key: cord-0902289-wbcy9vi5 authors: Khanra, Sourav; Sahoo, Rajeev Ranjan; Bose, Swarnali; Kumari, Reetu; Khess, Christoday Raja Jayant; Munda, Sanjay Kumar title: Impact of lockdown and health anxiety during COVID 19 pandemic among inpatients of a psychiatric hospital: an observational study date: 2020-11-10 journal: Asian J Psychiatr DOI: 10.1016/j.ajp.2020.102462 sha: 112fd1c8fc2f008fab572299c659b67ab302c1cc doc_id: 902289 cord_uid: wbcy9vi5 nan confusion, and anger. Several factors like longer quarantine duration, infection fears, frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma played role as stressors (Brooks et al., 2020) . During current ongoing COVID 19 pandemics too, people of this planet are facing "collateral damage" both due to the pandemic itself and responses to it like lockdown (Tandon, 2020) . Research have found emerging adverse psychological outcomes, increased loneliness, depression, anxiety. Health anxiety, loneliness and reduced social support are among few others which could be directly or indirectly linked to this pandemic and lockdown (Courtet et al., 2020; Tull et al., 2020) . Not surprisingly, few studies and review have shown that during COVID-19 pandemic and lockdown persons with pre-existing mental illness report worsening of psychiatric symptoms or development of anxiety, depression, stress, suicidal ideation, impulsivity, insomnia or post-traumatic stress disorder (Fernandez-Aranda et al., 2020; Zhou et al., 2020; Qiu et al., 2020; Vindegaard & Benros, 2020; Hao et al., 2020; Brooks et al., 2020) . While most of them are on psychiatric treatment on out-patient basis, those who are on inpatient care might deserve special attention as they are far from their homes and families and their illnesses are presumably in symptomatic phase which further make them vulnerable to pandemic and lockdown. To our best of knowledge, no study has examined impact of COVID-19 pandemic and lockdown among admitted inpatients of a psychiatric hospital. Hence our study was aimed to examine impact of lockdown, health anxiety and depression among inpatients of a psychiatric hospital during lockdown in India. After approval from institute ethics committee, a hospital based cross-sectional study was conducted at a psychiatric hospital located in India. All inpatients were approached for the study. Data was collected during month of June and July in 2020. Those inpatients who were 1) having active psychotic symptoms in recent mental state examination as recorded in case record file of the inpatient and/or 2) were undergoing electroconvulsive therapy and/or 3) refused to give informed consent were excluded from the study. Thus, 60 inpatients were included in the study. Sociodemographic and clinical details were recorded with a pre-J o u r n a l P r e -p r o o f designed semi-structured data sheet. The Clinical Global Impression-severity (CGI-S) (Guy, 1976 ) was applied to measure severity of illness among participants. A predesigned questionnaire Impact of Lockdown questionnaire (IOLQ) which was adapted from the Impact of Event Scale -Revised (IES-R) (Weiss and Marmar, 1977) was used to assess impact of lockdown. The Impact of Event Scale (IES-R) is one of the most widely used self-report measures to assess subjective distress caused by traumatic events. IOLQ was developed for assessing PTSD like symptoms. After serial interviews with patients, a questionnaire was The Health Anxiety Inventory-18 (HAI-18) (Salkovskis et al., 2002) and Patient Health Questionnaire -9 (PHQ-9) (Spitzer et al., 1994) were administered to assess health anxiety and depression, respectively. Analysis was done with Statistical Packages of Social Science (SPSS) version 25 for Windows. Spearman's correlation revealed distance of home was negatively corelated with PHQ-9 (ρ = -0.26, p<0.05). CGI-S score was positively corelated with HAI-18 scores (ρ=0.27, p<0.05). IOLQ score was positively corelated with both PHQ-9 (ρ = 0.49, p<0.01) and HAI-18 (ρ = 0.38, p<0.01). Participants of our study were young adults mostly hailing from rural area and affiliated to Hinduism which followed existing demographic pattern of India. Considering mean duration of illness of approximate 60 months, their illness could be termed 'chronic' one. Mean CGI-S score indicates that during time of data collection their severity of illness reduced to near 'normal' according to measure applied (Guy, 1976) . Lower severity of illness presumably due to their mean duration of stay and treatment of approximate three months in the institute would have an advantage to speculate that effect of psychopathology on impact of lockdown and health anxiety might be minimal. Mean PHQ-9 score of 6.71 indicates presence of mild depression among the participants (Kroenke et al., 2001) . High health anxiety was observed among inpatients (Salkovskis et al., 2002) . Our findings that female inpatients suffered from depression and health anxiety more than males might be explained by their higher severity of illness. This is in accordance with earlier research during current and past epidemics where females were found to have greater psychological impact than males (Taylor et al., 2008; Qiu et al., 2020; Zhang et al., 2020b; Ozdin and Bayrak Ozdin, 2020) . Though non-affective psychosis has significantly higher severity of illness, patients with substance use disorder diagnosis had experienced most impact of lockdown. As they were free from psychosis, we can speculate their functioning returned earlier than other group of inpatients and thus became aware of lockdown to much more extent than other groups of inpatients. Similarly, they had experienced highest health anxiety among all groups. Inpatients with higher severity of illness experienced higher health anxiety which might be explained by their more severe psychopathology. Those who had higher impact of lockdown J o u r n a l P r e -p r o o f were more likely to suffer from depression and higher health anxiety. Those having higher health anxiety also were more likely to suffer from depression. Inpatients who came from distant home address were less likely to suffer from depression which was against our presumption. This might be due to heterogeneity of inpatients having different diagnosis which might have a bearing on this. Our study suffered from limitations. We did not have any healthy control group which did not allow for comparison of findings. Where pandemic to this extent is uncommon in occurrence, a qualitative approach would have complemented the results of this study. SK, SB and CRJK conceived the work. RRS, RK, SK and SB collected data. SK drafted the manuscript. SKM critically appraised the manuscript. 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