|Year : 2020 | Volume
| Issue : 1 | Page : 8-12
Mental health status among the family members of COVID-19 patients in Jabalpur District Madhya Pradesh: A Cross-sectional study
Arvind Sharma1, Tej Pratap Singh1, Aditi Bharti1, Richa Sharma2, Deepali Soni1, Priyanka Dubey1
1 Department of Community Medicine, NSCBMC and Hospital, Jabalpur, Madhya Pradesh, India
2 Department of Emergency Medicine, NSCBMC and Hospital, Jabalpur, Madhya Pradesh, India
|Date of Submission||20-Nov-2020|
|Date of Decision||06-Dec-2020|
|Date of Acceptance||09-Dec-2020|
|Date of Web Publication||31-Dec-2020|
Dr. Tej Pratap Singh
C/O- Mr. Kamlesh Prasad Singh, Rajrekha Niwas Ground Floor, Berdi Road, At&Post- Sausar, Dist- Chhindwara-480106, Madhya Pradesh
Source of Support: None, Conflict of Interest: None
Objective: The objective of the study was to assess mental health status among the family members of the COVID-19 patients and the severity of depression in the Jabalpur district, Madhya Pradesh. Setting and Design: A cross-sectional study was conducted among family members of COVID-19 patients admitted at a tertiary care center. Methodology: Out of 160 respondents, 130 have participated, and the remaining 30 were dropouts. Participants included one member from each family of confirmed COVID-19 cases admitted at a tertiary care hospital, preferably their spouse or first-degree members living in the same house, aged 18 years and above. The Patient Health Questionnaire-9 was used to determine depression and was completed through a telephonic platform survey. Statistical Analysis Used: SPSS 20.0 statistical software was used to analyze the data. Significance was determined at P < 0.05 and 95% confidence interval. Results: The majority of respondents, 61.5%, screened positive for depression. Among them, 46 were mildly depressed (35.4%), 28 were moderately depressed (21.5%), 4 were moderately severe depressed (3.1%), and two were severely depressed (1.5%). Females had approximately 4 times higher risk for depressive symptoms (P = 0.001). Conclusion: There is a need to emphasize the mental health of this vulnerable population. Our findings are also crucial in enabling the government to allocate health resources and offer appropriate treatment for family members who suffer mental health problems during the COVID-19 pandemic or any other infectious disease outbreak in the future.
Keywords: Covid-19, depression, family members, mental health
|How to cite this article:|
Sharma A, Singh TP, Bharti A, Sharma R, Soni D, Dubey P. Mental health status among the family members of COVID-19 patients in Jabalpur District Madhya Pradesh: A Cross-sectional study. J Prim Care Spec 2020;1:8-12
|How to cite this URL:|
Sharma A, Singh TP, Bharti A, Sharma R, Soni D, Dubey P. Mental health status among the family members of COVID-19 patients in Jabalpur District Madhya Pradesh: A Cross-sectional study. J Prim Care Spec [serial online] 2020 [cited 2021 Mar 4];1:8-12. Available from: http://www.jpcs.com/text.asp?2020/1/1/8/305887
| Introduction|| |
Since December 2019, an outbreak of COVID-19, caused by the severe acute respiratory syndrome coronavirus 2 (SARS), has spread widely and rapidly worldwide. According to the World Health Organization, as of March 18, 2020, more than 180,000 confirmed cases and 7500 deaths on an average have been reported in 159 countries (territories/areas). Fear, worry, and stress are normal responses to perceive when we face an uncertain situation. Added to the threat of contracting the virus in a pandemic is the significant changes to our daily lives, which intensify mental health problems.
Mental health issues following the COVID-19 pandemic make people face abnormal situations. The most important and the earliest social grouping to which a man belongs is the family. The idea of family well-being summons the acknowledgment that an individual's prosperity, even in his physical, psychological part, is significantly influenced by the essential social gathering, which is the family. The significance of family health includes the evolving physical and mental well-being of the family members. For families, isolated from his member during this pandemic, especially with those who were admitted with COVID-19, could be excruciatingly painful, leading to worry, helplessness, and frank depression. There will be a situation when people have to face the worse outcomes or even startling instance of a family member's death, which ultimately creates a psychological burden. Thus, mental health is becoming an issue that cannot be ignored while trying to control the outbreak.
Preceding studies have shown that depression is a common and persistent mental illness in various chronic diseases and other serious diseases.,, Hence, these studies indicated that patients with mental illness, including depression, may have difficulty with symptom control, immense worry, and have impaired quality of life. Recently published research mainly focused on the psychological impact of COVID-19 on health-care workers and the general public.,, However, the mental health of the family members of hospitalized COVID-19 patients during the pandemic remains unknown.
Considering that the family members, after a diagnosis of COVID-19 in their family, were more probably to have psychological burdens such as fear of advancement of member's illness, disability, or premature death. It is vital to investigate related factors of depression in families with COVID-19-positive members.
This study will draw more consideration to the psychological state of families with COVID-19 members and assist doctors in providing some psychological interventions to improve the mental and physical health of families during the campaign to reduce the COVID-19 burden. This study aims to assess the mental health status among the family members of the COVID-19 patients and the severity of depression.
| Methodology|| |
This cross-sectional study was conducted on 160 respondents out of total admitted 193 participants in tertiary care hospital, Jabalpur district (Madhya Pradesh), as remaining were the residents of the other district. Among them, 130 have participated, and the remaining thirty were dropouts, as they were not available during that period. The study was done from May 2020 to July 2020 using the convenient sampling method. Participants included one member from each family of confirmed COVID-19 cases admitted at a tertiary care hospital, preferably their spouse or first-degree members living in the same house. The valid questionnaires of all participants were completed telephonically on the 15th day after their member was diagnosed as COVID-19 positive, making them aware of the study purpose and maintaining confidentiality.
(1) Who gave verbal consent and currently a resident of Jabalpur district, (2) aged 18 years and older, and (3) family members of patients admitted in a tertiary care hospital.
Patients with preexisting mental illness or were on the medications for the same.
Ethical approval was obtained from the hospital authority to conduct this study in a defined period with reference letter no. 12,774.
The patient health questionnaire-9 (PHQ-9) used in this study is based on the diagnostic criteria for depression from the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. The response choices were: 0 = “not at all,” 1 = “several days,” 2 = “more than half the days,” and 3 = “nearly every day.” A 14-day recall period was used to assess the severity of depression. The total score ranged from 0 to 27, with a higher score indicating greater self-reported depression. Depression severity was determined using the score for PHQ-9, graded as minimal depression (0–4), mild depression (5–9), moderate depression (10–14), moderate-to-severe depression (15–19), and severe depression (20–27). A total score of ≥5 indicated depressive symptoms, with a sensitivity of 80% and specificity of 92%., In the present study, the Cronbach's alpha coefficient of the PHQ-9 was 0.831, indicating good internal consistency.
IBM SPSS statistics software, version 20 (IBM) was used for statistical analysis. To determine the reliability of the scale, we measured Cronbach's alpha coefficient. Frequency tabulation is used to summarize participant's demographic information and the grading of the depression among gender and age group. For the percentage of depression, we employed the PHQ-9 score to determine the severity. We adopted multiple binary logistic regression analysis to explore the factors associated with depression. Significance was determined at P < 0.05 and 95% confidence interval (CI).
| Results|| |
A total of 130 participants, including 73 females and 57 males, were included in the study. The age group of participants ranged from 18 to 78 years. Their mean age was 47.4 (standard deviation [SD] 12.53), and the majority of respondents, 97.7% (127), were married. Demographic characteristics enlisted in [Table 1].
The severity of depression using patient health questionnaire-9 scoring
The mean score of the depression scale for all participants was 6.65 (SD-4.62). We found that most of the participants, 61.5% (80), screened positive for depression. Referring to PHQ9, the participants depression levels, 46 were mildly depressed (35.4%), 28 were moderately depressed (21.5%), 4 were moderately severe depressed (3.1%), and 2 were severely depressed (1.5%) [Table 2]
|Table 2: Depression classification using patient health questionnaire 9 scoring|
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All participants, 100% (130), answered all questions. Every question had a score ranging from 0 to 3. About 63.8% (83) of participants had little interest or pleasure in doing things, and 50.8% (66) of participants felt down, depressed, and hopeless on several days. Another 46.2% (62) were having difficulties with either trouble falling or staying asleep or sleeping too much on several days; hence, sleep disorder is also associated with depression. Similarly, about 34.6% (45) felt tired or had a little energy. The table also indicates that 56.2% (73) of participants had trouble concentrating such as watching television or reading the newspaper on several days; around 0.8% (1) thought of hurting themselves or be better off dead [Table 3].
|Table 3: The results of depression screening using patient health questionnaire-9 (n=130)|
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[Table 4] represents the frequency and percentages of participants based on the sociodemographic variables. Out of 130 respondents, 80 (61.5%) were in depression, and 50 (38.5%) did not show any depression level. Most of the depression among participants in the study were among 45–59 years, 38 (29.2%), followed by 26–44 years, 27 (20.8%), and the majority were married, 79 (60.8%). Furthermore, there was a significant association found between gender and depression (P = 0.001). Nevertheless, other sociodemographic factors had no significant association with depression.
|Table 4: Association between sociodemographic factors and depression (n=130)|
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[Table 5] shows analysis using binary logistic regression to ascertain the relationship between depression and other variables including gender. In our findings, depression came higher in females than males, with a statistically significant association between gender and depression (P = 0.001). Taking male as a reference, female respondents showed 4 times higher risk for depression (odds ratio = 4.07 and 95% CI = 1.85–8.92).
|Table 5: Logistic regression analysis of depression percentage to patient's age and gender|
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| Discussion|| |
This study included 130 participants with female preponderance and those above 45-year age, forming a larger proportion of the study sample. The current study showed that 61.5% were in depression, and 38.5% did not have any depressive symptoms. Many studies have shown an association with depression to patient's family members with various diseases. However, there is hardly any study done on the mental status of family members of COVID-19 patients. This study reported depression and associated factors among family members of COVID-19 patients during this pandemic.
Past studies suggest that widespread health crises, such as epidemics and pandemics, can spur and compound psychosocial suffering in the general population. A study conducted on the Ebola outbreak in West Africa in 2015 found that 6% of the survivors, family members, and caretakers met the clinical cutoff for anxiety–depression 1 year after the outbreak. Another survey done during the 2003 SARS outbreak in Canada on quarantine people, quarantined for a median of 10 days, revealed that 31% had symptoms of depression. Similarly, in the current study, overall depression was around 61.5% including mild-to-severe depressive symptoms. Similarly, a similar study in Kenya revealed that 79% of the caregivers were at risk of depression, derived from the Beck Inventory score. Similarly, two more studies conducted by Mukeshimana et al. in Rwanda and China by Chin et al. reported that overall depression in patients with diabetes was around 83.8% and in COVID-19 patients who screened positive for depression was found to be 23.1%, respectively.,, A systematic review and meta-analysis by Rogers et al. showed that depressed mood was about to be 32.6% in the acute-illness stage, and 10.5% of depressive symptoms were reported in the postillness stage. Whereas the findings of the cross-sectional study done in Ningbo, China, noted that 29.35% (95% CI: 26.27%–32.43%) of family members of health-care workers reported symptoms of depression using cutoff score ≥5 of PHQ-9, which was significantly higher than the levels reported among the general public of China.
The current study showed the scores for a different level of symptoms (e.g., moderate-to-severe depression, PHQ-9 score ≥10) was 26.1%. A similar study conducted during the pandemic in China showed that around 17.4% of patients had minor and 18.2% had moderate-to-severe depression. Depression symptoms were more prevalent during the peak period of the COVID-19 pandemic than in nonepidemic times.
Depression has always been associated with gender; various studies give the same inference. A similar study conducted in Greece on the family members of the patients undergoing palliative radiotherapy reported 76% of the depression among female caregivers. A study on the psychological responses among the general population during the COVID-19 pandemic in China demonstrated that female patients are prone to develop higher depression levels, as shown in the current study. Furthermore, another study by Chin et al. noted that females are more at risk of developing depressive symptoms than male counterparts. With similar findings, the current study indicated that female respondents had a significant association with depression than male respondents. Taking male as a reference, female respondents showed 4 times higher risk for depression.
With an age-group depressive symptom, they have always been a concerning issue. To conclude, several studies have demonstrated to elaborate the same. Similarly, similar findings in a study reported that age ≥35 is at increased risk and had a significant relationship with depression. However, in contrast, the current study showed no significant association with depression. Notwithstanding, early counteraction of psychological wellness issues is critical for excellent clinical results and better life quality for patients and their family members. As the COVID-19 pandemic heightens, this study will consider building up a mental help system for families affected by COVID-19 and different zones influenced by this pandemic.
Strength of the study
As far as we could know, this is the first study to investigate the mental health issues and related factors among family members of COVID-19 patients and one of the first to investigate this issue during an infectious period. Second, the tool used for the assessment of mental health has good reliability and validity. As the COVID-19 pandemic elevates, our disclosures will help develop some psychological assistance framework for family members with COVID-19 patients and various zones affected by this pandemic.
(1) Study sample is not highly representative, as the respondents were from a single-center, limiting the result's generalizability. (2) To prevent potential COVID-19 infection from spreading, a telephonic survey was conducted; study sampling was voluntary, resulting in possible selection bias. (3) A cross-sectional study does not determine a causal relationship between mental health and sociodemographic variables.
| Conclusion|| |
The present study provided evidence of a significant mental health burden on family members of admitted patients suffering from COVID-19 during this pandemic. In summary, we suggest that more attention should be made to this vulnerable population's mental health during an infectious disease outbreak. Our findings are also crucial in enabling the government to allocate health resources and offer appropriate treatment for family members who suffer mental health problems during the COVID-19 pandemic or any other infectious disease outbreak in future.
| References|| |
Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al
. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: A retrospective cohort study. Lancet 2020;395:1054-62.
Polikandrioti M, Goudevenos J, Michalis LK, Koutelekos J, Kyristi H, Tzialas D, et al
. Factors associated with depression and anxiety of hospitalized patients with heart failure. Hellenic J Cardiol 2015;56:26-35.
Natale P, Palmer SC, Ruospo M, Saglimbene VM, Rabindranath KS, Strippoli GF. Psychosocial interventions for preventing and treating depression in dialysis patients. Cochrane Database Syst Rev 2019;12:CD004542.
Hopwood P, Stephens RJ. Depression in patients with lung cancer: Prevalence and risk factors derived from quality-of-life data. J Clin Oncol 2000;18:893-903.
Dai Y, Hu G, Xiong H, Qiu H, Yuan X. Psychological impact of the coronavirus disease 2019 (COVID-19) outbreak on healthcare workers in China. Available from: https://doi.org/10.1101/2020.03.03.20030874
[Last accessed on 2020 Nov 10].
Zhu Z, Xu S, Wang H, Liu Z, Wu J, Li G, et al
. COVID-19 in Wuhan: Sociodemographic characteristics and hospital support measures associated with the immediate psychological impact on healthcare workers. EClinical Med 2020;24:100443.
Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al
. Immediate psychological responses and associated factors during the initial stage of the 2019 Coronavirus Disease (COVID-19) epidemic among the general population in China. Int J Environ Res Public Health 2020;17:E1729.
Kroenke K, Spitzer RL, Williams JB. The PHQ-9. J Gen Intern Med 2001;16:606-13.
Manea L, Gilbody S, McMillan D. Optimal cut-off score for diagnosing depression with the patient health questionnaire (PHQ-9): A meta-analysis. CMAJ 2012;184:E191-6.
Jalloh MF, Li W, Bunnell RE, Ethier KA, O'Leary A, Hageman KM, et al
. Impact of ebola experiences and risk perceptions on mental health in sierra leone. BMJ Glob Health 2018;3:e000471.
Hawryluck L, Gold WL, Robinson S, Pogorski S, Galea S, Styra R. SARS control and psychological effects of quarantine, Toronto, Canada. Emerg Infect Dis 2004;10:1206-12.
Chin WY, Chan KT, Lam CL, Wong SY, Fong DY, Lo YY, et al.
Detection and management of depression in adult primary care patients in Hong Kong: A cross-sectional survey conducted by a primary care practice-based research network. BMC Fam Pract 2014;15:30.
Mbugua MN, Kuria MW, Ndetei DM. The Prevalence of Depression among Family Caregivers of Children with Intellectual Disability in a Rural Setting in Kenya. Int J Family Med 2011, Article ID 534513, 5 pages, 2011. https://doi.org/10.1155/2011/534513.
Mukeshimana M, Chironda G. Depression and associated factors among the patients with type 2 diabetes in rwanda. Ethiop J Health Sci 2019;29:709-18.
Rogers JP, Chesney E, Oliver D, Pollak TA, McGuire P, Fusar-Poli P, et al
. Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: A systematic review and meta-analysis with comparison to the COVID-19 pandemic. Lancet Psychiatry 2020;7:611-27.
Ying Y, Ruan L, Kong F, Zhu B, Ji Y, Lou Z. Mental health status among family members of health care workers in Ningbo, China, during the coronavirus disease 2019 (COVID-19) outbreak: A cross-sectional study. BMC Psychiatry 2020;20:379.
Ran L, Wang W, Ai M, Kong Y, Chen J, Kuang L. Psychological resilience, depression, anxiety, and somatization symptoms in response to COVID-19: A study of the general population in China at the peak of its epidemic. Soc Sci Med 2020;262:113261.
Govina O, Vlachou E, Kalemikerakis I, Papageorgiou D, Kavga A, Konstantinidis T. Factors associated with anxiety and depression among family caregivers of patients undergoing palliative radiotherapy. Asia Pac J Oncol Nurs 2019;6:283-91.
] [Full text]
Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al
. Immediate psychological responses and associated factors during the initial stage of the 2019 Coronavirus Disease (COVID-19) epidemic among the general population in China. Int J Environ Res Public Health 2020;17:1729.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]