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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 15  |  Issue : 2  |  Page : 85-88

Effect of COVID-19 crisis on mental health of physiotherapy students


1 Department of Physiotherapy, Sancheti College of Physiotherapy, Maharashtra University of Health Sciences, Pune, Maharashtra, India
2 Department of Community Physiotherapy, Sancheti College of Physiotherapy, Maharashtra University of Health Sciences, Pune, Maharashtra, India

Date of Submission02-May-2021
Date of Decision08-Dec-2021
Date of Acceptance17-Dec-2021
Date of Web Publication15-Feb-2022

Correspondence Address:
Dr. Suroshree Mitra
Sancheti Institute College of Physiotherapy, 11/12, Thube Park, Shivaji Nagar, Pune - 411 005, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/pjiap.pjiap_7_21

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  Abstract 


CONTEXT: COVID-19 outbreak has disrupted the lives of many people. The lockdown imposed from March 2020 in India, a necessary step taken for containment of the coronavirus infection, also had its effect on students' social and academic life. Along with many individuals, the student population has also gone through a range of psychological and emotional reactions due to uncertainty, lack of financial stability, academic delay, lack of physical contact with family members, friends, and constant overloading of information via social media.
AIMS: The study was conducted to determine the effects of the COVID-19 crisis on the mental health of physiotherapy students.
SETTINGS: Community (online).
DESIGN: Survey study-Questionnaire based.
SUBJECT AND METHODS: An online survey was conducted via Google forms consisting of demographic data and Depression Anxiety Stress Scale (DASS)-21 questionnaire (a shorter version of DASS41) having seven questions each subscale, i.e., depression, anxiety, and stress. The data were collected from June 22, 2020, to July 3, 2020.
STATISTICAL ANALYSIS USED: Descriptive analysis of the data obtained was performed.
RESULTS: A total of 275 physiotherapy students participated in the study. About 34.6% of students were found to have depression, 31.1% have anxiety, and 16% have stress in the range of mild, moderate, severe, and extremely severe. Majority were in mild category of depression, anxiety, and stress. 4th-year students were found to be more affected as compared to other students.
CONCLUSIONS: COVID-19 crisis has affected the mental health of students.

Keywords: COVID-19, mental health, physiotherapy students


How to cite this article:
Tiwari SS, Mitra S, Dabadghav R. Effect of COVID-19 crisis on mental health of physiotherapy students. Physiother - J Indian Assoc Physiother 2021;15:85-8

How to cite this URL:
Tiwari SS, Mitra S, Dabadghav R. Effect of COVID-19 crisis on mental health of physiotherapy students. Physiother - J Indian Assoc Physiother [serial online] 2021 [cited 2022 Jul 3];15:85-8. Available from: https://www.pjiap.org/text.asp?2021/15/2/85/337725




  Introduction Top


COVID-19 is a disease caused by a new strain of coronavirus. “CO” stands for corona, “VI” for virus, and “D” for disease. The virus is transmitted through direct contact with the respiratory droplets of an infected person (generated through coughing and sneezing). Individuals can also be infected from touching surfaces contaminated with the virus and touching their face (e.g., eyes, nose, and mouth).[1]

The outbreak started in Wuhan, China and further spread to other parts of the world. The disease, which started as an epidemic mainly limited to China, was declared as a pandemic on March 11, 2020, by the World Health Organization (WHO). To avoid the devastating effect of the disease had on Western countries and considering the vast population, India implemented a countrywide lockdown on March 23 with only stores of essentials and basic amenities allowed to function for a limited period of time of the day.[2] A complete lockdown can have a downgrading effect on the psyche of the general public. It also has a devastating effect on economy, farming, and daily wage earners of the country.[3]

The worldwide rapid increase of infected cases has also created a sense of uncertainty and anxiety about what is going to happen.[4] Thus, it leads to various psychological reactions such as fear, anger, stress. During these times, population psychological reaction plays a critical role in keeping both spread of disease and of emotional distress and social disorder during and after the outbreak.[5] Constant overloading of information called “infodemic” via social media platforms also contributes to uncertainty and worry among the people while risking the spread of false information.[6] It affected students who are worried about economic influences, academic delay, and influences on daily life.[7] Mental health has its correlation with the physical domain,[8] spiritual, and social domain.

There need to evaluate mental health in physiotherapy students as it may affect their academic performance and thus be hinder in excelling to be a physiotherapist. It is also necessary as mental health disturbances are proved to affect physical health,[8] which is addressed by a physiotherapist. And also, COVID-19 is an uneventful turn of odds, so it is required to study it in all spectrums such as mental health.


  Subject and Methods Top


Subject

A total of 275 physiotherapy students, in which 231 were undergraduate and 44 were postgraduate students, participated in the study. The participants demographic data is mentioned in [Table 1].
Table 1: Participants from each class

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Methodology

Ethical approval was obtained from the Institutional ethical committee. A google form link consisting of description about the study, demographic data consisting of their year of studying, and questionnaire Depression Anxiety Stress Scale-21 (DASS-21), was circulated to the participants. The questionnaire consists of 7 items for each subscale. The participants were asked to fill the form if they gave their consent. The responses were collected on a 4-point rating scale ranging from 0 “did not apply to me at all” to 3 “applied to me very much.”


  Results Top


Two hundred and seventy-five students participated in the study.

Each subscale, i.e., depression, anxiety, and stress questions are randomly placed in the questionnaire. The depression subscale questions are questions 3, 5, 10, 13, 16, 17, and 21. The anxiety questions are 2, 4, 7, 9, 15, 19, and 20. The stress ones are 1, 6, 8, 11, 12, 14, and 18. The aggregated number for each scale was multiplied by 2 and was interpreted. Results are mentioned in [Table 2] and [Table 3].
Table 2: Result of all participants

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Table 3: Year wise interpretation

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  Discussion Top


The main aim of this study was to determine the effect on mental health during the COVID-19 crisis. The study showed that almost one-third of students were depressed, that is the 34.6%, almost one-third were having anxiety, i.e., 31.1%, almost one-sixth faced stress, i.e., 16%. Fourth-year students were found to be significantly affected with respect to the other different-year students, which can be attributed to the uncertainty of their examination, postponed dates of their examination, and the uncertainty of future employment and salary. The conducted study also resulted in more students with no affection (that is normal) of mental health, which may be due to students being with their family members at home and in protected environment that might have helped them.

With no alternative ways to escape from the COVID-19 pandemic, almost all the countries, including India, have adopted lockdown as a potentially effective strategy to fight against the COVID-19 pandemic. Studies have suggested that public health emergencies like the COVID-19 pandemic can have psychological effects on college students, especially medical students, which can be anxiety, fear and worry, including others.[7] Keeping in mind the concerns regarding psychological distress raised around the globe, Xiang et al. have argued for a timely action on mental health during the COVID-19 pandemic.[9] Furthermore, the WHO has also issued in public interest guidelines to address psychological issues that may arise due to pandemic.[10] What is alarming here is the heightened fear related to the coronavirus culminating in people committing suicides.[11],[12] A study by Wang et al. reported severe psychological distress (anxiety, stress, and depression) during COVID-19 among Chinese nationals.[13] Similarly, another research on Chinese nationals found psychological distress such as stress, anxiety, and depression quite common and hence, alarming.[14] Evidently, people's mental health was severely affected during pandemics such as in severe acute respiratory syndrome which was in 2002-2004. For example, Leung et al. found that their respondents reported experiencing anxiety during Severe acute respiratory syndrome.[15] Moreover, stress, depression, and anxiety were also found to be common among people during severe acute respiratory syndrome.[16] Clearly, being social is a human being tendency that also facilitates social interaction, and thus, when our movements are curtailed and restricted, psychological distress results such as depression, anxiety, stress, and fear.[17] Van Bortel et al. and Kumar and Nayar have suggested that issues of mental health should be considered and also addressed as anxiety, stress, fear, trauma, helplessness, and other psychological issues which are experienced during a pandemic such as recent one.[18],[19] Moghe et al. study showed that when it comes to students coping with COVID-19, the urban student scores in unpleasant feelings, irritability, helplessness, and uncertainty with a noticeable difference. This might mean that though used to the fast-paced lifestyle and corporate culture, the urban youth find a crisis hard to handle due to the societal pressure and demands being higher in cities than in rural areas.[20] Rehman et al. studied that students were found moderately depressed, which was attributed to changes in their day-to-day life and their teaching and learning activities.[21]

The above findings may also be due to the fear of contracting COVID-19 infection. While fear of contracting of the virus may be justified considering worldwide mortality and infection rate, these could also be attributed to issues such social media hype and prevailing myth related to it.[13] It could also be due to the closure of universities and college that offer limited technological support and knowledge resulting in to the uncertainty about the future of students, teachers. The pandemic also places demand on the students and the teachers alike to adapt to online teaching, though with limited resources. Students may not be competent with the online platform. In addition, online learning may be disruptive due to technological issues, network connectivity issues, unavailability of devices and thereby, jeopardizing their future careers.[21] While the overall impact on mental health during the pandemic is not as high as suspected, a social aspect is worth mentioning.

Individuals are going through a crisis situation and feeling lack of control on their lives. Although students are finding ways out to deal with the uncertain situation, for example, creating a schedule for daily activities, getting involved in developing a skill, online counseling, increasing use of social media for the entertainment and also to gain information about safety measures, the repercussions of uncertainty, feelings of depression. However, the role and importance of family and friends cannot be undermined and remains a crucial factor in handling crises. An increase in mental health awareness, relevant coping mechanisms for the youth from varied backgrounds may be devised to help the students cope with the issues related to mental health, during a pandemic or otherwise.

It is the right time for the faculty, the students, and the administrators to learn from this critical situation and to overcome these challenges. Online learning could be greater opportunity as a result of this crisis. Faculty can motivate the younger minds and draw them into active participation in various ways. Universities authorities should encourage students and faculty to stay connected through the online or any social media platform and move forward together during this extremely difficult time. This force experimentation will guide universities to upgrade their technical infrastructure and make online a core aspect of teaching and learning.[22] Students are concerned amid widespread fears that the outbreak will adversely affect their examination and career performance. Clear directions should be given to them regarding the procedures for the administration of examination. Faculty members with respective heads should frame a flexible assessment guideline to keep in mind that the students are not at a disadvantage, and in turn, jeopardizing their career. If any students are not able to attend a course online due to the illness or any disturbance, universities should remain as flexible as possible to ensure that he or she will not get any negative impact in terms of the marks.[23]

Clinical implication and further scope

The study can be used to develop psychological interventions for students that can positively deal with the underlying psychological conditions among the COVID-19 outbreak.

Limitations of the Study

  1. The size of the sample of some groups was more and some less
  2. This study uses the DASS-21 scale, which may not be as effective as being assessed by trained mental health professionals, adding to the limitation of this study
  3. The study failed to compare mental health with students of other professions to conclude specifically about the mental health of physiotherapy students.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Key Messages on COVID-19. Available from: http:/www.who.int>coronavirus. [Last accessed on 2021 Apr 30].  Back to cited text no. 1
    
2.
Ghosh A. COVID-19 Latest Updates March 23: 20 States, UTs Under Lockdown as Cases Mount to 433, Indian Express Newspaper; Mar 22, 2020.  Back to cited text no. 2
    
3.
Grover S, Sahoo S, Mehra A, Avasthi A, Tripathi A, Subramanyan A, et al. Psychological impact of COVID-19 lockdown: An online survey from India. Indian J Psychiatry 2020;62:354-62.  Back to cited text no. 3
  [Full text]  
4.
Kafka AC. Shock, Fear, and Fatalism: As Coronavirus Prompts Colleges to Close, Students Grapple with Uncertainty. The Chronical of Higher Education; 2020.  Back to cited text no. 4
    
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Cullen K, Gulati G, Kelly BD. Mental health in COVID-19 pandemic. QJM 2020;113:311-2.  Back to cited text no. 5
    
6.
Fiorillo A, Gorwood P. The consequences of the COVID-19 pandemic on mental health and implications for clinical practice. Eur Psychiatry 2020;63:E32.  Back to cited text no. 6
    
7.
Cao W, Fang Z, Hou G, Han M, Xu X, Dong J, et al. The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry Res 2020;287:112934.  Back to cited text no. 7
    
8.
Ohrnberger J, Fichera E, Sutton M. The relationship between physical and mental health: A mediation analysis. Soc Sci Med 2017;195:42-9.  Back to cited text no. 8
    
9.
Xiang YT, Yang Y, Li W, Zhang L, Zhang Q, Cheung T, et al. Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. Lancet Psychiatry 2020;7:228-9.  Back to cited text no. 9
    
10.
WHO. Mental Health and Psychosocial Considerations during the COVID-19 Outbreak. Geneva: WHO; 2020.  Back to cited text no. 10
    
11.
Mamun MA, Griffiths MD. First COVID-19 suicide case in Bangladesh due to fear of COVID-19 and xenophobia: Possible suicide prevention strategies. Asian J Psychiatr 2020;51:102073.  Back to cited text no. 11
    
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Goyal K, Chauhan P, Chhikara K, Gupta P, Singh MP. Fear of COVID 2019: First suicidal case in India! Asian J Psychiatr 2020;49:101989.  Back to cited text no. 12
    
13.
Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al. Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. Int J Environ Res Public Health 2020;17:1729.  Back to cited text no. 13
    
14.
Qiu J, Shen B, Zhao M, Wang Z, Xie B, Xu Y. A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: Implications and policy recommendations. Gen Psychiatr 2020;33:e100213.  Back to cited text no. 14
    
15.
Leung GM, Lam TH, Ho LM, Ho SY, Chan BH, Wong IO, et al. The impact of community psychological responses on outbreak control for severe acute respiratory syndrome in Hong Kong. J Epidemiol Community Health 2003;57:857-63.  Back to cited text no. 15
    
16.
McAlonan GM, Lee AM, Cheung V, Cheung C, Tsang KW, Sham PC, et al. Immediate and sustained psychological impact of an emerging infectious disease outbreak on health care workers. Can J Psychiatry 2007;52:241-7.  Back to cited text no. 16
    
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Usher K, Durkin J, Bhullar N. The COVID-19 pandemic and mental health impacts. Int J Ment Health Nurs 2020;29:315-8.  Back to cited text no. 17
    
18.
Van Bortel T, Basnayake A, Wurie F, Jambai M, Koroma AS, Muana AT, et al. Psychosocial effects of an Ebola outbreak at individual, community and international levels. Bull World Health Organ 2016;94:210-4.  Back to cited text no. 18
    
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Kumar A, Nayar KR. COVID 19 and its mental health consequences. J Ment Health 2020;30:1-2.  Back to cited text no. 19
    
20.
Moghe K, Kotecha D, Patil M. COVID -19 and mental health: A study of its impact on students. medRxiv 2020.  Back to cited text no. 20
    
21.
Rehman U, Shahnawaz M, Khan N. Depression, anxiety and stress among Indians in Times of COVID-19 -19 lockdown. Community Ment Health J 2020;57:42-8.  Back to cited text no. 21
    
22.
Gewin V. Five tips for moving teaching online as COVID-19 takes hold. Nature 2020;580:295-6.  Back to cited text no. 22
    
23.
Lim M. The Educating Despite the COVID-19 Outbreak: Lessons from Singapore. Times Higher Education; Mar 2020.  Back to cited text no. 23
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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