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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 37  |  Issue : 1  |  Page : 64-70

A study on psychological distress, functional impairment, and social attitude toward the COVID-19 pandemic and lockdown among Indian population


1 Laboratory of Disease Dynamics and Molecular Epidemiology, Amity Institute of Public Health, Amity University, Noida, Uttar Pradesh, India
2 Laboratory of Disease Dynamics and Molecular Epidemiology, Laboratory of Health Data Analytics and Visualization Environment, Amity Institute of Public Health, Amity University, Noida, Uttar Pradesh, India

Date of Submission07-Jul-2020
Date of Decision20-Sep-2020
Date of Acceptance10-Oct-2020
Date of Web Publication31-Mar-2021

Correspondence Address:
Dr. Neha Taneja
Amity Institute of Public Health, Amity University, Noida 201 304, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijsp.ijsp_192_20

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  Abstract 


Objective: The objective was to evaluate the prevalence of psychological distress, functional impairment, and social attitude toward the COVID-19 pandemic and induced lockdown among the Indian population. Methodology: A cross-sectional study was conducted among 155 people residing in India. Data were collected on sociodemographic variables, psychological distress, functional impairment, and social attitude toward COVID-19 and the induced lockdown via an online survey. Kessler's K10 scale was used to measure psychological distress and Work and Social Adjustment Scale (WSAS) was used to evaluate functional impairment due to the COVID-19 pandemic. Descriptive statistic and Chi-square test were applied, where P < 0.05 was considered statistically significant. Pearson's analysis was used to measure the correlation between psychological distress and functional impairment. Results: Overall, the mean age of the study participants was 29.24 (standard deviation = 7.869) years. Majority of the study participants were female (63.9%). On applying K10 scale, it was found that 20% of the participants suffered from mild psychological distress and 16.1% were moderate-to-severely distressed. On applying WSAS scale, it was found that 23.9% of the study participants suffered from significant functional impairment and 7.9% from severe functional impairment. On assessing the social attitude, 63.9% of the participants purchased groceries from local market and 56.8% said that they would visit mall after the lockdown gets over. Eating out in a restaurant (P = 0.028) and visiting shopping mall (P = 0.032) after the lockdown gets over were significantly associated with psychological distress. Conclusion: Our findings identified the level of psychological distress, functional impairment, and social attitude toward the COVID-19 pandemic and the induced lockdown. Such evidences can be used to formulate interventions to improve the mental health and well-being of people during such emergencies.

Keywords: COVID-19 pandemic, functional impairment, lockdown, psychological assessment


How to cite this article:
Badola M, Chauhan R, Taneja N, Janardhanan R. A study on psychological distress, functional impairment, and social attitude toward the COVID-19 pandemic and lockdown among Indian population. Indian J Soc Psychiatry 2021;37:64-70

How to cite this URL:
Badola M, Chauhan R, Taneja N, Janardhanan R. A study on psychological distress, functional impairment, and social attitude toward the COVID-19 pandemic and lockdown among Indian population. Indian J Soc Psychiatry [serial online] 2021 [cited 2021 Jun 15];37:64-70. Available from: https://www.indjsp.org/text.asp?2021/37/1/64/312865




  Introduction Top


A pneumonia-like virus originated in Wuhan, Hubei province of China, and created a panic-like situation all over the world. The virus was identified as a part of coronavirus family, but its strains were new to the nature. The disease was a respiratory infection caused by human-to-human transmission and causes flu-like symptoms, but it had relatively low mortality rate than severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome. On December 31, China reported this to the World Health Organization and the disease was named COVID-19. Later, on March 11, 2020, it was declared as a pandemic. As of May 16, 2020, COVID-19 had affected nearly 4,425,485 people across the globe and there are 302,059 confirmed deaths.[1]

As a preventive measure to protect people from COVID 19, the Government of India on March 25, 2020, first announced a 21-day lockdown. The purpose of the lockdown was to break the chain of transmission of the infection. It was strictly prohibited to go out from one's house until absolutely necessary. And, in such conditions, only a healthy family member could go out for the required work.[2] This sudden announcement brought undue changes in the lives of people. Not only the fear and anxiety about the disease but living under the lockdown had some effect on the mental well-being of people.

People react differently to such stressful situations.[3] Some people are good at coping up with sudden changes, but others find it very difficult to maintain their mental peace. The latest situation affected and changed the daily routine of many individuals, not only the way they worked but also their sleeping and eating pattern. Even the general functioning of the society was affected. The new change demanded people to lock in and create physical and social distancing. All these situations challenged the skills and abilities of an individual. Patients with COVID-19 may be experiencing fear of the consequences, but people who are living under the lockdown might experience boredom, loneliness, agitation, anxiety, and depression.[4]

At present, there is an acute lack of evidence on how this pandemic and the lockdown is affecting the psychological well-being of Indian residents and also how it is affecting the activities of an individual which they usually does during normal days.[5] Hence, the current study was conducted with the objective to assess the psychological distress, functional impairment, and social attitude toward the COVID-19 pandemic and the induced lockdown among the Indian population.


  Methodology Top


A cross-sectional study was conducted among the Indian population from April 20, 2020, to May 10, 2020. An online survey was done to assess the participants' responses during the lockdown. A self-structured, pretested questionnaire was designed to collect the information related to sociodemographic variables and social attitude toward the COVID-19 pandemic and the lockdown among the study participants. The initial set of questions comprised age, gender, religion, education, occupation, and place of residence.

Psychological assessment

Kessler Psychological Distress Scale (K10) was used to examine the psychological status of the participants. This scale comprises ten questions, with each having five-level responses. It is a brief screen to identify the level of distress. Each question is scored from 1 “none of the time” to 5 “all of the time;” the scores of ten questions are then summed in which 10 is the lowest and 50 is the highest score. Scores are interpreted as having a mental distress as 10–19 likely to be well, 20–24 likely to have mild disorder, 25–29 likely to have moderate disorder, and 30–50 likely to have severe disorder.[6] We adopted the cutoff score of >19 for mild psychological distress and >24 for moderate-to-severe psychological distress.[7]

Functional impairment

The impairment toward day-to-day functioning is measured by the Work and Social Adjustment Scale (WSAS). It consists of five questions which determine how much your problems impair your ability to carry out the activity. For each question, each individual's response was scored ranging from “0 – not at all impaired,” 2 – slightly impaired, 4 – definitely impaired, 6 – markedly impaired, and 8 – severely impaired. The maximum score of WSAS is 40, where score below 10 shows no impairment, while scores from 10 to 20 and 20–40 represent significant and severe functional impairments, respectively.

Informed consent was taken from the study participants. The study was approved by the institutional ethics committee. Data analysis was performed using statistical software SPSS (VER. 23.0, IBM SPSS Statistics (Version 23.0)). Descriptive statistics and bivariate analysis were carried out to find the association between categorical variables. P < 0.05 was considered statistically significant. Pearson's correlation coefficient was used to assess the correlation between psychological distress and functional impairment.


  Results Top


The total number of study participants included in the study was 155, out of which 63.9% were female. The overall mean age of the participants was 29.24 (standard deviation = 7.869) years [Table 1].
Table 1: Sociodemographic profile of the study participants (n=155)

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K10 psychological distress scale responses revealed that 20% of the participants were under mild distress, whereas 16.1% of the participants were moderate-to-severely distressed, as shown in [Figure 1].
Figure 1: Prevalence of psychological distress among the study participants (n = 155)

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Upon studying the social attitude toward the COVID-19 pandemic and lockdown situation, 45.5% of the participants observed that people around them were following the guidelines of the lockdown, whereas 78% of the participants were going out to buy daily groceries and 63.9% of them were purchasing it from the local grocery shop. On asking them about purchasing Chinese products such as mobile phones, electronic items, clothes, and Chinese food such as packaged noodles/Maggie, spices, and grocery material, 74.8% said yes, they will avoid purchasing/eating such items. On asking them about going out from home, 56.8% of them said they would visit malls and 91% said change in travels plans is a must after this situation subsides. On being asked about the use of personal grooming products, 63.9% of the participants responded that they will visit saloon or call a home service parlor after the removal of lockdown-enforced restrictions [Table 2].
Table 2: Social attitude of the participants toward COVID-19-induced lockdown (n=155)

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Out of the total participants, 76.8% reported that they spent 1–2 h on reading about coronavirus in a day. Regarding the current government action plan on dealing with COVID-19, 68.4% of them are satisfied with the current government's response toward the COVID-19 pandemic, as shown in [Figure 2].
Figure 2: Percentage of responses of how much participants are satisfied with the current government management strategy of the COVID-19 pandemic

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On analyzing the functional impairment toward activities at either personal or professional level, it was found that 23.9% of the participants suffer from significant functional impairment and 9.7% from severe functional impairment [Figure 3].
Figure 3: Prevalence of functional impairment among the study participants (n = 155)

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Chi-square analyses to assess the association between psychological distress and sociodemographic profile and social attitude of the study participants revealed that few activities such as eating out in a restaurant after the lockdown (P = 0.028) as well as visiting shopping mall after the lockdown (P = 0.032) had a statistically significant association with psychological distress (K10). Although female participants (18.2%) were found to be more under more distress in comparison with males (12.5%), this association was not statistically significant. Similarly, age, current residence, occupation, and education were not found to be significantly associated with psychological distress [Table 3].
Table 3: Bivariate analysis of relationship between psychological distress with sociodemographic variables and social attitude of the study participants (n=155)

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Upon analyzing the association of the variables with functional impairment of the study participants, it was observed that current residence was statistically significantly associated with functional impairment (P = 0.043), whereas going out for purchasing household items also had a statistically significant association with functional impairment (P = 0.012). Males (10.7%) were more severely impaired than females (9.1%), however this association was not statistically significant [Table 4]. Furthermore, age, gender, religion, and monthly income were not found to be significantly associated with functional impairment [Table 4].
Table 4: Bivariate analysis of the relationship between functional impairment with sociodemographic profile and social attitude of the study participants (n=155)

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On applying correlation analysis, it was found that psychological distress was statistically significantly correlated with functional impairment with P < 0.01 [Figure 4]. Thus, the present study reveals that psychological distress has an impact on functional ability of the study participants.
Figure 4: Correlation between Work and Social Adjustment Scale with K10 Psychological Distress Scale (n = 155) (r = 0.264). **Correlation is significant at the 0.01 level (two tailed)

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  Discussion Top


It is not possible to exactly determine the time frame when the menace of the COVID-19 pandemic would abate, but what is known is that it has significantly impacted the physical and mental well-being of an individual. Past experiences with natural and humanmade disasters have taught public health officials that it is not easy to decipher the mental health condition of individuals living in the area of crisis. People's responses to such infectious diseases like COVID-19 outbreaks are more out of fear and anxiety. The causes of such mental outburst could be due to fear of getting ill and facing financial crisis during such public health emergencies. Our study is a humble yet pioneering attempt to understand the psychological well-being, ability to function, and social attitude of people during such public health emergencies.

The results of our study indicated that 20% of the participants suffered from mild psychological distress, while 16.1% suffered from severe psychological distress. Similar results were observed in a study conducted on the Chinese population during COVID-19 outbreak where 35% of the participants experienced psychological distress.[8] Another study conducted among Italian population[9] during the COVID-19 outbreak showed that 38% of the participants perceived a form of psychological distress. A study conducted during the COVID-19 outbreak among the students of University of Kosovo, Europe,[10] using Kessler Distress Scale (K10) revealed that only 13.3% of the study participants were under moderate psychological distress, whereas 11.4% of the study participants were under severe psychological distress. A study conducted among the general population of China mentioned that 53.8% of the participants responded moderate-to-severe psychological distress from the COVID-19 outbreak using the Impact of Event Scale-Revised.[11]

Analyses of the social attitude of participants about the COVID-19 pandemic along with enforced lockdown situation revealed that a staggering 91% of the respondents indicated that there would be change in their travel plans post COVID-19 pandemic. In contrast, another study carried out in India showed that 88.7% of the people considered safe to travel within India during this pandemic.[12] Whereas in a study conducted among the residents of Hong-Kong during SARS epidemic, 70.8% believed that it is not safe to travel in this condition.[12] Similarly, a study among the residents of Qatar during the SARS epidemic reported that 60% participants were afraid to travel because of SARS.[13]

Another article on the impact of COVID-19 on the daily lives stated that COVID-19 pandemic has already had a statutory impact on the daily activities, travel plans (both national and international), and visiting shopping malls after the abatement of the enforced lockdown. Another online survey conducted by PYMNTS.com website among the residents of the USA indicated that 19% of them would prefer shopping online rather stepping out from their home.[14] A similar survey conducted among the residents of the USA stated that 17% of the participants had modified their travel plan due to coronavirus outbreak, whereas 9% of the total participants stated that they would restrict their travel plan for the time being.[15]

The results obtained from the current study suggest that the COVID-19 pandemic has had no impact on the eating habits of Indians as 54.8% of the study participants responded that they would go out to eat after the abatement of the enforced lockdown. In another online survey conducted among the individuals living in the USA, it was stated that only 22% of the participants felt comfortable in going out to eat.[16] In our study, it was observed that 50.3% of the participants were going out to buy daily household items. Similarly, in the same online survey conducted in the USA, 57% of the study participants felt comfortable in going out and buying groceries.[16]

In the current study 5.2% of the participants consumed alcohol to cope up with the anxiety induced by the COVID-19-enforced lockdown. Similarly, results from another online survey among the residents of the USA during the COVID-19 outbreak showed that 20% of the study participants consumed more alcohol than usual.[15] It was observed in our study that 69% of the participants followed the rules of lockdown, whereas an online survey done by the Department of Administrative Reforms and Public Grievances (DARPG), India, among the district collectors showed that 71% of the people were following the rules of lockdown.[17]

On being asked about the satisfaction levels of the general populace regarding the current government's approach in tackling the COVID-19 pandemic, 68.4% of the study participants said that they were satisfied with the actions taken by the government to combat the situation. Similarly, an online survey done by DARPG, India, among the district collectors, showed that 82% of them believed that the government has taken sufficient steps in combating COVID-19.[17] In contrast, an online survey among the residents of the USA revealed that only 24% of the study respondents had confidence in their government's ability to handle the situation appropriately.[15] The results from our study suggest that there is a significant correlation between psychological distress and functional impairment. Similarly, another study among 100 depressive patients of a psychiatry department at a hospital in Karnataka showed that depression score is correlated with functional score (r = 0.417).[18]

We have studied many more variables which have been found to be associated with the Kessler Psychological Distress Scale (K10) and WSAS. However, there is a need to conduct more studies on a larger scale to provide comprehensive evidence to the government to frame policies that could help in managing such stressful public health emergencies in future.


  Conclusion Top


The results from our study using the K10 Psychological Distress Scale show that only 16.1% of the study participants suffered from moderate-to-severe distress, whereas 9.7% suffered from severe functional impairment based on WSAS scale. This necessitates the need to address the mental health of people as much as their physical health during such times of public health emergency. Overall, although the physical impact of COVID-19 pandemic and the enforced lockdown will be short term, its impact on mental health of the population could be substantial.

Strengths

To the best of our knowledge, this is one of the very few studies to examine the prevalence of psychological distress and functional impairment associated with the COVID 19 pandemic among the Indian population. The study also includes the social attitude of participants toward the pandemic and the lockdown.

Limitations

There are few limitations to be considered in this study. The sample size is small; due to lockdown, we could only collect data through online mode. The study is limited to people who had smartphones, E-mail ID, and who are able to read and understand English language. This represents the educated population of the country, therefore the results obtained from the study cannot be generalized to the whole country.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

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Mental Health and Coping during COVID-19. CDC. Available from: https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/managing-stress-anxiety.html. [Last accessed on 2020 May 3].  Back to cited text no. 3
    
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Xiang YT, Yang Y, Li W, Zhang L, Zhang Q, Cheung T, et al. Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. Lancet Psychiatry 2020;7:228-9.  Back to cited text no. 4
    
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Sibley CG, Greaves LM, Satherley N, Wilson MS, Overall NC, Lee CH, et al. Effects of the COVID-19 pandemic and nationwide lockdown on trust, attitudes towards government, and wellbeing. American Psychologist 2020;75:618-30. https://doi.org/10.1037/amp0000662.  Back to cited text no. 5
    
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Kessler RC, Andrews G, Colpe LJ, Hiripi E, Mroczek DK, Normand SL, et al. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med 2002;32:959-76.  Back to cited text no. 6
    
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Andrews G, Slade T. Interpreting scores on the Kessler psychological distress scale (K10). Aust N Z J Public Health 2001;25:494-7.  Back to cited text no. 7
    
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Qiu J, Shen B, Zhao M, Wang Z, Xie B, Xu Y. A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: Implications and policy recommendations. Gen Psychiatr 2020;33:e100213.  Back to cited text no. 8
    
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Moccia L, Janiri D, Pepe M, Dattoli L, Molinaro M, De Martin V, et al. Affective temperament, attachment style, and the psychological impact of the COVID-19 outbreak: An early report on the Italian general population. Brain Behav Immun 2020;87:75-9.  Back to cited text no. 9
    
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Arenliu A. Rapid Assessment : Psychological Distress among Students in Kosovo during the COVID 19 Pandemic Running Head : Psychological Distress COVID-19; 2020.  Back to cited text no. 10
    
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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;17:21.  Back to cited text no. 11
    
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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.  Back to cited text no. 12
    
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Bener A, Al-Khal A. Knowledge, attitude and practice towards SARS. J R Soc Promot Health 2004;124:167-70.  Back to cited text no. 13
    
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How COVID-19 Changed Consumers' Daily Lives. PYMNTS.com. Available from: https://www.pymnts.com/coronavirus/2020/consumer-spending-behavior-covid19-study/. [Last accessed on 2020 May 12].  Back to cited text no. 14
    
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COVID-19 Report: How the Virus is Affecting Everything, from Politics to Brands. YouGov. Available from: https://today.yougov.com/topics/science/articles-reports/2020/03/12/covid-19-report-how-virus-affecting-world-politics. [Last accessed on 2020 May 12].  Back to cited text no. 15
    
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Most Americans Say Coronavirus Outbreak Has Impacted Their Lives | Pew Research Center. Available from: https://www.pewsocialtrends.org/2020/03/30/most-americans-say-coronavirus-outbreak-has-impacted-their-lives/. [Last accessed on 2020 May 12].  Back to cited text no. 16
    
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Of R, Collectors D. National preparedness survey on COVID-19 national preparedness survey on COVID 19; 2020.  Back to cited text no. 17
    
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Urs SD. Quality of life and functional impairment among depressive patients in a psychiatric outpatient setting in India; 2013.  Back to cited text no. 18
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
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  [Table 1], [Table 2], [Table 3], [Table 4]



 

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