|Year : 2021 | Volume
| Issue : 4 | Page : 203-207
Psychological impact of COVID-19 pandemic and its coping: A one-year follow-up study from India
Susmita Halder1, Akash Kumar Mahato2, Shinjini Samajdar3
1 Department of Psychology, St. Xavier's University, Kolkata, West Bengal, India
2 Department of Clinical Psychology, Amity University, Laketown, West Bengal, India
3 Consultant Clinical Psychologist, Mind Care Clinic, Laketown, West Bengal, India
|Date of Submission||25-May-2021|
|Date of Decision||17-Jul-2021|
|Date of Acceptance||23-Jul-2021|
|Date of Web Publication||21-Dec-2021|
Ph.D Susmita Halder
Major Arterial Road, Action Area II, Newtown, Kolkata - 700 135, West Bengal
Source of Support: None, Conflict of Interest: None
Objective: The coronavirus disease pandemic has been posing as a serious health hazard with high mortality risks along with global disastrous economic consequences. A pervasive and long-term impact of the pandemic on mental health has been expected and reported in literature. It is vital to study its nature and whether there has been any change in the impact perception and coping of people toward the COVID pandemic after a year it started. Methods: The study was conducted in two phases, with a gap of one year in between the phases. The present study produced the findings of second phase, which was basically a follow-up after one year. Totally, 100 consenting participants of both sex from the pool of first phase (n = 625) who agreed for follow-up assessment were re-assessed to see the changes in psychological impact of COVID pandemic and their coping using the Psychological Impact and Coping in COVID Pandemic Questionnaire. Results: The psychological coping of the participants significantly lowered from the first phase to the second phase (22.09 ± 3.44 vs. 20.02 ± 3.37, t = 3.75, p < 0.001). Under domain category, psychological coping showed significant lowering in male student participants (21.67 ± 3.50 vs. 19.09 ± 3.35, t = 3.001, p < 0.01) and in female student participants (22.37 ± 3.43 vs. 20.26 ± 3.43, t = 3.2, p < 0.01) from the first to the second phase. Young-aged adults had significantly lowered in psychological coping (22.50 ± 3.15 vs. 19.26 ± 3.72, t = 4.4 p < 0.001) from the first to the second phase. No change in psychological impact on the participants existed, across first to second phase, in the domain for age and sex. Conclusion: The psychological impact of the pandemic was reduced but not conclusively after a year of the COVID pandemic, and the coping was poorer after a year, especially in young adults. The continuation of the pandemic with a persistent increase in infection and mortality numbers and uncertainty over treatment and vaccination is to maintain the phenomenon and needs to be controlled to limit secondary long-term mental issues in the population.
Keywords: age difference, Psychological Impact and Coping to COVID Pandemic Questionnaire, sex differences, young adults
|How to cite this article:|
Halder S, Mahato AK, Samajdar S. Psychological impact of COVID-19 pandemic and its coping: A one-year follow-up study from India. Taiwan J Psychiatry 2021;35:203-7
|How to cite this URL:|
Halder S, Mahato AK, Samajdar S. Psychological impact of COVID-19 pandemic and its coping: A one-year follow-up study from India. Taiwan J Psychiatry [serial online] 2021 [cited 2022 Aug 12];35:203-7. Available from: http://www.e-tjp.org/text.asp?2021/35/4/203/332968
| Introduction|| |
The COVID-19 pandemic has progressed in different ways in different countries depending on the lockdown measures, early testing, treatment facilities, and vaccination. Despite all the measures, the pandemic is yet to be over and continues posing as an unparalleled global health and economic hazard. After the start of the pandemic in 2019, people are more apprehensive regarding the nature of the pandemic and uncertainty of the situation . During the first wave of the pandemic in India, controlling measures such as national lockdown, social distancing, and quarantine were enforced which were unprecedented experience for the people, negatively impacting their physical health, increased financial instability, and elevated mental health concerns ,. The unpredictability and constant apprehensions lead to emotional distress in anxiety, panic, low mood, and irritability in the general public. With the passage of time, people were gradually coming into terms with the “new normal,” expecting the situation to normalize soon like a stress phenomenon. The presumptive stress of the pandemic is bound to impact the mental health of the general population and accordingly, the authors did a survey study across 21 cities of India in the month of May 2020 to see the psychological impact of the pandemic and how people were coping with it. Then, findings suggested that differences exited in psychological impact and coping with the COVID-19 pandemic, and that young adults were found adversely impacted compared to their older compatriots. The factor sex has the same impact, but young adults represented mostly by students have been found to have poorer coping.
People hoped after vaccines were approved from the month of November 2020 and expected a gradual waning off of the pandemic. But after a brief lull in infection rates during January–February 2021, India faced the second wave of the pandemic in April 2021. In the second phase of the pandemic, people were already aware of the do's and don'ts and the safety precautions in the pandemic, but eventually, the daily infection cases were crossing 0.2 million per day and subsequent mortality numbers were high. Subsequent public concerns regarding getting timely vaccination, availability of beds, and oxygen cylinders in the event of infection were constantly looming. Although vaccinations had been started in India, bringing some sense of relief, the uncertainty lingered as even vaccinated people were getting infected, and vaccination was open to only a specific age group people to streamline demand and supply of the vaccine.
In such a backdrop, we intended to study whether the psychological impact of the pandemic was worsened or reduced and whether change existed in peoples coping to it. In this study, we also intended to study the changes in perception of psychological impact of the COVID pandemic and changes in coping of adult participants at follow-up after one year.
| Methods|| |
In the first phase of the study, done in May 2020, a total of 625 individuals of both sexes, in the age range of 20–55 years, were recruited from different cities across India through an online Google Form. None of the participants or their family members was infected with COVID-19. The participants in the first phase filled up the questionnaire through Google Form itself; duly giving their informed consent in the form.
We intended to do the present (the second phase) study on those 625 individuals. The study was approved by the Departmental Research Committee of the Amity Institute of Behavioural Health and Allied Sciences, Amity University Kolkata (protocol number = DRC-AIBHAS/ETHICS/04/2021/01 and date of approval = March 10, 2021) with the need of obtaining informed consent from all recruited study participants. The principal as well as co-authors of the first and second phases being the same had access to data of the first phase. We chose 100 consenting participants from the pool for follow-up at one year and reassessed them on the same parameters of impact and coping using the same tool using Google Form shared through e-mail. Keeping parity with the criteria of first phase, we included only those participants who themselves and whose immediate family members were still not infected with COVID-19. Informed consent was obtained from all participants and confidentiality was maintained.
Psychological Impact and Coping to COVID Pandemic Questionnaire as the study tool
A 20-item survey using the Psychological Impact and Coping to COVID Pandemic Questionnaire [Table 1] was specifically developed by us, to assess psychological impact and coping to COVID pandemic and lockdown situation during the first phase of the study. The same study tool was repeated to assess the psychological impact of the pandemic and study participants' coping with it.
|Table 1: Psychological impact and coping in coronavirus disease pandemic questionnaire|
Click here to view
The initial item pool of the questionnaire consisted of 129 questions, which were further trimmed discarding lengthy and conspicuous items. Further rated by two experts for appropriateness of the items, the items were categorized into domains of impact and coping. The items in domain of impact are focused on general and social impact and mental health aspects, while the coping items are focused on adaptive coping. The expert rating was collated to obtain a set of 59 questions discarding the rest. Further, overlapping items in the pool were discarded and the final questionnaire consisted of 20 closed ended questions with 14 items on impact domain and 6 items on coping domain. As shown in [Table 1], the scoring of the items is on a five-point Likert scale (never, rarely, sometimes, often, and most of the times). Direct scoring was used for the positively worded items and reverse scoring for negatively worded items. The impact items can have maximum score of 70, where higher score suggests higher adverse impact and its perception. The coping items can have maximum score of 30, where higher score suggests better and adaptive coping.
The participants of the first phase were shared with the questionnaire in Google Form through e-mail. A total of 100 participants, who themselves and their immediate family members were not infected with COVID-19, responded in affirmative to respond and data collection was completed in two weeks of time. The participants were blind to their responses on the same assessment tool a year back in 2020, and were instructed to respond their current state of mind.
Data were scored and analyzed using descriptive statistics. We used Student's t-test to compare between the scores of two phases. Statistical analysis was done using Statistical Package for Social Science software version 17 for Windows (SPSS, Inc. Chicago, Illinois, USA). The differences between two phases were considered significant if p-values were smaller than 0.05.
| Results|| |
[Table 2] shows the data of psychological impact and psychological coping of the participants across two phases. The 100 study participants had the age of 32.98 ± 10.73 (mean ± standard deviation) years, with men being 40% of the sample. No significant change was found in the psychological impact in the participants (43.44 ± 7.84 vs. 42.14 ± 6.49) from the first to the second phase.
|Table 2: Psychological impact and psychological coping of the participants across two phases (N = 100)|
Click here to view
Based on the results of [Table 2], the psychological coping was significantly lowered in participants from the first phase to the second phase (22.09 ± 3.44 vs. 20.02 ± 3.37, t = 3.75, p < 0.001). Further, under domain category, psychological coping showed significant lowering in male student participants (21.67 ± 3.50 vs. 19.09 ± 3.35, t = 3.001, p < 0.01) as well as in women participants (22.37 ± 3.43 vs. 20.26 ± 3.43, t = 3.2, p < 0.01) from the first to the second phase. Age-wise, young adult participants were significantly lowered in psychological copying (22.50 ± 3.15 vs. 19.26 ± 3.72, t = 4.4, p < 0.001) from the first to the second phase.
| Discussion|| |
Survey method was used to gather data for the study which was the only feasible method considering the pandemic situation and enforced lockdown. The method could help reach a large number of participants from different cities across India during the pandemic period in 2021. It helped understand the nature and perspectives regarding the psychological impact of COVID pandemic and coping of the participants, and based on the findings, intervention could be planned. While the number of participants was much higher in the first phase of the study, it was dropped significantly for the follow-up, and only 100 participants could participate in the study considering non-inclusion of infected participants.
Findings [Table 2] show no significant difference in the domain of psychological impact as perceived by the sample even after one year of the pandemic. Psychological impact reported as anxiety and stress was evident. Even though there was a slight dip in the impact perception scores, but the difference was not significant. This finding suggests that even after a year, the population was still under stress of the pandemic. The possible explanation could be the continuity of the pandemic and recent surge in its severity and a possibility of further worsened situation in case of a third wave hit.
Results [Table 2] showed a significant difference in the domain of psychological coping of the participants in the second Phase, and it was significantly lowered compared to the first phase (p < 0.01). This was not an expected finding considering human resilience capabilities and coping with stressors in long-term. In COVID-19 pandemic, the constant demand of limitations, restrictions and changes in usual lifestyle patterns, exposure to devastating news of the pandemic on a daily basis, and death of known people in and outside family are leading to emotional turbulence on a daily basis. A sense of grief prevails even if none is dead directly from the family. We can see from the results [Table 2] that psychological coping of both men and women participants was significantly lowered from first to second phase (p < 0.01), and was an expected finding considering the cumulative impact of the pandemic on the general population.
Age-wise [Table 2], we found that coping among young adult participants was significantly lowered compared to previous year (p < 0.001). Prolonged stress is known to multiply its adverse effects , and in addition, older adults are known to better appraise stressful conditions  which could be the possible reason why young adults in the sample had poor to poorer coping. The prolonged duration of the pandemic has been suggested to surge the feelings of uncertainty and emotional distress and presence of emotional turbulence in different studies  and visible in the individuals surveyed in the present study too.
The stress mechanism suggests that awareness of the stressor reduces the perception of stress, which seems not to apply in case of COVID pandemic. As uncertainty regarding vaccination and treatment of COVID-19 persists, the participant's perception of lack of control over this stressor can explain this phenomenon. After a year of pandemic, awareness of pandemic might have been improved , but perceived control and resources to deal with the pandemic stressor are inadequate. Uncertainty of job, dwindling finances and business loss, limitation in lifestyle, worries about children's education, indefinite wait for getting vaccination, doubts on the efficacy of vaccination, disproportionate health infrastructure which appear to have crumbled dealing with the volume of patients, and constant news of daily deaths in close circuits have taken a toll on mental health of people and a possible reason of poor coping among the participants.
COVID-19 pandemic is expected to have adverse impacts on people's psychosocial well-being and is depending on the extent and duration or extremity of the pandemic situation. Since last year, the public health responses to reduce or manage mental health concerns have been focused and measures were also taken place. The situation calls for appropriate arrangements to meet the mental health need of the population, which may not be feasible in peak moment of the pandemic, but much required after the pandemic subsides to stop any wave of mental health issues.
The readers are advised against overinterpreting the study results because this study has two major limitations:
- The sample for the study was drawn using convenient sampling and dropped significantly in numbers compared to those in the first phase. Although this was the only feasible method of assessing the sample, the method might have reduced the generalization of the findings.
- The perception of the people toward the COVID pandemic might have been molded by the information available over the print and digital media, which itself has gone a big change over a year, depending on new revelations coming up, but the psychological stress due to the pandemic with a varying degree in different individuals.
Psychological distress due to the outbreak of COVID-19 pandemic is evident and mental health concern has become one of the most observant public health policies in the pandemic situation all over the world. The impact perception of the pandemic remains the same after a year of the pandemic and people's coping has lowered than before. In India, the second upsurge of the disease has increased the unpredictability of resolution of the situation and impacted the coping strategies to deal with this prolonged and unsure situation. In current situation, enhancement and encouragement of coping strategies of individuals through psychotherapeutic interventions could help improve the mental health and tolerance of people. Mental health professionals should come forward and reach a larger population for providing crisis counseling services in a large number and using online resources for maximum reach.
| Financial Support and Sponsorship|| |
| Conflicts of Interest|| |
The authors declare that there are no conflicts of interests of this paper.
| References|| |
Brauner JM, Mindermann S, Sharma M, et al.: Inferring the effectiveness of government interventions against COVID-19. Science
2021; 371 (6531).
Pierce M, McManus S, Jessop C, et al.: Says who? The significance of sampling in mental health surveys during COVID-19. Lancet Psychiatry
2020; 7: 567-8.
Holmes EA, O'Connor RC, Perry VH, et al.: Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. Lancet Psychiatry
2020; 7: 547-60.
Kelly MM, Tyrka AR, Price LH, et al.: Sex differences in the use of coping strategies: predictors of anxiety and depressive symptoms. Depress Anxiety
2008; 25: 839-46.
Schneiderman N, Ironson G, Siegel SD: Stress and health: Psychological, behavioral, and biological determinants. Annu Rev Clin Psychol
2005; 1: 607-28.
Aldwin CM, Sutton KJ, Chiara G, et al.: Age differences in stress, coping, and appraisal: findings from the Normative Aging Study. J Gerontol B Psychol Sci Soc Sci
1996; 51: P179-88.
Chen YY, Wu KC, Gau SS: Mental health impact of the COVID-19 pandemic in Taiwan. J Formos Med Assoc
2021; 120: 1421-3.
Modi PD, Nair G, Uppe A, et al.: COVID-19 awareness among healthcare students and professionals in Mumbai Metropolitan Region: a Questionnaire-Based Survey. Cureus
2020; 12: e7514.
[Table 1], [Table 2]