Physical as well as psychological distress and coping with situational dilemmas experienced by people infected with COVID-19: a mixed method study

doi:10.21203/rs.3.rs-1824658/v2

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Physical as well as psychological distress and coping with situational dilemmas experienced by people infected with COVID-19: a mixed method study

https://doi.org/10.21203/rs.3.rs-1824658/v2

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Background

The COVID-19 pandemic caused serious health problems that affected people physically, and psychologically around the globe. This study aimed to (1) understand physical distress (PhD), psychological distress (PsD), and coping experiences among people infected with COVID-19 (2) develop a grounded theory (3) examine PhD, PsD, and coping among people infected with COVID-19.

Methods

A sequential exploratory mixed methods strategy was employed. A qualitative procedure was based on a grounded theory, data collection included observation and in-depth interviews with 25 participants, aged 18 years and above. The quantitative one included 180 participants, from Bangkok Metropolitan, and Northeastern region of Thailand from February to May 2022. A snowball sampling technique was used. Quantitative instrument: was built based on grounded data from a qualitative approach. Physical, psychological distress, and coping were assessed. Content analysis was applied using the Strauss and Corbin method, and software ATLAS.ti. Descriptive statistic, Pearson’s correlation, and independent t-test were used.

Results

Six major themes included 10 sub-themes. The six major themes appeared (1) severity of COVID-19 symptoms (2) death anxiety (3) uncertainty (4) barrier to healthcare access (5) compliance, and self-regulation coping (6) post-COVID-19 effects. PhD, PsD, and coping were at a moderate level. All PhD, PsD, and coping were in positive relations. Comparison of PsD, and coping between the non-severe group and severe group was significantly different (p < 0.001, p < 0.05). Post COVID-19 effects were fatigue, dyspnea, high blood sugar level, impairment of lungs, liver, and kidney.

Conclusions

The findings of the study supported 6 major themes including 10 sub-themes. All PhD, PsD, and coping were in positive relations. The PsD, and coping of the severe group was higher than non-severe group. Suggestions, healthcare providers should be concerned with sufficient healthcare services, physical and psychological supports. The interventions are needed for their recovery from physical and psychological effects.

People infected with COVID-19

Physical distress

Psychological distress

Coping experienced

Mixed methods study

The COVID-19 pandemic caused serious health issues that affected people physically, and psychologically and is still spreading around the globe. Similar to the globe, Thailand’s population is 66.1 million [1], that had approximately 4.4 million confirmed novel Corona Virus (COVID-19) cases with 29,681 deaths [2]. There is experiencing an increase in cases caused by the highly-contagious Omicron variant [3]. Bangkok Metropolitan is the capital city that had the number of COVID-19 cases from 2020 to 2022 at 817,000 people [4]. As a result of the pandemic, patients have experiences with physical, and psychological distresses such as fever, shiver, headache, dyspnea, stress, anxiety, and fear of death. Moreover, adult respiratory distress syndrome/ ARDS is most prevalence of complication, leading cause of death [5]. Many patients are critically ill, ICU and ventilator are needed. The Public Health Ministry, Thailand is encouraging the patients with COVID-19 to recover at home in response to the kingdom's bed shortage [6].

The people with COVID-19 have to stay long with isolation setting in hospital. They have negative emotion reaction, and perceived threat [7]. The prevalence of COVID-19 pandemic is a situational dilemmas crisis in Thailand. These problems affect the quality of life of Thai people. Unfortunately, no study has mixed methods to understand how they perceived physical, psychological distress, and coping with situational dilemmas experienced by people infected with COVID-19. Therefore, this study aimed to (1) understand physical, psychological distress, and coping experiences (2) develop a grounded theory (3) examine physical, psychological distress, and coping experiences.

Study design

A mixed methods study using sequential exploratory design was employed with three-phases approach. The finding from the initial qualitative phase was built an instrument, and focuses on the subsequent quantitative phase [8]. A qualitative procedure was based on a grounded theory and it explored how they had physical distress, perceived stress and coping experiences. For quantitative procedure, the sequential exploratory supportive data were the same to these matters.

Sampling

A snowball sampling technique was used. Inclusion criteria were Thais adults aged ≥18 years who had been infected with COVID-19, becoming to recover during ≤ 6 months. Not only hospitalization but also non-hospitalization was a negative COVID-19 test. They were not cognitively impaired, able to communicate by using social media, no physical suffering, and willing to provide rich information about their physical distress, psychological distress and coping strategies experiences. The inclusion criteria of this study were written informed consent. Exclusion criteria included cognitive impairment, and visual and hearing impairment. Participants (key informants) were 32 adults. These were screened, and 25 were eligible. In grounded theory, the ultimate criterion for the final sample size is theoretical saturation [9], which relates to the development of theoretical categories and relates to grounded theory methodology [10]. Moreover, a sample size of quantitative one was calculated using G* power 3.1.9.4 [11], which was based on an acceptable power level of .95, effect size of .30, and alpha level of .01. For correlation, the estimate sample size was 152 participants. This study was required a sample size 180 participants, for missing data. This divided 90 of Bangkok Metropolitan, 40 of Nakhon Ratchasima province, 30 of Ubon Ratchathani province and 20 of Nakhon Phanom province. The setting was participants’ home onsite or via video call, and via Google forms.

Instruments

The data was collected using a semi-structure interview, open-ended dialogue, field notes, reflective notes, and audio recording tape were used. Quantitative instrument: was built based on grounded data from a qualitative approach, then testing the instrument feature to a sample of population [12]. This instrument divided physical distress 19 items, psychological distress 22 items, and coping 12 items on five-point Likert scale. The question score ranged from 1 (strongly disagree) to 5 (strongly agree). The score ranges are grouped into physical distress; mild (≤44), moderate level (45-70), and severe level (≥71). The score ranges of psychological distress; mild level (≤ 51), moderate level (52-81), and severe level (≥82). Then, the score ranges of coping; mild level (≤ 28), moderate level (29-45), and high level (≥46).

Data Collection

Phase 1: Qualitative study

The sequential exploratory strategy involved a first phase of qualitative which based on a grounded theory approach [8]. Rapport and trust were established. The data was collected through semi-structure interview in a private or at home, which were well ventilation. The researchers reviewed the research procedure and obtain informed consent from key informants. Qualitative data was initially collected all interviews were conducted by onsite, and video call, audio-record. In-depth interviews were guided by the research questions. Some examples of questions were: “Could you please describe your experiences infected with COVID-19?” “Could you please describe the physical symptoms while you were getting ill?” “How did you feel? Was there any emotional affect?” Observations were focused on their voice and the express of experiences. Each interview was taken for 30-45 minutes, two to four times. These interviews were face-to-face, and online using video conference call, via Line-application. During the interviews, family members or significant persons were with the key informants. The data was saturated when the information collected in the study became redundant or fresh data no longer sparked new insights [12]. Therefore, a grounded theory has systematic steps, this involve generating category of information (open coding), selecting one of the categories and positioning it within a theoretical model (axial coding), and then explicating a story from interconnection of these categories or selective coding

[8]. The study was conducted between February and May 2022.

Phase 2: Building an instrument

A new instrument was built following the first phase because the existing instrument was not available [8]. It was pilot-tested for reliability with 30 people with infected COVID-19. The internal consistency was Cronbach’s α at .74.

Phase 3: Quantitative study

It was focused on in the subsequent quantitative phase. The data was collected using either Google-forms via online survey or a conventional questionnaire onsite, with a total of 180 participants.

Data analysis

A mixed-methods approach combining qualitative content analysis of the interviews and statistical analysis of the survey. The interviews were recorded and transcribed to be subsequently analyzed by using software ATLAS.ti 22 and was applied by using the Strauss and Corbin method. A grounded theory was chosen because it is to move beyond description and to generate or discover a theory, a unified theoretical explanation [13]. Those were really physical and psychological distress, and coping strategies among people infected with COVID-19. The theory was derived from the words of the key informants, which were not derived from another theoretical framework [8]. An iterative process of data analysis was used to develop a theoretical explanation of human behavior grounded [14]. The researchers performed all data analysis tasks with regular consultation and feedback from three external auditors to review the entire project [12]. It was a three-phase approach including: (1) researchers gathered qualitative data, (2) used the analysis to development an instrument, (3) that was subsequently administered to a sample of a population [8]. Then, themes were searched, mapped, and interrelated so that meaning of the themes were interpreted. Quantitative data were analyzed by using SPSS version 18. Descriptive statistic, Pearson’s correlation, and independent t-test were used.

Rigor and Trustworthiness

Four criteria were considered-credibility, dependability, confirmability, and transferability, accumulatively contributed to trustworthiness [14]. Rapport and trust were established and prolonged periods of time were spent. The interviewers avoided using ideas to lead participants to express their physical symptoms, psychological distress, and coping strategies. The reflexive data, which the research team had checked methods, were carefully collected to make confirmability. Dependability was enhanced through debriefing data collection and analysis including external consultants, sharing emerging ideas, codes, and interpretation. It was confirmed that the findings and conclusions were supported by the data collected.

Ethical considerations

The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Institutional Review Board of Kuakarun Faculty of Nursing, Navamindhradhiraj University (approval no KFN IRB 2022-2, and date of approval 17 Feb 2022). Informed consent was obtained from all subjects involved in the study. They could withdraw from the study at any time without negative consequences. To protect confidentiality a pseudonym was used in the participants. All audio-record and transcript data were stored securely. Participants who agreed to participate in the study provided written informed consent.

Individual characteristics

The participants’ demographic characteristics in mixed methods, the total qualitative method consisted of 25 participants with COVID-19 with 15 of them were severe symptoms while the other 10 were of non-severe symptoms. They were 10 males and 15 females, with an average age of 52 years (range from 21 to 85 years old). Eight of them were admitted to the ICU, 10 to the COVID ward, and 7 of non-hospitalization. The participants of the quantitative group were 180 including 45 of severe cases (25%), and 135 of non-severe cases (75%). They were 56 males (31%), and 124 females (69%), vulnerable people (aged ≥60, co-morbidity, and pregnant women) 87 (48%), non-vulnerable 93 (52%). Additionally, there were non-vaccination 32 (18%), and vaccination 148 (82%).

In this mixed method study, the qualitative and quantitative data were integrated in each major theme. The analysis of data revealed six major themes emerged with ten sub-themes (Figure 1). In addition, a grounded theory framework was built (Figure 2).

Theme 1 Severity of COVID-19 symptoms

Fifteen participants were severe symptoms, all of them expressed that they were long-termed admitted in ICU or COVID-ward for 28-40 days. According to symptoms were progression of infection, they mentioned that, they had dyspnea/ difficult breathing or shortness of breath, tiredness, fever and shiver, headache, backache, sore throat, stomach upset, diarrhea, etc. Three of them were shocked and unconsciousness. They told:

I have high fever and shiver, took medication and warm wipe to reduce fever. It helped me a bit. The nurses helped me by giving me some oxygen but didn’t work well after that I had blackout. I was conscious again, a tube was inserted in my throat and connected to the monitor. There were many tubes on me. A few days later the doctor had to make a hole on the outside of my throat to help me breathing better. I was admitted in ICU for 30 days and was transferred to the primary hospital for 10 more days. (S-female, 47)

The non-severe cases of high-risk group, including the patients of cancer, diabetes mellitus (DM), hypertension, heart disease, chronic kidney disease (CKD), obesity, and pregnant woman, were admitted in order to monitor closely. They took Favipiravir which helped them to recover very soon, by 7-14 days.

I had mild symptoms, having low fever, headache, body aches but I was in a risk group I have cancer and on chemotherapy. The doctor advised me to be admitted. When I walked to the toilet, I felt too tired. I needed to have oxygen and took Favipiravir then I felt better. I stayed in the hospital for 4 days and 14 days for home isolation. (N-S 10 female, 59 y)

Theme 2 Death anxiety

Participants’ increasing of stress, fear of death and anxiety, sadness when their symptom conditions had worsened. They were afraid of dying from lung infection. They expressed fear of facing lonely dying, hopelessness. Two of them were pregnant women, who mentioned that fear of death fetus due to lung problems and shortness of breath. They had experienced the death of other patients in the ICU every day and the bad news of family death, which were situational stressor.

At that moment, I was so worried, feared the death. I was not ready to die I haven’t done anything yet about my assets and will management. (S- male,75y)

For me, I had mild symptoms, took anti-viral drugs for 2-3 days. I felt much better, but my 2-year-old daughter had fever and her test of ATK was positive. Her fever wasn’t that high but she developed seizure. I’m so sorry for her, felt so sad and worried about her. I didn’t want to lose her and I cried a lot, couldn’t sleep, no time to rest. I started to have chest pain, shortness of breath, coughing a lot. I couldn’t stand how I felt at that time. Then I thought that I had to be stronger in order to looking after my daughter. The time has gone by 2 months I’m still scared for her critical. (NS- male, 43y)

Theme 3 Uncertainty

Participants had the uncertainty of severe symptoms and unknown prognosis. The false negative results of COVID test were found and needed to repeat 3-5 times to find a positive result. The most of them did not trust the efficacy of COVID vaccine. They were worried about the side effects of them. They were 4 older adults with underlying diseases and all 2 pregnant women haven’t got any vaccination because there weren’t any recommendations for the testimonial of vaccine. Some of them had lost their family member.

I was not expected to be infected. I had the problem of both ATK and PCR test results. I had done for 4 times, the results were negative until the fifth time, mine was positive. In spite of the onset of the symptoms became apparent and getting worse. (NS- male, 43 y)

I was admitted for oxygen therapy at all time. There was a bad news during my admission. My son who had cirrhosis of liver with COVID infection and died after 5 days admission. I was so sad, I did not expect him to die so soon. That was reality uncertainty. (S-female 75 y)

I protected myself strictly because my work was related to COVID infection patients. I wore N 95 double masks and face shield all time including washing my hands frequently. The first COVID infection was on August 24, 2021. I had got it from my work place and Delta virus was found. On March 5 ,2022, I was infected again with Omicron virus….could not believe it. (NS- male, 29 y)

Theme 4 Barrier to healthcare access

Participants expressed that Delta variant was so dangerous and spread easily. The risk group or vulnerable group acknowledged the danger of it. There are aging people, pregnant women. The underlying disease such as DM, hypertension, cancer, chronic lung disease, chronic kidney disease (CKD), etc. At that moment, the situation area was critical and in peak conditions. The people were panic when they focused on the number of infected and dead people, fought for rapid antigen test and for admission as well. Participants mentioned that the official announced that there were many sick and dead people, so the hospitals in Bangkok would not be able to handle them.

I was certain of Delta virus was so dangerous, even though I protected myself really good but I still got it. (NS male, 43 y)

In 2021, while I was infected, the situation was so scared. There were many infected people sending by the ambulances to the hospitals but there were not enough health services even COVID screening.

(S-male,75y)

I contacted many hospitals in Bangkok, there was not the place for COVID test or the admission waiting was for 3 days, I felt worse, so my husband with my kid took me in our car in up country, far away more than 400 kilometers. Luckily I was admitted in a hospital, if not I would die.

(S- female 47y)

Theme 5 Compliance and self-regulation coping

The participants expressed their experiences of the onset coping. They would have done the COVID test, using ATK by themselves, and went to hospitals for their treatment. They would follow all the rules and accepted to do so because they were afraid of dying, thinking positively that everything would be better. The severe group, they complied everything as the health care provider advised, and patience to suffering in the ICU. For non-severe group, they would do as advised by well-informed persons, using alternative therapy such as consuming herbs, in order to decrease cough, and sore throat. They were remote treated by Favipiravir sending from the hospital. Some cases used spiritual and religion dimensions. Moreover, social supports, such as helping of family, and health volunteers made them secured.

I prayed with a little Buddha image which I brought with me to the ICU that made me mindful, distractions, lay on lateral side and on oxygen therapy all the time as the nurse advised. And I felt better. (S-pregnant woman, 31 y)

The nurses advised me to lay on the stomach and I must do as they advised. I could do only 5-7 minutes in the daytime, but the night time I was so afraid that no one could come to help me in case the oxygen tube was missing. (S-female, 75 y)

My daughter who looked after me, call the ambulance taking me to the hospital. She had talked to the doctor via phone every day and let me know all that. (S-male,75 y)

Theme 6 Post COVID-19 effects

Almost all participants remained post COVID-19 symptoms such as tiredness, headache, fatigue and decreased activity tolerance. A few cases, the sugar level was increasing, the doctor prescribed the medication to control it. Increasing of allergies, the lungs had fibrosis, and hands and feet were numb. The memory was decreased. In case of pregnant woman, expressed that the baby was been both of valve stenosis and regurgitation.

I was discharged 6 months ago. At the moment I am not the same, easily tired. My sugars level was increased, the doctor prescribed me more medication for my DM. (S-female, 47 y)

After my baby was born by surgery his weight was 3,000 grams and being easy baby. The doctor told me that he had abnormal heart valves. There were both of leakage on the right side and stenosis on the tip of lung.

I believed it was caused by COVID infection, but the doctor stated that

the baby might have it as a congenital disease. (S-pregnant female, 29 y)

In this mixed methods study, the qualitative and quantitative data were integrated in each major theme using a new instrument. This phase was examined physical distress, psychological distress and coping experiences among people with infected COVID-16. The findings revealed that overall physical distress was at a moderate level (mean =48.06, SD= 19.93), psychological distress was at a moderate level (mean= 52.01, SD =20.94). The coping was at a moderate level (mean =37.68, SD= 13.92) respectively.

The relationship between physical distress, psychological distress, and coping among people with infected COVID-19. There were as follows (Table 1).

Table 1 Correlation of physical distress, psychological distress, and coping among people with infected COVID-19 (n=180)

No.		Variables	1	2	3	p-value	Mean			SD
1	Physical distress		-	.62**	.18*	<.001,<.05	48.06			19.93
2	Psychological distress		-	-	.33**	<.001		52.01		20.94
3	Coping		-	-	-	-	37.68		13.92

The comparison of physical distress, psychological distress, and coping between the non-severe group and severe group was employed independent t-test. The matching of the participants’ age in the non-severe group and severe group were administered. There were 45 for each equally, a total of 90 (Table 2).

Table 2 Comparisons of mean difference of physical distress, psychological distress, and coping

between non-severe and severe group by using independent t-test

Variables	Non -severe group n=45		Severe group n=45		t-test	p-value
Variables	mean	SD	mean	SD	t-test	p-value
Physical distress	48.06	13.98	71.02	7.16	-14.66	< .001
Psychological distress	38.71	16.31	66.15	19.09	-7.33	< .001
Coping	34.46	13.17	40.68	12.88	-2.26	< .05

Note: ES= -.47 (Cohen’s d), large effect size

The Post-COVID-19 effects during the 1^st and 6^th months were 70% effects (Table 3).

Table 3. Post COVID-19 effects (n=180)

Effect of COVID-19	frequency	percent
Non-effects	54	30
Effects	126	70
1. Decreased activity tolerance	72	40
2. Fatigue	60	33
3. Anxiety / fear of abnormal lungs	60	33
4. Dyspnea	50	27
5. Allergy and asthma	44	24
6. Lung impairment	40	22
7. Cough/ sore throat	23	13
8. Muscle pain / back pain /and neck pain	23	13
9. Drowsiness	23	13
10. Sleep disturbance	22	12
11. Loss of appetite	22	12
12.Headache	13	7
13.Hypertension (HT)	12	6
14. High blood sugar level	12	6
15. Memory impairment	10	5
16. Palpitation / chest pain	8	4
17. Hair loss/ fragile nail	6	3
18. Hyper platelet and stroke	3	2
19. Eyes impairment	2	1
20.The others: liver, kidney impairment, gout, and neuritis	12	7

Note: Many of them had more than 3 effects

This study aimed to (1) understand physical, psychological distress, and coping with situational dilemmas experienced among people infected with COVID-19, (2) develop a grounded theory (3) examine physical distress, psychological distress, and coping experiences. Data showed 6 major themes and 10 sub-themes.

The first major themes were the severity of COVID-19 symptoms such as fatigue, dyspnea, cough, sore throat, headache, shiver, etc. The previous study was reported symptoms of headache, fever and shiver, exhaustion, shortness of breath prevalent among more than 50% of the participants and developed within fourth days in above 90% of the patients [15]. The severe group was admitted to ICU with intubation, ventilator, and high flow nasal cannula (HFNC). Using HFNC was associated with trend toward increased survival on ICU or hospitalization [16]. Then, non-severe group were admitted in order to monitor closely and oxygen therapy. They took antiviral drugs resulted in short hospitalization and short time recovering. The studies found that antiviral drugs exhibited efficacy to improve clinical outcomes in patients with COVID-19, none demonstrated efficacy in reducing mortality [17].

The second major theme was death anxiety refers to a great fear of dying. It is a phenomenon related to unknown prognosis of disease, environmental stressors in the ICU, lack of communication of health care providers [18]. Previous study found that hospitalizing in ICU and intubation were sources of death anxiety in COVID-19 patients. The results of studies show that the rate of death anxiety in patients with COVID-19 is very high, and the patient suffers from a high level of death anxiety [18]. Some study suggested that death anxiety was relatively high during the COVID-19 pandemic process. [19]. Patients with COVID-19 experience great psychological distress during the acute phase of the disease or even long after recovery. [20]. Other study showed that patients with COVID-19 would experience a difficult time during isolation due to physical problems, loneliness, being separated from the family [21]. Prevalence of psychological distress increased six-fold from 9.6% to 72.5% [22]. Thus, thinking about the death of patient with COVID-19 infection is a significant challenge that should be concerned.

The third major theme was uncertainty, although a natural and unavoidable part of life, is also a prevailing cognitive state during health crises, as in the case of the ongoing pandemic [23]. The uncertainties associated with COVID-19 includes uncertainty at the level of the disease and its management, including its prognosis; how health and social care systems and professionals who work within them should respond [24]. The study was reported nursing care areas likely to be missed for patients with SARS-CoV-2, and barriers to delivering care [25]. Most of participants expressed that Delta variant so dangerous and spread easily. The study found that the severity of SARS-CoV-2, Delta variant was 11.1%. The risk of progression to severe cases increased 13.44-fold and 3.92-fold when the age was greater than 58.5 years [26]. The Delta variant also poses a greater risk of more severe outcomes, including in younger age groups [27]. Therefore, SARS-CoV-2 included a considerably more significant, more deadly, risk of hospitalization, intensive care people.

The fourth major theme was barrier to healthcare access related to situational of overcrowding of infection and in the hospital. As reported via the government hospital on June 21, 2021. There were shortage beds even for severe cases. As the situation of increasing COVID-19 infected continuously but the number of patients’ beds were limited, the situation of insufficient beds in Bangkok area was too concerned [28]. These were situational dilemmas. Similar, reporting of the situation is getting worse due to insufficient beds for patients in the capital, an issue that needs urgent action to reduce new infections, and establishing ICU rooms in field hospitals [6]. Previous study found that problems and challenges of nursing administration model included the structure and management of nursing manpower. The study suggested that the hospital’s nursing administration model that was developed during COVID-19 outbreak for the in-patient department was effective and practical in managing care for COVID-19 patients [29].

The fifth major theme was compliance, and self-regulation. The participants complied with the advisory of health care providers for fear of death, patience, strengthen the mind, positive thinking that everything will be fine. They used spiritual and religion dimensions, mindful, transcendence meditation. Self-regulation seems to be a good indicator of adopting a healthy lifestyle and better mental health and well-being in the context of the COVID-19 pandemic [30]. Previous study found that COVID-19 distress and general mental distress were strongly related both meaningfulness and self-control were negatively associated with general mental distress [31]. Social support from family, friends, community, and workplace may be protective. The study found that social support moderated the relationship between perceived uncontrollability and mental health symptom [32] and associated with lower COVID-19 psychological impact, though not with threat perception [33]. Previous study founded that psychological distress during the COVID-19 pandemic were having a poor self-perception of health, having diarrhea, having headache, having muscle pain, and having had casual contact with an infected person [34]. Moreover, the study found that resilience had a positive relationship with mental health, and social support served as a buffer against the negative impact of low resilience on mental health. [35]. Similarly, a meta-analysis suggested that resilience may play a role in protecting mental health, accelerating recovery, and mitigating the negative effects of a crisis [36].

The sixth major theme was post COVID-19 effects. They experienced from the 1^st to 6^th months, the residual of physical symptoms and psychological symptoms. Previous study revealed that survivors persist symptoms, depression, and dysfunctions of specific organs, mainly the lungs, heart, kidneys, and nervous system [37]. The relationship of the physical distress, psychological distress, and coping were positive relating. The severe group’s psychological distress, and coping was significantly different with the non-severe group. Previous studies founded that psychological distress during the COVID-19 pandemic were having a poor self-perception of health, diarrhea, headache, and muscle pain, etc. [37, 38] which further have negative impacts on quality of life.

Limitations and Recommendations

There were limitations in involving participants from 3 communities in Bangkok Metropolitan, and 3 provinces in Northeastern Thailand. This homogeneous context of the study might not be representative of a wider area. Thus, it could not be generalized and applied widely for many situations. The number of participants, non-severe group were more than severe group. Further study should be conducted on a wider scale in Thailand, and should include a longitudinal study in quantitative research. The instrumental scales of physical, psychological distress and coping among people with infected COVID-19 should be developed. Finally, the interventions are needed for their recovery from physical and psychological effects.

The findings supported 6 themes related to people with infected COVID-19 which included 10 sub-themes. This study adds a great emphasis on physical distress, psychological distress, and coping. Overall, physical distress, psychological distress, and coping were at a moderate level. The physical distress, psychological distress, and coping were positive relations. The severe group had psychological distress and coping higher than non-severe group. Post COVID-19 effects were many residual symptoms, and impairment of lung, liver, kidney and nervous system. Health care providers should be concerned with sufficient of healthcare services, physical and psychological supports, and post COVID-19 effects. The interventions are needed for their recovery from physical and psychological effects.

Funding: The study was supported by grants from Navamindradhiraj University, Thailand.

Data Availability Statement: The data presented in this study are available on request from the corresponding author. The data are not publicly available due to privacy.

Acknowledgments: The authors thank and show appreciation to all participants. We also thank Navamindharadhiraj University, and Bangkokthonburi University.

Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

ORCID iDs

Arunee Hengyotmark https://orcid.org/0000-0003-2009-2152

Wichitra Kusoom https://orcid.org/0000-0001-6065-0644

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Physical as well as psychological distress and coping with situational dilemmas experienced by people infected with COVID-19: a mixed method study

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