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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 10  |  Issue : 1  |  Page : 26-31

A study of perception of stress in COVID-19 suspected and confirmed patients during the process of screening, diagnosing, and treatment in a tertiary care center during the COVID-19 pandemic


Assistant Professor (MD Pulmonary Medicine), Department of Pulmonary Medicine, Bangalore Medical College and Research Institute, Bangalore, Karnataka, India

Date of Submission06-Jul-2021
Date of Decision06-Dec-2021
Date of Acceptance18-Dec-2021
Date of Web Publication19-Apr-2022

Correspondence Address:
Dr. K.U. Vivek
Assistant Professor, Department of Pulmonary Medicine, Victoria Hospital Bangalore Medical College and Research Institute-560002
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jacp.jacp_30_21

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  Abstract 


Importance: Coronavirus disease 2019 (COVID-19) is a disease caused by the novel coronavirus severe acute respiratory syndrome coronavirus 2. Research has shown that pandemics tend to have an impact on the mental health of the community. Objective: As the COVID-19 disease continues to spread, anxieties and stress related to it continue to increase exponentially. The present study has been conducted to assess the perception of stress in COVID-19 suspected or confirmed positive patients. Design, setting, and participants: This was a prospective cross-sectional study conducted on 1000 COVID-19 suspected and confirmed patients to assess their levels of stress during the screening, diagnosis, and treatment processes. The duration of the study was 3 months. The perceived stress scale (PSS) was used to assess the participant’s levels of stress since the previous month. Results: Out of the total number of patients, 63.80% were males and 36.20% were females. Nearly half of the participants, that is, 52.60% were between 18 and 30 years of age and 42.50% of the surveyed participants had stress levels in the high perceived stress category. We concluded that there is a prevalence of perceived stress associated with COVID-19 at high levels. Conclusion and relevance: These results therefore necessitate the need for stress management and counseling therapy to cope with the psychologic distress caused due to COVID-19. Future research and surveys must be conducted to assess the psychologic impact caused in individuals due to pandemics.

Keywords: COVID-19, psychological impact, stress


How to cite this article:
Vivek K, Deepa A, Arun B, Nagaraja C, Shashibhushan B. A study of perception of stress in COVID-19 suspected and confirmed patients during the process of screening, diagnosing, and treatment in a tertiary care center during the COVID-19 pandemic. J Assoc Chest Physicians 2022;10:26-31

How to cite this URL:
Vivek K, Deepa A, Arun B, Nagaraja C, Shashibhushan B. A study of perception of stress in COVID-19 suspected and confirmed patients during the process of screening, diagnosing, and treatment in a tertiary care center during the COVID-19 pandemic. J Assoc Chest Physicians [serial online] 2022 [cited 2022 Dec 4];10:26-31. Available from: https://www.jacpjournal.org/text.asp?2022/10/1/26/339687




  Introduction Top


Coronavirus disease 2019 (COVID-19) caused by the virus severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) which originated in China in December 2019 was declared as a pandemic by the World Health Organization (WHO) on March 11, 2020.[1] It has globally affected 183 million people, resulting 3,978,581 deaths as per WHO report on July 6, 2021.[2] Till date, COVID-19 continues to spread across the country and has resulted in 30,585,229 confirmed cases and 402,728 deaths as on July 6, 2021.[3]

Measures such as isolation, lockdown, and quarantine are necessary to contain the spread of pandemics. Studies have demonstrated that people’s mental health is known to get adversely affected when they are restricted to a certain kind of environment.[4] Several reports during the lockdown suggest that mental illness is on the rise since the outbreak of the novel coronavirus. A recent survey conducted by the Indian Psychiatry Society indicates a 20% rise in patients suffering from mental illness.[5]

The study in the United Kingdom which explored the association between high serum total cortisol concentrations and mortality from COVID-19 showed that patients with COVID-19 with high serum cortisol levels caused due to physiologic stress are at risk of increased mortality and reduced survival.[6]

To the author’s knowledge, no original research has been conducted to assess the perception of stress in COVID-19 suspected or confirmed positive patients. Therefore, to address the current gap in literature, this study aims to estimate the perception of stress in COVID-19 suspected and positive patients during the process of screening, diagnosis, and treatment of COVID-19.


  Materials and methods Top


We conducted a prospective cross-sectional study on 1000 positive and suspected COVID-19 patients at the Department of Pulmonary Medicine, Victoria Hospital affiliated with the premiere institute Bangalore Medical College and Research Institute. The Victoria Hospital was the first designated COVID-19 hospital with 1000-bedded capacity established exclusively for COVID-19 in India. This study was approved by the Institutional Ethics Committee.

All confirmed COVID-19-positive subjects who were above 18 years of age as well as COVID-19-suspected patients who visited the COVID-19 screening outpatient department (OPD) at the hospital or were quarantined at home or at the hospital were eligible to participate in the study. Patients were enrolled after providing their consent for participation. Patients were excluded from participating in the study if they were unwilling to give consent for participation or had any previous or existing psychiatric illness.

Patients visiting the COVID-19 screening OPD at the facility were asked to fill out a hard copy of the questionnaire. All patients who participated were asked questions based on the perceived stress scale (PSS) questionnaire and once the survey was completed, the scores were entered on to the system and then calculated. Data were collected over a period of 3 months. The survey was in English, hence no translation and back translation were required.

Study participants were asked to provide demographic information on age, gender, education level, marital status, and occupation. They were also asked to list down their comorbidities. The participants were informed about the purpose of their participation and were under no coercion to participate in the survey. They were also aware that they could opt out at any time.

For the purpose of this survey, the PSS was used [Table 1]. The PSS is the most widely used psychologic instrument for measuring the perception of stress. The items are easy to understand, and the response alternatives are simple to grasp. Moreover, the questions are of a general nature and hence are relatively free of content specific to any subpopulation group. The questions in the PSS ask about feelings and thoughts during the last month. In each case, respondents are asked how often they felt a certain way. PSS scores are obtained by reversing responses (e.g., 0 = 4, 1 = 3, 2 = 2, 3 = 1, and 4 = 0) to the four positively stated items (items 4, 5, 7, and 8) and then summing across all scale items. Individual scores on the PSS can range from 0 to 40 with higher scores, suggesting higher perceived stress. As per the PSS score, individuals with scores between 0 and 13 are said to have low perceived stress levels, scores between 14 and 26 suggest moderate perceived stress levels, and scores between 27 and 40 suggest high perceived stress levels.
Table 1 Perceived stress scale

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  Results Top


In total, 1000 people participated in this survey. Among the participants who were surveyed, 52.60% were in the age group of 18 to 30 years, 42.90% were in the age group of 31 to 59 years, and 0.42% of the participants were above 60 years of age. About 63.80% of the participants were males and the remaining 36.20% were females. About 14% of the participants reported comorbidities which are mentioned in [Table 2] and [Table 3].
Table 2 Demographic characteristics of the participants

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Table 3 Patients reporting comorbidities

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As shown in [Table 4],[Table 5],[Table 6], 45% of participants who were in the age group of 18 to 30 years had high perceived stress levels, whereas 39% of participants in the age group of 31 to 59 years had moderate perceived stress levels. About 90% of senior citizens had high perceived stress levels. This shows that younger and older age groups had high perceived stress levels. About 47% of male participants had moderate perceived stress levels, whereas 74% of female participants showed high perceived stress levels. This shows that the incidence of high stress was more in women than in men. About 41% of married participants had moderate perceived stress levels, 56% of unmarried participants had high perceived stress levels, and 91% of participants who were either divorced or widowed had high perceived stress levels. Forty-three percent of participants with associates degrees and 49% with bachelor’s degrees had moderate perceived stress levels, whereas 90% of participants with master’s degrees and 58% of participants who had completed their secondary school education or lower had high perceived stress levels. With regards to occupation, 48% or businesspersons and 49% of professionals were in the moderate perceived stress category. High perceived stress levels were observed in students (76%), retired persons (100%), and unemployed persons (82%).
Table 4 Stress levels as indicated by perceived stress scale scores

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Table 5 Relationship perceived stress scale scores with gender and marital status

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Table 6 Assessment of perceived stress scale scores and educational qualifications

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In total, 21.10% of the participants had a low perceived stress level with scores between 0 and 13, 37.10% had a moderate perceived stress level with scores between 14 and 26, and 42.50% of the participants reported a high perceived stress level with scores between 27 and 40.

As shown in [Table 7] and [Table 8], 425 (42.5%) of the participants scored for high perceived stress associated with COVID-19. The incidence of high stress was greater in women than in men. Two hundred and sixty-eight participants (63.06%) were females and 157 participants (36.94%) were males. More than half of the highly stressed patients were young adults. Two hundred and forty (56.47%) were between the ages of 18 and 30 years, 147 (34.59%) were between the ages of 31 and 60, and 38 participants (8.94%) were above 60 years of age. Among these individuals, 305 (71.76%) had no comorbidities, whereas 120 (28.23%) reported having comorbidities.
Table 7 Assessment of perceived stress scale scores and occupation

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Table 8 Participants with high perceived stress scale (PSS) scores

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  Discussions and conclusions Top


This study was conducted in suspected and confirmed positive COVID-19 patients. There have been several instances of increased stress, depression, and even suicides in COVID-19-positive patients. Recent studies have shown that the current COVID-19 pandemic is associated with distress, anxiety, fear of contagion, depression, and insomnia. Such factors along with economic difficulties may lead to the development or exacerbation of stress-related disorders and suicidality in vulnerable populations including individuals with pre-existing psychiatric disorders, low-resilient persons, individuals who reside in high COVID-19 prevalence areas, and people who have a family member or a friend who has died of COVID-19.[7] Repeated exposures to news and media about COVID-19 facts, figures, and fatalities can instill and intensify a sense of dread and panic in a person who is tested positive or is suspected to be COVID-19 positive. Constant worry and fear may lead to various psychologic disorders such as anxiety, depression, and sleep disorders. In severe cases of psychologic disturbances, patients may even commit suicide.

Another aspect of increased stress due to COVID-19 is its economic implications. Till date, there is no known treatment or vaccine available for the disease. A large number of vaccines, whose clinical trials are underway, still have time before they can be administered to the general population. The USFDA has authorized the use of certain antiviral drugs to be used as emergency treatment in case of severe cases of COVID-19. However, the cost of such treatment is quite high. Due to the current state of lockdown that has been imposed in the country, a large number of people have lost their jobs. Therefore, these treatments as well as hospitalization costs prove to be a burden on patients who are already stressed.

There is a high probability that the COVID-19 survivors especially survivors who had severe COVID-19 are at elevated suicide risk. Stressful experiences such as learning about the diagnosis of COVID-19, fear of infecting others, symptoms of the illness, hospitalization, especially admission to an intensive care unit, and loss of income may lead to the development of anxiety, depressive, and post-traumatic stress disorder.[8] A recent study in China indicated that 96.2% of recovering COVID-19 patients had significant post-traumatic stress symptoms.[9] Around 50% of recovered patients remained anxious after the 2003 SARS epidemic in Hong Kong. COVID-19 infection is associated with neurologic conditions including acute ischemic stroke, headache, dizziness, ataxia, and seizures. A recent review of the impact of the COVID-19 on the brain show that neurologic conditions are present in about 25% of the COVID-19 patients.[10] Many recovering COVID-19 patients have physical symptoms including pain for a long time. Neurologic disorders such as ischemic stroke, headache, and seizures are associated with suicidal behavior. Physical symptoms, especially pain also increase suicide risk.

It is imperative to decrease stress, anxiety, fears, and loneliness in the general population especially in the current COVID-19 scenario. Traditional and social media campaigns to promote mental health and reduce distress must be encouraged. People need to be encouraged to stay connected and maintain relationships by telephone or video, get enough sleep, eat healthy food, and exercise. It is vital to deliver community support for those living alone and to encourage families and friends to check in. Screenings for anxiety, depression, and suicidal feelings should be employed. Transparent, timely, and responsible media reporting is absolutely necessary. Mental health helplines should be available and may be very useful in preventing or aggravating mental illness. Integration of basic mental health services into outpatient primary care may help to minimize the harmful psychologic effects of the COVID-19 crisis. Whenever possible, governments and nongovernmental organizations should provide financial support for people in needs. This may include direct cash payments, postponement of loan repayments, tax credits, etc.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Huang CL, Wang Y, Li XW et al. Clinical features of patients infected with2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506.  Back to cited text no. 1
    
2.
Coronavirus Disease. World Health Organisation. Available at https://www.who.int/emergencies/diseases/novel-coronavirus-2019. [Acessed date 5th July 2021].  Back to cited text no. 2
    
3.
COVID-19 Latest Updates. Ministry of Health and Family Welfare-Government of India. Available at https://www.mohfw.gov.in. [Acessed date 5th July 2021].  Back to cited text no. 3
    
4.
Rehman U, Shahnawaz MG, Khan NH et al. Depression, anxiety and stress among Indians in times of Covid‑19 lockdown. Community Ment Health J 2021;57:42-8.  Back to cited text no. 4
    
5.
20% Increase in Patients with Mental Illness Since Coronavirus Outbreak: Survey. India Today. Available at https://www.indiatoday.in/india/story/20-per-cent-increase-in-patients-with-mental-illness-since-coronavirus-outbreak-survey- 1661 584-2020- 03–31. [Acessed date 5th July 2021].  Back to cited text no. 5
    
6.
Tan T, Khoo B, Mills EG et al. Association between high serum total cortisol concentrations and mortality from COVID-19. Lancet 2020;8:659-60.  Back to cited text no. 6
    
7.
Verma S, Mishra A. Depression, anxiety, and stress and sociodemographic correlates among general Indian public during COVID-19. Int J Soc Psychiatry 2020;66:756-62.  Back to cited text no. 7
    
8.
Ćosić K, Popović S, Šarlija M, Kesedžić I. Impact of human disasters and covid-19 pandemic on mental health: potential of digital psychiatry. Psychiatria Danubina 2020;32:25-31.  Back to cited text no. 8
    
9.
Zhang Y, Ma ZF. Impact of the COVID-19 pandemic on mental health and quality of life among local residents in Liaoning province, China: a cross-sectional study. Int J Environ Res Public Health 2020;17:2381.  Back to cited text no. 9
    
10.
Sher L. The impact of Covid-19 pandemic on suicide rates. QJM 2020;113:707-12.  Back to cited text no. 10
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]



 

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