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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 8  |  Issue : 1  |  Page : 23-26

Perceived stress during lockdown due to corona pandemic in Indian urban population: A questionnaire-based study


1 Adjuct Research Faculty, Dental Research Cell Department, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai, India
2 Department of Public Health Dentistry, Vyas Dental College and Hospital, Jodhpur, Rajasthan, India

Date of Submission03-Feb-2021
Date of Decision21-Feb-2021
Date of Acceptance25-Feb-2021
Date of Web Publication29-May-2021

Correspondence Address:
Dr. Namrata Dagli
Adjuct Research Faculty, Dental Research Cell Department, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Chennai
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jhrr.jhrr_1_21

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  Abstract 

Aim: The coronavirus pandemic led to lockdown to control the spread of Covid-19. The lockdown caused various lifestyle changes that might have affected mental health. The study aimed to assess the effect of lockdown on stress level of Indian urban population. Materials and Methods: A questionnaire-based exploratory survey was conducted. A prevalidated Perceived Stress Questionnaire (PSQ) was used. A total of 120 questionnaires were sent via online social media using snowball sampling technique. PSQ Index scores were calculated for each participant. On the basis of these scores, participants were grouped into three categories: mild, moderate, and severe. The Shapiro–Wilk test was applied to check data for normality. Independent t-test was applied to find the difference of PSQ scores between males and females. One-way analysis of variance (ANOVA) was used to find the difference in PSQ scores between various occupational groups and between various age groups, followed by post hoc Tukey’s honest significant difference (HSD) test. Results: Completely filled 100 responses were analyzed to form results. About 44% population was found to have moderate stress. Mean PSQ index was 0.35 for sample population with standard deviation of 0.17. Pearson’s correlation between age and PSQ score was –0.452. Values of PSQ scores were higher for female participants, but the difference was not statistically significant. PQS scores were the highest in healthcare workers when compared with other occupations. Results of one-way ANOVA for various age groups were significant (F = 6.73, p = 0.001). Post hoc Tukey’s analysis revealed that only group of senior citizens is significantly different from others. Results of one-way ANOVA for various occupational groups are significant (F = 3.79, p = 0.01), and the result of post hoc Tukey’s HSD test suggests that only group of healthcare workers is significantly different from other groups. Conclusion: Results suggest prevalence of moderate stress level in studied sample population. More stress level was observed in females than males but the difference was not statistically significant. The stress level was higher among healthcare workers when compared with participants with other occupations. Stress was found to be negatively correlated with age of participants. The stress level was lowest in senior citizen participants when compared with other participants.

Keywords: Corona virus, Covid-19, lockdown, mental health, stress level


How to cite this article:
Dagli N, Dagli R. Perceived stress during lockdown due to corona pandemic in Indian urban population: A questionnaire-based study. J Health Res Rev 2021;8:23-6

How to cite this URL:
Dagli N, Dagli R. Perceived stress during lockdown due to corona pandemic in Indian urban population: A questionnaire-based study. J Health Res Rev [serial online] 2021 [cited 2021 Jun 19];8:23-6. Available from: https://www.jhrr.org/text.asp?2021/8/1/23/317210


  Introduction Top


Covid-19 caused marked increase in hospitalization and death of infected people all over the world. It was declared a global pandemic on March 11, 2020.[1] In many countries, lockdown was done in an effort to control transmission of virus. The first nationwide lockdown was announced in India on March 25, 2020, for 21 days, which was extended to May 3, 2020 on 14th April.[1] Lockdown caused drastic changes in lifestyle that might have increased mental stress among people. “Stress is a particular relationship between the person and the environment that is appraised by the person as taxing or exceeding his or her resources and endangering his or her well-being”[2] High level of perceived stress is often accompanied by symptoms of depression or anxiety, most common of mental disorders.[3]

Studies done in various countries have reported increased stress levels. A survey found more than 3-fold rise in prevalence of depression symptoms among adults in US.[4] Another survey indicated that 28.2% of the sample population suffered from post-traumatic stress disorder during lockdown in India.[5] Another study reported that students, researchers, and health professionals suffered moderate level of anxiety, whereas teachers and corporate employees had mild level of stress during lockdown.[6] A study done on young children and adolescents concluded that despite low rate of Covid-19 infection, they are still highly vulnerable to stress.[7] Very few studies have been done on Indian population till now; therefore, this exploratory study was planned to assess level of stress perceived by Indian urban population during first nationwide lockdown.


  Materials and Methods Top


Study Design and Settings

It was a questionnaire-based exploratory study. The study was conducted after first national lockdown for a duration of 1 week. Virtual snowball sampling technique (i.e. non-probability sampling technique) was used. It was not possible to include rural population due to corona pandemic; therefore, only urban population was studied. Ethics Committee approval was not taken as it is a blinded study (subjects’ identity was unidentifiable).

Sample size calculation

The sample size calculated was 97 for Indian urban population (i.e. 483,098,640 in year 2020)[8] with 10% margin of error and 95% confidence interval. Questionnaires were sent to 120 people. Completely filled 100 forms were received. The response rate was 83.33%.

Questionnaire

Perceived stress was measured by a questionnaire (developed and validated by Shahid et al.[9]). The questionnaire comprised 30 multiple choice questions. It was compulsory to answer all the multiple choice questions.

Statistical analysis

The Shapiro–Wilk test was applied to check data for normality. Parametric tests were applied on the data as the distribution was approximately normal. Pearson’s correlation was used to check correlation between age and PSQ scores. Independent t-test was applied to find the difference of PSQ scores between males and females. One-way analysis of variance (ANOVA) was used to find the difference in PSQ scores between various occupations. Various age groups were also compared using one-way ANOVA, followed by post hoc Tukey’s honest significant difference (HSD) test.

Scoring

Four options were there in all 30 questions and a score was assigned to all four options.[9]

Scores given to each option are as follows:

  • Almost never =1;


  • Sometimes =2;


  • Often =3;


  • Usually =4.


  • Question nos 1, 7, 10, 13, 17, 21, 25, and 29 are positive questions; therefore, scores are inverted for them (almost never=4, sometimes=3, often=2, usually=1).

    Using the sum of this score, the PSQ index was calculated:

    PSQ index= (raw score–30)/90.

    Higher scores indicate higher level of anxiety. This questionnaire was reported to be reliable. All the study subjects were classified based on their PSQ index score using tertiles for the purpose of this study. Participants with PSQ score <33.33% were categorized in the low stress group, 33.33–66.66% in the moderate stress group, and >66.66% in the high stress group.


      Results Top


    A total of 100 filled questionnaires were received. Sixty-four were females and 36 were males. Age of the participants ranged between 21 and 67 years with the mean age of 34.93 years and standard deviation (SD) of 13.57. Responses were received from people from 26 cities of India. About 44% of the studied population was found to have moderate stress level (16% males and 28% females).

    PSQ scores ranged between 0.03 and 0.78 with an SD of 0.17. The mean value of PSQ score calculated for sample population was 0.35. The mean PSQ score in males was 0.31 and in females was 0.37 [Table 1]. However, female scores are higher than males but the difference is not statistically significant (t-value= –1.16, p-value= 0.25).
    Table 1: Difference in stress levels between males and females

    Click here to view


    PSQ scores were calculated for three age groups: youth, adults, and senior citizens. Out of these three groups, senior citizens’ group showed least score (0.15) [Table 2]. Age and PSQ scores correlate negatively (Pearson’s correlation= –0.45). According to post hoc Tukey’s test, only group of senior citizens is significantly different from the other two groups. Difference between youth and adults is statistically not significant.
    Table 2: Mean PSQ index, level of stress, and standard deviation value in youth, adults, and senior citizens age groups

    Click here to view


    PQS scores were the highest in healthcare workers when compared with other occupations. Results of one-way ANOVA for various age groups were significant (F-value= 6.73, p-value= 0.001) [Table 3]. Healthcare workers included allopathy doctors, homeopaths, physiotherapists, dentists, and nurses. Occupations other than the above-mentioned four categories were categorized as others, as it was not possible to compare them as a separate group due to smaller number of participants like four teachers, four chartered accountants, five businessmen, etc. Retired persons were also included in this group. Post hoc Tukey’s test revealed that difference was statistically significant only between healthcare workers and others.
    Table 3: Mean PSQ index and standard deviation value

    Click here to view



      Discussion Top


    Results of our study show that the moderate level of stress was found in 44% of the population. Stress was found to be negatively correlated with age; association was moderate between the two. The stress level was mild among senior citizen participants. They were found to be least affected when compared with participants of other age groups. This finding is in line with a cross-sectional study done in Spain that noted lower anxiety and depression in older age (60–80 years) when compared with younger age (40–59 years).[10] The moderate level of stress was observed in participants of other age groups, i.e. youth and adults.

    Healthcare professionals are more affected when compared with the participants of other groups. Difference of stress level was statistically insignificant between females and males. Both these findings are in line with the results of study done by Rehman et al.[6]

    Even after one year, vaccines are now available but its efficacy, availability, and reliability are still questionable.[11] Many countries have to announce lockdown again due to the more infectious mutant of the previous strain. This lockdown due to Covid-19 pandemic is not the first incidence of lockdown in history[12] and may happen again in future. Therefore, it is important to know how lockdown has affected mental health.

    However, before drawing any conclusion, we should also consider stress levels of Indian population before Covid-19. A study done in 2015 showed high burden of perceived stress in residents of low-income urban population in India.[13] A study done in 2016 identified that doctors and nurses face considerable stress at workplace and prevalence of stress was calculated to be 39.5%.[14] Another study found that 48.8% of the university students fall under the category of having average to high stress levels.[15] In previously published studies, these two groups were already high stress groups. The result of our study only assesses the stress level during lockdown but to evaluate whether it has increased during lockdown, the data need to be compared with studies done before lockdown.

    Though the sample population studied in this exploratory study is not a representative sample of the population, still the data may be helpful in planning further longitudinal studies with larger sample size. Data may be helpful for health authorities in planning further interventions to reduce the negative impact of COVID-19 on Indian urban population. If lockdown is unavoidable, health authorities should consider its negative effect on mental health on different age groups and persons with various occupations.

    The limitation of our survey was small sample size. Such survey needs to be conducted on a larger scale and tries to aggregate appropriate data to have a clear picture of stress level in India. The questionnaires were available in only English language. Google forms were circulated using online social media; therefore, it hindered participation of people who cannot understand English and those who do not use mobile phones. Rural population was not included as it was not possible to collect data because of movement restrictions due to corona pandemic. A prevalidated questionnaire was used for the study with 0.82% of reliability. Data were normally distributed. Sample population was diverse as we received responses from 26 cities of India.


      Conclusion Top


    Results of this exploratory study show prevalence of moderate level of stress among sample population during first nationwide lockdown. Difference in stress levels of males and females was not statistically significant. The stress level was higher among healthcare workers when compared with other occupations. The stress level was significantly lower among senior citizens when compared with the other age groups. Stress was found to be negatively correlated with age.

    Future study recommendation

    There is a need to study and assess the effect on rural population. Effect of long-term lockdown should be studied. Qualitative studies are required to identify the potential stressors.

    Financial support and sponsorship

    Nil.

    Conflicts of interest

    There are no conflicts of interest.

     
      References Top

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    De A Coronavirus India timeline: Tracking crucial moments of Covid-19 pandemic in the country (msn.com). The Indian Express Coronavirus India timeline [Internet] 2020;582.  Back to cited text no. 1
        
    2.
    Lazarus RS, Folkman S. Stress, Appraisal and Coping. New York: Springer; 1984.  Back to cited text no. 2
        
    3.
    Ettman CK, Abdalla SM, Cohen GH, Sampson L, Vivier PM, Galea S. Prevalence of depression symptoms in US adults before and during the COVID-19 pandemic. JAMA Netw Open 2020;3:e2019686.  Back to cited text no. 3
        
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    Wiegner L, Hange D, Björkelund C, Ahlborg G Jr. Prevalence of perceived stress and associations to symptoms of exhaustion, depression and anxiety in a working age population seeking primary care—An observational study. BMC Fam Pract 2015;16:1-8.  Back to cited text no. 4
        
    5.
    Singh SP, Khokhar A. Prevalence of posttraumatic stress disorder and depression in general population in India during COVID-19 pandemic home quarantine. Asia Pacific J Public Health2020;33:154-6.  Back to cited text no. 5
        
    6.
    Rehman U, Shahnawaz MG, Khan NH, Kharshiing KD, Khursheed M, Gupta K, et al. Depression, anxiety and stress among Indians in times of Covid-19 lockdown. Community Ment Health J 2021;57:42-8.  Back to cited text no. 6
        
    7.
    Singh S, Roy D, Sinha K, Parveen S, Sharma G, Joshi G. Impact of COVID-19 and lockdown on mental health of children and adolescents: A narrative review with recommendations. Psychiatry Res 2020;293:113429.  Back to cited text no. 7
        
    8.
    worldometer. [Online] Available from: https://www.worldometers.info/world-population/india-population. [Last accessed on 2020 Jun 13].  Back to cited text no. 8
        
    9.
    Shahid A, Wilkinson K, Marcu S, Shapiro C, editors. Perceived Stress Questionnaire (PSQ). STOP, THAT and One Hundred Other Sleep Scales. New York: Springer; 2011.  Back to cited text no. 9
        
    10.
    González-Sanguino C, Ausín B, Castellanos MÁ, Saiz J, López-Gómez A, Ugidos C, et al. Mental health consequences during the initial stage of the 2020 coronavirus pandemic (COVID-19) in Spain. Brain Behav Immun 2020;87:172-6.  Back to cited text no. 10
        
    11.
    Bhatia R. The quest continues for perfect COVID-19 vaccine. Indian J Med Res2021. doi: 10.4103/ijmr.ijmr_4165_20.  Back to cited text no. 11
        
    12.
    Hawryluck L, Gold WL, Robinson S, Pogorski S, Galea S, Styra R. SARS control and psychological effects of quarantine, Toronto, Canada. Emerg Infect Dis 2004; 10:1206.  Back to cited text no. 12
        
    13.
    Pangtey R, Basu S, Meena GS, Banerjee B. Perceived stress and its epidemiological and behavioral correlates in an urban area of Delhi, India: A community-based cross-sectional study. Indian J Psychol Med 2020;42:80-6.  Back to cited text no. 13
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    14.
    Sathiya N, Ruwaidha R, Nusrath FS, Fathima F, Gomathy T. Perceived stress levels and its sources among doctors and nurses working in a tertiary care teaching hospital, Kancheepuram, Tamil Nadu. Natl J Commun Med2016;7:603-8.  Back to cited text no. 14
        
    15.
    Reddy KJ, Menon KR, Thattil A. Academic stress and its sources among university students. Biomed Pharmacol J2018;11:531-7.  Back to cited text no. 15
        



     
     
        Tables

      [Table 1], [Table 2], [Table 3]



     

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