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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 3  |  Issue : 3  |  Page : 83-88

Mental health problems and impact on youth minds during the COVID-19 outbreak: Cross-sectional (RED-COVID) survey


1 Department of Pharmacy Practice, Institute of Pharmacy, Nims University, Jaipur, Rajasthan, India
2 Department of Pediatric Gastroenterology, Institute of Gastroenterology, Hepatology and Transplant, Nims University, Jaipur, Rajasthan, India

Date of Submission09-Jun-2020
Date of Decision10-Jun-2020
Date of Acceptance18-Jun-2020
Date of Web Publication27-Jul-2020

Correspondence Address:
Pratima Singh
Department of Pharmacy Practice, Institute of Pharmacy, Nims University, Jaipur, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/SHB.SHB_32_20

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  Abstract 


Introduction: The COVID-19 outbreak had impacted humankind with herculean force. Extensive Indian population which comprises youths are going through psychological resilience due to isolation, contact transmission, and economic crisis. Methods: A cross-sectional study among youth Indian citizens aged 15–30 years through social media platforms was conducted. The survey instrument consisted of demographic characteristics, assessment psychological impact by Depression, Anxiety and Stress-21 scale, and four items on COVID-19 stressors. Results: Out of 684 responses from red containment zones, 474 participants completed the study. Overall, moderate-to-severe stress, anxiety, and depression were 37.36%, 30.89%, and 24.63% in youths, respectively. Mental health outcomes were associated with female gender (odds ratio [OR] = 2.76, 95% confidence interval [CI]: 1.70–4.46), marital status (OR = 2.30, 95% CI: 1.47–3.88), residence in rural area (OR = 2.89, 95% CI: 1.74–4.78), and postgraduate qualification (OR = 1.49, 95% CI: 0.74–3.36). Economical stressors, physical illness, and changes in daily life were found to be positive predictors of mental health problems. Conclusion: Our finding suggested requirement psychological intervention targeting youth living in rural areas especially women through government schemes irrespective of educational status.

Keywords: Anxiety, Depression, Anxiety and Stress Scale-21, depression, severe acute respiratory syndrome, stress


How to cite this article:
Nathiya D, Singh P, Suman S, Raj P, Tomar BS. Mental health problems and impact on youth minds during the COVID-19 outbreak: Cross-sectional (RED-COVID) survey. Soc Health Behav 2020;3:83-8

How to cite this URL:
Nathiya D, Singh P, Suman S, Raj P, Tomar BS. Mental health problems and impact on youth minds during the COVID-19 outbreak: Cross-sectional (RED-COVID) survey. Soc Health Behav [serial online] 2020 [cited 2020 Aug 8];3:83-8. Available from: http://www.shbonweb.com/text.asp?2020/3/3/83/290979




  Introduction Top


Coronaviruses are positive-sense RNA viruses discovered in the 1960s, which also emerged as respiratory viruses with previous outbreaks: severe acute respiratory syndrome (SARS-CoV) in 2002, human coronavirus HCoV NL63 in 2004,[1] HKU1 in 2005,[2] the Middle East respiratory syndrome coronavirus in 2012, and now potential unprecedented threat bracing up with novel pathogen SARS-CoV-2. Originating from the cluster of cases in Wuhan, China, and exponentially spreading in more than 180 countries, COVID-19 has turned down into a global pandemic causing infection and high fatality rates.[3] Although the major paradigm is centralized on testing, treatment, and averting transmission, the extensive Indian population which comprises youths are going through psychological resilience due to ubiquitous isolation, contact transmission, and economic crisis, which is a grave concern. Systemic studies on COVID-19 and mental health outcomes are indicative of the indirect effects of the psychological and negative impact of general mental health without any stratification.[4] As of now, India is witnessing largest containment in history with 1.3 billion population under lockdown in the attempt to flatten the curve of COVID-19 cases, this awaits emerging epidemic so called mental health crisis.[5]

A cognitive model presented by Ehlers and Clark proposed individuals experiencing traumatic events lead to negative appraisals or its sequelae.[6] This model demonstrated youth being one of the most vulnerable population on the verge of post-traumatic psychological problems such as depression, anxiety, or psychological distress.[7]

A recent study showed that nearly 45% of youths of the USA reported a negative impact on mental health.[8] Another study from China suggested that 40.4% of the sampled youth were suffering from psychological problems.[9] As of now, India lacks with systemic nationwide study except a few narrative discussions and cases on psychological impact of COVID-19 outbreak on youth.[10]

Therefore, we aimed to assess the mental health of youth groups during COVID-19 with the purpose to serve as strong evidence and suggestion for formulation health care needs policymaking.


  Methods Top


Study design

With a quantitative approach, this web-based, cross-sectional study was conducted using the snowball sampling technique to gather information regarding the mental impact of COVID-19 on young Indian residents. Data collection was done using Google Form survey. Invitation for participation was made through social media sources.

Study participants and dissemination

Due to nationwide lockdown in India, it was not feasible to conduct a systematic community-based survey, therefore we opted for an online survey. The study was conducted after almost 2 months of the quarantine, between May 23 and May 29, 2020. The developed survey was made accessible to ten participants for a pilot survey to understand the clarity and acceptance of the self-reported questionnaire. After revision to facilitate comprehension, the questionnaire was distributed through a URL link in both English and Hindi languages with a standardized description. WhatsApp and Facebook were selected to disseminate the questionnaire as both are the most popular social media platforms.[11]

Survey instrument and scoring

The survey consists of a questionnaire on the following three major themes:

(1) Demographics which consist of questions on sociodemographic information – gender, age, marital status, type of residence, education status, staying at home; (2) psychological impact assessment through Depression, Anxiety, and Stress Scale-21 (DASS-21); and (3) assessment of COVID-19-related stressors.[12] As the survey was offered in both English and Hindi languages, a backward translation approach was used in the conversion of English questions into Hindi, and discrepancies were resolved and verified with the help of bilingual researchers.[13]

Depression, Anxiety, and Stress Scale-21

Mental health was measured using DASS-21, which is a 21-item self-reported questionnaire developed by the University of New South Wales, Australia, based on the following three subscales – depression, anxiety, and stress. Each subscale consists of seven questions on a 4-point rating scale ranging from 0 (did not apply to them at all) to 3 (apply to them very much). In depression, scores above 9 were classified as mild depression (10–12), moderate depression (13–20), severe depression (21–27), and extremely severe depression (28–42). In anxiety scores above 7 were classified as mild anxiety (7–9), moderate anxiety (10–14), severe anxiety (15–19), and extremely severe anxiety (20–42). In Stress, scores above 10 were classified as mild stress (11–18), moderate stress (19–26), severe stress (27–34), and extremely severe stress (35–42).[14] The Cronbach's alpha coefficient of DASS-21 was 0.733.

Statistical analysis

Categorical variables were expressed in absolute values (percentage) and continuous variables were expressed in mean ± standard deviation (SD). Multivariate logistic regression analysis was performed to establish a relation between the participants and mental health status. Pearson's correlation coefficient (r) was used to evaluate the association between COVID-19 stressors and psychological impact. Data were analyzed using IBM SPSS version 22.0. (Released 2013. IBM SPSS Statistics for Windows, Version 22 Armonk, Chicago, Illinois: IBM Corp.). The statistical significant level was set at P < 0.05.

Ethical approval

The study was cleared by the Institutional Ethical Committee, Nims University, Rajasthan, Jaipur. The cover page includes electronic informed consent with a declaration of confidentiality and anonymity of the participants. The study was conducted following the Checklist for Reporting Results of Internet E-surveys guidelines.[15]


  Results Top


Characteristics of the respondents

Among a total of 684 participants, 479 completed the questionnaires (83.4%), including 278 (58.04%) males and 201 (41.96%) females. Their age ranged from 15 to 30 years; most of the participants belonged to the age group of 20–25 years (47.0%). Majority (61.8%) of the respondents were single; 64.5% lived in urban areas, 33.8% were postgraduates, and 61.2% lived with a family [Table 1].
Table 1: Demographic characteristics by Depression, Anxiety, Stress Scale-21, n=479

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Psychological impact and subscales

The psychological impact of COVID-19 in the outbreak, as measured by DASS-21, revealed a mean score of 12.49 (SD = 7.87). On depression subscale, 186 (38.3%) respondents were considered to have a normal score, whereas 175 (36.5%), 82 (17.1%), 25 (5.2%), and 11 (2.3%) participants were considered to have mild, moderate, severe, and extremely severe depression scores. On anxiety subscale, 174 (36.3%) participants were considered to have a normal score, whereas 158 (32.9%), 92 (19.2%), 32 (6.6%), and 24 (4.8%) respondents were considered to have mild, moderate, severe, and extremely severe anxiety scores. On stress subscale, 163 (34.0%) respondents were considered to have a normal score, whereas 138 (28.8%), 99 (20.4%), 47 (9.8%), and 33 (6.8%) participants were considered to have mild, moderate, severe, and extremely severe scores [Table 1].

Factors influencing psychological impact and demographic variables

Univariate analysis

[Table 1] reveals a significant association in the anxiety and stress DASS-21 subscales. Although age and education did not have any significant relation with any characteristics, the type of living area and the category of living with family had a significant association with depression, anxiety, and stress subscales.

Multivariate regression analysis

To determine the factors associated with psychological problems, multivariate logistic regression analysis was conducted. The results showed that participants who are female (odds ratio [OR] = 2.76, 95% confidence interval [CI]: 1.70-4.46), who are married (OR = 2.30, 95% CI: 1.47–3.88), who reside in rural areas (OR = 2.89, 95% CI: 1.74–4.78), and those who are not living with family (OR = 2.91, 95% CI: 1.77–4.79) were associated with stress DASS subscales, although participants with postgraduate qualification (OR = 1.43, 95% CI: 0.51–4.03) and those who are not living with family (OR = 1.42, 95% CI: 1.00–2.01) had an association with anxiety and depression DASS subscales [Table 2].
Table 2: Multivariate analysis of association between sociodemographic characteristics by psychological impact

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Correlation between the COVID-19 stressors and psychological impact during the COVID-19 pandemic

Worries about the economic influence were positively related to the level of stress (r = 0.312, P < 0.001), whereas physical illness in COVID-19 was positively related to the level of anxiety (r = 0.269, P < 0.001) in youth participants. Moreover, COVID-19-related influence on daily life correlated with anxiety (r = 0.260, P < 0.002) and stress levels (r = 0.279, P < 0.001). In addition, the results suggested a negative association between social support and psychological problems in youths [Table 3].
Table 3: Correlation analysis between COVID-19-related stressors and Depression, Anxiety, Stress Scale

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  Discussion Top


COVID-19 is not only a public health emergency but also an unprecedented challenge to our economy and livelihood in peacetime, resulting in mental health sequelae. To our knowledge, our study is the first report on mental health outcomes among youths from India after 2 months of stringent lockdown on March 24, 2020, to terminate the spread of infection.[16] Our Ministry of Health and Family Welfare in collaboration with reputed national institutes is trying to mitigate the negative impact of COVID-19.[17]

Our study findings will assist government health officials and policymakers to target specific youth populations. This survey indicated that 24.63% of respondents had moderate-to-extremely severe depressive symptoms, 30.89% had moderate-to-extremely severe anxiety symptoms, and 37.36% respondents had moderate-to-extremely severe stress symptoms, which is consistent with a Chinese study on youth by Liang et al.[9] Adolescents and teenagers have different “psyche,” which makes them experience emotions more intensely. However, wearing a facemask is an effective method to reduce the spread of infection. Young people tend to be more sensitive to the perceived judgment of others. Having popular role models wearing masks might help in this case.[18] Lockdown and its sudden implication on future studies, ubiquitous social distancing affecting interpersonal relationships, and contagious infodemics on social media are acting as factors intensifying the psychological response of youths.[19],[20] Studies have suggested that poor couple interaction or poor relationship quality also affects their mental health, such as anxiety or depression symptoms during pregnancy. Therefore, behavior of husbands affects their wives' mental health and the reverse and vice versa. Hence, their support or positive behavior may mitigate their emotional distress or improve their mental health.[21] In India, over 32 million students were affected due to the closure of educational institutes which have disrupted their lifestyle and physical activity linking up with negative physical and mental health outcomes.[22] According to the study, the higher level of psychological distress may come from a greater level of problematic social media use. Problematic social media use in children with overweight requires additional attention during prolonged school suspension after the COVID-19 outbreak; further addiction or prolonged use of social media has been found to be a great risk of overweight. Unfortunately, such dependence on social media is not significantly increased in terms of time spent, this may trigger the development of psychological distress, especially for schoolchildren.[23] According to a survey by the Center of Monitoring the Indian Economy, 11% of youngsters from 20 to 24 years' age group had lost their jobs in April 2020 following a nationwide lockdown for the containment of infection.[24] In this survey, it was found that young females are prone to have psychological problems, which is consistent with previous studies demonstrating that acute psychological disorders are more prevalent in women than men. Evidence is suggestive that women have a more reactive neural network toward arousal response and fear in comparison to men.[25] Multivariate logistic regression analysis suggested that living in rural areas was associated with increased stress level; this might be explained due to multifactorial reasons which includes a deficit of awareness, inadequate level of nutrition, and statutory public health centers causing prolonged stress regulating psychoneuroimmunological release of pro-inflammatory cytokines.[26],[27] Living with family was a protective factor against psychological problems in the COVID-19 pandemic, similar to the findings in the existing research.[28] Consistent with our postulate, COVID-19-related stressors which include economical effect, physical illness, and impact of daily life were positively associated with mental health outcomes.[12] An unexpected finding was the nonstatistical significance of educational status and the statistical significance of marital status to youth respondents.[29] This could be due to the low sample size of participants, limiting the inference of the finding.[9] Using personal protective equipment at workplace, social distancing, periodic cleaning, and maintaining respiratory hygiene are some few ways out to reduce the spread of infection and thus stress among youth.[30] Further, mutual race discrimination, fear and stigma toward disease lead to negative control over disease, which need to address by designing an antistigma program and by increasing knowledge toward disease, which is ultimately helpful in reducing depression, anxiety, and stress among youth, especially on social media.[31] The Government of India along with the Press Information Bureau had started conferencing and broadcast live on a daily basis and had also setup a dedicated website and social media channels to inform the public about the COVID-19 epidemic and the disease control measures being undertaken. Through these actions, people receive not only correct and timely information but also supportive and encouraging messages, substantially lowering public fear and anxiety.[32]

Limitations

Due to inherent study design, sampling was restricted to social media platforms as a result, possibility of socially desirable response to mental health issues leading to the probability of bias in the study. Second, in comparison to the diversity of the Indian youth population, increased representativeness of the sample and longitudinal study nature will improve the generalizability of findings. Furthermore, mental health is a complex concept associated with innumerable factors such as fear which we failed to assess. Future studies using validated and specific scales such as FC19-S, with robust psychometric properties, will explain in-depth mental health outcomes. The FC19-S is only a 7-item scales and has the advantage of brevity and available in different language versions, which is useful to develop cross-cultural comparisons and is easy to administer.[33],[34],[35]


  Conclusion Top


In summary, study demonstrated a significant psychological impact of COVID-19 outbreak on larger proportion of youth population in India which includes younger age, female gender, with higher education level, and being married. Living in urban areas and with families were considered as protective factors against this psychological impact. The mental health of youths has been positively affected by an economic stressor, physical illness, and changes in daily life. Though the Government of India is taking effective measures with the goal of self-reliance by funding to economic disrupted classes especially focused on youth, living in rural areas through government schemes by providing directory benefits for social and health security, comprising telepsychiatry consultations in collaboration with health care organizations. Government policymakers should develop, time-crisis oriented psychological intervention targeting grass root level, as India is developing country with high socio-economic diversity.

Financial support

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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