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 Table of Contents  
Year : 2022  |  Volume : 66  |  Issue : 3  |  Page : 323-326  

Psychological impact of the COVID-19 pandemic among adults in India: A longitudinal study

1 Assistant Professor, Department of Psychology, Mehr Chand Mahajan DAV College for Women, Chandigarh, India
2 Professor, Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Chandigarh, India

Date of Submission13-Apr-2021
Date of Decision18-Nov-2021
Date of Acceptance26-Nov-2021
Date of Web Publication22-Sep-2022

Correspondence Address:
Manjit Sidhu
Mehr Chand Mahajan DAV College for Women, Sector 36, Chandigarh - 160 036
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijph.ijph_1034_21

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A longitudinal follow-up design was used to study the psychological distress and coping among 168 individuals immediately after the national lockdown and after 6 months of the pandemic. Psychological distress was measured using the Depression, Anxiety, and Stress Scale (DASS-21). The coping strategies used were measured by the Brief-COPE, and Intolerance of Uncertainty Scale (IUS-12) was employed to measure response to uncertainty. On follow-up, the prevalence rates for severe/very severe levels of depression, anxiety, and stress had increased substantially from time 1 to time 2. The stepwise multivariate regression analyses revealed that the change in the three DASS-21 scores over time was primarily predicted by intolerance of uncertainty as measured by the IUS-12 and dysfunctional style as assessed by the coping Brief-COPE. There is a need to implement public health policies that promote psychological resilience among high-risk groups.

Keywords: Coping, coronavirus, longitudinal, psychological impact

How to cite this article:
Sidhu M, Prahbhjot M, Pandeya N. Psychological impact of the COVID-19 pandemic among adults in India: A longitudinal study. Indian J Public Health 2022;66:323-6

How to cite this URL:
Sidhu M, Prahbhjot M, Pandeya N. Psychological impact of the COVID-19 pandemic among adults in India: A longitudinal study. Indian J Public Health [serial online] 2022 [cited 2022 Nov 26];66:323-6. Available from:

The psychological impact of the COVID-19 pandemic is an unprecedented public health emergency of global concern. The extended lockdown and the mandatory protection measures increased uncertainties and transformed many facets of daily life. Some of the earlier studies conducted on the prevalence of mental health issues revealed that symptoms of stress, depression, and posttraumatic stress symptoms were fairly common and high.[1],[2] However, the majority of studies are cross-sectional in design and do not shed light on the risk and protective factors that mediate the relationship between the stressor and subjective well-being.

There is a paucity of research focusing on the longitudinal change of mental health functioning during the pandemic and its sociodemographic and psychological correlates. The present study is a descriptive longitudinal study that examines mental health status at two points during the ongoing pandemic to identify the risk and protective factors and coping mechanisms used by adults in India. The present study aimed to better understand the course of the psychological impact of the COVID-19 pandemic on the depression, anxiety, and stress during the initial stage of the outbreak and 6 months after the pandemic.

The data for the descriptive longitudinal study were collected at two points in time. The baseline data were collected during the initial pandemic phase just after the first lockdown was announced (April 1–6, 2020, Time 1, T1). The initial survey utilized the snowball sampling technique, and the inclusion criterion was the general population aged 18 years and above who consented to participate in the survey. A total of 614 respondents from 22 states and one Union Territory of India responded to the initial phase of the study. The follow-up data were collected after 6 months of the initial survey (follow-up survey, T2), and 168 of the 614 participants (45.3% of the consenting respondents with correct e-mail addresses) responded to the second phase of the study.

A structured closed-ended questionnaire elicited demographic and socioeconomic background information. The following three scales were administered at baseline and were readministered at follow-up. The psychological distress of the respondents was measured using the Depression, Anxiety, and Stress Scale (DASS-21).[3] It is 21 items self-report scale and contains 7 items each to measure the emotional states of depression, anxiety, and stress. The scores are summed to yield total scores for each of the measures, and cutoff scores define whether the score is in normal/mild, moderate, and severe/extremely severe range. The Brief-COPE, a 28 items scale, measured the extent to which respondents used emotion-focused, problem-focused, and dysfunctional strategies to cope with a stressful life.[4] Higher scores in these three subscales reflect more frequent use of that strategy. The brief version of the Intolerance of Uncertainty Scale (IUS-12), a 5-point 12-item scale, assessed participants responses to uncertainty, ambiguous situations, and the future.[5] Higher scores indicated a greater amount of intolerance of uncertainty. Ethics approval was obtained from the institutional ethics committee (vide letter number 1286/MCM dated October 20, 2020).

Chi-square test compared respondents who participated in the follow-up study (n = 168) and those who did not (n = 446) on background variables and it showed that the groups were well matched on age (P = 0.232), educational status (P = 0.934), and family type (P = 0.403), however, more females responded to the follow-up study (P = 0.0001). Comparisons of depression, anxiety, and stress scores for phase 1 and 2 revealed that on follow-up, the prevalence rates for severe/very severe levels of depression, anxiety, and stress had increased substantially from 7.7% to 36.9%, 10.1% to 41.7%, and 3.6% to 37%, respectively. This indicated nearly a fivefold increase in the percent of respondents reporting severe depression, four times increase in severe anxiety, and ten times increase in severe stress during the pandemic compared with rates just after the COVID-19 lockdown was declared.

[Table 1] presents the mean scores for each of the three coping strategies used by the respondents on the Brief-COPE scale over time by gender. The paired t-test revealed that for females, the use of emotion focused (t = 2.89, P = 0.004), problem-focused (t = 4.00, P = 0.0001), and dysfunctional coping strategies (t = 5.94, P = 0.0001) increased over time. However, this was not true for the males and all comparisons for the three coping styles revealed no significant differences over time (all P ≥0.05).
Table 1: Comparison of coping strategies (mean scores) used over time by gender

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We compared the DASS-21 scores at T1 and T2 to identify three groups: respondents whose scores remained in the same category over time (normal/mild, moderate, and severe/very severe); respondents whose scores changed for the worse over time (changed from normal/mild to moderate or severe/very severe or from moderate to severe/very severe); and respondents whose scores improved over time (changed from moderate or severe/very severe to normal/mild). On all the three parameters of the scale, very few were found to have improved their scores, so only two groups, namely same or worse, were subjected to further analysis. The comparison of the DASS-21 status change over time by sociodemographic variables is presented in [Table 2]. The results show that females (χ2 = 9.32, P =0.002), younger (χ2 = 11.63, P = 0.009), less educated (χ2 = 10.51, P = 0.015), and students (χ2 = 14.51, P = 0.001) were more likely to experience an increase in their stress scores as compared to their counterparts. No significant increases were found on the depression and anxiety scores as measured on the DASS-21 by sociodemographic characteristics. The participants whose DASS-21 scores worsened over time, relative to those whose scores remained the same, were found to be significantly using more dysfunctional coping tactics specifically venting, self-blame, substance use, and disengagement (all comparisons P ≤ 0.05).
Table 2: Comparison of Depression, Anxiety, and Stress Scale-21 status change over time by sociodemographic variables

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The change in the three DASS-21 scores was subjected to stepwise multivariate regression analysis to identify the significant psychosocial and demographic predictors. The independent variables included in the analysis were age, education, coping strategies employed, and the intolerance of uncertainty score that the respondent had at the beginning of lockdown, at T1. The results revealed that the change in depression score was primarily predicted by a dysfunctional style of coping and intolerance of uncertainty. These two variables explained 8% of the variance in the increase in depression scores (F = 8.23, P = 0.0001). The change in the anxiety score was explained by intolerance of uncertainty and this variable explained only 2.7% of the variance (F = 5.61, P = 0.019). The change in stress score was predicted by three variables including intolerance of uncertainty, age of the respondent, and dysfunctional coping. These variables explained 34.6% of the total variance in the dependent variable (F = 30.45, P = 0.0001).

Results indicated that there was no immediate impact of the lockdown on psychological distress; however, a range of adverse mental health symptoms persisted over time well beyond the easing and lifting of restrictions, particularly among females, younger, less educated, and among students. Our findings are consistent with studies conducted across the world that document that psychological distress has increased with time following COVID-19.[6] We found higher rates of depression, anxiety, and stress symptoms among the females at follow-up. These findings are also consistent with findings from other countries that the current global crisis is impacting the mental health functioning of women to a greater extent.[1],[7]

Coping tactics used mediated the relationship between coping and psychological distress. A positive relationship was found at follow-up between dysfunctional coping and mental health functioning. Previous studies have found an association between maladaptive coping like active avoidance and denial and increased distress during the pandemic.[8] The use of maladaptive coping strategies such as self-blame and venting were associated with increases in depression, anxiety, and stress levels. The current findings support the growing body of literature suggesting that dysfunctional coping is associated with adverse impact on mental health functioning.[7],[9] Another factor that emerged as a strong predictor of psychological distress was intolerance of uncertainty. Other studies too have reported that intolerance of uncertainty is a significant predictor of negative psychological response to COVID-19.[10] These results have practical implications for potential areas of psychological interventions aimed at improving the functioning of high-risk groups during the pandemic.

The findings of the study need to be interpreted in light of a few drawbacks including the high attrition rate and the study population being restricted to educated and English-speaking participants with Internet access. Despite these limitations, the study has several strengths, the main being the longitudinal design that permits the identification of some of the causal and mediating factors for increased distress among participants. In sum, the research demonstrates that the impact of the mandated lockdown after the declaration of the pandemic on the mental health of individuals is substantial and long-lasting. There is an imperative need for the implementation of timely public mental health strategies that can attenuate the impact of the pandemic. Subsequent waves of the virus after a sustained decrease in new coronavirus cases is going to further increase the mental health problems among the general population, and identification and management of the high-risk groups is urgently needed. The findings have implications for the public health policy regarding the management, preventive, and support strategies that need to be made available during the pandemic to promote psychological resilience among vulnerable adults.

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Conflicts of interest

There are no conflicts of interest.

   References Top

Ozamiz-Etxebarria N, Dosil-Santamaria M, Picaza-Gorrochategui M, Idoiaga-Mondragon N. Stress, anxiety, and depression levels in the initial stage of the COVID-19 outbreak in a population sample in the northern Spain. Cad Saude Publica 2020;36:e00054020.  Back to cited text no. 1
Rossi R, Socci V, Talevi D, Mensi S, Niolu C, Pacitti F, et al. COVID-19 pandemic and lockdown measures impact on mental health among the general population in Italy. Front Psychiatry 2020;11:790.  Back to cited text no. 2
Lovibond SH, Lovibond P. Manual for the depression anxiety stress scales. 2nd ed. Sydney: Psychology Foundation; 1995.  Back to cited text no. 3
Carver CS. You want to measure coping but your protocol's too long: Consider the brief COPE. Int J Behav Med 1997;4:92-100.  Back to cited text no. 4
Carleton RN, Norton MA, Asmundson GJ. Fearing the unknown: A short version of the intolerance of uncertainty scale. J Anxiety Disord 2007;21:105-17.  Back to cited text no. 5
Ramiz L, Contrand B, Rojas Castro MY, Dupuy M, Lu L, Sztal-Kutas C, et al. A longitudinal study of mental health before and during COVID-19 lockdown in the French population. Global Health 2021;17:29.  Back to cited text no. 6
Sameer AS, Khan MA, Nissar S, Banday MZ. Assessment of mental health and various coping strategies among general population living under imposed COVID-lockdown across world: A cross-sectional study. Ethics Med Public Health 2020;15:100571.  Back to cited text no. 7
Agha S. Mental well-being and association of the four factors coping structure model: A perspective of people living in lockdown during COVID-19. Ethics Med Public Health 2021;16:100605.  Back to cited text no. 8
Viana Machado A, Volchan E, Figueira I, Aguiar C, Xavier M, Souza GG, et al. Association between habitual use of coping strategies and posttraumatic stress symptoms in a non-clinical sample of college students: A Bayesian approach. PLoS One 2020;15:e0228661.  Back to cited text no. 9
Deniz ME. Self-compassion, intolerance of uncertainty, fear of COVID-19, and well-being: A serial mediation investigation. Pers Individ Dif 2021;177:110824.  Back to cited text no. 10


  [Table 1], [Table 2]


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