In India, COVID-19 has adversely impacted the economy, jobs, and health infrastructure (22). After a dip in the number of cases, there is again a surge in COIVD-19 cases; mental health of the patients is a concern. Using standardized instruments, this cross-sectional study is perhaps the first study from India done among the hospitalized COVID-19 patients to assess the psychological distress experienced by them.
Around 20% of hospitalized patients with COVID-19 reported psychological distress. Psychological distress among hospitalized patients is reported by researchers (23, 24) and apart from PTSD, excessive pre-occupation about pandemic and confinement to a closed space without any opportunity to move out and interact with familiar people could be contributing to the same. Psychosocial interventions are recommended by experts to such distressed patients admitted in the hospitals. Information and accessibility to tele-interventions through dedicated psychosocial and mental health helplines or those run by mental health professional bodies or availability of mental health professionals within the hospital for undertaking tele-video mental health interventions is important. Evidences of some interventions which could be applied with hospital admitted patients include psychological–behavioral intervention (PBI) program comprising psychological support and breathing exercises (25); brief crisis intervention (26); music therapy (27); progressive muscle relaxation training (28); Yoga – meditation and mindfulness (33); mobile phone-based individual counseling (29); internet-based self-help intervention (30) and multimedia psycho educational intervention (24).
Males (71.4%) were found to be having more psychological distress than females. This could be due to their bread winner status in the family and their concerns for the other family members as COVID-19 has resulted in more death among males than females across the World, though in India the scenario was opposite (31). Caseness (Psychological distress) was significantly more among urban population (67.3%). Similar finding was reported in a post COVID-19 research from Turkey where they have found urban residents experiencing depression and anxiety more than those from rural areas (32). Strict quarantine within the limited spaces / houses, stress resulting from the difficulty to maintain social distancing due to population density and a general high prevalence of covid cases in the cities (33) are cited as few probable reasons. Contrary to the known findings (34, 35), in the present study patients without any co-morbid conditions were having significantly more distress than those with co-morbid conditions. Hospitalization, attention and care, food and safety measures, regular monitoring of the vitals by the health professionals and psychosocial counseling support made available from the day of admission to such vulnerable patients could be the possible reasons.
Mean trauma and perceived stress scores of patients under ‘case’ category was significantly more than those belonging to ‘non- case’ category. Trauma, stress and psychological distress go hand in hand and this had been reported in various studies across the globe (36, 37, 38). The probable reasons for high trauma and perceived stress leading to high psychological distress could be infective nature of illness, reports of deaths and other medical complications arising or triggered due to covid, lack of proven drugs or specific treatment (4), fear of isolation by the community members due to stigma and misinformation, overloading of information at times conflicting and fake ones in social media, impact of negative news report (38), worries about the non affected family members, livelihood issues and financial worries.
Looking at the coping strategies, it was seen that in spite of resorting to dysfunctional coping strategies such as behavioural disengagement, venting and self-blame, patients in the non-case category were showing significant “acceptance” to the situation. It’s culturally not uncommon among people to resort to self-blame, venting and behavioural disengagement to cope with difficult situations in India and that perhaps would have reduced the psychological distress. The lesser distress level among patients in ‘non-case’ category also could be due to their better perceived emotional support and active coping strategy. Patients in ‘case’ category were reposing their faith in God (religion) significantly more than those under ‘non-case’ category which is again well within the religious - spiritual cultural background of the country where people resort to god for resolution of their physical and psychological problems. Both the category of patients was receiving fairly equal support from family, friends and significant others.
PTSD (trauma) was the only variable found to be a significant predictor of the psychological distress. PTSD is widely reported in literature in the aftermath of various types of disasters such as nuclear accidents, floods, earthquake, tsunami, war and pandemic outbreaks such as SARS (39-44). Earlier studies also have found a similar relationship between PTSD and Psychological Distress (39, 7).
Our study had the following limitations: (a) we have included only hospitalized patients and patients with moderate COVID-19; therefore, our study results may not be generalizable to the other groups of patients; (b) this study was from a single center and from an Union Territory of India; the city stands at first position in human development index in the country and has a relatively better health infrastructure (GMSH, GHCH and PGIMER) and per-capita income (4th position in the country) than many other states and union territories of the country (45); therefore, the results of our study may not be extrapolated to other states; (c) we did not use any diagnostic instruments, and therefore could not comment on the incidence of a particular psychiatric diagnosis; (d) this cross-sectional study could not inform us about the course of severe psychological distress.