Perceived stress and generalized anxiety in the Indian population due to lockdown during the COVID-19 pandemic: a cross-sectional study

Introduction

Since the beginning of 2020, humanity has been confronted with a pandemic caused by the severe acute respiratory syndrome coronavirus-2 that causes coronavirus disease 2019 (COVID-19)¹. The government of India declared a 21-day nationwide ‘lockdown’ from 25^th March 2020, which was subsequently extended in phases till 31^st May 2020, to break the cycle of spread of infection. The lockdown was in tune with the initiatives taken by many countries across the globe against this pandemic^2,3.

‘Lockdown’ is an emergency protocol and is a means of preventing the public from moving from one place to the other. This led to shutting down of all activities except those considered ‘essential services’, which included healthcare, police, sanitation, grocery shops, petrol stations and fire stations. All educational institutions, offices, factories, shopping malls, religious places, and public transport, including buses, railways and aeroplanes, were completely shut down, and sports, religious ceremonies, family functions and all outdoor activities were strictly prohibited.

While isolation and lockdown are recognized as effective strategies of social distancing to stop the spread of COVID-19, the reduced access to family, friends, and other social support systems causes loneliness, increasing mental health issues like anxiety and depression^4–6.

Researchers, in the past and during this present crisis, have tried to address the psychological stress in healthcare providers^7–9 and the general population^2,3,10. The present study, conducted during the fourth phase of nationwide lockdown, from 18^th to 31^st May 2020, attempts to examine levels of perceived stress and generalized anxiety disorders and causal stressors among the Indian population related to the COVID-19 pandemic and consequent lockdown.

Methods

Results

A total of 257, out of the 300 participants who were sent the survey, responded and completed the survey. They belonged to central, north and western India. The mean age of the participants was 25 years. Men constituted 58% (n=149) of the respondents. Overall, 84% (n=217) of participants had moderate to severe levels of perceived stress and 88% (n=228) had moderate to severe levels of anxiety (Figure 1).

Figure 1. Percentage of perceived stress & generalized anxiety stress in Indian population grouped as low, moderate and severe as per scoring guides of PSS-10 and GAD-7.

Table 1 shows the PSS-10 and GAD-7 scores of the study participants as stratified by gender, age, level of education, and place of residence. Women as well as those not employed reported significantly higher perceived stress and anxiety, urban residents reported higher perceived stress while the level of education had no difference in terms of perceived stress as well as anxiety. The psychosocial impact of the lockdown due to the COVID-19 pandemic is shown in Table 2. Fear of contracting COVID-19 was the highest stressor followed by difficulties in executing routine exercise schedule and worry about the future.

Discussion

The levels of stress and anxiety reported in the present study are similar to those reported by researchers from other countries^2,3,5,14. The present study is in agreement with previous studies from other parts of the world where women and those with lower incomes are prone to higher levels of stress and anxiety^2,3,5,15,16; this was in contrast to a study from Pakistan where men reported a higher degree of stress during the current crisis¹⁷. This could be attributed to cultural factors, which need further evaluation for clearer understanding.

In the present study, older respondents reported lower levels of stress. This could suggest the struggle and hardships of daily life which the younger generation is under¹⁸; also, the younger generation tends to obtain a large amount of information from social media, which can easily trigger stress^3,10. We found significant difference in the levels of perceived stress reported between urban and rural residents, while no such difference was noted in generalised anxiety scores.

In the present study, we found no difference in the levels of stress when considering the level of education of the respondents. Vallejo et al.¹⁹ found those with a lower level of education to be reporting higher stress. Other studies found that those who were highly educated had a higher risk of depression; it is presumed that highly educated and professional people are forced to stay at home and delve into other aspects of family life leading to higher levels of perceived stress^5,10.

When considering the psychosocial impact of COVID-19, fear of contracting COVID-19 was the highest stressor, which was consistent with other studies^17,20. This was followed by difficulties in executing your routine exercise schedule and worry about the future (Table 2).

Conclusions

The psychosocial impact of the nationwide lockdown on the Indian population has been high. The vulnerable groups for stress and anxiety include women, those of a younger age, and the unemployed. The stressors recognized include fear of contracting COVID-19, inability to execute routine exercise schedule and worry about the future.

Data availability