The impact of COVID-19 on mental health outcomes among hospital fever clinic attendants across Nepal: A cross-sectional study

  1. Hridaya Raj Devkota
  2. Tula Ram Sijali
  3. Ramji Bogati
  4. Meraj Ahmad
  5. Karuna Laxmi Shakya
  6. Pratik Adhikary

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Abstract

The COVID-19 pandemic has been creating a panic and distressing situations among the entire population globally including Nepal. No study has been conducted assessing the psychological impact of this pandemic on the general public in Nepal. The objective of this study is to assess the mental health status during COVID-19 outbreak and explore the potential influencing factors among the population attending the hospital fever clinics with COVID–19 symptoms.

Methods

A cross-sectional survey was conducted between May—June, 2020 with a sample of 645 participants aged 18 and above in 26 hospitals across Nepal. Telephone interviews were conducted using a semi-structured questionnaire along with a validated psychometric tool, the Depression, Anxiety and Stress (DASS-21) scale. The metrics and scores of symptoms and their severity were created and analyzed. Multivariate logistic regression was used to determine the association of potential covariates with outcome variables.

Results

The prevalence of anxiety, depression and stress were 14%, 7% and 5% respectively. In reference to Karnali, participants from Bagmati province reported higher level of anxiety (OR 3.44, 95% CI 1.31–9.06), while stress (OR 4.27, 95% CI 1.09–18.32) and depressive symptoms (OR 3.11, 95% CI 1.05–9.23) observed higher among the participants in Province 1. Women were more at risk of anxiety (OR 3.41, 95% CI 1.83–6.36) than men. Similarly, people currently living in rented houses reported more stress (OR 2.97, 95% CI 1.05–8.43) and those living far from family reported higher rates of depressive symptoms (OR 3.44, 95% CI 1.03–11.46).

Conclusion

The study identified increased prevalence of stress, anxiety and depressive symptoms during the initial stage of COVID-19 pandemic in Nepal. Considering the findings, there is urgent need to develop and implement appropriate community-based mental health programs targeting individuals who have had COVID-19 symptoms and who are prone to develop adverse mental health outcomes.

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  1. Version published to 10.1371/journal.pone.0248684
  2. ScreenIT

    SciScore for 10.1101/2020.07.28.20163295: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementConsent: Before interviews, verbal informed consent was taken from all participants.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Statistical Analysis: The data collected in KoBo Collect software were downloaded into Excel Windows 10, cleaned and then transferred into SPSS (version 23.0 for Windows) for analysis.
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strength and limitation of the study: To the best of our knowledge, this is the first population study to evaluate the mental health status among Nepalese people during the COVID-19 pandemic. We feel this study is therefore, an important addition an important contribution to the literature as it provides preliminary data about the impact of COVID-19 on Napalese mental health. The strength of this study is a fairly large sample (n=618) recruited from 26 health facilities across the country representing main populations groups from different strata that included ecological region, urban rural residents and caste ethnicity. Moreover, the study had a high response rate (94%) that is considered good enough for telephone-based survey. Furthermore, the telephone interviews were taken by the well-trained and highly experienced interviewers under close supervision that ensured the quality of data collected. With all these strengths, the study had a number of limitations. We intended to have a representative sample covering all province and ecological clusters, however, the purposive selection of health facilities conducting fever clinics may have resulted selection bias. Likewise, the potential sampling biases may have occurred with under or over representation from the different cluster, social groups, and also with the criteria as exclusion of under 18 populations and individual with communication and long-standing medical problems. Furthermore, the study population were only those ...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. ScreenIT

    SciScore for 10.1101/2020.07.28.20163295: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementBefore interviews, verbal informed consent was taken from all participants.Randomizationnot detected.Blindingnot detected.Power Analysisnot detected.Sex as a biological variableWomen were more at risk of anxiety (OR 4.26,

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Statistical Analysis The data collected in KoBo Collect software were downloaded into Excel Windows 10, cleaned and then transferred into SPSS (version 23.0 for Windows) for analysis.
    SPSS
    suggested: (SPSS, SCR_002865)

    Data from additional tools added to each annotation on a weekly basis.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore is not a substitute for expert review. SciScore checks for the presence and correctness of RRIDs (research resource identifiers) in the manuscript, and detects sentences that appear to be missing RRIDs. SciScore also checks to make sure that rigor criteria are addressed by authors. It does this by detecting sentences that discuss criteria such as blinding or power analysis. SciScore does not guarantee that the rigor criteria that it detects are appropriate for the particular study. Instead it assists authors, editors, and reviewers by drawing attention to sections of the manuscript that contain or should contain various rigor criteria and key resources. For details on the results shown here, including references cited, please follow this link.

  4. Version published to 10.1101/2020.07.28.20163295 on medRxiv