|Year : 2021 | Volume
| Issue : 2 | Page : 72-77
The COIVD-19 pandemic first wave and copings among the urban patients in India
Kannappa V Shetty1, Sreevani Rentala2, Dayananda Bittenahalli Omkarappa3, Sanjeev Kumar Manikappa4, Urmila Bamney5
1 Department of Psychiatric Social Work, Dharwad Institute of Mental Health and Neurosciences, Dharwad, Karnataka, India
2 Department of Psychiatric Nursing, Dharwad Institute of Mental Health and Neurosciences, Dharwad, Karnataka, India
3 Yeovil District Hospital, Somerset, UK
4 Centre for PSS in Disaster, Management, NIMHANS, Bengaluru, Karnataka, India
5 Department of Social Work, Central University of Karnataka, Kalaburagi, Karnataka, India
|Date of Submission||10-May-2021|
|Date of Decision||17-Jun-2021|
|Date of Acceptance||19-Jun-2021|
|Date of Web Publication||21-Dec-2021|
Dr. Kannappa V Shetty
Department of Psychiatric Social Work, Dharwad Institute of Mental Health and Neurosciences, Dharwad, Karnataka
Source of Support: None, Conflict of Interest: None
Context: The COVID-19 pandemic first wave has had a huge psychological impact on COVID patients living in urban areas. Materials and Methods: The study adopted a descriptive research design to determine the coping strategies among home isolated patients with COVID-19 in urban districts of south India. The convenient sampling technique was used to select 60 persons infected with COVID-19 during the first wave of the pandemic as sample of the study. The coping strategies were assessed by using the Brief COPE Inventory scale. It has 28 statements which can identify 14 possible coping strategies and sociodemographic data were collected through the telephonic interview method. Results and Conclusions: Negative coping strategies such as denial and self-blame were found high, and positive coping strategies such as active coping, use of emotional support, use of instrumental support, venting, positive reframing, planning, and religion were reported to high among COVID patients in urban areas. The study suggests providing at least psychological first aid to reduce mental distress during isolation/quarantine.s
Keywords: Copings, COVID-19 pandemic first wave, urban patients
|How to cite this article:|
Shetty KV, Rentala S, Omkarappa DB, Manikappa SK, Bamney U. The COIVD-19 pandemic first wave and copings among the urban patients in India. Indian J Psy Nsg 2021;18:72-7
|How to cite this URL:|
Shetty KV, Rentala S, Omkarappa DB, Manikappa SK, Bamney U. The COIVD-19 pandemic first wave and copings among the urban patients in India. Indian J Psy Nsg [serial online] 2021 [cited 2022 Jul 1];18:72-7. Available from: https://www.ijpn.in/text.asp?2021/18/2/72/332796
| Introduction|| |
The most critical and challenging health concern that the human civilization suffered after the 2nd world war is the new infectious respiratory disease that initially appeared in China. The COVID-19 pandemic has enormous psychological impact on individuals, families, and communities. Coronavirus not only affects physical health but also causes detrimental effects on the mental and emotional well-being of individuals. The disingenuous and deficient information about the COVID-19 has caused worry, fear, and anxiety among the general population. The consequences of mental health inference during the pandemic may have long-term effects on individuals, groups, and society.
To reduce the spread of the infectious virus, the government has imposed mass quarantine by applying nationwide lockdown and then quarantine for positive patients, which creates anxiety, distress among citizens. Further, it results in loneliness and physical health complications increasing the risk of mortality among older adults and vulnerable groups. The pandemic has severe impact on children by leading to certain psychosocial and behavioral problems such as inattention, distraction, clinginess and fear of asking queries about the pandemic. The school closure has restricted the social and physical activities of children, imposing them to stay at home. Parents and guardians find themselves to be the central responsibility in teaching children.
The lockdown and restrictions have increased the work of women due to the absence of domestic help and increased workload that causes stress among them as well as makes them more vulnerable to domestic violence. The lockdown has differently impacted men and women. The work from home for women has impelled them to spend most of the time with their abusive partners.
Similarly, the pandemic has terribly affected the mental health and wellbeing of home isolated patients in urban areas. Sudden shock, emotional exhaustion, depersonalization, stigma and discrimination, lack of treatment facilities and lack of social support, lockdown/restriction by the government, the demise of their relatives/colleagues after being exposed to the virus and social distancing from their family members and relatives can have a negative impact on the mental health and well-being of the home isolated patients living in urban areas., The people with preexisting physical and mental health issues are more vulnerable to experience psychological and emotional issues such as anxiety, panic, depression, posttraumatic stress disorder, etc.
During the pandemic, people have adapted various means of coping with traumatic circumstances based on their socio-cultural background. Coping is defined by Folkman et al. as cognitive and behavioral efforts made to master, tolerates, or reduces external and internal demands and conflicts among them. Coping primarily refers to action taken with the aim of minimizing the adverse impact of a problematic or stressful situation. Coping effects may serve of two major functions problem solving or emotion-regulating. It is argued that individuals possess a wide repertoire of coping styles, and the style they select depends on the stressor at hand. Hence, the current study has intended to understand the coping strategies among COVID patients during the first wave in urban districts of south India.
| Materials and Methods|| |
The present study adopted a descriptive research design to determine the coping strategies among home isolated adult patients with COVID-19 in urban areas.
The study employed a convenient sampling technique and included 60 home-isolated COVID patients from an urban area in Karnataka state, India.
The inclusion criteria: (1) home isolation patients with mild COVID-19 infection diagnosed with real-time reverse transcription-polymerase chain reaction test. The COVID patients were being screened by respective hospitals based on mild, moderate, and severity criteria. In the present study, the researchers have focused mainly on patients who were asymptomatic and some of whom were having low symptoms as diagnosed by respective physicians and suggested for home-based treatment rather than hospitalization. (2) Those patients who gave oral consent to participate in the research, as COVID-19 is a contagious disease and patients are supposed to be in-home isolation. Hence, the ethical guidelines and existing literature suggested taking oral consent from the patients and their family members. (3) The patients who were in between 7th and 14th day isolation period, (4) those aged between 18 and 60 years, and (5) those who could understand Kannada or English language were included in the study.
Dharwad Institute of Mental Health Neurosciences (DIMHANS), a state-run tertiary mental health care center has been designated as a tele-counseling center for home isolated COVID-19 patients. The institution has been receiving the list of such patients from the district authority (Three main hospitals including District Government Hospital Dharwad, Karnataka Institute of Medical Sciences Hubli, and Taluk Government Hospitals) for the purpose of counseling daily. The patients fulfilling the inclusion criteria were recruited for the study.
Three of the researchers from DIMHANS, where the study was carried out were trained in tele-counseling care. The trained team has provided counseling to patients followed by data collection. The data was collected by the researchers through standardized scale.
The data were collected between September and November 2020. One-to-one telephonic interviews spanning over 40–45 min were conducted in either local (Kannada) or English language for each patient at a time convenient to them. A semi-structured pro forma was developed to collect the sociodemographic profile of the study participants. And brief COPE scale was used to assess the patients' coping strategies.
Sociodemographic variables such as age, gender, marital status, religion, education, occupation, and monthly income of respondents were assessed.
The coping strategies were assessed using the Brief COPE Inventory developed by Carver. The scale consists of 28 statements which can identify 14 possible coping strategies. It reported reliability and validity data with Cronbach alphas ranging from 0.50 to 0.90. There is no negative scoring; the higher the score, the better the coping of the person. It is focused mainly on understanding the frequency with which people use different coping strategies in response to various stressors. The scoring pattern indicates scores from 1 to 4 with 1 being "I have not been doing this at all" and 4 being "I have been doing this a lot." For example, when patients give the response of 3 or 4 for a given statement, they are considered to be using that as one of their core coping strategies. On the other hand, if they give a score of a 1 or 2 for a particular coping strategy, then it is not considered as one of their core coping strategies. This scale includes self-distraction, active coping, denial, substance use, use of emotional support, use of instrumental support, behavioral disengagement, venting, positive reframing, planning, humor, acceptance, religion, and self-blame.
Ethical approval for this research was obtained from the ethical review board (No: DIMHANS/I.E.R. B/2020-21). The study objectives and voluntary nature of the study were explained to patients and their caregivers and oral consent was taken before commencing each telephonic interview for the study. The data collected was documented in individual response sheets. Confidentiality was assured by deleting the identification details of each patient. The patients who expressed distress during the interviews were provided with a brief supportive counseling and educative techniques were employed to enable them to cope with negative thoughts, manage overwhelming emotions and accept their present feelings. Contact information on available clinical services was shared and patients were encouraged to seek professional help wherever required.
The analysis was performed using SPSS version 18.0. (statistical software Epi Info 7.2.4. (Public domain software package)) Continuous data are presented as mean and standard deviation and categorical data are presented as frequency and percentage. The Pearson Chi-square test was applied to find the association between demographic variables and coping strategies used. P < 0.05 was considered statistically significant.
| Results|| |
[Table 1] explains the mean score and percentage of sociodemographic variables. The mean age of the respondents was 42 ± 14.56 and most of them (57%) were male. Nearly half (45%) of the respondents studied up to 12th grade and one-fourth (25%) of the respondents were working in private sectors and also nearly one-fourth (23%) of the respondents were jobless, nearly half (51%) of the respondents had 3–5 lakhs of annual income and majority (82.8%) of the respondents belonged to Hinduism.
[Table 2] depicts the mean score of coping strategies among COVID-infected patients. The mean score of negative coping strategies such as denial (4.91) and self-blame (4.18) were found higher among all negative coping strategies, where as positive coping strategies such as, active coping (4.55), use of emotional support (5.13), use of instrumental support (5.15), venting (4.85), positive reframing (5.15), planning (5.26) and religion (5.86) were reported to higher among all positive copings of COVID patients. However, no statistically significant difference was noticed on the type of coping strategies used to cope with the pandemic stress.
[Table 3] explains the association between sociodemographic characteristics with overall coping scores. No statistically significant difference was found between the age group, gender, educational qualification, occupation, annual income and marital status, and coping strategies of the respondents.
|Table 3: Association between sociodemographic characteristics with overall coping scores|
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| Discussion|| |
The objective of the present study was to understand the coping strategies among COVID patients in an urban district of South India. The results show that there were both positive and negative coping skills among COVID patients and that there was no statistically significant difference found between the coping and sociodemographic background of the respondents. Studies on disaster management have reported that people have a great deal of anxiety, worry, and distress in the initial stage of any disaster like the COVID 19 pandemic, which is an overwhelming situation for all age groups. However, many of them have the ability of adopting to stressful situation with time.,,, This could be one of the reasons why the majority of the respondents of the current study were found to use more positive coping strategies such as active coping, use of emotional support, use of instrumental support, venting, positive reframing, planning, and religion. Another theoretical assumption is that disaster survivors might use negative coping strategies such as denial and self-blame (as reported in the current study as well) when they do not have strong social support or they are in the stressful situation for a long time. That is why it is necessary to start early psycho-social interventions with disaster survivors so that positive coping can be built and strengthened and abnormal reactions to the stressful situation can be reduced, thus leading to the prevention of mental illnesses such as posttraumatic stress disorder (PTSD).,,
The results of the current study corroborate with various Indian and western studies and with those of Ogueji et al. and Kar et al. who explained in their studies that during any stressful circumstances people adopt positive coping startegies such as seeking social support, being empathetic, getting involved in exercise, indore games, yoga or meditation, mentally preparing for stressors, thinking positively, maintaing healthy eating habits, engaging themselves in games and activities, focusing on self-care, self-motivation and hoping for the best.
Previously, during the former epidemic, the general population used coping methods such as problem-solving and looking for social support to control anxiety and depression. During the current pandemic situation, people are trying to cope with the stressful circumstances of COVID-19 by minimizing the exposure to media, by developing healthy relationship with their family members and friends through various social media platforms, by maintaining healthy sleep hygiene, by focusing on regular exercises and by using various other techniques such as yoga and meditation.
Another study conducted on psychological experience and coping strategies of patients in the US showed that, out of 214 female patients, the use of alcohol increased to 23.8% and 1.9% of patients used marijuana to cope with pandemic stress. During the pandemic, people also used positive behavioral coping strategies such as socially connecting to people, distracting from stressful situations, and practicing religious activities.
A study conducted in Ethiopia, shows that Ethiopians have used various coping strategies in chronic disease like self-distraction, denial, active coping, substance use, seeking emotional support, behavioral disengagement, ventilation of feelings, positive reframing, acceptance, and getting involved in religious practices.
In another study, problem-solving technique was reported to lessen the sadness among individuals, and the same technique shoots up the anxiety level. Kar et al. found it is vital to have effective coping skills to overcome stressful situations. Yet another study recommends the use of technology-based intervention like, "Tele counseling services" for those individuals who lost their close family members because of the pandemic.
The studies condcuted by Kar et al. and Wang et al. have revealed that COVID infected patients mostly experience fear of contagiousness, fatality, boredom, loneliness, anger, depression, anxiety, denial, despair, insomnia, harmful substance use, self-harm, and suicidal ideas. A study done by Li et al. found that because of continuation of safety behaviors, COVID-positive people may develop obsessive-compulsive disorder and COVID survivors were prone to develop PTSD.
Knowing coping strategies used by home isolated COVID-19 patients will help mental health care professionals to provide appropriate psychological support and alleviate the associated impact on their mental health. The main limitation of the study is its small size sample as it is a service-based research study. The limitation was the usage of convenient sampling technique due to practical reasons.
| Conclusions|| |
The COVID-19 has led to various mental health issues among different populations and it further caused damage to the well-being and mental status of COVID infected people due to poor coping strategies. This study may guide mental health professionals including psychiatric nurses to develop an intervention to strengthen the coping abilities and reduce negative emotions.
The authors are grateful to all the COVID-19 patients and their family members.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]