|Year : 2020 | Volume
| Issue : 2 | Page : 118-127
Anxiety related to COVID-19 infection: An online survey among the general public in India
Sandeep Grover, Swapnajeet Sahoo, Aseem Mehra, Ritu Nehra
Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
|Date of Submission||12-Sep-2020|
|Date of Decision||19-Sep-2020|
|Date of Acceptance||25-Sep-2020|
|Date of Web Publication||23-Feb-2021|
Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012
Source of Support: None, Conflict of Interest: None
Background: There are widespread anxiety and fear related to contracting COVID-19 infection in the general public ever since the outbreak of COVID-19, which had now increased to a great extent due to the ever-rising number of positive cases and mortality rates associated with COVID-19. Aim: The present study aimed to evaluate the anxiety related to contracting COVID-19 infection in the public. Methodology: An online survey was conducted using the SurveyMonkey® platform-generated link in which a COVID-19 anxiety-specific questionnaire was used to assess anxiety and worry related to contracting COVID-19. A total of 462 responses were analyzed. About one-sixth (18.8%) of the responders reported anxiety in at least one domain and worry in at least one domain related to contracting COVID-19 infection. While 42.2% of the responders had anxiety in at least one domain, highest being in the domain of anxiety related to behaviors of others, about one-fourth of the responders (26.6%) expressed worry in at least one domain, more in the domain of worry related to family members going out to buy something or for work. Males and people of younger age group had significantly greater anxiety score, and those with a chronic physical illness had significantly greater worry score. Conclusion: The present study suggests that there is a heightened level of anxiety in the society due to COVID-19 and about 18.8% of the people may be having anxiety severe enough to require clinical attention. However, the survey findings should be interpreted well with regard to its limitations being circulated in few social media platforms and, therefore, may not be generalized to the entire country.
Keywords: Anxiety, COVID-19, worry
|How to cite this article:|
Grover S, Sahoo S, Mehra A, Nehra R. Anxiety related to COVID-19 infection: An online survey among the general public in India. J Mental Health Hum Behav 2020;25:118-27
|How to cite this URL:|
Grover S, Sahoo S, Mehra A, Nehra R. Anxiety related to COVID-19 infection: An online survey among the general public in India. J Mental Health Hum Behav [serial online] 2020 [cited 2021 Jun 14];25:118-27. Available from: https://www.jmhhb.org/text.asp?2020/25/2/118/309965
| Introduction|| |
The COVID-19 outbreak since December 2019 and its subsequent transformation into a pandemic had resulted in several challenges to humanity and the health-care system across the World. As per the recent World Health Organization (WHO) Statistics (as on August 10, 2020), COVID-19 had infected >19.4 million individuals across 216 countries with about 7.22 lakhs deaths worldwide. The WHO and national authorities of every country have been using various strategies to tackle the COVID-19 infection and minimize the associated mortality. There had been promotion of hand hygiene measures, infection control practices; creating awareness over mobile caller tunes, telecommunication, social media platforms; practicing social distancing, closure of the schools, colleges, shopping arcades, etc., and the “lockdown” strategy and complete “shut down” or seal off strategies are being used to control the spread of COVID-19 infection. While all these measures are of immense importance in view of the propensity for rapid spread of infection and the associated mortality, these have also created a sense of “panic” in the general public. The repetition of the same instructions again and again so as to safeguard oneself and their significant others from getting infected has also resulted in anxiety, fear, and apprehension in the general public., Further, irrational panic buying and stockpiling of groceries, medicines, masks, etc., among the general public has added to the fear and anxiety., While there is uncertainty about resuming back to usual routine soon across the World, the COVID-19 pandemic had resulted in an economical set back to all countries, most affected being the low- and middle-class populations of the low- and middle-income countries., Along with these, there are several rumors/myths related to spreading of COVID-19 infection from particular groups/communities of people, specific objects (newspapers, fomites, etc.) as well as several indigenous methods/strategies to reduce the risk of infection or to cure the infections (ginger/garlic use, herbal teas, drinking hot water/cow's urine, etc.) being circulated in social media platforms that have added to the anxiety. Till now, there is no specific cure/vaccine to curb the COVID-19 crisis, which is leading to further uncertainty in the minds of the laypersons. Many persons are also hooked on to the news channels and web pages to keep a track on the growing number of cases per day or even per hour. All these add on to the prevailing anxiety and are fuelling the ongoing anxiety of contracting COVID-19 infection.
Time and again, it had been stressed upon not to ignore the mental health needs of the public and the health-care workers during this COVID-19 crisis. Some of the common mental health issues which have been identified so far in patients with suspected infection, those under quarantine, and among health-care professionals are anxiety and depressive symptoms, feelings of hopelessness, feelings of isolation, insomnia, decreased appetite, etc., Providing psychological first aid to the affected individuals and the health-care workers has been recommended by the WHO. In addition, several tips for coping with COVID-19-related anxiety and stress have been proposed by the WHO. However, it is essential to know the viewpoints of the general public about their knowledge, awareness about contracting COVID-19 infection, and the level of prevailing anxiety, so as to allay the prevailing anxiety among them. Adequate knowledge about the public's viewpoint about their anxiety and fear about COVID-19 can help in planning appropriate information broadcasting and educational materials/programs which can benefit broader community at large.
Considering the fact that currently there is widespread anxiety among the people, irrespective of the profession, the current study was planned with an aim to evaluate the anxiety related to contracting COVID-19 infection as well to evaluate the prevailing anxiety and concerns of the public related to getting infected with COVID-19.
| Methodology|| |
It was an online survey to assess the level of anxiety related to the COVID-19 infection. The study was approved by the institute's Ethics Committee.
For formulating the items for the assessment for the study, a focused group discussion was held among 4 mental health professionals telephonically to design a scale to assess COVID-19-related anxiety. In addition, 5 telephonic interviews were held with people who currently reported anxiety related to COVD-19 and 5 people who presented to the emergency services with COVID-19 anxiety were also interviewed. The specific issues, which emerged during the discussions, were the fact that people are scared of developing the infection themselves, infecting others, have a fear of death/painful death, and were unsure about the extent to which they should follow the hand hygiene measures and social distancing. The fear and anxiety are much more among or for the elderly and those with physical comorbidities. The factors which are associated with rise in anxiety include having symptoms (of cough, fever, rhinitis, etc.), facing certain situations (such as meeting strangers, going out, and bringing things to home), coming to know that someone (relative/neighbor) has been found to be/suspected to be/or quarantined for suspected COVID-19, and following the news related to COVID-19 on various platforms. The autonomic anxiety symptoms are often accompanied by disturbances in sleep, appetite, and mood. Based on this information, a questionnaire was designed to assess anxiety specifically related to COVID-19 infection. Scoring pattern for the different domains was descriptive with ratings of 0–4, except for one domain of the scale, in which participants were asked to rate the items on 0–10 numeric points. For all the domains, mean scores were calculated, and if the participants scored >1 standard deviation of the mean score, they were considered to have anxiety or worry in that domain.
Initial few questions of the survey inquired about the basic information about the participants in the form of age, gender, marital status, employment, educational qualifications, and comorbid physical illness. These were followed by sections, specifically inquiring about psychophysiological reaction on listening to the word COVID-19, worry related to getting infected with COVID-19 or getting near ones infected by COVID-19, general health-care measures one is currently indulging to monitor his/her health parameters (monitoring blood pressure, temperature, pulse, etc.), level of anxiety on experiencing cough, fever, sneezing, etc., and anxiety in different social situations.
The questionnaire had 5 anxiety domains and 2 worry domains. The 5 anxiety domains included anxiety following listening to the word “COVID-19/coronavirus” (8 items); anxiety and level of tension, experienced while experiencing certain symptoms (7 items); behavioral response to anxiety related to contracting COVID-19 infection (3 items); anxiety related to COVID-19 infection in different situations linked with COVID-19 (14 items); and anxiety related to behaviors of others (6 items). The 2 worry domains were worry related to the prevailing scare of COVID-19 infection (15 items) and reaction to the individual when one of his/her family members goes out to buy something or for work (9 items). Based on these sections, the mean total anxiety score and the mean worry score were calculated. In addition, the prevalence of anxiety in each domain was calculated by estimating the proportion of the participants who scored >1 standard deviation above the mean in the particular domain, total anxiety domain, and total worry domain.
The questionnaire thus developed was circulated online through the SurveyMonkey® platform. For this, a link was generated for the questionnaire which was circulated to the general public on the WhatsApp® and Facebook®/Twitter® platforms. A nonprobability snowball sampling technique was followed, in which people participating were expected to forward the link further. The link of the survey was circulated in the 1st week of April, i.e., from April 5, 2020, and the survey was closed on April 14, 2020. The survey invitation clearly stated that the participants have the right not to participate in the survey and participation in the survey would imply providing informed consent. Further, it was mentioned that strict confidentiality and anonymity will be maintained. The survey questionnaire was circulated in English language and would take 10–12 min to complete.
Descriptive statistics were applied, and the data collected were analyzed using the Statistical Package for the Social Sciences (SPSS)® (developed by IBM, Stanford, United States), 20.0 version. Frequency/percentages were calculated for nominal/ordinal variables, and mean and standard deviation were calculated for each item score, i.e., continuous variables. Pearson correlation coefficient was used to evaluate the association of anxiety in different domains. Comparisons were done using t-test.
| Results|| |
During the survey period, a total of 465 responses were collected, of which 462 responses were included in the analysis (3 responses were excluded due to noncompletion of the entire survey questionnaire). The mean age of the participants (439 responses; other participants did not complete this information) was 40.66 (standard deviation [SD]: 13.82) years. More than half of the participants were males (55.6%), about two-thirds of the participants had completed postgraduation (64.3%), and another one-third had completed graduation (33.3%). Only a small proportion of the participants were educated up to 12th (1.7%) or up to 10th only (0.6%). Majority of the participants were married (75.6%), and most of them were residing with their spouses (69.5%). In terms of profession, about one-third of the participants were doctors (35%). Majority of the participants were residing in cities (85%), with a small proportion belonging to town (10.4%), and very few participants were from village (4.1%). About one-fourth (n = 120; 26.0%) of the participants had at least one chronic physical morbidity (diabetes mellitus [n = 30], hypertension [n = 77], malignancy [n = 3], and asthma/chronic respiratory illness [n = 10]), 36 (2.8%) had a minor illness (obesity [n = 30], arthritis [n = 4], and migraine [n = 2]), and two-third had no physical illness (n = 306; 66.2%).
Psychophysiological reaction to encountering (listening or seeing or both) the word “COVID-19/coronavirus”
As shown in [Table 1], half of the participants reported that encountering the word “COVID-19/coronavirus” “ sometimes ” led to psychological reaction of anxiety and sadness, and about one-fourth reported that it led to anxiety “often/most of the time/always.” About one-sixth reported emotional reaction of sadness “often/most of the time/always.” About one-fourth of the participants reported experiencing “palpitation/increased heart rate” “sometimes or more,” and one-third reported feeling “restless” “sometimes or more.” Other autonomic symptoms were less frequently experienced [Table 1]. The mean score was highest for the anxiety, followed by sadness, restlessness, and palpitations.
|Table 1: Anxiety following listening to the word “COVID-19/coronavirus” (anxiety domain 1)|
Click here to view
Anxiety and tension on experiencing certain symptoms
Only a few participants reported anxiety and tension related to experiencing certain symptoms. Among the listed symptoms which elicited at least moderate level of anxiety and tension in about one-fourth of the patients was 'difficulty in breath'. Other symptoms which elicited at least moderate level of anxiety in about 15% or more of the participants were fever and sore throat [Table 2].
|Table 2: Anxiety and level of tension experienced while experiencing certain symptoms (anxiety domain 2)|
Click here to view
Behavioral response to anxiety
Very few participants showed behavioral responses, in the form of checking their blood pressure, temperature, and pulse, due to anxiety [Table 3].
|Table 3: Behavioral response to anxiety related to contracting COVID-19 infection (anxiety domain 3)|
Click here to view
Anxiety related to specific situations which can lead to COVID-19 infection
When the participants were given a list of specific situations, which are likely to elicit anxiety of contracting COVID-19, at least moderate level of anxiety was reported for facing situations or having to face the situation by 60% of the participants, if they came to know that neighbor is a confirmed case of COVID-19. Less than half reported moderate level of anxiety reported that they would experience/experienced at least moderate level of anxiety if they came to know that their neighbor is found to be a suspected case of COVID-19 (45%), meeting a person with travel history (45%), on knowing that the person visiting them is a health-care worker managing patients with COVID-19 (35%), and on listening to news related to COVID-19 (31.6%). Other situations which led to or may lead to moderate or higher level of anxiety in at least one-third of the participants were as follows: following statistics of number of COVID-19 cases, following statistics of deaths due to COVID-19, someone standing or sitting close to them, accepting things from strangers, accepting online orders, purchasing things from market, and listening to news that someone in close vicinity is suspected to have COVID-19 infection [Table 4].
|Table 4: Anxiety related to COVID-19 in different situations linked with COVID-19 (anxiety domain 4)|
Click here to view
Anxiety related to behaviors of others which can elicit anxiety related to COVID-19 infection
In terms of behaviors of others, which elicited about 50% or more level of anxiety in about one-third of the participants were someone spits near them (44%), someone coughing near them (37%), someone near them reports of fever (36%), someone sneezes near them (35%), someone near them has running nose (33%) and someone near them reports of having visited hospital in last few days (31%) [Table 5].
|Table 5: Anxiety related to behaviors of others which can elicit anxiety related to COVID-19 infection (anxiety domain 5)|
Click here to view
Worries related to the prevailing scare of COVID-19 infection
When asked about the worries related to different aspects, more than one-fourth (30.5%) were worried to some extent or more about themselves getting infected with COVID-19. Nearly equal proportion were worried to “some extent or more” about their children (32%) and spouse (33%) being infected. However, the highest proportion (44.4%) were worried to “some extent or more” about their parents getting infected. When asked about infecting others, about one-fourth were worried to “some extent or more” about themselves infecting their children, spouse, and parents. When asked about they getting infected from others, 45% were worried to “some extent or more.” About one-fourth to one-fifth of the participants were also worried to “some extent or more” with respect to not being able to escape the infection, death of self, death of loved ones, hospitalization, and of being quarantined. A small proportion were worried to “some extent or more” about the issues related to cremation and other rituals [Table 6].
|Table 6: Questions relating to worry, which the individual may be experiencing due to the prevailing scare of COVID-19 infection (worry domain 1)|
Click here to view
Worries related to one of your family members going out to buy something or work
When enquired about the worries related to someone from the family going out of home to buy something or work, about one-third or more of the participants reported that they “most of the time or always” instruct him/her for wearing mask (54%), instruct him/her for maintaining social distancing (48.7%), do not allow him/her to enter the house without using the sanitizer at the doorstep (44%), make him/her bath immediately after entering the house (33.1%), and keep his/her belonging (clothes, shoes, etc.) separately (34.9%) [Table 7].
|Table 7: Reaction to the individual when one of his/her family members goes out to buy something or for work (worry domain 2)|
Click here to view
The prevalence of anxiety in each domain was calculated by estimating the proportion of the participants who scored more than one standard deviation for that domain. As shown in [Table 8], the proportion of participants with anxiety and worry in each domain varied from 10% to 4% to 19.3%. In terms of proportion of participants with anxiety in at least one domain, 42.2% had anxiety. In terms of worry in at least 1 domain, 26.6% had worries in at least 1 domain [Table 8]. When the proportion of participants with anxiety in at least 1 domain and worries in 1 domain was estimated, it was seen that 18.8% fulfilled these criteria. The approach used was of a conservative nature in which those responders whose mean score of all domains in anxiety and worry exceeded the mean plus one SD were considered to be positive for anxiety/worry domain and the prevalence was calculated. This was done so as to include all those with increased anxiety and worry greater than the mean score who may require clinical attention.
|Table 8: Estimated prevalence of anxiety and worry related to contracting infection|
Click here to view
When the association of different anxiety and worry domains was evaluated, as shown in [Table 9], psychophysiological reaction domain of anxiety correlated significantly with all other domains of anxiety and both the domains of worry. Anxiety and tension related to symptom domain correlated with all the domains of anxiety and worry, except for the behavioral response domain and worries related to one of the family members going out. Other details are given in [Table 9]. A strong and significant association was seen between mean anxiety score and mean worry score (Pearson's correlation coefficient value – 0.570; P < 0.001***).
|Table 9: Association between anxiety and worry domains related to contracting COVID-19 infection|
Click here to view
Association of anxiety and worries with other variables
When the association of the mean anxiety and mean worry score with respect to sociodemographic variables was carried out, participants who were of younger age had significantly higher anxiety score (Pearson's correlation coefficient value: −0.108; P = 0.023*) and higher worry score (Pearson's correlation coefficient value: −0.184; P < 0.001***). Compared to females (mean score – 87.2; SD – 29.9), males had higher mean anxiety score (mean: 96.7; SD – 29.4), and the difference was statistically significant (t-test value – 3.419; P = 0.001***). When those with chronic physical illnesses (hypertension and diabetes mellitus), compared to those without these morbidities, patients with chronic physical illnesses had significantly higher worry score (t-test value: −2.940; P = 0.003**). The mean anxiety and mean worry scores were not related significantly with the place of residence, educational qualification, current profession, and marital status.
| Discussion|| |
While every possible step is being taken to control the spread of the infection, yet the rapid rise in the number of confirmed cases of COVID-19 and the mortality associated with it along with the “lockdown” across the globe has added to the anxiety and worry in the public.
Many studies have evaluated the prevailing anxiety using different scales, which have reported that 29%–80% of the responders have anxiety or preoccupation with thoughts related to COVID-19.,, However, the scales used in these studies are not specific to the prevailing pandemic (Beck Anxiety Inventory and the Generalized Anxiety Disorder-7 item scale), and hence, they may not be able to provide the exact prevalence of anxiety. Hence, it is important to assess the anxiety and worry related to COVID-19 using a specific scale. During the inception and drafting of the study results, only one study was available in this regard. In this study, mental health professionals from Shanghai Mental Health Center, China, developed a COVID-19-specific “Peritraumatic Distress Index (CPDI)” – a 24-item descriptive scale (score ranging from 0 to 4) which inquired about the frequency of anxiety, depression, specific phobia, cognitive change, voidance and compulsive behavior, physical symptoms, and loss of social functioning in the past week. However, as the anxiety related to COVID-19 is multidimensional, the questionnaire used in the present study possibly provides broader evaluation of anxiety.
Anxiety related to COVID-19 is multidimensional ranging from fear/panic of contracting infection, fear of getting near ones infected, fear of death to different behavioral and avoidance responses in different situations. The study questionnaire so developed was very broad and took into account the psychophysiological reactions in the individuals when they encountered the word “COVID”/coronavirus, experience of anxiety on having symptoms similar to common flu, behavioral response of anxiety, anxiety related to exposure to specific situations in the individual and anxiety related to behaviors of others, worries related to prevailing scare of infection, and worries when any family member goes out for buying essential goods or to work. Therefore, the survey questionnaire so developed attempted to account for almost all the aspects of anxiety and worries associated with contracting COVID-19. Accordingly, it can be said that compared to a previous study from India and 2 studies from China,, the estimates of anxiety using this scale may be more useful in assessing the anxiety and also addressing the prevailing myths related to COVID-19 infection and also might help possibly in formulating some recommendations for media, with respect to spreading infection about COVID-19. Further, we attempted to draw cutoffs for the scale, using more conservative approach, to identify people, who may require clinical attention.
Two Chinese studies, which have explored the psychological states of the public during the outbreak of COVID-19 in different regions of China have reported anxiety and depression to be in the range from 6.33%–28.8% to 16.5%–17.17%, respectively (as per the Self-Rating Anxiety Scale, Self-Rating Depression Scale, and Depression, Anxiety, and Stress Scale-21). In the present study, the prevalence of anxiety in at least one domain varied from 10.4% to 19.3%, depending on the various subscales, and the worry varied from 14.3% to 17.5%. When the proportion of people estimated to have anxiety and worry in at least one domain, 18.8% scored above the cutoff, and when more conservative estimate was used, 5.5% of the participants had anxiety in 3 domains and worry in at least 1 domain. If one goes by these conservative estimates, it can be said that at least 5.5%–18.8% of the participants have anxiety and worry, which possibly requires clinical attention and management. Therefore, the current study results are in line with the estimates of the Chinese surveys.,
While three Chinese surveys had revealed that higher rates of anxiety and depressive symptoms in younger people (21–40 years) and students,,, another study reported greater anxiety risk in participants aged >40 years. In the present study too, when the association of anxiety and worry was evaluated with age, it was seen that anxiety and worry were more in younger people. There could be many reasons for higher prevailing anxiety and worries in younger people, one of which could be due to higher fear of death among young than older people, who are possibly more mentally prepared for adverse outcome at this stage of their life. There is a lack of consensus with respect to the association of gender with anxiety, with some of the studies reporting lack of any gender differences,, and others suggest higher prevalence of anxiety in females., However, in the present study, males were found to have significantly higher anxiety than females. This could be due to the fact that they are more often expected to go out of the home (for shopping/buying essential commodities, etc.) and work. Further, this can also be attributed to difficulties in maintaining isolation, social distancing, travel restrictions, etc., in Indian context. Another factor which could contribute to this higher anxiety in males is the fact that recent findings have suggested that males are more vulnerable to COVID-19 infection.,
Another finding of the study was higher level of worry in those with chronic physical illnesses such as hypertension and diabetes mellitus, which is understandable, as available data suggest that these people are at increased risk to COVID-19 infection and are estimated to have higher level of mortality.,
There are reports to suggest that a heightened level of distress and anxiety due to listening to repeated updates related to COVID-19 and always remaining preoccupied with contracting infection can precipitate physiological symptoms of anxiety which can lead to a vicious cycle of further anxiety and can set the individual to a “panic” mode. Similar responses have been provided by the recent online Indian survey from India. Findings of the present study too suggests that psychophysiological reaction on encountering the word “COVID-19,” about one-fourth of the responders reported anxiety and sadness “often/most of the time/always” and a sizeable proportion reported “sometimes or more” having physiological symptoms of palpitations (26.6%) and feeling restless (34.7%). These findings suggest that there is a need to draw a line between providing information and overflooding a person with information and this must be kept while reporting facts about COVID-19. Similarly, it can also be said people should seek, useful, desirable information about the infection, rather than trying to follow all the information, which can increase the scare.
With regard to behavioral responses to anxiety related to contracting COVID-19 infection, few participants engaged themselves in checking their blood pressure, temperature, and pulse frequently. This small subgroup of individuals may be considered to be having extreme anxiety, as evident from their behavioral response to anxiety. However, it is also possible that these behavioral responses were less frequent than estimated because many of the participants were not directly associated with medical profession and hence did not know how to assess these parameters.
The international and national health advisories of the countries have set down many precautions to be carried out in different situations to prevent getting infected by COVID-19 infection, such as avoid going out from home unless in emergency or to buy essential goods, maintain good hand hygiene, maintain social distancing, etc. The present study suggests that the common scenarios in which the participants reported at least moderate level of anxiety were when they came to know that neighbor is a confirmed case of COVID-19, if they came to know that their neighbor is suspected to have COVID-19, while meeting a person with travel history, on knowing that the person visiting them is a health-care worker managing patients with COVID-19 and on listening to news and updates related to COVID-19. Further, behaviors of others which elicited or could elicit about 50% or higher level of anxiety in the responders were when someone would sneeze/sneezed, would cough/coughed, spitted/spits, had running nose near the individual, and when one comes to know that someone near him had visited a hospital in last few days. All these suggest that anxiety related to contracting COVID-19 is not only limited to coming in contact with a COVID-19 patient but also is quite broad and widespread to different situations, and people possibly believe that there may be many undiagnosed cases in the community. While listening to or remaining updated with basic precautions of contracting the infection is advisable, yet it is prudent to overcome the abovementioned related thoughts and responses, and more awareness is required to be dispensed to the public to reduce the anxiety related to COVID-19. It is also possible that these prevailing anxieties might emerge as social isolation, social boycott, and stigmatizing those who contracted the infection.
A study from Singapore which evaluated anxiety during the severe acute respiratory syndrome outbreak also had reported higher level of anxiety toward neighbors being quarantined and while seeking/visiting general practitioner clinics. Considering COVID-19 to be a pandemic affecting over a million people across the World, greater degree of anxiety in the public is clearly evident from the findings of the present study. Another study which explored the psychological predictors of anxiety in response to the H1N1 pandemic found health anxiety, contamination fears, and greater disgust sensitivity to be the significant predictors of anxiety in the participants. Findings of the present study of anxiety in response to someone sneezing, spitting, coughing, etc., (contamination fears) also point toward similar reactions.
Another important finding of the present study was evidence of worry related to the prevailing scare of COVID-19 infection in about 30% of the responders in different aspects ranging from worries related to getting the infection themselves or development of infection in their children and spouse, which was further more (44%) with regard to infecting parents. Further, worry related to contracting COVID-19 also extended to not being able to escape infection, death of self, getting hospitalized, or being quarantined. As the COVID-19 infection had been found to be getting transmitted through fomites and can be prevented by following basic hand hygiene, maintaining social distancing, wearing masks, etc., worries related to contracting COVID-19 infection was found to be reflected by repeating asking the family member to follow the precautions when they step out to buy something or for work.
The present study was limited to the responders who had smartphones with Internet and WhatsApp access and ability to read English. Therefore, the study findings depict the anxiety and worries related to contracting COVID infection in the educated mass, majority of whom were residing in cities. Considering the fact that the vast majority of the Indian population resides in small towns and in rural areas and the survey questionnaire was limited to circulation in few social media platforms, the results could not be generalized to the entire country, and there is every possibility of higher or lower level of anxiety and worries in the rural communities related to contracting COVID-19 infection, who are more worried about the impact of pandemic on their livelihood due to lockdown. Other limitations of this survey include the use of a tool which has not been validated before use in public due to the nature of COVID-19 pandemic, limited representation of elderly participants, and inclusion of participants > 18 years. This survey was cross sectional in nature, and resultantly, it might not have captured the dynamic aspect of the psychological responses related to the COVID-19 situation, which is rapidly changing.
In summary, the present study suggests that there is a heightened level of anxiety in the society due to COVID-19 and about 18% of the people may be having anxiety severe enough to require clinical attention. Hence, in this changed scenario, while evaluating people with anxiety and depressive symptoms clinicians should routinely question them about anxiety and worries specifically related to COVID-19 infection, allay the same by providing authentic information and clarifying their myths. In addition, the clinicians need to utilize strategies such as distraction, relaxation exercises, and cognitive therapy to address excessive anxiety. Further, at the community level, mental health professionals should advocate for authentic but useful information for the public, rather than they being flooded with minute-to-minute updates, like that of commentary of a cricket match. Media should refrain from talking much about mortality statistics, ongoing treatment trials, or beneficial effects of certain medications, as this is possibly fuelling the prevailing anxiety in the society. More awareness programs aimed at allying the anxiety of the common public is the need of the hour.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Duan L, Zhu G. Psychological interventions for people affected by the COVID-19 epidemic. Lancet Psychiatry 2020;7:300-2.
Xiang YT, 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.
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;51:102092.
Zhao N, Huang Y. Chinese mental health burden during COVID-19 outbreak: A web-based cross-sectional survey. Asian J Psychiatry 2020;102052.
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 J Psychiatr 2020;51:102083.
Qiu J, Shen B, Zhao M, Wang Z, Xie B, Xu Y. A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: Implications and policy recommendations. Gen Psychiatr 2020;33:e100213.
Wang Y, Di Y, Ye J, Wei W. Study on the public psychological states and its related factors during the outbreak of coronavirus disease 2019 (COVID-19) in some regions of China. Psychol Health Med 2020:1-10.
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. Int J Environ Res Public Health 2020;17.
Guan W, Liang W, Zhao Y, Liang H, Chen Z, Li Y, et al
. Comorbidity and its impact on 1590 patients with COVID-19 in China: A nationwide analysis. Eur Respir J 2020;55.
Wang B, Li R, Lu Z, Huang Y. Does comorbidity increase the risk of patients with COVID-19: Evidence from meta-analysis. Aging (Albany NY) 2020;12:6049-57.
CDC COVID Response Team. Preliminary estimates of the prevalence of selected underlying health conditions among patients with coronavirus disease 2019 United States, February 12–March 28, 2020. MMWR Morb Mortal Wkly Rep 2020;69.
Vijaya K, Low YY, Chan SP, Foo LL, Lee M, Deurenberg-Yap M. Behaviour of Singaporeans during the SARS outbreak: The impact of anxiety and public satisfaction with media information. Int J Health Promot Educ 2005;43:17-22.
Wheaton MG, Abramowitz JS, Berman NC, Fabricant LE, Olatunji BO. Psychological predictors of anxiety in response to the H1N1 (swine flu) pandemic. Cogn Ther Res 2012;36:210-8.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9]