Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : November | Volume : 16 | Issue : 11 | Page : LC06 - LC12 Full Version

Loneliness and Social Support Experienced by COVID-19 Patients Attending a Telemedicine Centre of a Tertiary Care Hospital in Kolkata: A Cross-sectional Study


Published: November 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/58378.17028
Sinjita Dutta, Vineeta Shukla, Smiti Rani Srivastava, Ratul Kumar Bysack, Meghna Mukherjee, Mausumi Basu

1. Associate Professor, Department of Community Medicine, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India. 2. Postgraduate Trainee, Department of Community Medicine, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India. 3. Associate Professor, Department of Ophthalmology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India. 4. Postgraduate Trainee, Department of Community Medicine, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India. 5. Statistician, Department of Community Medicine, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India. 6. Professor and Head, Department of Community Medicine, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India.

Correspondence Address :
Dr. Ratul Kumar Bysack,
14/3B, Sovaram Bysack Street, Kolkata-700007, West Bengal, India.
E-mail: ratulbysack2000@yahoo.co.in

Abstract

Introduction: Telemedicine acted as one of the biggest medium in treating Coronavirus Disease-2019 (COVID-19) patients during the second wave of the still ongoing pandemic. Although the symptoms were taken care of and treated through teleconsultation, the loneliness and social support system of these patients went largely unrecognised. The morbidity pattern, effect of self-isolation and quarantine, uncertainties in social support were major contributors to loneliness among patients suffering from COVID-19.

Aim: To estimate the proportion of loneliness and level of social support experienced by COVID-19 patients seeking advice from a telemedicine centre of Kolkata and to find out their socio-clinical profile and the associated relationship.

Materials and Methods: An observational study with cross-sectional design was conducted on 403 COVID-19 patients, who had taken advice from the telemedicine centre of Institute of Post Graduate Medical Education and Research (IPGME and R), Kolkata for a period of 12 weeks (May-July 2021). Loneliness was assessed by the 11-item De Jong Gierveld Loneliness scale, whereas social support was assessed using 12-item Multidimensional Scale of Perceived Social Support scale through telephonic interview. Data were tabulated in the Microsoft Office Excel 2019 (Microsoft Corp, Redmond, WA, USA) and the analysis was performed using Statistical Package for the Social Sciences (IBM, New York City, USA) version 25.0.

Results: Out of 403, more than half of the study population, 194 (48.2%) belonged to 18-35 years of age. Of the total, 235 (58.3%) were males, 319 (79.2%) were currently married and 300 (74.4%) were Hindus. About 142 (35.2%) respondents had experienced severe loneliness, while 297 (73.7%) had experienced high social support. There was a significant negative correlation found between loneliness and social support (r=-0.495, p-value <0.01). It was found that being male, belonging to nuclear family, education upto higher secondary level, being addicted, loneliness due to physical distancing, and those who had socialised frequently had higher odds of loneliness, whereas unemployed, unskilled, semi-skilled and skilled occupation, having one chronic disease had lower odds of social support.

Conclusion: About 338 (84%) patients had experienced loneliness which was strikingly high. This shows a deeper aspect into the actual picture of how COVID-19 impacts mental health of those who are affected. Future interventions are needed to address loneliness and develop social support system along with addressing healthcare needs of COVID-19 patients.

Keywords

Healthcare, Mental health, Pandemic, Psychology, Teleconsultation

Deeply concerned by the alarming levels of spread and severity of Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2), the World Health Organisation (WHO) made the assessment that COVID-19 can be characterised as a pandemic on 11th March, 2020 (1). Apart from isolation, people who have been exposed to or infected with the virus, enforcement of “quarantine” and “social distancing” had to be must amongst the general population as well to cut down the spread (2). Thus, in a bid to control the pandemic, implementation of stringent social distancing, quarantine and isolation measures also led to severe sense of social isolation and loneliness among the population all over the world (3). Psychological effects of the pandemic including grief and worry appeared to underline the importance of intervention efforts (3). In other words, unlike other crisis, the COVID-19 pandemic changed how individuals live because of the uncertainty, altered daily routines, financial pressures, and social isolation associated with it. The physical distancing recommendations to reduce transmission of the SARS-CoV-2 increased the risk of social isolation and loneliness, which are associated with negative outcomes like anxiety, depression, cognitive decline, and mortality. Loneliness is the subjective feeling of isolation, not belonging, or lacking companionship. Feelings of loneliness differ from a diagnosis of depression as the former is only weakly associated with enjoyment, energy and motivation, which however are central to the diagnosis of depression. But persons who are lonely are more likely to experience depressive symptoms (4). Studies have shown that social support and psychological resilience are two resources that protect individual’s mental health in stressful situations (5),(6). Research also shows that social support is the key to resilience (7),(8).

Loneliness was predominant over Europe, the United States of America (USA), and China before COVID-19 and ranging from 10-40% and were described as a “behavioural epidemic” (9),(10),(11). This situation worsened with the restrictions imposed to contain viral spread such as social distancing, isolation and quarantine of infected patients. Thus, the COVID 19 pandemic had posed unprecedented challenges to even the world’s best healthcare systems both due to exponential increase in number of cases as well as mental health issues imposed by containment measures. Adapting to the challenges posed to the health system due to the pandemic the concept of telemedicine emerged to the fore front in Indian healthcare system. Telemedicine practices include delivery of clinical information as well as permit consultation and discussion between healthcare professionals and patients. They help to cut down travel expenses, time and medical costs, while increasing ease of access to healthcare professionals (12). Telemedicine also allows likelihood of better maintenance of records and documentation (13). Like in many other Indian hospitals the pandemic had also triggered to start telemedicine services to cater to the healthcare needs of COVID-19 patients in home-based isolation. However, though the disease related symptoms were taken care of and treated through teleconsultation, the loneliness and social support system of these patients still went unrecognised.

There is scarcity of available literature on loneliness and social support of COVID-19 patients who are availing telemedicine services (14),(15),(16),(17). Keeping this background in mind the study was conducted with the research hypothesis that COVID-19 patients attending telemedicine centre experienced loneliness. Thus, this study aimed to assess the proportion of loneliness and social support experienced by COVID-19 patients seeking advice from a telemedicine centre of Kolkata as well as to find the factors associated with them.

Material and Methods

It was a descriptive type of observational study with cross-sectional design conducted from May-July 2021, a period corresponding with the second wave of COVID-19 pandemic in India. The study setting was the Telemedicine Centre of Institute of Postgraduate Medical Education and Research, Kolkata, West Bengal, India. The study was initiated after approval from Institutional Ethics Committee (IEC) of IPGME&R, Kolkata (IPGME&R/2021/387), West Bengal, India.

Inclusion criteria: Patients older than 18 years and consenting to the interview were included in the study.

Exclusion criteria: Patients refusing to give consent were excluded from the study, 20 such patients were excluded.

Sample size calculation: The study population included COVID-19 patients having mild infection, seeking advice from the Telemedicine Centre. As on review of literature no similar type of study was found, the prevalence of loneliness among patients attending telemedicine centre was taken as 50%. Assuming 95% confidence interval and allowing 10% relative error, the minimum sample size was calculated to be 384. The sample size was taken as 423 after adjusting for 10% non-response. As 20 patients refused to give consent, the final sample arrived at 403. COVID-19 patients’ telecallers list maintained at the Telemedicine Centre prior to one month of the study was taken as the sampling frame. There were a total of 1488 callers.

Study Procedure

A simple random sampling without replacement technique was adopted to select the study participants. A predesigned pretested structured schedule was used for data collection. The schedule was developed after reviewing literature with help of three experts, including two Professors from Community Medicine and one Professor from Psychiatry. Loneliness was assessed by the 11-item De Jong Gierveld loneliness scale, which is the most widely used instrument in Europe for measuring loneliness (18). It is composed of six items formulated negatively and five items formulated positively. The first subscale, composed of neutral and negatively worded items, and called social loneliness, assesses feelings of sociability and the existence of meaningful relationships. The second, composed of the positively worded items, and called emotional loneliness, relates to feelings of abandonment and missing companionship. The sum of the social loneliness score and the emotional loneliness score gives the total loneliness score which is categorised into four levels: not lonely (score 0, 1 or 2), moderate lonely (score 3 through 8), severe lonely (score 9 or 10), and very severe lonely (score 11) (19). Social support was assessed by the Multidimensional Scale of Perceived Social Support (MSPSS) comprising of 12 items containing response options on a 7-point Likert scale ranging from very strongly disagree to very strongly agree (20). The MSPSS comprised of three subscales which are perceived support from family, friends and a significant other (other than family and friends). Sum across all 12 items, then divided by 12 provides the mean social support score. The mean social support score ranging from 1 to 2.9 is considered low support; a score of 3 to 5 as moderate support and a score from 5.1 to 7 is considered high support. The Bengali version of the scale has been validated conducted by Islam MdN among 812 Bangladeshi adults (21). Both the above two scales have been previously used on Indian population. The schedule was translated into the regional language (Bengali) by one language expert and then retranslated into English by another independent expert. It was then matched by another independent reviewer to assess consistency before applying on the study population. The schedule was the pretested among 20 callers (who were not included in the final sample) after which some modifications were made. The content validity was checked using Content Validity Index (CVI), which was 0.77, and Cronbach’s alpha was calculated to assess the reliability of the schedule (0.82).

The mobile numbers of the study participants were obtained from the telecallers list and data were collected by telephonic interview after explaining the purpose of the study and obtaining informed verbal consent. The dependent variables included loneliness and social support experienced by the study population. The independent variables included socio-demographic characteristics like age, gender, education, occupation, marital status, and type of family as well as other factors like presence of severity of symptoms, chronic diseases, addiction, place of isolation, availability of caregivers and type of activities done during isolation.

Statistical Analysis

Data were tabulated in the Microsoft Office Excel 2019 (Microsoft Corp, Redmond, WA, USA) and the analysis was performed using SPSS (IBM, New York City, USA) version 25.0. Descriptive statistical measures were employed to summarise the data. Kolmogorov-Smirnov test was performed to assess normal distribution of loneliness and social support scores (p-value <0.05 was considered as significant, that is, normal distribution). Multivariable binary logistic regression was performed to ascertain relationship between the dependent (loneliness and social support) and the independent variables (socio-demographic characteristics and other factors). All variables having a p-value <0.2 in the univariate model were considered to be biologically plausible to be included in the multivariable models. Data were checked for multicollinearity (VIF <10) and a p-value of <0.05 was considered significant. Correlation between loneliness and social support was seen using Spearman’s rank correlation coefficient (as the distribution of these variables were skewed).

Results

Out of 403, more than half of the study population, 194 (48.2%) belonged to 18-35 years of age, 235 (58.3%) were males, 319 (79.2%) were currently married and 300 (74.4%) were Hindus, 251 (62.3%) belonged to nuclear family, 261 (64.8%) were educated to at least higher secondary and 219 (54.3%) belonged to upper socio-economic class as per Modified BG Prasad Scale 2021 (22). 340 (84.4%) were in home isolation during infection, 306 (75.9%) of the study population did not have any addiction and 295 (73.2%) had care providers during infection. Most of the study population slept well at night, 323 (80.1%), 363 (90.1%) regularly socialised and 306 (75.9%) were engaged in activities that provided entertainment during infection (Table/Fig 1).

Out of 403, 338 (84%) of the study population had experienced some category of loneliness, 142 (35.2%) of the participants had experienced severe, while 122 (30.3%) had experienced moderate loneliness. Emotional loneliness was centred around 23.32% of the maximum possible score (Median=4.00; IQR=3.00) and social loneliness was centreed on 38.46% of the maximum possible score (Median=4.00; IQR=5.00). However, 297 (73.7%) respondents had experienced high social support while 18 (4.5%) and 88 (21.8%) had faced low and moderate social support, respectively (Table/Fig 2).

(Table/Fig 3) shows the logistic regression of loneliness score and social support score on socio-demographic variables. It is found that being male, belonging to nuclear family, education up to higher secondary level, being addicted, loneliness due to physical distancing, and those who had socialised frequently had higher odds of loneliness, whereas age group 36 to 52 years, being married, having more than one chronic disease, those who stayed at home isolation and had care givers had reduced odds of loneliness.

Factors which had significantly reduced odds of getting social support were unemployed, unskilled, semi-skilled and skilled occupation, having one chronic disease and those who had decreased sleep at night, whereas belonging to higher socio-economic status, staying at home isolation, presence of caregiver and loneliness due to physical distancing had significant higher odds of getting social support (Table/Fig 4).

There was significant negative correlation among loneliness and social support (Spearman’s rank correlation coefficient: -0.495, p<0.01) (Table/Fig 5).

Discussion

Restrictions imposed by the COVID-19 pandemic had led to reduced social contact and impeded face-to-face interactions. The present study was set out to assess the proportion of loneliness and level of social support experienced by COVID-19 patients seeking advice from a telemedicine centre of Kolkata, West Bengal, India. The present study reported that 84% of the participants had experienced some form of loneliness (moderate, severe or extremely severe). This was much higher than that reported by Newby JM et al., in Australia where half (50.1%) of the study population had reported feeling moderately to extremely lonely (14). Another study from India by Lahiri A et al., which evaluated loneliness among apparently healthy Indian adults during lockdown reported a prevalence rate of 54.47% (15). A study by Zhang Z et al., in China reported that among 119 COVID-19 patients, 51.3% had generalised anxiety symptoms, 41.2% had depressive symptoms, and 33.6% had Posttraumatic Stress Disorder (PTSD) symptoms, all of which were associated with loneliness be due to the quarantine and isolation policies and insufficient social support (16). Thus, addressing this issue becomes important as loneliness due to social isolation is strongly associated with anxiety, depression, self-harm, and suicide attempts across the lifespan (23),(24).

A study by Landmann H and Rohmann A among German population during COVID-19 had reported that emotional loneliness was centreed around 31% of the maximum possible score and social loneliness was centreed around 24% of the maximum possible score (17). The present study by using the same scale found that emotional loneliness was centreed around a lower level i.e., 23.32% of the maximum possible score and social loneliness was centreed around much higher level i.e. 38.46% of the maximum possible score.

In the current study, loneliness was found to be significantly associated with age group, marital status, type of family, education, socio-economic status, symptoms, presence of chronic disease, location of stay during infection, addiction, presence of caregiver, physical distancing, type of activities during isolation, and socialisation. It was seen that being married and belonging to joint family had reduced odds of loneliness. In a study conducted by Liu C et al., among general Chinese population on relationship between risk perception, social support, and mental health during the COVID-19 pandemic, it was found that about 42.5% of the respondents were not married (25). This was higher than this study where only 20.8% were not married at the time of the study. While the Chinese study reported 57% of subjects had a bachelor’s degree, in the present study only 35.2% respondents had studied up to higher secondary or above.

Newby JM et al., in their study among Australian adult population during COVID-19 pandemic reported that being female, better educated, older, and having better self-rated health were associated with lower depression, whereas being a student, retired or stay at home parent were associated with higher depression (14). Mental health and chronic illness were associated with higher depression, as were increased uncertainty about the future, loneliness, and financial worries. Like Newby JM et al., (14), this study found that older age group and being female had lower odds of loneliness. A study from USA by Lisitsa E et al., also indicated that young adults were lonelier than older adults during the pandemic, which corroborated with the current study (26). In the present study, participants with more than one chronic disease were less lonely than others, whereas Newby JM et al., (14), reported that having better self-rated health was associated with lower depression. This might be because these participants were already on regular medication for those diseases for a long time.

There was a lower odd of loneliness in participants who were in home isolation. Moore KA and March E in Australia reported that participants who were socially isolated in their homes had moderate levels of loneliness (27).

Socialisation is an interactive communication process that influences individual development, personal reception and interpretation social messages (28). In this study, it was found that participants with higher social support, mostly (55.21%) belonged to younger (18-44 years) age group. This was similar to the findings of the study by Grey I et al., who reported that among all age groups those aged 25 to 34 years had experienced maximum level of high social support i.e., 32.61% (29). The study by Liu C et al., indicated a high level of social support improved the effects of the depressive symptoms (25). However, the present study found higher social support in among participants with self-reported loneliness. A study by D’ Silva J studied to assess the role of social support in handling loneliness among male and female adolescents during COVID-19 pandemic found negative correlation between social support and loneliness (-0.464) (30). In this study, it was -0.495.

In the current study, education, occupation, marital status, socio-economic status, presence of care giver, chronic disease, type of stay during infection, sleep, loneliness were strongly associated to social support. Present study estimated that 56.08% and 83.13% study respondents had reported high social support from friends and family respectively. These results are little higher than the data available from a study by El-Zoghby SM et al., among adult Egyptian, which reported 24.2% and 40.6% participants had experienced social support from friends and family members respectively (31).

The strength of this study was its robust methodology including large sample size. This study provides us with the estimate of the burden of loneliness and perceived social support among the study population during this pandemic condition. Adopting appropriate steps to keep social and familial connections, physical exercise, recreational activities, networking with others using educational and social support programs, reminiscence therapy and management of emotions and psychiatric symptoms can prevent loneliness and social isolation and thereby help relieve the adverse consequences.

Limitation(s)

The study did not involve assessment of factors such as coping mechanisms, physical disabilities etc. and was limited to participants attending telemedicine centre. The study relied exclusively on self-reported data from the participants, which can be impacted by recall and social desirability bias. Future longitudinal COVID-19 patients-based studies involving all the factors from the community through face-to-face interview, focus group discussions answer these questions.

Conclusion

The present study highlighted the fact that quarantine and social distancing lead to elevated levels of loneliness and social isolation. About 84% respondents had experienced some category of loneliness which was negatively correlated (Spearman’s rank correlation coefficient=-0.495). Taken together, the findings of the present study put forward the evidence that loneliness is more prevalent among COVID-19 patients attending telemedicine. This higher proportion suggests that there is an increasing need to timely recognise loneliness among these people, increase the awareness about the same and strengthen tele-counselling system, so that social support can be provided during the teleconsultation as well. The doctors who are answering the calls at the telemedicine centre need proper training and orientation in this regard.

Acknowledgement

The authors would like to extend their gratitude towards all the study participants for spending their valuable time and for full co-operation. The authors would also like to acknowledge the telemedicine nodal officers for providing the telemedicine callers list prior to the study.

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DOI and Others

DOI: 10.7860/JCDR/2022/58378.17028

Date of Submission: Jun 10, 2022
Date of Peer Review: Jul 14, 2022
Date of Acceptance: Aug 18, 2022
Date of Publishing: Nov 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jun 19, 2022
• Manual Googling: Aug 16, 2022
• iThenticate Software: Aug 17, 2022 (21%)

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