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ORIGINAL ARTICLE
Year : 2022  |  Volume : 11  |  Issue : 3  |  Page : 227-232

Screening and assessment of mental health issues in patients with COVID-19


Department of Psychiatry, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Vijayawada, Andhra Pradesh, India

Date of Submission05-Feb-2022
Date of Decision24-Mar-2022
Date of Acceptance14-Apr-2022
Date of Web Publication26-Dec-2022

Correspondence Address:
Dr. Srikanth Lella
Department of Psychiatry, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Vijayawada - 521 286, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdrntruhs.jdrntruhs_19_22

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  Abstract 


Context: COVID-19 pandemic has an impact on the mental health of the most vulnerable populations, especially those afflicted with the disease. Psychological consequences can be due to disease progression, perceived danger, fear of virus transmission to others, uncertainty, and physical discomfort among others.
Aim: To screen for mental health issues and to assess the levels of anxiety and depression in patients with COVID-19.
Setting and Design: Designed as a cross-sectional study conducted in district COVID-19 hospital.
Methods and Material: A cross-sectional study was conducted involving 510 hospitalized patients with COVID-19 between 18 and 60 years of age. Screening instrument of clinical schedule for clinical psychiatry version 2.3 was applied to screen for common psychiatric disorders and Hospital Anxiety and Depression Scale was applied to assess the levels of anxiety and depression in these patients.
Statistical Analysis Used: Data were analysed using SPSS version 25.
Results: The mean age of our sample was 38.7 years. Panic disorder followed by generalized anxiety disorder, depressive disorder, and alcohol use disorder was the most frequent psychiatric disorder in our sample of participants. Fear of infection with Corona virus was observed to be greater among the patients with COVID-19 screened for mental illnesses, and they were at an increased risk of developing symptoms of anxiety and depression.
Conclusion: COVID-19 has a significant psychological impact on the mental health of those afflicted with the disease.

Keywords: Anxiety, COVID-19 patients, depression


How to cite this article:
Bodepudi S, Lella S, Benerji T, Miyan R, Palagulla H, Kodali M. Screening and assessment of mental health issues in patients with COVID-19. J NTR Univ Health Sci 2022;11:227-32

How to cite this URL:
Bodepudi S, Lella S, Benerji T, Miyan R, Palagulla H, Kodali M. Screening and assessment of mental health issues in patients with COVID-19. J NTR Univ Health Sci [serial online] 2022 [cited 2023 Feb 7];11:227-32. Available from: https://www.jdrntruhs.org/text.asp?2022/11/3/227/365020




  Introduction Top


COVID-19 is an infectious disease caused by severe acute respiratory syndrome Corona virus 2 (SARS-CoV-2) that has rapidly spread in China and worldwide.[1] The various insecurities that arose due to the pandemic, decreased social interactions, financial constraints, the severity of illness, and lack of adequate medical support had led to adverse effects on the mental health of individuals afflicted with the disease.[2]

Strict pandemic prevention measures, mandatory closure of schools, and the suspension of all nonessential productions severely affected people's daily life, working activity, and had a significant psychological effect.[3],[4] Specific populations like the elderly, children, and health-care professionals reported different levels of psychological distress.[5],[6],[7] Psychological reactions to pandemics include maladaptive behaviours, emotional distress and responses such as anxiety, frustration, loneliness, anger, boredom, depression, stress, and avoidance behaviours.[8],[9]

It is hypothesized that patients affected by COVID-19 may experience psychiatric symptoms due to disease progression, perceived danger, fear of virus transmission to others, uncertainty, physical discomfort, and overwhelming news portrayal in mass media coverage.[10],[11] The negative effects observed in response to quarantine, isolation, and social distancing were fear, nervousness, sadness, guilt, confusion, numbness, and anxiety-induced insomnia.[12],[13]

Some patients reported post-traumatic stress symptoms before discharge, leading to lower quality of life and impaired working performance.[14] In a Chinese study, nearly 50% of those diagnosed with COVID-19 had depressive symptoms, over 55% had anxiety, 70% had somatic symptoms, and few reported insomnia, self-mutilating, or suicidal thoughts.[15]

The COVID-19 pandemic had a considerable impact on the mental health of the most vulnerable populations, especially those afflicted with the disease. Psychological care ought to be provided as part of treatment for patients with COVID-19 to preserve their mental health. This study is taken up with the aim to screen for mental health issues in patients with COVID-19 and to assess the levels of anxiety and depression in these patients.


  Methodology Top


The present study was a cross-sectional study conducted in a designated district COVID-19 hospital over a period of 2 months from 1 April 2021 to 31 May 2021 after obtaining approval from the Institutional Ethics Committee. During this period, a total of 2035 patients were admitted with COVID-19 in the hospital. All the patients diagnosed positive for COVID-19 between 18 and 60 years of age with SpO2 95 and above on room air were approached. Patients with acute medical and surgical conditions, and those not willing to participate in the study were excluded. A total of 510 patients meeting the fixed criteria were included. Informed consent was obtained from all participants after they were explained about the nature and purpose of the study and verbally assured about their information confidentiality. Sociodemographic details were obtained, including age, gender, and marital status using a semi-structured proforma developed in the department of Psychiatry.

Screening instrument of clinical schedule for clinical psychiatry version 2.3 was applied to screen for common psychiatric disorders, and Hospital Anxiety and Depression Scale (HADS) was applied to assess the levels of anxiety and depression in patients with COVID-19.

Screening instrument of clinical schedule for clinical psychiatry version 2.3 is an instrument to screen for common psychiatric disorders, including alcohol and tobacco use disorders, panic disorder, generalized anxiety disorder, depressive disorder, psychotic disorder, and fear of infection with COVID-19. It has the advantage of being brief, hence saves time and reduces the risk of prolonged exposure.[16]

The Hospital Anxiety and Depression Scale (HADS) is a self-report questionnaire designed to assess the levels of anxiety and depression. It consists of two subscales with seven items each, one measuring anxiety, and another measuring depression. Each item of the scale is scored on a four-point Likert scale (0-3). Scores of 0 to 7 on this scale are considered normal, 8-10 borderline abnormal, and 11-21 are considered abnormal.[17]

Statistical analysis was done using SPSS 25 software. The levels of anxiety and depression were assessed using the Chi-square test. A probability value of <0.05 has been taken as statistically significant.


  Results Top


The total sample comprised 510 participants between 18 and 60 years of age. The mean age of the sample of participants was 38.7 years. Most of them (19.8%) were between 36 and 40 years of age (n = 101), whereas 78 (15.3%) were between 25 and 30 years of age. Males (n = 364; 71.4%) outnumbered females (n = 146; 28.6%) in our study. Majority of them were married (n = 374; 73.3%).

Majority (n = 191; 37.5%) of our sample of participants had a fear of infection with Corona virus. Most of them had the possibility of panic disorder (n = 143; 28%), whereas 97 (19%) were found to have the possibility of generalized anxiety disorder, 93 (18.2%) depressive disorder, 75 (14.7%) alcohol use disorder, 12 (2.4%) psychotic disorder, and 5 (1%) tobacco use disorder as shown in [Table 1]. None of them resorted to self-harm.
Table 1: Results of the screening instrument of clinical schedule for clinical psychiatry

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All 75 participants of our study with the possibility of alcohol use disorder were males, which was statistically significant (p < 0.0001). Also, the majority of those with the possibility of panic disorder (n = 90; 62%) and depressive disorder (n = 47; 50.5%) were males, which was found to be statistically significant (P < 0.0001) as depicted in [Table 2].
Table 2: Results of the screening instrument of clinical schedule for clinical psychiatry as per gender

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Out of the 143 patients found to be having the possibility of panic disorder as per the Screening Instrument of Clinical Schedule, fear of infection with COVID-19 was found in 127 patients (88%), and in those with the possibility of generalized anxiety disorder (n = 97), fear of infection with COVID-19 was observed in 91 patients (93.8%), both of which were found to be statistically significant (P < 0.0001 for both panic disorder and generalized anxiety disorder) as shown in [Table 3].
Table 3: Fear of infection with COVID-19 in those with panic and generalized anxiety disorders as per screening instrument of clinical schedule for clinical psychiatry

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Results of the Hospital Anxiety and Depression Scale (HADS)—Anxiety subscale.

Out of the 510 participants of our study, 6.9% (n = 35) scored borderline abnormal, whereas 5.1% (n = 26) scored abnormal on the HADS anxiety subscale as depicted in [Table 4].
Table 4: Results of the hospital anxiety and depression scale

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Of the 143 patients with COVID-19 found to be having the possibility of panic disorder as per the Screening Instrument of Clinical Schedule, 15 (10.4%) scored borderline abnormal and 11 (7.6%) abnormal on the anxiety subscale of HADS, which were found to be statistically significant (P < 0.03). Of the 97 patients with COVID-19 found to be having the possibility of generalized anxiety disorder as per the Screening Instrument of Clinical Schedule, 15 (15.4%) scored borderline abnormal and 11 (11.3%) abnormal on the anxiety subscale of HADS, which were found to be statistically significant (P < 0.0001) as shown in [Table 5].
Table 5: Levels of anxiety in those with panic and generalized anxiety disorders as per screening instrument of clinical schedule for clinical psychiatry

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Results of the Hospital Anxiety and Depression Scale (HADS)—Depression subscale.

Out of the 510 participants of our study, 10% (n = 51) scored borderline abnormal, whereas 0.6% (n = 3) scored abnormal on the HADS depression subscale as depicted in [Table 4].

Out of the 93 patients with COVID-19 having the possibility of depressive disorder as per the Screening Instrument of Clinical Schedule, 5 (5.3%) scored borderline abnormal, whereas 3 (3.2%) scored abnormal on the depression subscale of HADS, which was found to be statistically significant (P < 0.001) as shown in [Table 6].
Table 6: Levels of depression in those with panic, generalized anxiety, and depressive disorders as per screening instrument of clinical schedule for clinical psychiatry

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  Discussion Top


The present study is taken up with the aim to screen for mental health issues in patients with COVID-19 and assess the levels of anxiety and depression in these patients.

The participants' mean age was 38.7 years. Most of them were between 36 and 40 years (19.8%) and were men (71.4%). A similar trend of age group as observed in our study was reported by Parikh NC et al.[18] in their study of screening mental health status of COVID-19–confirmed patients. Our study differed from a study by Taquet M et al.[19] in the aspect of gender, where females outnumbered males (55.4% vs 45.1%).

All the participants of our study with the possibility of alcohol use disorder were males, which is in line with the study by Yazdi K et al.,[20] whose sample was comprised of 66.9% males. In our study, the possibility of panic disorder, generalized anxiety disorder, and depressive disorder was found in more males than females, which is in contradiction to the results of Mazza MG et al.,[21] on COVID-19 survivors that found females to be suffering more from both anxiety and depression. Most of the participants in our study feared infection with COVID-19 which was observed to be highest among those with the possibility of panic disorder and generalized anxiety disorder. Al Dhaheri AS et al.,[22] in their research on the impact of COVID-19 on mental health and quality of life, found 61.0% of the participants to be feeling horrified, 61.5% apprehensive, and 45.2% helpless due to the pandemic.

Panic disorder followed by generalized anxiety disorder, depressive disorder, and alcohol use disorder was the most frequent psychiatric disorder in our sample of participants. A retrospective cohort study that examined the bidirectional associations between COVID-19 and psychiatric disorders reported anxiety disorders (generalized anxiety disorder to be more frequent than panic disorder, in contrast to our study) to be the most frequent psychiatric diagnoses, followed by mood disorder, insomnia, and psychotic disorder.[19]

Most of those with the possibility of depressive disorder (26.8%) in our study belonged to the age group 46-50, whereas 21.6% of those with the possibility of generalized anxiety disorder were between 31 and 40 years of age. In contrast, the mean age of the participants showing anxiety and depression, as reported by Mazza MG et al.,[21] was 58 years.

The HADS assessment in our study found that 12% and 10.6% of the participants showed abnormal anxiety and depression scores, respectively. In contrast to our study, the prevalence of abnormal HADS-Anxiety and HADS-Depression scores in admitted COVID-19 patients in three hospitals in China was reported to be between 20.9–41.5% and 18.6–50.5%, respectively.[23],[24],[25]

In our study, of those with the possibility of panic disorder, 10.4% scored borderline abnormal and 7.6% abnormal on the anxiety subscale of HADS and of those with the possibility of depressive disorder, 5.3% scored borderline abnormal, and 3.2% scored abnormal on the depression subscale of HADS. Higher prevalence of anxiety and depression in hospitalized patients with COVID-19 was reported by Kong X et al.,[26] wherein 17.36%, 12.5%, and 4.86% appeared to have mild, moderate, and severe anxiety, respectively, and13.89% were mildly depressed, 10.42% moderately depressed, and 4.17% severely depressed. We observed that, as in the studies of Blakey SM et al.,[27] on 2009–2010 Swine flu pandemic and Wheaton MG et al.,[28] on 2015–2016 Zika virus outbreak, health anxiety was related to increased fear of the current Coronavirus pandemic.

The COVID-19 pandemic posed a significant burden on mental health of individuals affected with the disease. Providing timely and adequate psychological support to those affected can help in dealing with stress and build resilience during such difficult situations.

This study assessed the psychological status of the patients with confirmed COVID-19 and screened them for any associated mental health issues. Although many studies focused on the impact of the pandemic on the mental health of the general population, our study remains one among the few which highlighted the mental health issues in persons afflicted with COVID-19. It was found that the fear of infection with Corona virus was greater among the patients with COVID-19 screened for mental illnesses, and that they were at an increased risk of developing symptoms of anxiety and depression. The extrapolation of our findings is restricted as the study was done in a single centre. Also, its cross-sectional nature could obtain pertinent data only at a solitary time period.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Tables

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



 

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