|Year : 2021 | Volume
| Issue : 1 | Page : 88-92
Prevalence of anxiety and depression among COVID-19 patients admitted to tertiary care hospital
Pankaj Kumar1, Rupesh Chaudhary1, Sandeep Chhabra2, Jasleen Kaur Bhalla1
1 Department of Psychiatry, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
2 Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
|Date of Submission||13-Oct-2020|
|Date of Decision||25-Jan-2021|
|Date of Acceptance||06-Dec-2020|
|Date of Web Publication||31-Mar-2021|
Dr. Rupesh Chaudhary
Department of Psychiatry, Dayanand Medical College and Hospital, Ludhiana, Punjab
Source of Support: None, Conflict of Interest: None
Context: COVID-19 patients undergo myriad of psychological problems such as mood swings, depression, fear of isolation, fear of dying, feeling helpless, insomnia, anxious forebodings, and nervousness. These are commonly seen among isolated and quarantined patients who experience notable levels of anxiety, uncertainty, anger, confusion, stress and insecurity. Aims: This study aims to determine the prevalence of anxiety and depression among these infected patients admitted to tertiary care center. Settings and Design: This cross-sectional study was conducted on 100 COVID-19 patients admitted to DMC&H, Ludhiana. Subjects and Methods: The data were collected on sociodemographic parameters and assessment was done using Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Rating Scale (HARS) at the time of discharge from the hospital. Statistical Analysis Used: SPSS 21 version for Microsoft Windows. Results: Majority of the patients were males and in the age group of 31–50 years. 48% patients had comorbid depression. Moderate-to-severe levels of depression were found more in males (25%) as compared to females (15%). Comorbid anxiety was seen commonly in females (60%) than male patients (28.75%), though the moderate-to-severe level of anxiety was more in males (71.25%) as compared to females (40%). On symptom checklist of HDRS and HARS, patients had high scores on insomnia (75%), psychic anxiety (45%–50%), somatic symptoms (gastrointestinal [50%], muscular [56%], and respiratory [81%]) and loss of weight (40%). Conclusions: COVID-19 patients score higher on comorbid anxiety and depression. Moderate-to-severe level of anxiety and depression is commonly seen among male patients than female patients.
Keywords: COVID-19, anxiety, depression, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale
|How to cite this article:|
Kumar P, Chaudhary R, Chhabra S, Bhalla JK. Prevalence of anxiety and depression among COVID-19 patients admitted to tertiary care hospital. Indian J Soc Psychiatry 2021;37:88-92
|How to cite this URL:|
Kumar P, Chaudhary R, Chhabra S, Bhalla JK. Prevalence of anxiety and depression among COVID-19 patients admitted to tertiary care hospital. Indian J Soc Psychiatry [serial online] 2021 [cited 2022 Oct 5];37:88-92. Available from: https://www.indjsp.org/text.asp?2021/37/1/88/312876
| Introduction|| |
COVID-19 infection per se not only has physical impacts on well-being of the patients but also has considerable effect on their mental health. The diverse psychological symptoms observed in patients includes emotional distress, depression, mood swings, fear of being left alone or being away from family (isolation), fear of dying, feeling helpless, insomnia, and anxious forebodings. Nervousness and anxiety are frequently seen in isolation and quarantine wards., Studies conducted in this pandemic have recorded a high prevalence of moderate-to-severe depressive and anxiety symptoms among the general population; particularly among the infected or suspected COVID-19 patients.
The common symptoms of COVID-19, such as fever and shortness of breath, can induce anxiety symptoms. The risk factors that make the patient vulnerable for psychological distress are poor sleep quality, physical symptoms of COVID-19 and the severity of infection. Patients with more symptoms are usually more serious and the anxiety symptoms among them increase as they are excessively worried and concerned about the progression of the illness and its likely outcome.,
The earlier research studies have focused on COVID-19-related mental health issues in the general population, health-care workers, children, pregnant women and in people already having a known mental illness. The research data are still limited on mental health effects of COVID-19 in infected patients probably because in the infection units, patient's physical well-being has always been the priority than his psychological assessment; more so in India where there is dearth of infrastructure and psychological screening protocols. The patient's mental well-being is often neglected and compromised during treatment. Hence, our study was planned to assess the prevalence of psychological distress in COVID-19 patients in the form of anxiety and depression which would further raise understanding and awareness on importance of addressing mental health issues in these patients. It will aid in guiding the treatment protocols to focus not only on the physical and medical aspect but also on the mental health aspect of the infected patients. Early identification of individuals in initial stages of psychological distress makes the intervention programs more efficient.,
Aims and objectives
Our study aims to assess the prevalence of anxiety and depression among the admitted COVID-19 patients. Further, we would correlate the association of these symptoms and the likely risk factors that might trigger the mental health problems in this population. This will help in addressing and improving the psychological well-being of the patient along with the physical aspect. The knowledge regarding psychosocial issues among the infected patients would also guide the implementation of health-care services and socio-economic reintegration of society.
| Subjects and Methods|| |
This cross sectional study was done on 100 diagnosed patients of COVID-19 presenting to DMC&H Ludhiana. After taking an informed consent, the assessment was done by Hamilton Depression Rating Scale (HDRS) and Hamilton Anxiety Rating Scale (HARS). They were assessed on sociodemographic profile and the data were analyzed on different domains of HDRS and HARS.
The HDRS (also known as Ham-D) is the widely used scale containing 21 items pertaining to symptoms of depression. Score is calculated from first 17 items. It has sensitivity of 86.4% and specificity of 92.2% and has good internal, inter-rater, and retest reliability. The score interpretation is as follows:
0–7 = Normal
8–13 = Mild depression
14–18 = Moderate depression
19–22 = Severe depression
>22 = Very severe depression
HARS consists of 14 items which measures both psychic anxiety (mental agitation and psychological distress) and somatic anxiety (physical complaints related to anxiety). Each item is scored on a scale of 0 (not present) to 4 (severe), with a total score range of 0–56. It has sensitivity of 85.7% and specificity of 63.5% and has good reliability and validity. The score interpretation is as follows:
- Inclusion criteria - diagnosed cases of COVID-19 admitted to DMC&H who consent for participation in the study at the time of discharge from hospital
- Exclusion criteria - patient suffering from depression/anxiety disorder/substance abuse before the diagnosis of COVID-19 or patient already receiving any psychotropic drugs or patient with a history of any serious organic illness or patient who does not consent for participation.
| Results|| |
[Table 1] shows sociodemographic profile of the 100 COVID infected patients with 80% males and 20% females. Majority patients were in age range of 31-50 years and were educated. [Table 2] shows that 48% patients had co-morbid depression and majority were in mild depression category (score range of 8-13 on HDRS). Moderate to severe levels of depression was found more in males (25%) as compared to females (15%).
[Table 3] shows that 47% of the patients had moderate anxiety (score range 18-24) on HARS.
Co-morbid mild anxiety was seen commonly in females (60%) than male patients (28.75%) whereas moderate to severe level of anxiety was more in males (71.25%) as compared to females (40%).
On symptom checklist of HDRS [Table 4] and HARS [Table 5] , patients had high scores on insomnia (75%), psychic anxiety(45-50%), somatic symptoms [gastrointestinal(50%), muscular(56%) and respiratory(81%)] and loss of weight (40%).
|Table 4: Comparative distribution of positive rating on symptoms checklist of Hamilton depression rating scale between male and female patients|
Click here to view
|Table 5: Comparative distribution of positive rating on symptoms checklist of Hamilton anxiety rating scale between male and female patients|
Click here to view
| Discussion|| |
Sociodemographically, in our study, 80% patients were males and 20% were female [Table 1]. These findings can be attributed to the fact that males are usually the breadwinners of the family who go out to work to provide the family with income and are usually less likely to be stringent in following the safety precautions of wearing masks properly and maintaining social distancing. The females in our Indian set-up, on the other hand, are mostly the ones who stay at home and take care of kids and the elderly. Hence, the risk of getting infected increases in males.
In our study, out of 80% males, 56.25% were in the age group of 31–50 years while among 20% females, 70% were in the same age group. The reason behind this age group being the commonest to present with infection is that this age group is the major productive population in the society who is more concerned about the future, economic challenges, and long-term consequences caused by pandemic.,
As far as psychiatric disorders are concerned, our study shows that 48% of the total patients had comorbid depression [Table 2]. Out of 80% males, 50% shows depression and out of 20% females, 40% has depression. Moderate-to-severe levels of depression were found more in males (25% of 80%) as compared to females (15% of 20%). Self-isolation, travel restrictions, decreased demand for essential commodities, job interruption, and the consequent social stigma are the factors that make the patient vulnerable for the development of depressive symptoms. Once they are infected, the economic growth comes to halt, workers receive less salaries and some even lose their jobs. Similar findings were seen in other studies.,,,,
Female patients showed more anxiety symptoms (60% of 20%) as compared to male patients (28.75% of 80%), though the moderate to severe level of anxiety was found more in males (71.25% of 80%) as compared to females (40% of 20%) [Table 3]. As the females are the key household caretaker of the family, who once infected, are isolated and physically distanced from their children and family. In Indian context, it is usually seen that a female is more concerned and apprehensive as she has fear of passing infection to her kids or other vulnerable family members. Many researchers have supported the statement that severity level of anxiety and depressive symptoms are more in admitted patients.,,,
Similarly, the worries regarding long term sequelae of infection, social stigma, and fear of re-infection might also contribute to the development of anxiety and depression in patients. The reasons could be plenty including uncertainty about the treatment, perceived neglect by healthcare workers in fear of getting infected, cost-effectiveness, to be in the isolation wards or quarantine centers, shortage of personal protective equipment, intensification of physical symptoms, and uncertainty about the progression of pandemic.,,,,,,
On the symptom checklist of HDRS [Table 4] and HAR [Table 5], majority of the patients showed higher scoring on depressed mood (50% males; 40% females), anxious mood (75% females and 68.75% males), insomnia (75%), and psychic anxiety (males 43.75% vs. females 50%), and physical symptoms (gastrointestinal [50%], general [22.5% in males and 40% in females], muscular [56.25% in males and 60% in females] and respiratory [81.25% in males and 65% in females]). Insomnia is one of the main triggering factors in the development of depression and anxiety symptoms among patients. The literature has also supported that the poor sleep quality and having more current physical symptoms of COVID-19 are risk for anxiety and depression among admitted patients.,,,,,
In Indian tradition and culture, family has a role to play in all types of illnesses. However, COVID is peculiar as it compromises the very social nature of existence of an individual. This social isolation, physical distancing, decreased family connections, and loneliness puts the patient at risk of developing anxiety and depressive symptoms. These may be further aggravated by the infodemic, i.e., spreading panic and fear through social media and fragmented information in the print and electronic media.,
| Conclusions|| |
COVID-19 infection has taken toll on the mental health of the patients. Anxiety and depression have been seen frequently among the infected. These aspects need to be taken into consideration as they affect the overall outcome of the patient in physical, psychological, social, and occupational domain of life. The distressing symptoms of anxiety and depression make the individual unproductive and lead to social and familial dysfunction in the form of isolation, loneliness, loss of income and fear of re-infection or spread of infection to society. The understanding and realization of association of anxiety and depressive symptoms in COVID-19 infected patients is essential for early screening and timely psychiatric intervention for a better functional outcome of the patient. Psychiatric medications and psychological interventions can be planned in terms of short-term as well as long-term management. Medication, supportive psychotherapy, and crisis management are required for short-term management. Behavioral management focusing individual Cognitive Behavior Therapy and family therapy can be planned for long run. The social crisis created by the COVID-19 pandemic might increase inequality, social exclusion, discrimination, and unemployment in the patients. Hence, the social rehabilitation also becomes as important as the timely diagnosis and adequate medical care.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
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 research 2020;288:112954. Available from: https://doi.org/10.1016/j.psychres.2020.112954
. [Last accessed 24 January 2021]
Hall RC, Hall RC, Chapman MJ. The 1995 Kikwit Ebola outbreak: Lessons hospitals and physicians can apply to future viral epidemics. Gen Hosp Psychiatry. 2008;30:446-52.
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;14;395:912-20.
Wang Y, Xu B, Zhao G, Cao R, He X, Fu S. Is quarantine related to immediate negative psychological consequences during the 2009 H1N1 epidemic? Gen Hosp Psychiatry 2011;33:75-7.
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. International journal of environmental research and public health 2020;17:1729. https://doi.org/10.3390/ijerph17051729
Fitzgerald PJ. Serious infection may systemically increase noradrenergic signaling and produce psychological effects. Medical Hypotheses 2020;139:109692. DOI: 10.1016/j.mehy.2020.109692.
da Silva AM, Vilhena E, Lopes A, Santos E, Gonçalves MA, Pinto C, et al
. Depression and anxiety in a Portuguese MS population: Associations with physical disability and severity of disease. J Neurol Sci 2011;306:66-70.
Piontek K, Ketels G, Albrecht R, Schnurr U, Dybowski C, Brunahl CA, et al
. Somatic and psychosocial determinants of symptom severity and quality of life in male and female patients with chronic pelvic pain syndrome. J Psychosom Res 2019;120:1-7.
Xiang Y-T, 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.
Zhang J, Lu H, Zeng H, Zhang S, Du Q, Jiang T, et al
. The differential psychological distress of populations affected by the COVID-19 pandemic. Brain Behav Immun 2020;87:49-50.
Hamilton M. A rating scale for depression. J Neurol Neurosurg Psychiatry 1960;23:56-62.
Maier W, Buller R, Philipp M, Heuser I. The Hamilton Anxiety Scale: Reliability, validity and sensitivity to change in anxiety and depressive disorders. J Affect Disord 1988;14:61-8.
Ahmed MZ, Ahmed O, Aibao Z, Hanbin S, Siyu L, Ahmad A. Epidemic of COVID-19 in China and associated Psychological Problems. Asian J Psychiatr 2020 Jun;51:102092. doi: 10.1016/j.ajp.2020.102092. Epub 2020 Apr 14. PMID: 32315963; PMCID: PMC7194662.
Moghanibashi-Mansourieh A. Assessing the anxiety level of Iranian general population during COVID-19 outbreak. Asian J Psychiatr 2020 Jun;51:102076. doi: 10.1016/j.ajp.2020.102076. Epub 2020 Apr 18. PMID: 32334409; PMCID: PMC7165107.
Rieger MO. To wear or not to wear? Factors influencing wearing face masks in Germany during the COVID-19 pandemic. Soc Health Behav 2020;3:50-4. [Full text]
Lin CY. Social reaction toward the 2019 novel coronavirus (COVID-19). Soc Health Behav 2020;3:1-2. [Full text]
Li Y, Gu S, Wang Z, Li H, Xu X, Zhu H, et al
. Relationship Between Stressful Life Events and Sleep Qual- ity: Rumination as a Mediator and Resilience as a Moderator. Front Psychiatry 2019;10:348.
Chew NWS, Lee GKH, Tan BYQ, Jing M, Goh Y, Ngiam NJH, et al
. A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak. Brain Behav Immun 2020;88:559-65.
Zhou F, Yu T, Du R. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet 2020;395:1054-62.
Bo HX, Li W, Yang Y, Wang Y, Zhang Q, Cheung T, et al
. Posttraumatic stress symptoms and attitude toward crisis mental health services among clinically stable patients with COVID-19 in China. Psychological Medicine 2020;1-2. Advance online publication. Available rom: https://doi.org/10.1017/S0033291720000999
. [Last accessed on 2021 Jan 24].
Zhou J, Liu L, Xue P, Yang X, Tang X. Mental Health Response to the COVID-19 Outbreak in China. Am J Psychiatry 2020;177:574-5.
Bhattacharya S. The social impact of COVID 19 pandemic. Observer research foundation; 2020.
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 Journal of Psychiatry 2020;51:102083. Availble from: https://doi.org/10.1016/j.ajp.2020.102083
. [Last accessed on 2021 Jan 24].
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]