The coronavirus disease 2019 (COVID-19) outbreak was declared a public health emergency of international concern by the World Health Organization (WHO) on 30 January 2020, the same date when India reported its first case of the novel corona virus. On the 11th of March, WHO declared COVID-19 – a pandemic as by then about 114 countries were affected (WHO, 2020c). This has brought unprecedented efforts to institute the practice of physical distancing (called in most cases “social distancing”) in countries all over the world, resulting in changes in national behavioral patterns and shutdowns of usual day-to-day functioning.
On 24th March 2020, when a strict lockdown was announced in India as a response to contain the pandemic of COVID-19, there were only 519 confirmed cases across the country. Though the lockdown gave the government time to prepare for a possible surge in cases, India’s large population characterized by health, economic and social inequalities, presented several challenges. The sudden imposition of a curfew and strict social distancing measures along with increasing number of cases, spreading across several districts and states within the country and the grim international scenario particularly in USA and Europe provoked general concern about becoming infected. The World Health Organization emphasized that large populations were now faced with the new realities of working from home, 2unemployment, home-schooling of children, and lack of physical contact with other family members, friends and colleagues, hence it was now even more imperative to look after our mental, as well as our physical, health (WHO, 2020).
Widespread outbreaks of infectious disease, such as COVID-19, are associated with psychological distress (Bao et al., 2020). In addition, physical distancing and anxiety provoking media reports can lead to mental health concerns in the short and long term. (Sandro Galea, MD1; Raina M. Merchant, MD2; Nicole Lurie, MD3, 2020). To address the mental health concerns, the MoHFW GOI set up a mental health helpline and sent out various advisories, messages, audio and video content on Combating Mental Breakdowns.
The sparse literature on the mental health consequences of epidemics relates more to the sequelae of the disease itself (eg, mothers of children with congenital Zika syndrome) than to social distancing. However, large-scale disasters, whether traumatic (eg, the World Trade Center attacks or mass shootings), natural (eg, hurricanes), or environmental (eg, Deepwater Horizon oil spill), are almost always accompanied by increases in depression, posttraumatic stress disorder (PTSD), substance use disorder, a broad range of other mental and behavioral disorders, domestic violence, and child abuse. (Neria, Nandi , Galea, 2008)
Previous research has revealed a profound and wide range of psychosocial impacts on people at the individual, community, and international levels during outbreaks of infection. On an individual level, people are likely to experience fear of falling sick or dying themselves, feelings of helplessness, and stigma . During one influenza outbreak, around 10% to 30% of general public were very or fairly worried about the possibility of contracting the virus . With the closure of schools and business, negative emotions experienced by individuals are compounded . During the SARS outbreak, many studies investigated the psychological impact on the non-infected community, revealing significant psychiatric morbidities which were found to be associated with younger age and increased self-blame . Those who were older, of female gender, more highly educated, with higher risk perceptions of SARS, a moderate anxiety level, a positive contact history, and those with SARS-like symptoms were more likely to take precautionary measures against the infection .
The SARS epidemic was also associated with increases in PTSD, stress, and psychological distress in patients and clinicians (Lee, 2007)
Given the above, the present study was undertaken to understand the psychological fallout and mental health challenges associated with isolation and uncertainty during the first phase of the lockdown which was announced to contain the spread of the novel Corona Virus in India.
The data for the study was collected in the first week of April 2020, when India was in the middle of its first phase of the 21 day lockdown. A snowball sampling technique was used wherein an online semi-structured questionnaire was developed using google forms and was shared with contacts of the investigators through e-mails and social media. The participants were encouraged to share the link of the online survey with as many people as possible.
The link contained information regarding the study and a clause for confidentiality and informed consent. Inclusion criteria was that only those with access to the internet and comfort with filling out a google form could participate in the study. Participants with age more than 18 years, able to understand English and willing to give informed consent were included.
A total of 623 participants filled the online questionnaire. From the respondents, 614 participants provided online consent to use their data in the study. The participants responded from more than 20 states and union territories. Socio-demographic data for these 614 participants is presented in Table 1. The psychological impact of COVID-19 was measured using the using the Depression, Anxiety and Stress Scale (DASS-21). UCLA Loneliness Scale.
Inclusion criteria were: (a) 18 years and older, and (b) living in Italy. The online survey was closed on the sixth day following dissemination of the link. All participants voluntarily responded to the anonymous survey and indicated their informed consent within the survey. The procedures were clearly explained, and participants could interrupt or quit the survey at any point without explaining their reasons for doing so. Two respondents were excluded from the sample because they were younger than 18 years of age, and 44 participants were excluded because they were outside Italy during the outbreak.
The Depression, Anxiety and Stress Scale – 21 Items (DASS-21) is a set of three self-report scales designed to measure the emotional states of depression, anxiety and stress. Each of the three DASS-21 scales contains 7 items. The depression scale assesses dysphoria, hopelessness, devaluation of life, self-deprecation, lack of interest / involvement, anhedonia and inertia. The anxiety scale assesses autonomic arousal, skeletal muscle effects, situational anxiety, and subjective experience of anxious affect. The stress scale is sensitive to levels of chronic nonspecific arousal. It assesses difficulty relaxing, nervous arousal, and being easily upset / agitated, irritable / over-reactive and impatient. Scores for depression, anxiety and stress are calculated by summing the scores for the relevant items.
UCLA Loneliness Scale – UCLA LONELINESS SCALE Reference: Russell et al, 1978. A 20-item scale designed to measure one’s subjective feelings of loneliness as well as feelings of social isolation. Participants rate each item as either O (“I often feel this way”), S (“I sometimes feel this way”), R (“I rarely feel this way”), N (“I never feel this way”).