.95 years (median = 50, SD = 19.05, range: 18–86 years). and around 45% of respondents were with an age range of 18–39 years. More than half of the participants were females (57.6%) and unmarried (50.2%) with an urban background (59.1%) and educated up to 12th standard (58.53%). Around one-third of the subjects were students (29.82%) and one-fifth of the participants were employed in the private sector (20.76%). Most of the subjects stayed within the family set up during the lockdown period (93.3%).
The mean and standard deviation of the PHQ-4 was 1.81 (2.34). The overall prevalence of psychological problems was 30% as per the cutoff of the PHQ-4 score. The estimates of anxiety and depression (PHQ-4 Cut off ≥3) among study subjects were 11% (158/1435), 16.1% (232/1435), respectively [Table 1]. In most of the items of PHQ-4, the majority of the participants reported no psychological distress associated with the COVID-19 outbreak, yet approximately one-fifth of the study participants reported a slight worsening of negative emotions such as sadness (19.7%) and anxiety (18.4%) on several days. About 3–7.5% of the subjects reported the experience of anxiety and depressive symptoms nearly every day during the pandemic period [Table 2].
|Table 2: Mental health impact of corona virus disease-19 outbreak (n=1435)|
Click here to view
Concerning age, the total PHQ score was highest among subjects belonging to the age group of 18–39 years as compared to the subjects belonging to the age group of 40–59 and 60–79 years (P ≤ 0.01). There was a significant increase in the PHQ-4 scores among the female participants than male subjects (P = 0.009). The total PHQ score was highest among unmarried subjects and those who reside in rural areas. The association was statistically significant (P ≤ 0.01). Although the PHQ-4 scores were highest among subjects who were living alone, they did not reach any statistical significance (P = 0.915). [Table 3] describes the association of the total PHQ-4 scores as per the demographic profile of the subjects.
|Table 3: Assessment of the association between total patient health questionnaire score as per the demographic profile of study subjects (n=1435)|
Click here to view
| Discussion|| |
The index study investigated the anxiety and depression associated with the COVID-19 outbreak among the general public of the northern state of India. Considering the limited evidence on the feasibility and acceptability of an exclusive online community survey in the state of Haryana, we used the Hindi version of a brief well-established scale for evaluating the psychological problems associated with the present pandemic. Overall approximately 30% of the subjects reported anxiety and depression as per the PHQ-4 scale. The National Mental Health Survey, 2015–2016 reported a prevalence of 10% of psychiatric morbidity for common mental illnesses in our setting. However, our findings need to be analyzed based on the present scenario as there might be an increase in mental morbidity in the general public due to the pandemic period. A recent nationwide online survey conducted in the Indian population with an age range from 14 to 87 years reported 40.5% psychological problems in reaction to the COVID-19 outbreak. Furthermore, another Indian study measured psychological impact with the help of the Impact Event–revised (IES-R) scale, and reported one-third of respondents (33.2%) had a significant psychological impact (IES-R score >24). A cross-sectional study conducted in Chandigarh observed that 51% of the migrant laborers experienced both anxiety and depression during the COVID-19-related quarantine period. In another Indian study conducted during 22–24 March, 2020 by Roy et al. also reported that more than 80% of the general public was preoccupied with the thoughts of COVID-19. An online survey conducted in the general population of West Bengal from 29 to 31 March 2020 reported a significant psychological impact (24.7%) associated with the COVID-19 pandemic. A comparison of our findings with other similar studies conducted in the Indian setting shows that self-reported psychological problems are relatively lower in our study (30%).
There is a wide variation in the magnitude of psychological impact due to COVID-19 across the globe. This could be attributed to the study setting, sample sizes, and sampling criteria such as differences in assessment tools. Compared to an early study finding of 38.1% of mental health problems of COVID-19 in the Italian general population (Italian citizens ≥18 years) among 18,147 respondents, we found lower rates of anxiety and depression. A web-based survey from China evaluated the psychological problems as 56% among the Chinese people (n = 1074) during the peak period of the COVID-19 epidemic. A similar COVID-19 psychological impact study conducted in China reported an overall prevalence of 55.2% of depressive and anxiety symptoms. Another study conducted in China by Wang et al. reported that 53.8% of respondents suffered a psychological impact from the outbreak in 1210 respondents. Since these findings were reported during different periods with a varying magnitude of the pandemic, they should be interpreted accordingly.
The present analysis of the relationship between demographic characteristics and psychological problems showed that age, gender, marital status, and residential status significantly influenced psychological status. The current study found that anxiety and depression were higher in the younger population and the female gender. Similar online surveys among the Indian general population yields similar findings., A recent study reported that younger participants (<35 years) were more likely to develop anxiety and depressive symptoms during the COVID-19 outbreak than older participants (≥35 years). Uncertainty and insecurity of the future might have resulted in more depressive and anxiety symptoms. This is of special significance in terms of the younger population as they tend to obtain more information due to media hypes. Along with mitigating negative mental health, it has become necessary to build on the strengths to embrace positive mental health among younger generations during the pandemics. There is a need for regular interaction and emotional support from friends and family to minimize the psychological stress. Teleconsultation and online training and coaching are the emerging concept in India to boost mental health and combat the pandemic crisis. Considering the COVID-19-related quarantine in the Indian context, females might have more assumed responsibility toward their family and therefore bear more psychological pressure. It is the need of the hour to devise to beat the mental pressures such as meditation, lifestyle practices, good dietary habits, self-awareness, and exercises. As the pandemic made greater demand on the mental health care resources, the government policy should address the specialized mental health problems related to focused services in times of pandemics and must formulate strategies to improve the mental health in the community.
In summary, this study used a validated Hindi questionnaire and provided the first cross-sectional data on the psychological impact of COVID-19 and related lockdown among the general population of Haryana, India. Further, the study provides a comparison between the psychological status and demographic profile of the public, in which anxiety and depression were highest among young adults, female gender, unmarried subjects, and those who live in rural areas. Online surveys (or self-administered questionnaires) have been found as an effective way of accessing problems related to mental health, and this becomes a prudent method of researching in the period of lockdown. It is worth noting that our online survey was conducted after the announcement of a nationwide COVID-19 related lockdown in India. Apart from the myths associated with COVID-19 infection, the changed scenario might have influenced the participants, and around 30% of the people experienced psychological problems in this setting. Our findings reflect the importance of advocating for the public to stay away from overloaded COVID-19 information. Besides, providing useful information, the public mass campaigns should focus more on general coping strategies to counteract the ill effects of COVID 19 to address the psychological problems.
There are some limitations to be considered while evaluating the study results. First is the inherent design of the study like sampling technique being only restricted to people with internet access and having an understanding of Hindi. The survey circulated through a few social media platforms such as WhatsApp, which limit the generalizability of the study to the entire Haryana. As expected, the sample might be contaminated by selection and respondent bias. Second, the study was conducted during a period of lockdown, which can have a psychological impact and can be a confounder to under or over-reporting in the rate of psychological impact found in the study. Third, the study sample was recruited through a web-based survey, and certain factors that may influence the findings of the study such as the presence of the history of mental illness, substance use, and stress due to COVID-19, and attitude toward the COVID-19 were not explored.
| Conclusion|| |
The psychological response to the COVID-19 varies with sociodemographic status and about one-third of the people reported having psychological problems in the early phase of the COVID-19 pandemic in this setting. There is a need to expand the mental health services to each stratum of the society with a focus to provide personalized care as per the socio-demographic profile.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Dong L, Bouey J. Public mental health crisis during COVID-19 pandemic, China. Emerg Infect Dis 2020;26:1616-8.
Asmundson GJ, Taylor S. How health anxiety influences responses to viral outbreaks like COVID-19: What all decision-makers, health authorities, and health care professionals need to know. J Anxiety Disord 2020;71:102211.
Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al.
The psychological impact of quarantine and how to reduce it: Rapid review of the evidence. Lancet 2020;395:912-20.
Grover S, Dua D, Sahoo S, Mehra A, Nehra R, Chakrabarti S. Why all COVID-19 hospitals should have mental health professionals: The importance of mental health in a worldwide crisis! Asian J Psychiatr 2020;51:102147.
Depoux A, Martin S, Karafillakis E, Preet R, Wilder-Smith A, Larson H. The pandemic of social media panic travels faster than the COVID-19 outbreak. J Travel Med 2020;27:taaa031.
The Lancet. India under COVID19 lockdown. Lancet 2020;395:1315.
Kroenke K, Spitzer RL, Williams JB, Löwe B. An ultra-brief screening scale for anxiety and depression: The PHQ-4. Psychosomatics 2009;50:613-21.
Murthy RS. National mental health survey of India 2015-2016. Indian J Psychiatry 2017;59:21-6.
] [Full text]
Grover S, Sahoo S, Mehra A, Avasthi A, Tripathi A, Subramanyan A, et al.
Psychological impact of COVID-19 lockdown: An online survey from India. Indian J Psychiatry 2020;62:354-62. [Full text]
Varshney M, Parel JT, Raizada N, Sarin SK. Initial psychological impact of COVID-19 and its correlates in Indian community: An online (FEEL-COVID) survey. PLoS One 2020;15:e0233874.
Kumar K, Mehra A, Sahoo S, Nehra R, Grover S. The psychological impact of COVID-19 pandemic and lockdown on the migrant workers: A cross-sectional survey. Asian J Psychiatr 2020;53:102252.
Roy D, Tripathy S, Kar SK, Sharma N, Verma SK, Kaushal V. Study of knowledge, attitude, anxiety & perceived mental healthcare need in Indian population during COVID-19 pandemic. Asian J Psychiatr 2020;51:102083.
Chakraborty K, Chatterjee M. Psychological impact of COVID-19 pandemic on general population in West Bengal: A cross-sectional study. Indian J Psychiatry 2020;62:266-72. [Full text]
Rossi R, Socci V, Talevi D, Mensi S, Niolu C, Pacitti F, et al
. COVID-19 pandemic and lockdown measures impact on mental health among the general population in Italy. Web-based survey. Front Psychiatry. 2020;11:790.
Ahmed MZ, Ahmed O, Aibao Z, Hanbin S, Siyu L, Ahmad A. Epidemic of COVID19 in China and associated psychological problems. Asian J Psychiatry 2020;51:102092.
Huang Y, Zhao N. Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 outbreak in China: A web-based cross-sectional survey. Psychiatry Res 2020;288:112954.
Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al.
Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. Int J Environ Res Public Health 2020;17:E1729.
Khanna RC, Honavar SG, Metla AL, Bhattacharya A, Maulik PK. Psychological impact of COVID-19 on ophthalmologists-in-training and practising ophthalmologists in India. Indian J Ophthalmol 2020;68:994-8.
] [Full text]
[Table 1], [Table 2], [Table 3]