key: cord-0760207-8wo8h3a3 authors: Gopal, A.; Sharma, A. J.; Subramanyam, M. A. title: Dynamics of psychological responses to Covid-19 in India: A longitudinal study date: 2020-06-13 journal: nan DOI: 10.1101/2020.06.12.20129791 sha: ab49e3dfc279b05dd39381d0fb0ac85ee148de33 doc_id: 760207 cord_uid: 8wo8h3a3 To curb the spread of the novel coronavirus, India announced a nationwide lockdown on 24th March 2020 for 21 days, later extended for a longer time. This long period of lockdown greatly disrupted routine life and likely affecting citizens psychological well-being. The psychological toll of the pandemic on Indians is documented. However, no study has assessed whether the psychological toll changed over time due to repeated extensions of the lockdown. We followed up 159 Indian adults during the first two months of the lockdown to assess any change in their anxiety, stress, and depressive symptoms. Multilevel linear regression models of repeated observations nested within individuals, adjusted for socio-demographic covariates, showed that anxiety ({beta}=0.81, CI: 0.03, 1.60), stress ({beta}=0.51, CI: 0.32, 0.70), and depressive symptoms ({beta}=0.37, CI: 0.13, 0.60) increased over time during the lockdown. This increase was higher among women than men independent of covariates. Individual resilience was negatively associated with the psychological outcomes. This suggests that the state needs to address the current mental health impacts of a long-drawn out lockdown and its long-term sequelae. Disproportionate burden on women needs immediate attention. Sustainable change requires addressing the root causes driving the gender inequalities in psychological distress during such crises. lockdown, but also after the crisis. Previous studies have shown that prolonged periods of isolation and limited mobility significantly impacted mental wellbeing [ 14,15 ] during crises. Further, such prolonged exposure to negative mental health outcomes could have adverse effects on physical that higher greater social support and higher resilience will be related to lower levels of anxiety, stress, and depression, independent of all covariates. The responses were recorded on a 4-point Likert scale ranging from never (0) to nearly every day (3). The total score of GAD-7 ranged from 0 to 21. Greater score predicted higher levels of anxiety Sociodemographic characteristics: Sociodemographic information of the study participants included 143 age (in years), gender (male/female/ non-binary), education (high school or less/some college/above 144 college), annual income (in Indian Rupees) (0-3,00,000 (low)/ 3,00,000-7,00,000 (medium)/ 7,00,000 145 and above (high)), and place of residence (rural/ urban The responses were recorded as yes (1) or no (0). The aggregate of the four responsibility scores 169 reflected the total increased responsibility score. . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted June 13, 2020. . https://doi.org/10.1101/2020.06.12.20129791 doi: medRxiv preprint time points across gender, relationship status, education, annual income, and place of residence. participants. Model 1 included the primary predictor time and the sociodemographic variables. the buffer factors social support and resilience, and a history of mental health issues. Additionally, we ran an ANOVA model to analyze the gender differences in scores of responsibilities during the 181 lockdown. We set alpha at 0.05 in our study. All our models were run in STATA version 12 [ 34 ]. We collected data on psychological outcomes from 159 Indian adults across a period of two 196 months during the lockdown. Our sample comprised relatively young participants (mean age=27.44 197 years, SD=9.17 years). About 65% of the sample were men and the remaining were women. The annual income of about half of the participants was below 3,00,000 Indian Rupees (a cut-off 199 representing an income allowing decent living in a one-bedroom apartment for a couple in most 200 urban areas of India). About 55% of the participants were at least college-educated, while only 201 about 11% of the participants reported having an educational qualification less than high school. The distribution of the psychological outcomes across these groups is presented in Table 1 . . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted June 13, 2020. . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted June 13, 2020. Our fully adjusted models also found that a higher level of resilience was associated with 261 lower anxiety, stress, and depressive symptoms. However, the associations of social support with 262 the psychological outcomes were not statistically significant in our models. Using repeated measures of psychological outcomes from 159 Indian adults during a period of 270 two months of the Covid-19 lockdown, we found that there were statistically significant increases in 271 stress, anxiety, and depressive symptoms over this period. Moreover, this increase in negative 272 psychological outcomes was found to be more among women, compared to men. We also found 273 that a higher level of an individual's resilience was related to lower levels of anxiety, stress, and 274 depressive symptoms. Our findings suggest that anxiety, stress, and depressive symptoms increased during the is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted June 13, 2020. . https://doi.org/10.1101/2020.06.12.20129791 doi: medRxiv preprint followed by the social isolation maintained for a prolonged time, and the emotional and financial losses incurred during the lockdown might have created a synergistic psychological impact. Second, the government of India announced a relaxation of restrictions on certain activities even 288 while extending the lockdown. These relaxations included the resumption of trains, opening up of 289 small shops, and inter-state mobility. However, these graded "unlocks" (which potentially allowed 290 increasing physical mobility as well), were not accompanied by reports of a reduction in the perceived risk of contracting the disease and thus further increasing their stress, anxiety, and 294 depressive symptoms. However, these findings of our study are contrary to those found by Wang North America compared to their male counterparts during this pandemic, across all disciplines. Our results from India, a society with stronger patriarchy, fit this narrative. We found that women 314 reported a greater increase in their responsibilities during the lockdown compared to men. These We found that the greater increase in stress and anxiety among women versus men persisted 327 even after accounting for social support and resilience. This suggests that this gendered pattern was 328 strong enough to persist despite any protective effect exerted by these buffering factors. Even . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted June 13, 2020. . https://doi.org/10.1101/2020.06.12.20129791 doi: medRxiv preprint outcomes among our participants. Resilience is known to buffer the impact of stress on mental health [ 44 ] , especially during the Covid-19 pandemic[ 45 ]. Although not statistically significant, we also found evidence suggesting that social support reduced the intensity of increase in participants' likely that the initial announcement of the lockdown led to individuals moving to their social, and financial challenges during the time of crisis. Such perceived assurance of help from 345 others during the crisis could act as stress-ameliorating factors, preventing the increase of anxiety, 346 stress, and depression. However, due to the small sample size, we did not have statistical power to 347 support this. We also found that persons with a history of mental health issues were likely to have an We could not find statistical evidence to support the relationship of age, annual income, and 355 education with anxiety, stress, and depressive symptoms in our sample. However, despite the lack 356 of statistical significance, we found that a higher annual income, lower age, and living in urban 357 versus rural areas, were related to lower levels of adverse psychological outcomes. A higher income 358 could reflect employment that assured job security, flexibility, and a continued salary during the 359 lockdown, which in turn may dampen the psychological impact of the prolonged lockdown. Also, it 360 likely provides individuals with financial resources to better adapt to the crisis. Limitation and strengths The study has several limitations which we acknowledge. First, the survey was conducted 364 online limiting the sample to only those who had access to the Internet. However, the online 365 method of recruitment helped us collect data from a diverse sample within a short time, given the 366 restriction of physical mobility due to the lockdown. Second, we could not follow-up with the 367 majority of our participants during the study. This was likely because we relied on only one way of 368 communication, their email, for follow-up. In the chaos of the Covid-19 pandemic and the 369 challenges it brought, the participants might have missed the emails related to the follow-ups. Government of India Notification 2. . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted June 13, 2020. . . CC-BY 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted June 13, 2020. . https://doi.org/10.1101/2020.06.12.20129791 doi: medRxiv preprint 42. Sevilla-Sanz, A.; Gimenez-Nadal, J. I.; Fernández, C. Gender Roles and the Division of Unpaid Work in Health Security Capacities in the Context of COVID-19 2. Government of India Notification 1 Chaudieu, I. Resilience and Mental Health Mental Health Strategies to Combat the Psychological 494 Impact of COVID-19 Beyond Paranoia and Panic Stress and Coping in the Time of COVID-19: Pathways to Resilience Psychological Symptoms during 498 the Two Stages of Lockdown in Response to the COVID-19 Outbreak: An Investigation in a Sample of 499 Citizens in Northern Spain Depression Among Individuals With Spinal Cord Injury: A Structural Equation Model Health Care Workers during Coronavirus Disease 2019 Outbreak: A Moderated Mediation Model Predictors of Recurrence of 547 Major Depressive Disorder Initial Psychological Impact of COVID-19 and Its The authors declare no conflict of interest.