A total of 410 participants completed the whole self-rated questionnaires. Table 1 present the socio-demographic profile of respondents who participated in the study. In our study, mean age of study participants was 34.8 (± 11.7) years ranging from 17–83 years. The Male to Female ratio is 1.84 where 64.6% (n = 265) of male participation were male. Majority of the respondents were educated (post-secondary and higher) (n = 324, 79%) and Hindu by religion (n = 369, 90.0%). Among study participants 70% were employed (n = 290); and 40.7% (n = 167) were health care workers. About two third of respondent were residing in Province 3(Bagmati) (n = 258, 62.9%) (Table 1.)
Table 1
Socio-demographic profile of the respondents (N = 410)
Socio-demographic Variables | n | % |
Age (in Years) | < 30 | 163 | 39.8 |
30–45 | 188 | 45.9 |
> 45 | 59 | 14.4 |
Mean ± SD | 34.8 ± 11.7 | |
Gender | Female | 144 | 35.1 |
Male | 265 | 64.6 |
Other | 1 | 0.2 |
Religion | Hinduism | 369 | 90.0 |
Non-Hinduism | 41 | 10.0 |
Education | Less than secondary | 86 | 21.0 |
Post-secondary education | 131 | 32.0 |
Tertiary education | 193 | 47.1 |
Employment status | Employment | 290 | 70.7 |
Non-employment | 30 | 7.3 |
Student | 90 | 22.0 |
Monthly family income | < NRS 100900 | 374 | 91.2 |
> NRS 100900–309000 | 21 | 5.1 |
>NRS 309000 | 15 | 3.7 |
Nationality | Nepali | 403 | 98.3 |
Non-Nepali | 7 | 1.7 |
Ethnicity | Bhramin and Chettri | 252 | 61.5 |
Other | 158 | 38.5 |
Residence | Province 1 (Briatnagar as territorial capital) | 67 | 16.3 |
Province 2 (Janakpur as territorial capital) | 37 | 9.0 |
Province 3 (Bagmati) | 258 | 62.9 |
Province 4 (Gandaki) | 21 | 5.1 |
Province 5 (Butwal as territorial capital) | 13 | 3.2 |
Province 6 (Karnali) | 4 | 1.0 |
Province 7 (Sudurpaschim) | 10 | 2.4 |
Are you a healthcare worker? | Yes | 167 | 40.7 |
No | 243 | 59.3 |
| Total | 410 | 100 |
NB: Nepal is yet to name all the provinces under the mandate of new constitution and federal People's Republic. |
Table 2 depicts the prevalence of each symptom of CPDI. Among respondents, 50% (n = 205 were nervous, anxious at some moments and bought a lot of masks, medications, sanitizers, gloves, and other home supplies during the COVID-19 pandemic crisis. Two third (n = 271, 66.1%) of study population were worried about their families being infected and continue updating with COVID-19 related news and information (n = 248, 60.4%). Majority (n = 361, 88%), of respondents felt sympathetic to COVID 19 patients and their families.
Table 2
Presence of symptoms COVID19 Peri-traumatic distress (CPDI)
| Never n(%) | Occasionally n(%) | Sometimes n(%) | Often n(%) | Always n(%) |
Question 1: Compared to usual, I feel more nervous and anxious. | 200(48.8) | 166(40.5) | 30(7.3) | 13(3.2) | 1(0.2) |
Question 2: I feel insecure and bought a lot of masks, medications, sanitizers, gloves and/or other home supplies. | 205(50.0) | 122(29.8) | 64(15.6) | 8(2.0) | 11(2.7) |
Question 3: I can’t stop myself from imagining myself or my family being infected and feel terrified and anxious about it. | 139(33.9) | 177(43.2) | 75(18.3) | 14(3.4) | 5(1.2) |
Question 4: I feel helpless no matter what I do. | 291(71.0) | 82(20.0) | 27(6.6) | 9(2.2) | 1(0.2) |
Question 5: I feel sympathetic to COVID-19 patients and their families. | 49(12.0) | 81(19.8) | 99(24.1) | 58(14.1) | 123(30.0) |
Question 6: I feel helpless and angry about people around me, governors, and media. | 133(32.4) | 153(37.3) | 75(18.3) | 39(9.5) | 10(2.4) |
Question 7: I am losing faith in the people around me. | 213(52.0) | 113(27.6) | 65(15.9) | 16(3.9) | 3(0.7) |
Question 8: I collect information about COVID-19 all day. Even if it’s not necessary, I can’t stop myself. | 162(39.5) | 127(31.0) | 68(16.6) | 29(7.1) | 24(5.9) |
Question 9: I will believe the COVID-19 information from all sources without any evaluation. | 284(69.3) | 85(20.7) | 32(7.8) | 9(2.2) | 0(0.0) |
Question 10: I would rather believe in negative news about COVID-19 and be skeptical about the good news. | 310(75.6) | 63(15.4) | 28(6.8) | 7(1.7) | 2(0.5) |
Question 11: I am constantly sharing news about COVID-19 (mostly negative news). | 276(67.3) | 80(19.5) | 36(8.8) | 11(2.7) | 7(1.7) |
Question 12: I avoid watching COVID-19 news since I am too scared to do so. | 281(68.5) | 82(20.0) | 34(8.3) | 12(2.9) | 1(0.2) |
Question 13: I am more irritable and have frequent conflicts with my family. | 294(71.7) | 79(19.3) | 23(5.6) | 11(2.7) | 3(0.7) |
Question 14: I feel tired and sometimes even exhausted. | 227(55.4) | 125(30.5) | 37(9.0) | 19(4.6) | 2(0.5) |
Question 15: When feelings anxious, my reactions are becoming sluggish. | 277(67.6) | 97(23.7) | 24(5.9) | 11(2.7) | 1(0.2) |
Question 16: I find it hard to concentrate. | 233(56.8) | 121(29.5) | 31(7.6) | 21(5.1) | 4(1.0) |
Question 17: I find it hard to make any decisions. | 277(67.6) | 92(22.4) | 31(7.6) | 9(2.2) | 1(0.2) |
Question 18: During this COVID-19 period, I often feel dizzy or have back pain and chest distress. | 317(77.3) | 64(15.6) | 22(5.4) | 7(1.7) | 0(0.0) |
Question 19: During this COVID-19 period, I often feel stomach pain, bloating, and other stomach discomforts. | 299(72.9) | 81(19.8) | 21(5.1) | 8(2.0) | 1(0.2) |
Question 20: I feel uncomfortable when communicating with others. | 311(75.9) | 66(16.1) | 25(6.1) | 7(1.7) | 1(0.2) |
Question 21: Recently, I rarely talk to my family. | 325(79.3) | 57(13.9) | 17(4.1) | 9(2.2) | 2(0.5) |
Question 22: I have frequent awakening at night due to my dream about myself or my family being infected by COVID-19. | 321(78.3) | 68(16.6) | 18(4.4) | 2(0.5) | 1(0.2) |
Question 23: I have changes in my eating habits | 302(73.7) | 62(15.1) | 31(7.6) | 13(3.2) | 2(0.5) |
Question 24: I have constipation or frequent urination. | 338(82.4) | 48(11.7) | 19(4.6) | 3(0.7) | 2(0.5) |
More than two third (n = 277, 67.5%) of the participants felt helpless and angry about the people around them. One third (n = 126, 30.7%) believed COVID 19 information from all sources without validation; were irritable and have frequent conflicts with their family (28.2%. Approximately a quarter of the respondents felt dizzy, back pain, and chest distress (22.6%); and felt change in their eating habits during COVID-19 period (26.3%).More than two third of the respondents prefer not sharing negative news about COVID 19 67.3% (n = 276), not skeptical about the news (75.6%, n = 310), never avoided watching COVID-19 news because they were too scared (68.5%, n = 281) and had excellent communication with their family during the COVID-19 period (71.7%, n = 294).
Table 3 demonstrates distribution of level of distress by socioeconomic and demographic characteristics of Nepal. The prevalence of mild to severe distress in the age group < 30 years, 30–45 years and > 45 years old were 12.2% (n = 20); 9.5% (n = 18); and 15.3% (n = 9) respectively. The prevalence of mild to moderate and severe distress was higher among females than males. The prevalence of mild to moderate distress among males was 10.2% and 12.5% among females, and the severe distress prevalence was 0.4% among males and 0.7% among females.
Table 3
Prevalence of CPDI by socioeconomic and demographic characteristics, Nepal
| | Normal n (%) | Mild to moderate distress n (%) | Severe distress n (%) |
Age | < 30 | 143(87.7) | 19(11.7) | 1(0. 6) |
30–45 | 170(90.4) | 17(9.0) | 1(0.5) |
> 45 | 50(84.7) | 9(15.3) | 0(0.0) |
Gender | Female | 125(86.8) | 18(12.5) | 1(0.7) |
Male | 237(89.4) | 27(10.2) | 1(0.4) |
Other | 1(100.0) | 0(0.0) | 0(0.0) |
Religion | Hinduism | 327(88.6) | 41(11.1) | 1(0.3) |
Non-Hinduism | 36(87.8) | 4(9.8) | 1(2.4) |
Education | Less than Secondary | 80(93.0) | 6(7.0) | 0(0.0) |
Post-secondary | 104(79.4) | 27(20.6) | 0(0.0) |
Tertiary | 179(92.7) | 12(6.2) | 2(1.0) |
Employment | Employment | 258(89.0) | 31(10.7) | 1(0.3) |
Non-employment | 29(96.7) | 1(3.3) | 0(0.0) |
Student | 76(84.4) | 13(14.4) | 1(1.1) |
Household’s Monthly Income | <NRS 100900 | 331(88.5) | 42(11.2) | 1(0.3) |
>NRS 100901–309000 | 19(90.5) | 2(9.5) | 0(0.0) |
>NRS 309000 | 13(86.7) | 1(6.7) | 1(6.7) |
Nationality | Nepali | 359(89.1) | 43(10.7) | 1(0.2) |
Non-Nepali | 4(57.1) | 2(28.6) | 1(14.3) |
Ethnicity | Bhramin and Chettri | 217(86.1) | 33(13.1) | 2(0.8) |
Other | 146(92.4) | 12(7.6) | 0(0.0) |
Your State of Residence | Province 1 | 50(74.6) | 16(23.9) | 1(1.5) |
Province 2 | 29(78.4) | 8(21.6) | 0(0.0) |
Province 3 | 241(93.4) | 16(6.2) | 1(0.4) |
Province 4 | 21(100.0) | 0(0.0) | 0(0.0) |
Province 5 | 11(84.6) | 2(15.4) | 0(0.0) |
Province 6 | 3(75.0) | 1(25.0) | 0(0.0) |
Province 7 | 8(80.0) | 2(20.0) | 0(0.0) |
Are you a healthcare worker? | No | 211(86.8) | 32(13.2) | 0(0.0) |
Yes | 152(91.0) | 13(7.8) | 2(1.2) |
Further, the prevalence of distress was higher among respondents who have post-secondary education (20.6%, n = 27) than lower education group. Similarly, the prevalence of distress was higher among student (15.6%, n = 14), who have household income of < NRS 100900 (11.5%, n = 43), Bhramin and Chettri (13.9%, n = 35), non-Nepali (42.9%, n = 3), and resident of province one (25.4%, n = 17).
Overall 88.5% (n = 363) of the participants were not distressed while, 11% (n = 45) were mild to moderate distressed and 0.5% (n = 2) were severely distressed due to COVID-19 pandemic (Fig. 1.)
Table 4 illustrates the predictor of distress using binary logistic regression. After adjusting for other factors, the participants residing at province three (Bagmati) had less chance of being distressed in COVID-19 (OR = 0.244, 95% CI: 0.111–0.539, p = 0.000) compared to participants residing at province one.
Table 4
Predictors of CPDI through binary logistics regression
| Exp(B) | 95% C.I. for EXP(B) | p-value |
Lower | Upper |
Age (in Years) | < 30® | | | | .562 |
30–45 | 1.157 | .456 | 2.932 | .759 |
> 45 | 1.819 | .580 | 5.697 | .305 |
Gender | Male® | | | | .876 |
Female | 1.212 | .583 | 2.523 | .606 |
Other | .000 | 0.000 | | 1.000 |
Religion | Hinduism® | | | | |
Non-Hinduism | .792 | .265 | 2.365 | .677 |
Education | Less than secondary® | | | | .007 |
Post-secondary education | 3.320* | 1.208 | 9.124 | .020 |
Tertiary education | 1.152 | .358 | 3.710 | .813 |
Employment status | Employment® | | | | .300 |
Non-employment | 1.283 | .496 | 3.322 | .607 |
Student | .237 | .028 | 1.977 | .183 |
Monthly family income | < NRS 100900® | | | | .865 |
> NRS 100900–309000 | 1.043 | .200 | 5.443 | .960 |
>NRS 309000 | 1.654 | .264 | 10.350 | .591 |
Nationality | Nepali® | | | | |
Non-Nepali | 3.672 | .667 | 20.235 | .135 |
Ethnicity | Bhramin and Chettri® | | | | |
Other | .510 | .256 | 1.014 | .055 |
Your State of Residence | Province 1® | | | | .018 |
Province 2 | .882 | .311 | 2.502 | .814 |
Province 3 | .244* | .111 | .539 | .000 |
Province 4 | .000 | 0.000 | | .998 |
Province 5 | .775 | .139 | 4.324 | .772 |
Province 6 | 1.130 | .094 | 13.620 | .923 |
Province 7 | .842 | .139 | 5.098 | .851 |
Are you a healthcare worker? | Yes® | | | | |
No | 1.120 | .515 | 2.434 | .775 |
| Constant | .123 | | | .010 |
® Reference Category, *Significant at 5% level of significance |
Participants with post-secondary education had 3.32 (95% CI: 1.208–9.124, p = 0.020) times higher risk of developing distress as compared to secondary education or lower. Other variables did not show relation to develop distress of COVID after adjusting other factors.