Psychological aspect of common people during lockdown.

BACKGROUND: Lockdown was implemented to restrict the transmission of COVID-19. This brought upon many unforeseen hurdles, including mental health problems. AIM: The aim of the study is to assess the impact of lockdown on mental health.
MATERIALS AND METHODS: A cross-sectional study was conducted using Google Form, which the participants were requested to complete online. The questionnaire included sociodemographic information and general health questionnaire (GHQ)-12, which was used to screen for mental health.
RESULTS: A total of 343 participants took part in the study in which 113 participants (32.9%) were having GHQ score of less than or equal to 12. The study showed that people aged less than 41 years were able to concentrate more during lockdown (75.6%) as compared to people aged more than 41 years (65%). Younger participants who were less than 41 years reported sleep disorders associated with late-night entertainment and TV viewing (24.5%). Many experienced stress during lockdown, but it was more in people over 60 years (63.7%).
CONCLUSIONS: An appreciable proportion of the participants faced stress during lockdown. Elderly people were more affected. Sleeping disorders were associated with late-night entertainment and TV viewing in younger people. Copyright:

The World Health Organization defined mental health “as a state of well-being in which every person realizes his or her potential, can cope with normal day-to-day stresses of life, can work productively and fruitfully, and is able to contribute to his or her community.”[1] Conventionally, clinicians can successfully assess the state of an individual's well-being by gauging substance abuse, anxiety, distress, and depression.[2] Health is not merely an absence of ill health but is also defined as a “…state of complete physical, mental, and social well-being.[3] The general health questionnaire (GHQ)-12 helps screen psychological disorders in primary healthcare and outpatient settings.[456]

December 2019 saw a cluster of pneumonia-like disease, first reported in Wuhan, China, which was identified as novel coronavirus and later renamed as coronavirus disease 2019 (COVID-19).[7] More than a year has gone by and the world has seen around 190 million infections by the virus with 4 million deaths.[8] Lockdown was proposed as an emergency measure to restrict the movement of people to interrupt transmission.[9] It is estimated that one-third of the world's population were under some sort of restriction and lockdown.[10] A recent study on psychological impact of quarantine during the SARS pandemic showed a wide range of mental health impact ranging from stress, insomnia, depression, anxiety, and PTSD.[11] India clamped nationwide lockdown on March 24, 2020. We assessed the impact of lockdown in mental health using GHQ-12 as a screening tool.

MATERIALS AND METHODS

A cross-sectional study was conducted through Google Form using social media such as WhatsApp groups. Approval of institutional ethical committee was obtained before starting the study. All participants gave written informed consent. The study was conducted over a period of 3 months. A total of 343 participants over 18 years took part in the study.

Tool

The General Health Questionnaire (GHQ12) is a 12 item scale which is widely used as a screening test for mental health status.[12]

Methodology

In addition to the responses to GHQ-12, sociodemographic information such as gender, age, occupation, and residence was collected. Besides, we included questions about the effects of lockdown on concentration, sleep, self-confidence, and stress during lockdown. A pilot study was done first. Based on the results of pilot study, the calculated sample size was 300. After taking informed consent from participants, all the information was collected on predesigned and pretested questionnaire through Google Forms. Data collection was done for 1-month period. Data from 343 participants were collected.

Statistical analysis

Data analysis was carried out using Epi-Info TM 7.2.3.0 statistical software (developed by Centers for Disease Control and Prevention in Atlanta, Georgia). Categorical data were presented as numbers and percentages. Quantitative data were summarized with mean and standard deviation. Mann–Whitney U-test was used to test for significant differences.

RESULTS

Age and gender distribution of the participants

Out of the 343 participants, 149 (43.4%) were males and 194 (56.56%) were females; 207 (60.34%) were between 21 and 40 years and 11 (3.20%) were above 60 years. Most were from big cities such as Pune which had 106 (30.90%) participants and Delhi which had 39 (11.37%) participants. 82 (23.90%) participants were doctors, 125 (36.44%) participants were students, and 25 (7.2%) were in government service.

Participants aged between 21 and 40 years and above 60 years were not able to concentrate on task during lockdown as compared to other age groups. The elders also experienced difficulty in falling asleep due to worries related to news of COVID-19 and its consequences. All the participants highlighted that they were capable of making decisions during lockdown, but participants over 60 years were felt less confident. Stress was experienced by all age groups during lockdown more commonly between those 21 and 40 years of age, followed by participants with age less than 21 years and those above 60 years [Table 1].

Table 1

Age distributions of responses

Components	Mean (SD)				Total All age (343)
	Age groups (years) (n)
	18-20 (53)	21-40 (207)	41-60 (72)	60 plus (11)
You have been able to concentrate on whatever you are doing during lockdown	1.16 (0.87)	1.53 (0.91)	1.25 (0.93)	1.61 (0.86)	1.16 (0.83)
You are experiencing difficulty in falling asleep due to worries related to news of COVID-19 and its consequences	1.16 (0.91)	1.66 (0.97)	0.75 (0.68)	1.63 (0.92)	1.05 (0.90)
You feel like you are playing a useful part in things (household work) during the lockdown	0.80 (0.61)	1.06 (0.79)	0.68 (0.60)	1.12 (0.78)	0.75 (0.64)
You feel that you are capable of making decisions about things during this lockdown	1.04 (0.70)	1.08 (0.73)	1.06 (0.68)	0.85 (0.62)	0.98 (0.68)
You are experiencing constant strain (mental pressure) during lockdown due to pandemic	1.48 (0.91)	2.13 (0.83)	1.25 (0.77)	1.69 (0.88)	1.43 (0.91)
You feel like you could not overcome your difficulty during lockdown	1.38 (0.85)	1.33 (0.81)	1.43 (1.03)	1.63 (0.85)	1.28 (0.83)
You feel like you are enjoying your normal day-to-day activities during lockdown	1.49 (0.88)	1.80 (1.01)	1.43 (0.81)	1.60 (0.78)	1.32 (0.87)
You have been able to face up your problems during the lockdown	1.49 (0.88)	1.80 (1.01)	1.43 (0.81)	1.60 (0.78)	1.09 (0.68)
You have been feeling unhappy and depressed during long stay in home	1.38 (0.94)	1.52 (1.20)	1.58 (0.99)	1.19 (0.96)	1.36 (0.96)
You are feeling less confident in yourself during this phase of lockdown	1.14 (0.86)	1.08 (0.94)	1.12 (0.84)	1.08 (0.83)	1.14 (0.85)
You think yourself as a worthless person during the period of lockdown	0.84 (0.81)	0.95 (0.92)	0.93 (0.96)	1.06 (0.96)	0.89 (0.87)
You have been feeling reasonably happy during this phase of lockdown	1.28 (0.75)	1.34 (0.77)	1.41 (0.80)	1.27 (0.81)	1.29 (0.77)

SD – Standard deviation; COVID 19 – Coronavirus disease 2019

Majority were able to enjoy their daily activities and could manage problems with ease during lockdown. Few participants felt that they were “feeling less confident” and “feeling worthless” during the lockdown. Female participants were able to focus more on task during lockdown as compare to male counterpart (P = 0.0008). Sleep difficulty was seen more among women (P = 0.0094). Compared to females, more males believed that they were capable of making decisions during lockdown (P = 0.112); however, it was not statistically significant. Both genders equally felt stress due to lockdown (P = 0.84). Female participants felt that they consider themselves worthless during lockdown, whereas fewer males felt so (P = 0.28); however, the difference was not significant [Table 2].

Table 2

Gender distributions of responses

Components	Gender (n)				P
	Male (149) Mean (SD)	Median	Female (194) Mean (SD)	Median
You have been able to concentrate on whatever you are doing during lockdown	0.99 (0.79)	1	1.30 (0.83)	1	0.0008
You are experiencing difficulty in falling asleep due to worries related to news of COVID 19 and its consequences	0.91 (0.88)	1	1.16 (0.90)	1	0.0094
You feel like you are playing a useful part in things (household work) during the lockdown	0.72 (0.68)	1	0.75 (0.60)	1	0.4408
You feel that you are capable of making decisions about things during this lockdown	1.05 (0.72)	1	0.92 (0.64)	1	0.1120
You are experiencing constant strain (mental pressure) during lockdown due to pandemic	1.44 (0.87)	1	1.41 (0.93)	1	0.8493
You feel like you could not overcome your difficulty during lockdown	1.32 (0.80)	1	1.26 (0.85)	1	0.5372
You feel like you are enjoying your normal day-to-day activities during lockdown	1.27 (0.87)	1	1.34 (0.86)	1	0.5014
You have been able to face up your problems during the lockdown	1.08 (0.70)	1	1.10 (0.65)	1	0.7487
You have been feeling unhappy and depressed during long	1.35 (0.96)	1	1.36 (0.97)	1	0.9986
You are feeling less confident in yourself during this phase of lockdown	1.13 (0.85)	1	1.10 (0.85)	1	0.6779
You think yourself as a worthless person during the period of lockdown	0.81 (0.76)	1	0.96 (0.94)	1	0.2864
You have been feeling reasonably happy during this phase of lockdown	1.26 (0.73)	1	1.31 (0.81)	1	0.5272

The data reject normality and therefore Mann-Whitney test (independent samples) was applied. SD – Standard deviation; COVID 19 – Coronavirus disease 2019

DISCUSSION

Lockdown due to COVID-19 pandemic led to concerns regarding its impact on mental health. The widespread lockdown is expected to have a psychological impact on individuals, families, and communities.[13] People with age less than 21 years and participants aged between 41 and 60 years felt reduction in concentration during the lockdown period. Overall mean of this component of GHQ-12 was 1.16 which was much lesser than 2.68 which were seen in another study which took place between March and April 2020.[14]

Reports about anxiety, fear, frustration, loneliness, anger, depression, and stress were found commonly associated with restrictive measures, such as quarantine and lockdown.[13] Headline Stress Disorder was named for the psychiatric disorder caused by too many news coverage. It is a highly emotional response such as feeling of anxiety and stress, to endless reports from news media.[15] Another review article assessed the psychological impact of quarantine, reported insomnia, exhaustion, anxiety, and irritability as few common symptoms.[16] Sleep changes were observed during the COVID-19 lockdown. People went to bed later during the lockdown compared to prelockdown period. There was a significant increase in the waking hours. Other investigators have also reported insomnia and sleep disturbances during the COVID-19 pandemic.[17]

Msherghi et al.[18] reported irritability (70.8%), anger (70.1%), and fatigue (61.5%) among people under restrictive measures. These symptoms need to be addressed.[18] Similar to the present study, other studies have reported mental health issues in young adults.[192021]

While both genders faced more or less similar levels of stress, it has been reported than men underreport it due to societal expectations to be stronger mentally.[22]

Like in our study, 27% of people living in Michigan had suffered from low self-esteem during the pandemic, 22% of females in the above study felt the same, and 42% of people expressed that their self-esteem during pandemic has gone down.[23]

The findings of the study are limited to those with access to smartphones and having knowledge of the English language. This could lead to selection bias. In addition, it was an online survey, with inherent limitations. There is a need to find out the effect of repeated lockdowns on mental health by field studies.

CONCLUSIONS

Mental health of both young and old was affected in varying degrees by the lockdown. Some of the issues were stress, not able to overcome difficulties, feeling unhappy and depressed, and lack of confidence. Long periods of lockdown can have adverse effects on mental health.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.