Survey of Stress in COVID Patient Post Treatment: A Qualitative Research.

AIM: The purpose of our study was to examine the mental health status of patients with coronavirus disease-19 (COVID-19) who were hospitalized.
METHODOLOGY: In this cross-sectional study, 106 inpatients with COVID-19 who had stable clinical conditions were evaluated psychologically by questionnaire: Depression, anxiety, and stress scales-21 (DASS-21).
RESULTS: About one-third of patients had comorbidities. In totality, 97.2% of patients with COVID-19 had some grade of depression. Extent of depression, assessed with the help of the DASS questionnaire, was 85.8%. All patients (100%) had serious (0.9%) and grave level of (99.1%) anxiety. Regarding to stress levels, 97.1% of patients had some degree of stress. In the worsening of stress category, 84.9% of patients had high-stress levels.
CONCLUSION: The presence of such increased prevalence and seriousness of psychiatric disorders among hospitalized patients with COVID-19 underlines the necessity for serious consideration to the mental health standing of these patients. Copyright:

INTRODUCTION

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of the transmission of the novel coronavirus disease-19 (COVID-19), which is associated with the ability to transmit the disease from humans to humans. The disease is connected with grave health problems and can be deadly.[1] As some authors have recommended, severe acute respiratory syndrome (SARS) caused by coronavirus, as the primary outbreak of an infectious disease in the 21st century, was not the last one and COVID-19 was presented as a pandemic former this century.[2] A current review of the literature on the psychological effects of quarantine throughout past epidemics and pandemics (e.g., SARS, H1N1, Ebola, MERS, and equine influenza) emphasized that, when associating the psychological outcomes of quarantined versus nonquarantined persons, the former are more likely to show psychological distress.[3] Furthermore, quantitative studies have underlined that quarantined persons have a high prevalence of psychological symptomatology, with posttraumatic and depressive indications, stress, and anxiety.[4567] A new study on the influence of the COVID-19 emergency designated that “53.8% of participants rated the psychological influence of outbreak as moderate or severe; 16.5% of respondents reported moderate-to-severe depressive symptoms; 28.8% of respondents reported moderate-to-severe anxiety symptoms; and 8.1% reported moderate-to-severe stress levels.”[8] Similarly, Qiu et al. reported that almost 35% of the 52,730 participants in their study showed psychological distress.[9] With the upsurge in the number of infected patients and their deaths, many patients may have psychological suffering and physical glitches.[10] Randomness and doubt of the disease condition of diverse aspects of epidemiology and effective methods of treatment puts people exposed to stressful situations.[11] Fear of the consequences of a deadly disease, combined with severe anxiety and mental distress, which can coincide with insomnia and the physical effects of the disease, can create unfavorable conditions for patients due to the aggravation of mental health disorders.[121314] Early in the SARS epidemic, hospitalized patients raised concerns such as fear, loneliness, fatigue, and anger. They had anxiety as a consequence of fever and the ill effects of insomnia. Anxiety is seen as a significant effect of epidemics with high levels of involvement and risk of death, both among people who are directly involved in the disease and among the masses. This can be accompanied by depression and other psychological problems.[15] Duan and Zhu perceiving that the epidemic of diseases can have undesirable effects on individuals, highlight the presence of psychological distress subsequent to the spread of the COVID-19 and the need for active and appropriate intervention in this area.[16] In this regard, Zheng noted the high prevalence of psychiatric disorders among survivors of the SARS-CoV-2 epidemic, including depression and posttraumatic stress disorder (PTSD), and highlighted the position of prevention, screening and treatment of related psychiatric disorders during the COVID-19 pandemic.[17] Concerning age, both young adults (aged 18–30 years) and the elderly (older than 60 years) have been found to display the highest levels of psychological distress, while results have diversed across studies. A medical history of chronic illness has also been associated with higher levels of distress.[8] Other sociodemographic variables, such as education level, have yielded mixed results, with both higher and lower education levels associated with higher levels of distress.[89] Furthermore, many studies have highlighted significant differences in individuals' reactions to threats, according to specific personality traits.[1819] For instance, the literature indicates a relationship between negative affect and detachment–two maladaptive extremes of the five-factor model of personality[20]–and internalizing psychopathology (e.g., depression and anxiety).[202122] Nonetheless, the above-mentioned literature ropes the view that compulsory isolation has a enormous impact on many facets of people's lives, initiating substantial psychological strain and generating a change of psychological problems.

Aim of the study

Our aim was to examine the mental health status of patients with COVID-19 who were hospitalized and to know about their severity of anxiety and depression.

METHODOLOGY

This study was a cross-sectional study conducted in one of the city's referral centers for patients with COVID-19 requiring hospitalization. Three psychiatric nurses achieved preliminary screening of patients based on inclusion norms to select patients to be included in the project. These patients were designated from inpatients in secluded treatment wards. All psychiatric nurses had complete personal protective equipment during screening. All information collected was transmitted electronically. Patients were consulted and if desired, entered the study after obtaining informed consent. Members in the project were adults who were affected with COVID-19 and were clinically steady and eager to participate in the research project. Above the age of 18 was one of the conditions for entering the study. Patients “demographic info was recorded with the help of patients” medical archives and were cross-checked with the patient. These comprised genders, age, marital status, employment status, and education. Patients were assessed through two questionnaires, the depression, anxiety, and stress scales-21 (DASS-21). Around 120 patients were assessed and later 106 patients were encompassed in the study. DASS-21 is an appropriate instrument for determining depression, anxiety, and stress, for research and clinical determinations and is a validated tool among varied ethnicity and population clusters.[23] This tool has three scales, each comprising seven questions. The concluding score is also attained with the sum of the scores. Each question differs from zero (”it is not related to me”) to 3 (”it is related to me”). Since this questionnaire is a condensed form of the key scale (42 questions), the last score of each subscale must be doubled. Each of the subscales is divided into four groups based on the score got: Normal, moderate, severe, and very severe. The data were entered into the IBM SPSS Statistics for Windows, Version 23.0. Armonk, NY: IBM Corp. IBM Corp. version 23. Categorical variables were denoted as mean (standard deviation [SD]) and frequency (percentage), respectively. Pearson correlation test was used to assess correlation. P < 0.05 was determined as statistically noteworthy.

RESULTS

The average age of the patients was 55 (SD = 16.92) years. About 51.9%were men and 48.1%were women. About 86.8% of the participants were married and the rest were single [Table 1].

Table 1

Demographic information of hospitalized patients with coronavirus disease-2019 (n=106)

Variable	Percent
Marital status
Single	13.2
Married	86.8
Gender
Male	51.9
Female	48.1
Co-morbidities
Hypertension	38.7
Diabetes	31.1
Hyperlipidemia	31.1
Ischemic heart disease	25.5
Asthma	7.5
Renal disease	6.6
CVA	5.7
COPD	3.8
Cancer	1.9
Rheumatological diseases	1.9
Corticosteroids	11.3

COPD: Chronic obstructive pulmonary disease, CVA: Cerebrovascular accident

The prevalence of underlying diseases in hospitalized patients with COVID-19 in our study was as follows: Hypertension (38.7%), diabetes mellitus (31.1%), hyperlipidemia (31.1%), ischemic heart disease (25.5%), asthma (7.5%), renal disease (6.6%), Cerebro Vascular Accidents (CVA) (5.7%), chronic obstructive pulmonary disease (3.8%), cancer (1.9%), and rheumatological diseases (1.9%). Furthermore, 11.3% of patients were taking corticosteroids. Overall, 97.2% of patients with COVID-19 had some degree of depression. Degree of depression, based on DASS questionnaire, was 85.8% [Table 2]. All patients (100%) had severe (0.9%) and very severe (99.1%) anxiety. Regarding to stress levels, 97.1% of patients had some degree of stress. In the severity of stress category, 84.9% of patients had severe and very severe stress. There was no statistically noteworthy relation between gender and age with depression, anxiety, stress, and insight of stress [Table 3].

Table 2

Depression, anxiety and stress scales-21 data from questionnaire of hospitalized patients affected with coronavirus disease-2019

Variable	Pearson correlation coefficient	P
Depression	0.117	0.017
Anxiety	0.017	0.865
Stress	0.274	0.005

Table 3

Prevalence of severe depression, anxiety, and stress in hospitalized patients with coronavirus disease-2019

Variable	Frequency
Severe depression	85.5
Sever anxiety	100
Sever stress	84.9

DISCUSSION

Facing the misery related to COVID-19 may result in increased occurrence of PTSD, a mental ailment directed to serious suffering and incapacity amid survivors, family members, people who deliver first aids and care, and general public. While regulation of the epidemic and maintenance of patients with COVID-19 is one of the leading tasks of the whole world, this calls for consideration to initial interference and prevention of PTSD among affected populations. In 2007, the inter-agency standing committee (IASC) announced guidelines on mental health and psychosocial support in emergency settings, which has been widely adapted to direct mental health service after disasters, including infectious disease epidemics.[24] The IASC rules are shaped round a 4-tiered intercession pyramid: (1) Reestablishing basic upkeep and security for the concerned population, (2) consolidation family and community systems, (3) giving distraught individuals with psychosocial assistance, and (4) giving dedicated mental health services for severely affected survivors. Additional policies of intervention have also been experienced in various of situations. With deliberations of the previously large and will still growing number of people unprotected to the current COVID-19, so it crucial to provide mental health service embattled at prevention of PTSD to survivors and other people infected with COVID-19. Conceivable plans comprise health education, psychosocial support, and therapy aid to the general population, as well as early involvement, including psychosocial support, psychotherapies, and pharmacological treatments to vulnerable and high-risk groups.[25] Is Hak et al. examined a group of hospitalized patients and described that the occurrence of depression amid these patients was amongst 5% and 60% and mean of 33%. They recommended that hospitalized patients be diagnosed for depression. Depression amongst hospitalized patients has been related with inferior functional consequences, inferior physical health, and re-hospitalization.[26] As noted, in our study, 97.1% of patients had some degree of depression during hospitalization. Concerning all accessible indication and the consequences of our study, it is vital to pay vivid consideration to the mental health complaints of patients with COVID-19 in order to better control possible psychiatric disorders in future.

CONCLUSION

Depression, anxiety, stress, and apparent stress were decidedly widespread amongst patients with COVID-19 in the study. There was also a deep association between depression and anxiety with alleged stress.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.