Determination of Depression Anxiety Stress Levels in Individuals with COVID-19 Disease: The Example of Elazığ Province

1. INTRODUCTION

The 2019 coronavirus outbreak (COVID-19) has caused a global public health crisis, including physical injuries and mental and emotional trauma. According to the World Health Organization (WHO), 6.8 million people lost their lives in the outbreak, and the losses continue [1]. Evidence suggests that the highly contagious and unpredictable nature of the disease causes widespread anxiety, cognitive uncertainty and a reduction in people's sense of security [2]. Similar psychological effects, such as panic, depression, anxiety, and stress symptoms, have been reported by health system workers in various countries due to the pandemic [3].

The COVID-19 pandemic and the related quarantine measures have rapidly and abruptly changed people's habitual lives [4]. The problems arising from this pandemic are both physical and mental [5]. However, people under quarantine have started to lose their individual and social communication, and traditional and even religious ceremonies, which causes stress, resentment and loneliness. These challenges, combined with some misinformation, exaggeration of risks or doubts about public health and personal safety, increase anxiety and contribute to psychological disorders such as stress, anxiety and depression [6-8].

Given the multiple stressors and traumatic events associated with the COVID-19 pandemic and the increased level of distress in different populations, a mental health response that is sensitive to stress and trauma is vital. Alongside its negative consequences, the COVID-19 pandemic provides an opportunity for reforms and innovations in mental health care, increasing accessibility to services and contributing to de-stigmatisation of mental health and help-seeking behaviour. In order to mitigate the negative mental health consequences of the pandemic, modifiable risk and protective factors of mental health need to be identified and targeted. In this context, evidence-based mapping of risk and protective factors is important for managing the pandemic [9]. In addition, cognitive-behavioural interventions focusing on intolerance of uncertainty [10] may be useful in reducing the risk of developing health anxiety [11].

In addition to causing physical health problems in infected individuals, the COVID-19 pandemic has significantly increased the incidence of adverse psychological complications such as depression and anxiety, with some survivors continuing to experience long-term effects. In this unprecedented pandemic, positive health-related behaviours should be adopted or maintained through effective health promotion strategies to reduce the increase in acute and chronic psychological distress. COVID-19 patients and survivors should be screened and treated for psychological disorders such as depression and anxiety. To this end, it is recommended that vulnerable groups receive timely and appropriate psychological interventions through counselling and psychological services and more financial and psychological support, and nurses have a great responsibility in this regard [6-8, 12]. Furthermore, given the wide range of stressors experienced by survivors of infectious diseases, it appears that their stress not only persists but may also increase over time, leading to detrimental effects on their quality of life, functioning, and thus their mental health. Therefore, control measures and psychological interventions are necessary to help COVID-19 survivors improve their mental health [6]. Nurses have undertaken very important duties during the COVID-19 process. They have taken the necessary protective measures to prevent the spread of the disease in society and have applied the necessary precautions to individuals. Nurses have important responsibilities in preventing anxiety, depression, and stress in individuals who have experienced COVID-19. Nurses should provide psychological support to individuals during this pandemic process and follow up at regular intervals. In light of this information, this study was conducted to determine the depression, anxiety and stress levels of individuals living in Elazığ city centre and who had COVID-19 disease.

2. MATERIALS AND METHODS

2.2. Population and Sample of the Study

The population of the study consisted of individuals who lived in Elazığ city centre and had COVID-19 disease. The sample of the study was determined by using the sample calculation formula in cases where the universe is unknown because it is not possible to determine the number of the universe. According to this formula, at least 384 people should be included in the study. In this study, it was deemed appropriate to take 525 individuals in order to prevent possible data losses. The formula is as shown below;

(1.96²)x0.5x0.5/0.05² = 384

n= Number of individuals to be sampled.

p= Probability of occurrence (frequency) of the examined event (0.5).

q= Frequency of non-occurrence of the examined event (1-p) (0.5).

t= the theoretical value found in the t table at a certain level of freedom and at the determined error rate (1.96). d= symbolised as the desired ± deviation according to the frequency of occurrence of the event (0.05)

3. RESULTS

It was determined that 73.7% of the patients included in the study were in the 18-35 age group, 71.8% were female, 27.2% were high school graduates and 62.5% were single. It was found that 57.7% of the patients lived with their parents, 21.9% had children, 22.7% smoked and 14.9% had any chronic disease. Among the patients who participated in the study, 78.1% stated that they had COVID-19 for 6 months or more, 65.5% did not know who transmitted the disease, 94.9% did not receive inpatient treatment, and 23.6% lost family members due to this disease (Table 1).

When the mean scores of the Depression Anxiety Stress Scale were analysed, it was found that the anxiety sub-dimension was 7.47±4.73, the depression sub-dimension was 7.58±5.26 and stress sub-dimension was 8.04±1.00 (Table 2).

When Table 3 was examined, it was found that there was a significant difference between the mean scores of the Depression Anxiety Stress Scale according to the gender, marital and child status of the patients. It is seen that depression, anxiety and stress levels of female, single and childless patients are higher.

It was determined that there was a statistically significant difference between the mean scores of the Depression Anxiety Stress Scale according to smoking status. Patients who smoke cigarettes have higher levels of depression, anxiety and stress.

It was found that there was a statistically significant difference between the mean scores of the sub-dimensions of the Depression Anxiety Scale according to the presence of chronic disease, but there was no significant difference between the mean scores of the stress sub-dimension. It was determined that patients with chronic diseases had higher levels of depression and anxiety.

It was found that there was a statistically significant difference between the mean scores of the sub-dimensions of the Depression and Anxiety Scale according to the time of the patients' COVID-19 disease, but there was no significant difference between the mean scores of the stress sub-dimension. Patients who had the disease within 2-5 months had higher levels of depression and anxiety compared to other groups.

It was determined that there was a statistically significant difference between the mean scores of the Depression Anxiety Stress Scale according to the status of knowing who transmitted the disease and losing family members from COVID-19 disease. It was found that patients who knew who transmitted the disease and lost family members from this disease had high levels of depression anxiety and stress.

It was determined that there was a statistically significant difference between the mean scores of the sub-dimensions of the Depression Stress Scale according to inpatient treatment status, but the difference between the mean scores of the anxiety sub-dimension was not significant. Patients who did not receive inpatient treatment in the hospital had higher levels of depression and stress.

It was determined that there was no statistically significant difference between the mean scores of the Depression Anxiety Stress Scale according to the age groups, education, and with whom the patients lived at home (p>0.05).

4. DISCUSSION

The COVID-19 pandemic has affected the lives of individuals in different ways. In this study, it was determined that the depression, anxiety and stress levels of the patients were low. According to a study, it was reported that general anxiety, stress and depression findings of individuals were associated with the COVID-19 pandemic [16]. In a study conducted with 1498 people during the pandemic, it was found that 36.6% of the participants experienced stress, 57.9% experienced anxiety, and 47.9% experienced depression [17], and in another study, it was determined that a significant number of participants had moderate to severe perceived stress levels due to the COVID-19 outbreak [18]. Another study showed that COVID-19 patients experienced different levels of anxiety, depression and post-traumatic stress [6]. In studies conducted in Turkey, it has been reported that approximately 22.6%-23.6% of the population had depression during the COVID-19 pandemic [16, 19], and it is also observed that the anxiety and depression levels of individuals increased during the pandemic [16, 19-22]. Again, in a study conducted with 689 people living in different provinces of Turkey, it was observed that the average depression level of all participants included in the study was 14.05 and the depression level increased during the COVID-19 process [23]. The pandemic, which affects individuals at different levels, can also cause different mental consequences. The reason why the depression, anxiety and stress levels of individuals in this study were low may be explained by the fact that the research was not conducted in the first year when the pandemic started, and in the following process, individuals learned the methods to cope with the pandemic and followed the rules of society.

Among the patients included in the study, it is seen that depression, anxiety and stress levels of female and single patients and patients without children are higher. In a study, it was determined that the effects of the COVID-19 pandemic on the mental health of patients were particularly severe in women [24]. In another study conducted with individuals with COVID-19 disease, it was found that marital status and gender did not affect stress, anxiety and depression [6]. In another study, female gender was determined as a factor associated with high anxiety levels [25]. In a study, women's health anxiety during the pandemic was found to be significantly higher than men's [26]. In a study, it was revealed that there was a significant relationship between the number of family households and the increase in mean depression and anxiety scores [12]. In the same study, it was determined that gender did not affect the level of anxiety, it affected the level of depression, the number of people living in the family affected the level of anxiety and depression, and marital status did not affect the level of depression [12]. According to studies, the prevalence of depression, anxiety and stress is affected by demographic characteristics such as gender and urban living [27, 28]. In this study, the high number of female (71.8%), single (62.5%) and childless (78.1%) patients is thought to be effective on the results. In addition, the fact that singles and those without children receive inadequate support during the process of illness may also be effective in increasing the levels of depression, anxiety and stress.

In this study, it is seen that patients who smoke have higher levels of depression, anxiety and stress. Since COVID-19 disease affects the lungs, it is inevitable that patients who smoke have higher levels of depression, anxiety and stress.

Among the patients who participated in the study, those with chronic diseases were found to have higher levels of depression and anxiety. Similar to the finding of this study, it was determined that patients' other chronic disease status affected their anxiety and depression levels [12]. In a study, having a chronic disease was determined as a factor associated with high anxiety levels [25]. Having a chronic disease negatively affects the quality of life of individuals and causes more medication use. In addition to chronic disease, having COVID-19 disease is inevitable to have high levels of depression and anxiety in individuals.

It was found that there was a statistically significant difference between the mean scores of the Depression and Anxiety Scale sub-dimensions according to the time the patients had COVID-19 disease, but there was no significant difference between the mean scores of the stress sub-dimension. In a study, it was found that there was no statistically significant difference between the time elapsed since COVID-19 and the level of anxiety, depression and fatigue of individuals [29]. In another study, it was determined that there were significant differences in the mean scores of perceived stress and variable categories, such as the duration of the disease [18]. In this study, patients who had the disease within 2-5 months had higher levels of depression and anxiety than the other groups.

It was found that patients who knew who transmitted the disease and lost family members due to this disease had high levels of depression, anxiety and stress. The loss of a family member causes fear of death in the individual and this leads to high levels of depression, anxiety and stress.

Patients who did not receive inpatient treatment in the hospital had higher levels of depression and stress. Similar to the finding of this study, it was determined that the patients' inpatient treatment status in the hospital or at home affected their anxiety and depression levels [12]. It is expected that patients receiving treatment at home will have high levels of depression and stress due to the possibility that their condition may worsen at any time due to the disease.

It was found that there was no statistically significant difference between the mean scores of the Depression Anxiety Stress Scale according to the age groups, education, and with whom the patients lived at home. Unlike the finding of this study, the prevalence of depression, anxiety and stress is affected by demographic characteristics such as age [27, 28]. Many studies have also found an increase in anxiety among older adults after the pandemic and a high rate of COVID-19 anxiety in the elderly [30-32]. In a study similar to the finding of this study, it was found that the difference between age and anxiety and depression was insignificant, but unlike the finding of this study, the difference between educational status and mean anxiety and depression scores was significant [12]. In another study, it was reported that stress affected educational status, and depression and anxiety affected educational status and age [6]. In another study, being 61 years of age or older was found to be associated with high anxiety levels [25]. Unlike the findings of this study, significant differences were found between the mean scores of perceived stress and variable categories such as family size, duration of the disease and age of the participants [18]. Since age, educational status and with whom the participants lived at home differed in the studies, it is thought that depression did not affect anxiety and stress in this study.

CONCLUSION

In this study, which determined the depression, anxiety and stress levels of individuals with COVID-19, it was determined that more than half of the patients were in the 18-35 age group, female, single and living with their parents. The majority of the patients stated that they have had COVID-19 for 6 months or more and have not been hospitalised. It was determined that the depression, anxiety and stress levels of the patients included in the study were low. Patients who were female, single, smoked, had no children, knew who transmitted the disease and lost family members due to this disease had higher levels of depression, anxiety and stress. It was found that the age groups, education, and with whom the patients lived at home did not affect their depression, anxiety and stress levels. In line with these results, it is important to continue awareness of COVID-19 disease, to continue the measures taken for the disease and to provide regular training. In addition, coping strategies are important predictors of mental health measures. Education about positive thinking, active coping, and social support may be useful to cope with the decline in mental health due to the COVID-19 pandemic.

REFERENCES