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 : May | Volume : 16 | Issue : 5 | Page : VC15 - VC19 Full Version

Depression, Perceived Stress and Socio-demographic Correlates among General Population During COVID-19 Pandemic: A Cross-sectional Survey from Southern India


Published: May 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/56231.16403
Aparna Sasikumar, Aravind Karunakaran, Jaico Paulose, Chitra Venkateswaran, Jaimon Plathottathil Michael, Varghese P Punnoose

1. Senior Resident, Department of Psychiatry, Believers Church Medical College Hospital, Thiruvalla, Kerala, India. 2. Assistant Professor, Department of Psychiatry, Government Medical College, Kottayam, Kerala, India. 3. Assistant Professor, Department of Psychiatry, Believers Church Medical College Hospital, Thiruvalla, Kerala, India. 4. Professor, Department of Psychiatry, Believers Church Medical College Hospital, Thiruvalla, Kerala, India. 5. Assistant Professor, Department of Psychiatry, Government Medical College, Kottayam, Kerala, India. 6. Professor, Department of Psychiatry, Government Medical College, Kottayam, Kerala, India.

Correspondence Address :
Dr. Aravind Karunakaran,
Manakat, CRRA B-3, Chalakuzhy Road, Pattom, Thiruvananthapuram-695004, Kerala, India.
E-mail: aravind2k5@yahoo.com

Abstract

Introduction: The Coronavirus Disease 2019 (COVID-19) pandemic and its socio-economic consequences have had a significant impact on mental health. A quantifiable data regarding increase of mental health problems as a result of the pandemic is required to take necessary steps in tackling the issue.

Aim: To estimate the prevalence of depression, perceived stress and its socio-demographic correlates among general population of South India during COVID-19.

Materials and Methods: This cross-sectional survey conducted from 25th August 2021 to 25th October 2021 among the general population of South India during COVID-19. A total of 600 subjects were enrolled into the study. Study subjects included people of either sex between 20-50 years of age who were able to read and understand English and with access to internet. Subjects responded to a questionnaire packet of Patient Health Questionnaire-9 (PHQ-9), Perceived Stress Scale 10 (PSS-10) and a proforma for socio-demographic data. Data was analysed using GNU PSPP version 1. One-way Analysis of Variance (ANOVA) and independent t-test were used to assess associations. A value of p-value <0.05 was considered to be statistically significant. Pearson’s correlation coefficient was used to determine correlation.

Results: Of the 600 subjects who were enrolled into the study, 26.7%, 15.7%, 9.3% and 7.2% had mild, moderate, moderately severe and severe depression, respectively. About 62.7% had moderate and 17.5% had high perceived stress. Whereas, 28.7% had death wishes or thoughts to hurt themselves. Females (PHQ-9: p-value=0.006; PSS-10: p-value <0.001), 20-29 age group (PHQ-9: p-value <0.001; PSS-10: p-value <0.001), students (PHQ-9: p-value <0.001; PSS-10: p-value <0.001), those who were unmarried (PHQ-9: p-value <0.001; PSS-10: p-value <0.001), living with parents (PHQ-9: p-value <0.001; PSS-10: p-value <0.001), those who had a loss of income (PHQ-9: p-value <0.001; PSS-10: p-value=0.018) or job (PHQ-9: p-value <0.001; PSS-10: p-value <0.001) in the past one year, those with a history of psychiatry disorder (PHQ-9: p-value <0.001; PSS-10: p-value <0.001) had a significantly higher score in both depression and perceived stress. Correlation analysis showed a significant correlation between depression and perceived stress scores (r=0.691).

Conclusion: The present study showed a high prevalence of depression and perceived stress and shows the need for strengthening mental health services to address the challenge.

Keywords

Anxiety, Coronavirus disease 2019, Epidemiology, Mental health, Psychological distress

The Coronavirus Disease 2019 (COVID-19) outbreak and the measures taken to contain it have had an immense impact on people all over the world. It was declared as a public health emergency of international concern on January 2020 and a pandemic on March 2020 (1). A global event like the current COVID-19 pandemic and its social and economic consequences can have a significant impact on mental health. Exposure to large scale traumatic events following pandemics and disasters are associated with a heightened burden of mental illness in the affected population (2). An increase in mental health problems have been noticed after past epidemics like the Ebola virus and Severe Acute Respiratory Syndrome (SARS) outbreak (3),(4). The negative impact on mental health worldwide as a result of the current pandemic is also significant. Uncertainty about when the virus spread could be brought under control, fear of contracting the disease, steps enforced to contain the spread like social distancing, lockdowns and the associated economic loss and disruptions in daily life are all factors that negatively impacted the mental health (5).

Previous studies done nationally during this pandemic have shown prevalence of depression and stress to be 25% and 11.6% and that there was a high level of anxiety in the study population (6),(7). Studies done in other countries also show a high prevalence of depression and anxiety (8),(9),(10),(11). The pooled prevalence estimates of depression and anxiety symptoms were shown to be 25.2% and 20.5% in children and adolescents respectively in a meta-analysis and this was higher compared to pre-pandemic estimates (12). Incidents where people committed suicide as a result of mental stress were also reported (13),(14).

Concerns have been expressed by experts around the world about the increasing mental health problems and the need for adequate mental health support (15). Epidemiological studies need to be conducted nationwide to have a quantifiable information about increase in mental health problems as a result of the pandemic. This will help the policy makers to take adequate steps in tackling the issue and develop targeted strategies for vulnerable groups.

In India, only few studies have explored the impact of pandemic on mental health (6),(7),(16). However, the studies were done during the first wave of COVID-19 and the impact of different socio-demographic correlates have not been adequately explored. The second wave of COVID-19 was much more disruptive compared to the first wave and the impact on mental health of population needs to be studied (17),(18),(19). There is also a scarcity in studies from Southern India exploring the impact of pandemic on mental health.

Thus, the current study aimed to estimate the prevalence of depression and perceived stress in general public during the current COVID-19 pandemic and also to examine the socio-demographic correlates of depression and perceived stress.

Material and Methods

This was a cross-sectional online based survey conducted from 25th August 2021 to 25th October 2021 among the general population in Southern India. Institutional Ethics Committee permission was taken before starting the study from Believers Church Medical College Hospital, Thiruvalla, Kerala (IEC No. IEC/2021/09/238).

Sample size calculation: The study by Huang Y and Zhao N, showed a 20.1% prevalence for depressive symptoms (8). Sample size was calculated using the formula:

N=4pq/d2
where, p=20,
q=100-p=80,
d as 20% of p=4.

A minimum sample size of 400 was calculated, however, to increase the precision of study maximum responses were sought and a total of 600 participants completed the survey. The sampling technique used was snowball sampling starting from 25th August 2021.

Inclusion and Exclusion criteria: People of either sex between 20-50 years of age and having access to internet were included in the study. They should be able to read and understand English language. Those who refused to give informed consent were excluded from the study.

Study Procedure

A google form link of the questionnaire with a consent form appended to it was shared to all the general contacts of investigators who were between 20-50 years from WhatsApp, Facebook and other instant messengers like Google chat and Telegram. Participants were then requested to share the link of questionnaire to as many of their general, personal and official contacts as possible who were between 20-50 years. On clicking the link, participants were directed to details about the study and informed consent. If the participant gave consent to take the survey they were redirected to the study forms which constituted of a specially designed pro forma for collecting relevant socio-demographic data, Patient Health Questionnaire-9 (PHQ-9) and Perceived Stress Scale-10 (PSS-10) (20),(21),(22).

Socio-demographic data: A proforma for collecting relevant socio-demographic data of subjects who enroll into the study was used. Data about age, gender, education, occupation, marital status, family structure, whether the subjects were staying in rural or urban area were collected. Details regarding whether there was any loss of income or job in past one year were also taken. Information about presence co-morbid chronic medical illness like diabetes mellitus, hypertension, dyslipidemia was taken. History of any major psychiatric disorders like bipolar disorder, major depressive disorder, any psychotic disorder was taken. Information whether the person used alcohol use in past 30 days was also collected.

Patient Health Questionnaire-9 (PHQ-9): The PHQ-9 is a self-administered questionnaire for measuring depression symptoms containing a total of 9 items which are scored from 0-3. PHQ-9 was developed by Kroenke K et al., in 2001 (20).

Depression symptoms were categorised as:

• None- score of 0-4,
• Mild- score of 5-9,
• Moderate- score of 10-14,
• Moderately severe- score of 15-19
• Severe- score ≥20

Perceived Stress Scale-10 (PSS-10): The PSS-10 is a self-administered questionnaire containing a total of 10 items and is widely used for measuring perception of stress. The scale was developed by Cohen S et al., 1988 (21). The questions are scored from 0 to 4 with the scores being reversed for questions 4,5,7 and 8. The total score ranges from 0-40 with a score of 0-13 being low stress, 14-26 being moderate stress and 27-40 being high stress. The PSS-10 has a Cronbach’s α of 0.78 (22).

Statistical Analysis

Data was collected and analysed using GNU PSPP version 1.0, which is a freely available software for statistical analysis. Mean and standard deviation were used to summarise numerical data. Categorical variables were represented as frequency and percentages. One-way Analysis of Variance (ANOVA) and independent t-test, were used to assess associations. A value of p-value <0.05 was considered to be statistically significant. Pearson’s correlation coefficient was used to determine correlations. An r-value between 0.5-1.0 was considered to be a significant positive correlation (23).

Results

Socio-demographic characteristics of the study subjects are shown in (Table/Fig 1). The mean age of the study subjects was 34.2±9.3 years.

Prevalence of depression and perceived stress: Of the 600 study subjects 160 (26.7%) had mild depression, 94 (15.7%) had moderate depression, 56 (9.3%) had moderately severe depression and 43 (7.2%) had severe depression. The PSS-10 scores showed that 376 (62.7%) had moderate stress and 105 (17.5%) had high stress. The mean PHQ-9 score was 7.62±6.50 and the mean PSS-10 score was 19.48±7.1. Of the 600 subjects, 172 (28.7%) had death wishes or thoughts to hurt themselves.

Socio-demographic correlates: (Table/Fig 2), (Table/Fig 3) shows the association of socio-demographic variables with PHQ-9 and PSS-10 scores respectively.

Statistically significant higher mean scores for both depression and perceived stress were seen in females (PHQ-9: p-value <0.05; PSS-10: p-value <0.001), 20-29 years, age group (PHQ-9: p-value <0.001; PSS-10: p-value <0.001), students (PHQ-9: p-value <0.001; PSS-10: p-value <0.001), those who were unmarried (PHQ-9: p-value <0.001; PSS-10: p-value <0.001), those who were living with parents (PHQ-9: p-value <0.001; PSS-10: p-value <0.001), those who had a loss of income (PHQ-9: p<0.001**; PSS-10: p<0.05*) or a loss of job (PHQ-9: p-value <0.001; PSS-10: p-value <0.001) in past one year. Those with a history of psychiatric disorders had a statistically significant higher mean scores for both depression and perceived stress (PHQ-9: p-value <0.001; PSS-10: p-value <0.001) whereas subjects with history of chronic medical co-morbidities had a higher mean scores in perceived stress (PSS-10: p-value=0.041). Subjects who reported death wishes or thoughts to hurt themselves had a statistically significant higher mean scores for perceived stress (PSS-10: p-value <0.001).

(Table/Fig 4) indicates correlation between depression and PSS-10 scores. Pearson’s correlation analysis was done between depression and PSS-10 scores and a significant positive correlation was seen (r-value=0.691).

Discussion

The present study aimed to estimate the levels of depression and perceived stress among different sections of the Indian population. A previous study conducted in pre-pandemic periods showed a prevalence of depression of 3.3% in India (24). The present study showed that 15.7%, 9.3% and 7.2% had moderate, moderate to severe and severe depression which is markedly higher compared to a previous study from pre-pandemic times (24). A previous study by Verma S and Mishra A during the first COVID-19 wave in India showed a 25% prevalence of depression among general public (6). The perceived stress measures in the current study were also high with 62.7% having moderate levels of perceived stress and 17.5% having high levels of perceived stress. Studies across the world have also shown a heightened prevalence of depression and stress in general population (6),(7),(8),(9),(11). The period of data collection for the present study coincided with the second wave of COVID-19 in India and widespread lockdowns in most major cities. In India disruption during the second COVID-19 wave was much higher compared to first wave. The number of cases, death rate, shortage of oxygen and hospital beds were all much higher during the second wave (17),(18),(18),(19). These factors may have contributed to the higher prevalence of depression and perceived stress in the current study. These findings emphasise the need of timely measures for prevention and treatment of mental health problems.

Examination of the socio-demographic correlates showed that depression and perceived stress scores were higher in female sex (PHQ-9: p<0.05*; PSS-10: p-value <0.001). This is consistent with National Mental Health Survey 2015-16 which showed a higher prevalence for depression and stress related disorders in females (25). Those who were unmarried (PHQ-9: p-value <0.001; PSS-10: p-value <0.001) and those who were living with parents (PHQ-9: p-value <0.001; PSS-10: p-value <0.001) had a higher mean scores in depression and perceived stress.Similar findings were seen in the study conducted by Moghanibashi-Mansourieh A, where depression scores were significantly higher in unmarried participants compared to married group (26).

The current study shows how students have faced the brunt of pandemic with the scores being high both in depression and perceived stress measures (PHQ-9: p-value <0.001; PSS-10: p-value <0.001). The 20-29 years, age group also showed a similar finding (PHQ-9: p-value <0.001, PSS-10: p-value <0.001). The study by Cao W et al., shows a similar finding of high levels of anxiety among college students (27). The study done by Islam MA et al., in Bangladesh, showed that 82.4% students were having mild to severe depressive symptoms and 87.7% were having anxiety symptoms. The study also showed that students in early twenties showed higher depressive symptoms compared to other age groups (28). Closure of academic Institutions in India as a part of lockdown and the demands placed on students to adapt to online classes often with limited resources may be the reason for high level of stress (16). An interesting finding in the present study was that medical professionals (doctors, nursing staff) and others who were directly involved in COVID-19 duties had lowest mean PHQ-9 scores.Similar findings were seen in the study conducted by Rehman U et al., that mental health professionals reported only normal levels of depression and stress while other health professionals reported only mild levels of depression and stress (16). These may indicate that medical professionals and others directly involved in field work were more resilient in dealing with negative impact of the pandemic.

In the present study, those with a decrease in income (PHQ-9: p-value <0.001; PSS-10: p-value <0.05) and loss of job (PHQ-9: p-value <0.001; PSS-10: p-value <0.001) during past one year was shown to have significantly higher scores in both depression and perceived stress. Linn MW et al., has reported in a prospective study that symptoms of depression, anxiety and somatisation were significantly greater in unemployed. Loss of work may affect self-esteem and limit the person’s opportunity for satisfaction and feeling of accomplishment (29).

Alcohol use was taken as a categorical variable in the present study. Details of pattern of drinking were not enquired. The interesting finding is that those who used alcohol had a lower mean scores in perceived stress (PSS: p-value <0.05). Alcohol might have been used as a self-medication for stress and anxiety leading to a subjective relief in stress (30). Alcohol has been shown to interfere with the initial perception of stress leading to impaired appraisal of stress and thereby, protecting the drinker from experiencing the stressor to a full impact (30),(31). Those with history of psychiatric disorders (bipolar affective disorder, psychosis, major depressive disorder) experienced a higher perceived stress and depressive symptoms (PHQ-9: p-value <0.001; PSS-10: p-value <0.001). The meta-analysis by Fleischmann E et al., shows that symptoms of anxiety, depression and stress were higher in those individuals with a history of serious mental illness (affective disorders and schizophrenia) compared to healthy controls (32). This shows the necessity to strengthen the mental health services to provide more support to those individuals with serious mental illness. Encouraging the use of mediums like tele mental health services may help bridge the gap in providing adequate treatment to the vulnerable groups (14),(32).

Death wishes and thoughts of hurting themselves were significantly higher in those with higher mean scores of perceived stress (PSS-10: p-value <0.001). This requires attention as multiple incidences where people had committed suicide due to mental stress were reported during the pandemic (13),(14). The fear of possible infection, quarantine processes, information overload about COVID-19 in the media may all contribute to increased stress. Targeted strategies to promote mental health like tele-psychiatry to increase the outreach, especially in vulnerable population like those confirmed with the infection, quarantined family members are recommended in the current scenario (14),(15).

Limitation(s)

As the investigators used online google forms to collect data, only those segments of population with internet availability and know how to use a mobile phone or computer could participate in the present study. This could have led to a selection bias and hence, the present study results cannot be generalised to all segments of the population.

Conclusion

The present study showed a high prevalence of depression (15.7% had moderate depression, 9.3% had moderately severe depression, 7.2% had severe depression) and perceived stress (62.7% had moderate stress, 17.5% had high stress) in the population reflecting the pervasive influence of COVID-19 and its socio-economic consequences. This challenging situation requires a strengthening of mental health services and increased efforts to reach out to the vulnerable segments of population where the brunt of the pandemic would be most. There is also a need for more nationwide epidemiological studies to determine the level of mental health burden in the population.

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DOI and Others

DOI: 10.7860/JCDR/2022/56231.16403

Date of Submission: Mar 09, 2022
Date of Peer Review: Apr 04, 2022
Date of Acceptance: Apr 27, 2022
Date of Publishing: May 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: Mar 19, 2022
• Manual Googling: Apr 02, 2022
• iThenticate Software: Apr 19, 2022 (9%)

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