A Prevalence Study of Post-Traumatic Stress Disorder and Its Sociobiological Determinants During Second Wave of COVID-19 Pandemic Among General Population of National Capital Territory of Delhi

Neeti Purwar; Ambren Chauhan; Anshu Singh; Khushboo Juneja; Harsh Mahajan; Shalini Srivastava

doi:10.4103/mamcjms.mamcjms_36_22

ORIGINAL ARTICLE

Year : 2023 | Volume : 9 | Issue : 1 | Page : 29-34

A Prevalence Study of Post-Traumatic Stress Disorder and Its Sociobiological Determinants During Second Wave of COVID-19 Pandemic Among General Population of National Capital Territory of Delhi

Neeti Purwar¹, Ambren Chauhan¹, Anshu Singh¹, Khushboo Juneja², Harsh Mahajan¹, Shalini Srivastava¹
¹ Department of Community Medicine, School of Medical Sciences and Research, Sharda University, Greater Noida, U.P., India
² Department of Community Medicine, Manipal TATA Medical College, Jamshedpur, Jharkhand, Manipal Academy of Higher Education, Manipal, Karnataka 576104, India

Date of Submission	03-Jun-2022
Date of Acceptance	21-Feb-2023
Date of Web Publication	28-Apr-2023

Correspondence Address:
Khushboo Juneja
Department of Community Medicine, Manipal TATA Medical College, Kadani Road, Baridih, Singhbhum District, Jamshedpur, Jharkhand, 831017
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/mamcjms.mamcjms_36_22

Abstract

Introduction: Nationwide lockdown during COVID-19 pandemic, rapid transmission of SARS-CoV-2 and more intense second wave of pandemic in terms of high caseload, reduced essential supplies and scarcity of beds, and unpredictable mortality had a huge impact on mental health of general population. Objectives: This study aimed to estimate the prevalence and determine the factors of Post-Traumatic Stress Disorder (PTSD) among the general population of India during the second wave of pandemic. Methodology: An online survey was conducted to estimate the prevalence and assess the factors responsible for PTSD among 614 participants who were above 18 years of age. The prevalence of PTSD was measured using PTSD checklist for Diagnostic and Statistical Manual of Mental Disorder-5 (DSM-5). Results: In the present study, there were a total of 614 participants and the mean age of the participants was 23.64 years. More than half of the participants were female and majority of them were unmarried (76.7%). The prevalence of PTSD was 30.62%. A significant association was observed between occupation and PTSD prevalence. Also, COVID-19 illness, COVID-19 infection among the family members, work outside the home, hospital admissions, difficulty in acquiring the required medication were significantly associated with PTSD. Conclusion: COVID-19 pandemic and nationwide lockdown led to increased prevalence of psychological effects like PTSD. This highlights the importance of focusing on mental health during the pandemic.

Keywords: COVID-19, pandemic, post-traumatic stress disorder

How to cite this article:
Purwar N, Chauhan A, Singh A, Juneja K, Mahajan H, Srivastava S. A Prevalence Study of Post-Traumatic Stress Disorder and Its Sociobiological Determinants During Second Wave of COVID-19 Pandemic Among General Population of National Capital Territory of Delhi. MAMC J Med Sci 2023;9:29-34

How to cite this URL:
Purwar N, Chauhan A, Singh A, Juneja K, Mahajan H, Srivastava S. A Prevalence Study of Post-Traumatic Stress Disorder and Its Sociobiological Determinants During Second Wave of COVID-19 Pandemic Among General Population of National Capital Territory of Delhi. MAMC J Med Sci [serial online] 2023 [cited 2023 Jun 6];9:29-34. Available from: https://www.mamcjms.in/text.asp?2023/9/1/29/375332

Introduction

Globally as of September 2021, there have been approximately 226 million confirmed cases of COVID-19, including about 4.6 million deaths reported. In India, from January 2020 to September 2021, there have been about 33 million confirmed cases of COVID-19 with 0.44 million deaths reported to WHO.^[1] Since the middle of March 2021, the second wave of pandemic had started in India, and in April, very high number of cases, about 1.4 lakhs per day, were reported.^[2] The second wave of COVID-19 in India had severe consequences in the form of high caseload, reduced supplies of essential treatment and increased mortality, particularly in young population.^[3]

Second wave of pandemic, which was more intense, had a huge impact on the mental health of individuals. The scarcity of beds in COVID hospitals, unavailability of medicines, and lack of oxygen supply had turned this wave into mental trauma for many people. Significant amount of fear and anxiety led to socio-behavioral changes that might have had considerable impact on their everyday lives.^[4],[5]

This might have led to increase in the prevalence of PTSD among individuals caused by the fear of themselves being infected with SARS-CoV-2 (because of family members being infected) and scarcity of medicines and oxygen supply as PTSD may occur in individuals who have experienced the onset of sudden and immediate life-threatening events.^[6]

In the light of this, the present study was conducted to estimate the prevalence and determine the associated factors of PTSD among the general population of the National Capital Territory of Delhi, India during the second wave of COVID-19 pandemic.

Methodology

A web-based cross-sectional study was conducted during the month of June 2021, approximately three months after the onset of the second wave of COVID-19 pandemic in India.

An online survey questionnaire as Google form was circulated among MBBS students, which was further circulated by them to their family members, friends, and relatives residing in the National Capital Territory (NCT) of Delhi through various social media platforms and emails. Participants were asked to share the questionnaire with their friends or relatives or family members, who could further share it with their known persons residing in the NCT of Delhi. The participants were allowed to submit only one response. Data was collected anonymously. During the month of June 2021, 614 people filled the Google form. At the end of June, response acceptance was stopped. The participants included in the study were of age 18 years and above and were living in India. Before collecting the data, their electronic consent was taken.

Questionnaire

A semi-structured questionnaire was incorporated into Google forms. Every participant’s consent was taken at the beginning of the survey. Questions were asked regarding the following topics:

Socio-demographic profile
History of COVID-19 in past 3 months
Requirement of hospital admission
Difficulty in acquiring the required medicine
History of chronic illnesses like Diabetes mellitus, hypertension and other cardiovascular diseases, pulmonary diseases, thyroid disorders, and cancer
Previous or currently diagnosed psychiatric conditions like insomnia, depression, anxiety, stress and PTSD.
PTSD checklist of Diagnostic and Statistical Manual of Mental Disorder-5 (DSM-5)

PTSD checklist for DSM-5 was used for making a provisional diagnosis of PTSD.^[7] This is a 20-item self-report measure for assessing the presence and severity of PTSD symptoms. It can be completed in about 5–10 minutes. The participants were asked to report their symptoms in the past month. Participants were asked to rate each of the 20 items in the past month on a 5-point Likert scale ranging from 0–4. All the 20 items were summed to provide a total severity score (range 0–80), where

0 = Not at all

1 = A little bit

2 = Moderately

3 = Quite a bit

4 = Extremely

Provisional diagnosis of PTSD can be made using a cut-point score of 31–33. In the present study, a score of 33 or higher was used for making provisional diagnosis of PTSD to minimize false positives.

Statistical analysis

The data was entered and analyzed using Statistical Package for the Social Sciences (SPSS) software version 21.0 (IBM, New York, USA). Descriptive statistics included frequency, percentages, mean, range, and standard deviation for continuous variable. Odds ratio and 95% confidence interval was calculated to assess the association between the socio-demographic variables, past history of COVID-19, hospital admission, chronic illnesses, psychiatric conditions, and PTSD.

Results

A total of 614 participants took part in the study. Mean age of the participants was 23.64 years (Range: 18–68 years; SD ± 7.89). [Table 1] shows the socio-demographic characteristics and association between socio-demographic characteristics and PTSD cut-off score. Approximately two-third of the participants belonged to the age group of 20–30 years and 59.9% were females. Majority of them were unmarried (76.7%) and graduate (68.7%). More than three-fourth of the participants were either unemployed or homemaker or students (77.9%).

Table 1 Association between socio-demographic characteristics and PTSD (n = 614)

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The overall prevalence of PTSD was 30.62%. A significant association was observed between occupation and PTSD prevalence. Participants who were unemployed or homemakers or students were more likely to have PTSD compared to those who were employed (odds ratio [OR]: 1.575; confidence interval [CI] 95%: 1.014–2.445). No significant statistical association was observed between age-group, gender, educational status, marital status, and PTSD.

[Table 2] illustrates the association between socio-biological factors and PTSD. The odds of developing PTSD were 2 times higher among those who were affected with Covid 19 in past 3 months compared with those who were not affected (OR: 2.023; 95% CI: 1.398–2.928). Participants who had their family members been affected with COVID-19 in past 3 months were 2.3 times more likely to develop PTSD than those who had not (OR: 2.349; 95% CI: 1.650–3.342). The odds of developing PTSD were 1.7 times higher among those who were working outside their homes during the second wave of COVID-19 pandemic than those who were not going outside or were working from home (OR: 1.727; 95% CI: 1.185–2.518).

Table 2 Association between COVID-19 pandemic related factors and PTSD (n = 614)

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There were 342 participants who either were themselves affected or had their family members affected with COVID-19. From them, details regarding hospital admission, length of hospital stay, difficulty in acquiring the required medicine, and post COVID conditions were asked. The odds of developing PTSD was 1.9 times higher in those who either were themselves admitted in hospital or had their family members admitted in hospitals (OR: 1.931; 95% CI: 1.220–3.056). There was no association between length of hospital stay and PTSD (OR: 1.125; 95% CI: 0.504–2.512). Participants who faced difficulty in acquiring the required COVID-19 medication were 4 times more likely to develop PTSD than those who did not face any difficulty (OR: 1.931; 95% CI: 1.220–3.056).

Among all respondents (n = 614), the ones who had pre-existing chronic conditions like Diabetes mellitus, hypertension, etc. were 2.7 times more likely to develop PTSD than those who were not having any of the pre-existing chronic conditions (OR: 2.672; 95% CI: 1.871–3.818). The odds of developing PTSD were 3.2 times higher among participants who were having any of the pre-existing psychiatric conditions like insomnia, depression, anxiety, etc. than those who had not (OR: 3.245; 95% CI: 2.229–4.725).

[Table 3] showed distribution of study participants (n = 614) according to the responses on PTSD checklist for DSM-5. More than one-third of the study subjects (37.5%) reported repeated, disturbing, and unwanted memories of the stressful experience moderately, quite a bit or extremely. When they were asked if they had repeated, disturbing dreams of the stressful experience, 15.3% of them reported moderately and 9.8% reported quite a bit. One-fourth of them (25.1%) recounted that they were suddenly feeling or acting as if the stressful experience were actually happening again moderately or quite a bit. On being asked how much upset they felt when something reminded them of the stressful experience, 8.5% of them reported it extremely. A total of 17.9% of the participants told moderately when they were asked if they had strong physical reactions like heart pounding, trouble breathing, or sweating when something reminded them of the stressful event. About one-fifth of the respondents avoided memories, thoughts, or feelings related to the stressful experience quite a bit or extremely. On being asked if they had strong negative beliefs about themselves, other people, or the world, 8.8% of respondents informed that they felt extremely bad, there is something seriously wrong with them, they cannot trust anyone or the world is completely dangerous. An equal percentage of study participants (15.6%) reported moderately when they were asked if they blame themselves or someone else for their stressful event and if they had strong negative feelings like anger, fear, horror or guilt. More than one-third of them lost interest in activities that they used to enjoy (35.9%) or they felt distant or cut off from other people (42.7%) moderately, quite a bit or extremely. About one-fifth of them reported it moderately for each question when they were asked if they had irritable behavior, anger outburst or acted aggressively or difficulty in concentration or trouble falling or staying asleep.

Table 3 Distribution of study participants according to responses on PTSD Checklist for DSM-5 (n = 614)

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Discussion

This study aimed to estimate the prevalence and to determine the factors associated with PTSD among the general population of India after the onset of second wave of COVID-19 pandemic in the National Capital Territory of the country. The current study showed that the overall prevalence of PTSD was 30.62%. In contrast, a study conducted in Saudi Arabia showed lower prevalence of 22.63%. Similarly, studies conducted in China also showed lower prevalence like 7% and 12.8%. This can be attributed to different time frame of data collection as the study was conducted in June 2021 in India during the second wave of pandemic which was more severe whereas studies of Saudi Arabia and China were conducted during the beginning of the pandemic in 2020. Differences can also be due to different sample sizes and even different methods used to diagnose PTSD.^[8],[9],[10] In cohesion to our study, the prevalence of PTSD was 29.5% in a study conducted among Italian population.^[11] A study done in India among general population to estimate the prevalence of PTSD between March and April 2020 using Impact of Event Scale-Revised reported that the PTSD prevalence was 28.2% which is nearly similar to our finding.^[12]

In the present study, among socio-demographic characteristics, only occupation was significantly associated with PTSD. Those who were unemployed, homemaker, or students were more likely to have PTSD than employed persons. In other studies, in contrast to our findings, female gender was significantly associated with PTSD. This can be due to the differences in the sample size.^[13],[14]

The current study showed that the COVID-19 illness, COVID-19 infection among the family members, work outside the home, hospital admissions, difficulty in acquiring the required medication, pre-existing psychiatric and chronic conditions were significantly associated with PTSD. Similar Studies done in China and Saudi Arabia showed that COVID-19 infection or COVID-19 infection among the family members and friends was significantly associated with post-traumatic stress symptoms, consistent with our interpretation.^[8],[13] A study from Italy also found the association of previous history of psychiatric disorder with PTSD, which is in line with our finding.^[14] An Indian study on COVID-19 and psychological distress also observed that the respondents who were working on site and who had pre-existing medical conditions were more likely to be distressed.^[15]

Conclusions

Our study findings demonstrated the significant impact of COVID-19 pandemic among Indian population. Identified risk factors for PTSD were occupation, COVID-19 infection, COVID-19 illness in family, working outside the home, hospital admission, pre-existing psychiatric, and chronic conditions. Thus it can be concluded that COVID-19 pandemic and nationwide lockdown was significantly associated with psychological effects like PTSD. This study also highlighted the importance of mental health audits and therapy of trauma survivors during such crisis. Since this study revealed that those who faced difficulty in acquiring the required COVID-19 medication are more prone to PTSD, it is recommended that government ensures the availability of essential supplies for the management of such emergencies in future.

Limitations

An online survey was conducted in which a Google form was circulated through various social media platforms and emails. Only those with access to the Internet could have participated, leaving out some sections of society like individuals with no Internet access and no social media accounts or emails, cell phones, or computers. Furthermore, a non-probability sampling method was employed. Thus, the sample lacks representativeness, and these may have affected the generalizability.

Also, in self-report surveys, misinterpretation of questions could happen and persons with most severe symptoms may be more likely to volunteer for the participation, resulting in overestimation of frequency and severity of symptoms.

The present study followed a cross-sectional design; it could not capture changing trends during multiple lockdowns observed in India. Therefore, a longitudinal study can be designed to identify and understand the changes that could have occurred during a period of time.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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