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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 27  |  Issue : 1  |  Page : 48-59

Comprehensive mental health facets and their correlates amid “The New Normal” pandemic: How do adolescents differ from adults?


1 Department of Psychiatry, King George's Medical University, Lucknow, India
2 Department of Geriatric Mental Health, King George's Medical University, Lucknow, India

Date of Submission22-Nov-2021
Date of Decision28-Dec-2021
Date of Acceptance08-Jan-2022
Date of Web Publication13-Aug-2022

Correspondence Address:
Dr. Shweta Singh
Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jmhhb.jmhhb_241_21

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  Abstract 


Objective: The present study aimed to compare the comprehensive mental health facets of adolescents with the adults. Materials and Methods: A cross-sectional design with 1,027 participants (456 adolescents; 347 young and 224 middle age adults). The Comprehensive Diagnostic and Statistical Manual-5 self-rated Level 1 cross-cutting symptom measure, perceived stress scale, and brief COPE were used. Chi-square test of independence and spearman rank correlational analysis was performed. Results: 33.77% of adolescents, 25.65% of young adults, and 17.41% of middle-aged adults reported that their symptoms started during the pandemic. Adolescents reported higher depression, anxiety, suicidal ideations, anger, and somatic complaints. Significantly higher adolescent females (39.9%) were found to have sleep disturbances than their male counterparts (25.5%). The correlational analysis showed that most mental health domains, except substance use, showed moderate-to-low correlations with the “impact of COVID-19.” Conclusion: This study observed that adolescents to be more clinically vulnerable in the domains of depression, anxiety, suicidal ideations, anger, and somatic complaints. Middle-aged adults should further be seen as a clinically vulnerable population for substance use during the new normal. This research indicates the need for further extensive research on assessment and management. Also, it provides a comprehensive analysis for clinical decision-making and policy development to combat the mental health problems in the backdrop of the COVID-19 pandemic.

Keywords: Adolescents, COVID 19 pandemic, mental health, middle-age adults, substance use, the new normal, young adults


How to cite this article:
Singh S, Gupta PK, Tripathi RK, Datta M, Pandey NM, Batra S, Mahour P, Arya A, Tripathi A, Gupta B, Agarwal M, Nischal A, Agarwal V, Dalal P K. Comprehensive mental health facets and their correlates amid “The New Normal” pandemic: How do adolescents differ from adults?. J Mental Health Hum Behav 2022;27:48-59

How to cite this URL:
Singh S, Gupta PK, Tripathi RK, Datta M, Pandey NM, Batra S, Mahour P, Arya A, Tripathi A, Gupta B, Agarwal M, Nischal A, Agarwal V, Dalal P K. Comprehensive mental health facets and their correlates amid “The New Normal” pandemic: How do adolescents differ from adults?. J Mental Health Hum Behav [serial online] 2022 [cited 2022 Sep 27];27:48-59. Available from: https://www.jmhhb.org/text.asp?2022/27/1/48/353754




  Introduction Top


There has been a “parallel pandemic” of psychopathologies during COVID-19 pandemic while the world has been struggling with the viral pandemic.[1] The struggle to adapt to the “new normal” and dealing with the vicissitude of this situation has had significant implications for mental health. Due to work–life imbalance and stress associated with the pandemic, an escalation in the levels of academic disruptions, isolation, depression, anxiety, perceived stress, harmful substance use, self-harm, disturbed sleep cycles, and suicidal behavior was increased among adolescents and adults.[2],[3]

With the entire society coping with the same virus, the experience of stress among adolescents and adults is expected to be different. Literature suggests that while adults perceived the risks of COVID-19 to be higher than the younger population, they were less worried.[4] Given the increased academic stress, uncertainty, and change in routine, some researchers observed that school-age children and adolescents experienced significant depression, anxiety, and stress during the outbreak.[5] According to Eden et al.,[6] stress and anxiety were also present in adolescents and were negatively related to psychological well-being indicators of positive affect, mental health, and flourishing. A study from Ecuador that concluded the association of fear of COVID-19 with depression, mediated by anxiety, showed major psychological health among students in the context of the COVID-19 lockdown.[7]

A recent meta-analysis study suggested that depressive and anxiety symptoms in undergraduate students (32%) were higher than graduate students (32% versus 25%, and 24% versus 14%, respectively). In addition to that, there is an existing fear of losing career opportunities shortly due to the economic crisis.[2] A meta-analysis study suggested that depressive and anxiety symptoms in undergraduate students (32%) were higher compared to graduate students (32% versus 25%, and 24% versus 14%, respectively). This difference could be attributed to the possibility of their more incredible experiences with stressful situations; graduate students may have developed better coping strategies than undergraduates. It was also observed that the prevalence of depressive and anxiety symptoms could increase with time among students pursuing higher education. Moreover, it was indicated that students with poor financial backgrounds, female students, and students living alone showed a higher prevalence of depressive and anxiety symptoms.[8]

With the rise in work-from-home culture, balancing professional and personal lives has also been challenging as individuals are expected to complete more work at odd hours.[2] While no significant gender differences in levels of anxiety, stress, and depression have been found in most of the studies,[6],[9] others do not accept this observation and show that females tend to be more vulnerable to these disorders.[10],[11] Findings regarding education are also inconsistent; for instance, in Australia, distress was higher among less educated people,[12] whereas stress was higher among more educated participants in China.[13]

Given varied forms of stressors and experiences of the resultant stress due to the COVID 19 pandemic, adolescents could be particularly vulnerable to specific mental health facets. In this backdrop, there have been studies on stress, depression, and anxiety amongst people, including adolescents and adults. Still, most of them were conducted during the phase of “outbreak” or “lockdowns.”[8],[9],[10],[11],[12]

Though aspects of mental health have been studied during the current pandemic, to the best of the authors' knowledge, these studies have neither researched comprehensive mental health outcomes in adolescents in a single research design nor provided a comparative analysis by comparing them with adults. Hence, it was pertinent to explore how adolescents differed from adults regarding the comprehensive mental health facets amid the “new normal” phase, i.e., the duration between the first and second wave of COVID-19 in a developing country like India.

The present study aimed to (a) compare adolescents, young and middle-aged adults with comprehensive mental health facets (depression, anxiety, anger, repetitive thoughts and actions, somatic complaints, personality disturbances, memory, sleep problems, dissociation, suicidal ideation and substance use). Also, it aimed to (b) explore the associations of mental health facets with age, perceived stress, coping and impact of the pandemic. It was hypothesized that (1) adolescents would differ from adults on the comprehensive mental health facets (2) there would be an association of mental health facets with age, the impact of COVID 19 pandemic, perceived stress and coping.


  Materials and Methods Top


Participants and study characteristics

This study employed a cross-sectional design using standardized tools through an online platform. It was part of an institutional project on mental health aspects during the pandemic. The pro forma contained an assent form for adolescents and a consent form for adults. The ethical approval for conducting the study was obtained from the institutional ethics committee (ref code: 11th ECM COVID-19 1B/P7).

The study population comprises adolescents and adults between 13 and 60 years of age. They were further categorized as (a) adolescents (Ad = 13–19 years), (b) young adults (Y = 20–39) and (c) middle-age adults (MA = 40–60 years of age). All participants were selected by using a two-stage sampling. In the first stage, schools/colleges were selected, and in the second stage, participants were recruited from the selected schools/colleges. Further, the family members of the participants were also invited to participate. As a result, five higher secondary co-education schools and five undergraduate/postgraduate co-education colleges were randomly selected, and contacted to participate in the study.

Procedure

Among the randomly selected schools and colleges, three schools and four colleges within the premises of Lucknow agreed to participate in the study. The consenting school and college authorities were contacted for obtaining voluntarily informed consent to conduct a study in their institute. The data collection was commenced on the noon of December 1 and concluded on the noon of December 31.

For the recruitment of adolescents, parents of the 13–18 years old adolescents were shared a consent form through E-mail, which included information about the study, anonymity, and confidentiality. They were invited to give consent for the participation of their ward in the study. After receiving the parents' consent, the assent form and study pro forma were mailed to the adolescents through E-mail.

For the recruitment of adults, the web link of the study pro forma (self-explanatory information about the study, informed consent form, and questionnaire) was disseminated through E-mail to staff and students of schools/colleges. They further shared the forms with their family members. In addition, all participants were provided contact numbers of the investigators for clarifications and were given an option to consent for an online interview.

Measures

Semi-structured pro forma: A self-explanatory web-based semi-structured pro forma was developed, linked to a unique web link. This pro forma collected sociodemographic information related to the participants. The study pro forma was bilingual viz. in English and Hindi. With the permission of authors, the standard tools were translated using the WHO specified 'translation back-translation method. For those who reported the presence of mental health symptoms, there were 3 items on whether (1) did not report any change in their symptoms and/or level of symptoms experienced during COVID-19, (2) the symptoms worsened during the pandemic, and (3) the symptoms started during the COVID-19 outbreak.

Diagnostic and Statistical Manual-5 self-rated level 1 cross-cutting symptom measure-9

This tool was developed by the Diagnostic and Statistical Manual (DSM)-5 Task Force and Work Groups[14] to review the mental systems in each patient. It is the symptom screen tool that indicates the need for further assessment. We used this measure assesses the presence and severity of mental health domains. The respondents are asked how often they have been disturbed in the last 2 weeks (0–4). Research evidence shows that the measure has good to excellent test-retest reliability,[15] and good validity.[16]

Perceived Stress Scale

Perceived stress scale (PSS)[17] measures the extent to which one appraises the situations of one's life as stressful in the last month. It can be used in samples with minimum educational qualification of junior high school. It is a 10 item 5-point Likert scale (0–4). PSS-10 shows a strong Cronbach's alpha = 0.84, with test–retest reliability (intraclass correlation coefficient) to be 0.935 after 3 weeks and kappa's coefficient ranging from 0.74 to 0.89.[18],[19]

Brief COPE

Brief COPE[20] is a self-report questionnaire with 28 items designed to assess individuals' primary ways to cope with a stressful life event. The coping strategies were categorized as “adaptive” (active coping, use of emotional support, use of instrumental support, positive reframing, planning, self-distraction, and acceptance) and “maladaptive” (behavioral disengagement, venting, denial, substance use, and self-blame) for this study. After taking due cognizance of the sociocultural backdrop of India, an item on religion was included. The items are rated on a four-point Likert scale. The scale has shown high Cronbach's alpha values ranging from 0.69 to 0.8.[21]

Data analysis

The results were analyzed using descriptive statistics and making comparisons among various groups. The analyses were performed using SPSS version 23.0 (SPSS Inc., Chicago, IL, USA). Given the nonparametric nature of data, the difference between groups was analyzed using the Chi-square test of Independence and correlational analysis was done using spearman rank correlation.


  Results Top


A total of 1,027 participants have taken part in the study including 456 adolescents (M = 200; F = 256); 347 young adults (M = 124; F = 223) and 224 middle-aged adults (M = 103; F = 121). The mean age of male females was found to be comparable among all across the groups. In the adolescent age group majority were students of intermediate [Table 1]. Major participants were from Uttar Pradesh (870), others were as follows, Delhi (30), Assam (22), Haryana (16), Maharashtra (16), Uttarakhand (11), Karnataka (10), Madhya Pradesh (7), Andhra Pradesh (6), Odisha (6), Rajasthan (6), Gujarat (5), Telangana (5), West Bengal (5), Punjab (4), Bihar (3), Jharkhand (3), and Meghalaya (2).
Table 1: Sociodemographic characteristics of the study participants

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Our results show that 33.77% of adolescents, 25.65% of young adults, and 17.41% of middle-aged adults reported that their symptoms started during the pandemic were among those who had significant problems. Whereas 20.61% of adolescents, 21.04% of young adults, and 11.61% of middle-age adults reported worsening of symptoms during the pandemic [Table 2] and [Figure 1].
Figure 1: Severity of comprehensive mental health facets across age groups

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Table 2: Comparisons of comprehensive mental health facets across age and gender groups

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Depression

Significantly higher (P < 0.05), percentages of adolescents were (50.2%) found to have depression compared to young adults (42.9%) and middle-aged adults (26.4%), with 14%, 8.7%, and 3.4% respectively reporting severe symptoms. In addition, a significantly higher number of young adults (P < 0.001) reported depression compared to middle-aged adults.

Anger

Significantly (P < 0.01) higher percentages of adolescents (46.2%) and young adults (42.0%) were found to have anger compared to middle-aged adults (25.4%), with 15.1%, 7.7%, and 4.4% respectively reporting severe symptoms. No significant differences were found between adolescents and young adults.

Anxiety

Compared to middle-aged adults (26.3%), significantly higher number of adolescents (P < 0.001) and young adults (P < 0.05) of young adults reported significant anxiety levels, with 13.1%, 11.5%, and 5.8% respectively reporting severe symptoms.

Suicidal ideation

Significantly higher percentages of adolescents (P < 0.05), i.e., 32.46%, reported significant levels of suicidal ideation compared to 24.5% of young adults and 24.11% of middle age adults, with 8.11%, 4.61%, and 1.34% respectively reporting severe symptoms.

Somatic complaints

50.2% of adolescents, 42.9% of young adults, and 26.4% of middle-age adults reported significant levels of somatic complaints, with 14%, 8.7%, and 3.4% respectively reporting severe symptoms. Significant differences were found between adolescents and young adults (P < 0.05), adolescents and middle-aged adults (P < 0.001), and young adults and middle-aged adults (P < 0.001).

Sleep

Compared to middle-aged adults (25.4%), adolescents (33.3%) reported significantly higher percentage of sleep disturbances (P < 0.05), with 10.3%, 8.5%, and 4.9% respectively reporting severe symptoms.

Memory

In the memory domain, significant differences were found between adolescents and young adults (P < 0.01) and adolescents and middle-aged adults (P < 0.01) where 26.5% of adolescents, 18.2% of young adults, and 15.7% of middle-age adults reported significant levels of memory problems, with 9.21%, 4.32%, and 2.68% respectively reporting severe symptoms.

Repetitive thoughts/behaviors

Higher percentages of adolescents, i.e., 28.7% compared to young adults (P < 0.05) and middle-aged adults (P < 0.001), reported significant repetitive thoughts and actions 12.3%, 6%, and 2.1%, respectively, reporting severe symptoms.

Dissociative experience

27.8% of adolescents, 19.8% of young adults, and 14.2% of middle-age adults reported significant levels of dissociation, with 12.1%, 4.6%, and 1.7% respectively reporting severe symptoms. Significant differences were found between adolescents and young adults (P < 0.001) as well as adolescents and middle-aged adults (P <.001).

Personality changes

Significantly higher percentages of adolescents (34.4%), 26.5% of young adults, and 16.5% of middle-age adults reported some form of personality disturbances, with 14.7%, 8.1%, and 2.2% respectively reporting severe symptoms. Significant differences were found between all three age groups at P < 0.001.

Substance use

Our results showed that compared to adolescents (12.72%), a significantly higher proportion of young adults (21.33%) and middle-age adults (27.23%) reported being bothered due to some or the other substance use including alcohol, tobacco, or other drugs. 3.1% of adolescents, 6.1% of young adults, and 3.6% of middle-age adults reported severe level of symptoms.

Gender wise analysis of mental health facets

The differences between males and females in mental health facets were statistically insignificant on most domains. Among those who reported symptoms, our results show that 28.57% of males and 26.67% of females reported that their symptoms started during the pandemic. In addition, 18.97% of males and 18.67% of females reported worsening of symptoms during the COVID19 pandemic [Table 3] and [Figure 2].
Figure 2: Severity of comprehensive mental health facets across gender groups

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Table 3: Correlations between mental health domains, coping, and perceived stress

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  • Depression: 41.5% of males and 44.2% of females reported significant symptoms
  • Anger: 36.8% of males and 46.5% of females reported significant symptoms
  • Anxiety: 34.9% of males and 37.4% of females reported significant symptoms
  • Somatic complaints: 41.2% of males and 44.2% of females reported significant symptoms
  • Sleep: Significantly higher percentages of females (39.9%) in the adolescent group were found to have sleep disturbances than their counterparts (25.5%), with 27.7% of males and 31.5% of females reporting significant symptoms. Moreover, 36.8% of males and 46.5% of females reported significant symptoms
  • Suicidal ideation: 27.4% of males and 28.33% of females reported suicidal ideations
  • Memory: No overall gender variation was found; however, within young adults, more males (25.8%) reported memory problems than females (14%). Moreover, 27.7% of males and 31.7% of females reported significant symptoms
  • Repetitive thoughts/behaviors: 22.1% of males and 22.4% of females reported significant symptoms
  • Dissociative experience: 24.6% of males and 23.4% of females reported significant symptoms. Significantly (P < 0.01), higher percentages of females (32.4%) in the adolescent group and males in the young adult (27.5%) group were found to have dissociative experiences as compared to their counterparts (22.0% and 15.7%, respectively)
  • Personality disturbance: 26.7% of males and 28.7% of females reported significant symptoms. Significantly higher percentages of females (39.9%) in adolescent groups were found to have personality changes than their counterparts (27.5%)
  • Substance use: Males and females also differed, with more males (25.29%) reporting substance use than females (14.17%) where 5.4% of males and 3.3% of females reported severe symptoms. Gender differences were found within the young adult group, with males (35.48%) reporting more substance use than their female (13.45%) counterparts.


Correlations between mental health, age, impact of COVID 19, coping, and perceived stress

The correlational analysis showed “age” was negatively associated with depression, anxiety, repetitive thoughts, personality changes, suicidal ideations, and memory, and positively associated with “substance use” at low levels. There were moderate positive correlations between perceived stress and all the mental health domains. All mental health domains, except substance use, showed moderate-to-low correlations with “Impact of COVID.” Moreover, substance use showed moderate positive correlations with other mental health domains. Maladaptive coping was moderately positively correlated with all the mental health domains, whereas adaptive coping showed only a low positive correlation with anxiety.


  Discussion Top


The current study compared comprehensive facets of mental health reactions and their association with age, stress, and coping among adolescents and adults amid the “New Normal Pandemic Era.” The feelings of depression and sadness were the most prevalent complaints among Adolescents amid the pandemic. Moreover, a significantly large proportion of the sample reported suicidal ideations, consistent with the literature, suggesting statistically significant relations between pandemic stress and suicidal ideations.[22]

This detrimental effect was explicitly suggested by the high percentage of the adolescent population reporting an absence of the symptoms before the COVID-19 outbreak. Taking into account the mental health facets of DSM-5 self-rated level 1 cross-cutting symptom measure, it was observed that increased stress owing to the virus and its impact on individuals' social, occupational, and academic life led to more individuals reporting depression, anxiety, somatic concerns, obsessive thoughts and drives, suicidal ideations, sleep problems, memory problems, and personality issues.

Comparisons among adolescents and adults

Adolescence is marked by a period of “storm and stress,” social sensitivity, and a need for independence. In our study, a general decreasing trend was observed with an increase in age across most of the mental health indicators, i.e., Ad > Y > MA for Depression, Somatic Complaints, Suicidal Tendencies, and Personality Issues, Ad and Y > MA for Anger and Anxiety, and Ad > Y and MA for Repetitive Thoughts and Actions and Dissociation, suggesting that Adolescents had more significant symptoms with a need for further professional assessment and treatment. This trend is the opposite of the overall prevalence indicated in the National Mental Health Survey, which estimated higher mental morbidity in middle-aged individuals (40–49 years age group).[23],[24] Adolescents' depression point prevalence at 0.1%–6.94% in community studies and 1.2%–21% in the clinic-based studies,[25] and a crude prevalence of depressive disorders and anxiety disorders in adults at around 3.3%.[26] During the pandemic, adolescents were particularly distressed with being socially disconnected from their friends, and illness-related worries along with educational difficulties can be significantly associated with depression, anxiety, and life satisfaction[27],[28] making adolescents specifically vulnerable.

While prepandemic suicide risk, according to the National Mental Health Survey, increased from the age group of 18–29 years to 50–59 years.[23] During the pandemic, adolescents reported more suicidal tendencies. This could be attributed to the current pandemic being a major stressful life event and related experiences (such as a fatal threat for life and health and the effect of social distancing policies), which can be a significant risk factor for adolescents suicidality.[29] Mid adults report lesser deterioration of the sleep quality than adolescents as the pandemic had a more significant impact on adolescents' social interactions and education and caused them more significant anxiety, which led to disturbances in sleep such as difficulties initiating and maintaining sleep.[28],[30]

More adolescents with personality issues were found in our sample, which is explainable given that adolescence is the age for resolving Eriksonian conflict of “identity versus role confusion.” This resolution involves the exploration of roles, which was restricted during the pandemic. Hence, the emotional detriment caused during the lockdown leads to lower self-concept values than before the restrictions.[31] Higher somatic complaints in adolescents can be understood as stemming from three types of concerns-the threat to life and health posed by COVID-19, daily life necessities, and efficacy of prevention and control measures.[32] These concerns may be lesser in the older population due to higher perceived self-efficacy in times of crisis.[33]

In our sample, substance abuse (drinking, smoking, and other drugs) was reported by more Adults than Adolescents, which is aligned with various studies which suggest that the overall rate of alcohol drinking and smoking increased only marginally during the COVID-19 pandemic. However, the frequency of use increased substantially. Hence, substance use did not increase in the form of initiation by Adolescents but in regular drinkers and regular smokers, and as a relapse in ex-drinkers and ex-smokers.[34],[35]

Comparisons among males and females

Similar to previous studies,[7],[9] our findings posit that there is no significant gender difference in most mental health correlations, except substance abuse– where more males reported a high intake of substance compared to Females. This is an interesting finding as the National Mental Health Survey delineated that Males had a higher prevalence of mental morbidity in the prepandemic era.[23] Therefore, the lack of significant difference between genders highlights the importance of the COVID-19 pandemic as a significant stressor. However, substance use trends are similar to the pre-COVID mental health findings since externalizing disorders such as alcohol, drug abuse, and antisocial behavior are more predominant in men than existing cultural scripts.[36] Higher levels of substance use are also related to the Asian cultural value of masculinity and are, therefore, widely used as a form of coping in Asian men.[37],[38]

Within age groups, our study found significant differences in suicidal tendencies between male and female adolescents, where more females reported suicidal tendencies, and between young adult males and females, where more males reported suicidal tendencies. Even prepandemic females had a higher risk of suicide than males due to gender discrimination, social exclusion, gender disadvantage.[23],[39] However, the higher number of young adult males expressing suicidal tendencies is a notable change observed, which could be attributed to the externalization of their social and individual turmoil. The stress of probable unemployment due to the uncertainty during the pandemic could be a substantial risk factor for young adult males due to the social meanings attached to work and the association between hegemonic masculinity and working. Moreover, our study also found that more adolescent females reported sleep disturbances that could be understood as a product of catastrophic worrying that Adolescent Females are susceptible to sleep problems compared to adolescent males.

A disaster or crisis, such as the COVID-19 pandemic, is potentially traumatic and imposes massive collective stress. Moreover, an individual's work environment, school environment, and family environment play essential roles in the pathogenesis of mental disorders.[39] Our study indicates a specific vulnerability of the younger population while adjusting to environmental stressors and highlights the pivotal role of the pandemic for individual mental health.

Correlates of mental health facets

The correlational analysis showed age to be negatively associated with depression, anxiety, and other mental health facets, and positively associated with substance use at lower levels. In our study, a general decreasing trend was observed with an increase in age across most mental health indicators, i. e. Ad > Y >MA. Literature during the pandemic has posited poorer resilience and emotional regulation in adolescents in times of crisis.[4],[5],[6],[8],[9],[27]

There were moderate positive relations of mental health domains with perceived stress which is consistent with the literature that suggests that, regardless of the current level of adjustment for internal resources and social support, stress is consistently the strongest correlate of mental health.[40] The specifically high correlation between substance abuse and stress can be explained by the tension-reduction hypothesis that suggests that exposure to stressors induces substance use as a means of mitigating experienced tension and strain.[41] All mental health domains, except substance use, showed moderate-to-low correlations with “Impact of COVID 19.”[4],[5],[6],[8],[9],[27]

As expected, maladaptive coping was positively related to mental health domains and showed a moderate correlation with repetitive thoughts, personality disturbances, and suicidal ideation. It has been observed that ruminative coping acts as a significant maladaptive strategy and perpetuates repetitive thoughts.[42] Moreover, coping styles can mediate a stressful situation and a negative outcome, like suicidal behavior.[43]

A vital and interesting finding was the lack of negative correlation between adaptive coping and mental health domains and a significant positive correlation between adaptive coping and anxiety. This can be associated with the high uncertainty during the pandemic and further explains the low positive correlation between adaptive coping and anxiety. This highlights the limitations of coping styles and re-emphasizes that various factors, like the nature of pandemic as a “stressor” and the degree of stress experienced, can influence the relation between coping and mental health outcomes, which were particularly important during the pandemic.[44] Being a problem-focused coping strategy, planning was included in the “adaptive coping style” in this study. However, planning can be associated with more severe anxiety symptoms during COVID-19.[45]. These findings however need to be expanded further as the symptom measure used in the current study does not provide clear-cut diagnoses.

Limitations

The study's cross-sectional design acts as a significant limitation as it provided data within a single time frame and not throughout the pandemic. There are some confounding variables the study did not have control over, particularly during the pandemic era. For instance, personal losses due to the pandemic, preexisting mental health problems, self-report format etc., Attempt was made by researchers to control them by large sample size, population representation, two stage sampling and weighting by age and gender groups. Finally, most of the participants were residents of Uttar Pradesh, which could have affected the results from a cultural point of view.


  Conclusion Top


The DSM-5 Cross-Cutting Measure provides the severity of symptoms, where levels mild and above are significant for all disorders except substance use, suicidal ideation, and psychosis. Even a minimal level of severity is essential for clinical decision-making through research. Based on our results, it is vital to note that around half of the adolescents and young adults show significant symptoms of depression, anger, and somatic complaints. In addition, 35%-–45% of Adolescents and Young Adults reported anxiety, and 25%–35% reported suicidal ideations and sleep disturbances at significant levels. The clinical severity of substance use was more pronounced in middle-aged adults than adolescents and young adults.

Therefore, it can be observed that a significant amount of individuals from our sample require further clinical assessment and intervention, where adolescents are more clinically vulnerable in all domains except substance use. Therefore, middle-aged adults should further be seen as a clinically vulnerable population for substance use during the pandemic. The cross-cutting DSM symptom measure does not give diagnoses but indicates the need for further assessment. Hence future indication is there to expand the work. Hence, this study provides a comprehensive analysis for clinical decision-making and policy development to combat the mental health problems in the backdrop of the COVID-19 pandemic.

Ethical approval

The ethical approval was obtained from the institutional ethics committee (ref code: 11th ECM COVID-19 1B/P7).

Acknowledgments

The authors would like to acknowledge the help extended by the teachers and school and college authorities. In addition, we are thankful to Dr. Shahil Jamal for his help in editing. Also, the authors are grateful to all the participants for their active participation.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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