Common mental health problems among patients accessing care at ayurvedic health centers in Udupi Taluk.

Study location

Udupi Taluk, located in the southwestern coastal region of Karnataka, is known for its rich cultural legacy and traditional practices. Ayurvedic health centers in this area serve a diversified clientele seeking solutions to various health issues. Understanding the mental health landscape of patients seeking care at Ayurvedic centers is critical for individual well-being and optimizing healthcare delivery within this holistic paradigm.

There is a bidirectional relationship between physical health and mental health. Physical issues can lead to psychological distress, whereas mental health issues can manifest as physical symptoms.¹² In the context of Ayurveda, which encourages balance and harmony. Exploring the prevalence of common mental health issues is particularly crucial. Healthcare practitioners, policymakers, and researchers should work together to improve the overall quality of care at Ayurvedic health centers by highlighting this little-studied aspect. Furthermore, the findings of this study may help understand better-integrated healthcare approaches that prioritize mental and physical health holistically.

Given the growing interest in alternative healthcare practices and the global burden of mental health disorders, this study aimed to fill a critical knowledge gap by investigating the common mental health issues encountered by patients seeking care at Ayurvedic health centers in Udupi Taluk. This study sought to provide significant insights into the prevalence, types, and correlations of various mental health problems to inform future therapies, enhance patient outcomes, and promote holistic well-being within the Ayurvedic healthcare framework.

Stress distribution across age groups

The data suggest that the highest percentage (75%) of high stress is found among the youngest age group (18-30 years), and factors such as career uncertainty, financial instability, or life transitions may contribute to higher stress levels in younger individuals, while the middle-aged group (31-60 years) has a lower percentage (25%) of high stress, which may be due to a decrease in stress with age aligned with possible increases in life experience, stability, or coping mechanisms. The oldest age group (over 61 years) shows no high stress due to the potential influence of retirement on stress levels in the oldest age group. The data showed no significant difference in stress levels between males and females, with a p-value of 0.7. Both genders had similar distributions across the low-, moderate-, and high-stress categories. The p-values for age (0.1) and sex (0.7) indicate that the differences in stress levels across these variables were not statistically significant.

Impact of educational status on stress levels

The data showed a strong link between schooling and stress levels; a p-value of 0.001 indicated that this link was statistically significant. Most people with less than a PUC (Pre-University Course) education (59%) experienced moderate stress, while a higher number of people with a degree or higher (87.5%) experienced high stress. People with a bachelor’s degree or higher may be more stressed because they have more responsibilities, higher career demands, or work pressures. Does this trend have anything to do with job competition, student loans, or the desire to advance your career? Could people with more schooling be more aware of stress and more likely to talk about it? A p-value of 0.001 indicated a statistically significant link between the amount of education and stress. Different levels of schooling seem to cause various types of stress, which can help make remedies more effective. The link between education and stress significantly affects both society and the workplace.

Stress distribution across employment status

These numbers show that people with different types of jobs experience various levels of stress. Working people were mainly in the moderate stress category (68.8%), and unemployed people were also mainly in the moderate stress category (24.2%). Notably, students were more likely than other groups to be in the high-stress category (25%), whereas older adults were the least stressed. People with jobs usually feel moderate rather than high or low stress because of pressures at work, such as meeting deadlines, worrying about job stability, balancing work and life, and meeting performance standards. People who have jobs are more or less stressed depending on how happy they are with their jobs, the type of jobs they have, or the support systems at work.

Stress distribution across rural and urban areas:

The data show that people in rural places mostly feel low to moderate stress, whereas people who live in cities have a relatively even distribution of low, moderate, and high stress. The percentage of people living in high-stress places was the same in both rural and urban areas (50% each). People living in rural locations tended to have low (72.7%) or moderate (56.5%) stress levels. Stress levels are lower in rural areas because of a slower pace of life, more robust community ties, and being closer to nature. Problems with the economy, obtaining medical care, and finding work in rural places can all raise or lower stress levels. Moderate stress was more effective than high stress. With a p-value of 0.3, the differences in stress levels between people who live in rural areas and those who live in cities were not statistically significant.

The participants’ feelings and thoughts during the COVID-19 pandemic are presented in Table 4. Approximately one-third of the participants (34.2%) were extremely afraid, while 33.7% were rarely afraid of acquiring COVID-19 when going into the public. Nearly half (49.8%) of the participants were worried about contracting COVID-19. Approximately 41.6% of the participants reported that sleep was rarely affected because of thoughts related to COVID-19. About 22.3% reported avoiding conversations on COVID-19 because of fear or anxiety. Approximately 36.7% were worried about acquiring COVID-19 when an unknown person came closer to them. Approximately 20.9% were anxious about obtaining information on COVID-19. Approximately 40.5% were concerned about acquiring COVID -19 when people coughed or sneezed.

Prevalence of fear:

The results showed that many of the participants were afraid of contracting COVID-19 in public places. About one-third (34.2%) were very afraid and another third (33.7%) were rarely scared. This indicates that people’s fears are very different. The fact that 34.2% were scared shows how widespread anxiety was during the pandemic. This anxiety may have been caused by news stories, rising case numbers, and lack of knowledge about the virus. This terrible fear comes in the way of everyday activities like work, shopping, and taking the bus. The 33.7% of those who were rarely afraid may have had more faith in protective measures (such as masks and social distancing), or they may have thought they were less at risk because of their age, health, or ability to obtain correct information. Fear levels vary, which means that public health messages need to be adapted to reach terrified people and those who are not worried. For example, reassuring people and giving them clear information might lower their anxiety, while stressing how important it is to take steps might make those who are not afraid of being more alert.

Prevalence of worry:

About 49.8% of the people who took the survey said they were worried about getting COVID-19 “sometimes.” This shows that worry is a normal, if not always present, feeling for many people. Almost half of the people who participated in the study said that they sometimes felt worried. This shows that fear was not overwhelming, but constant worry could change depending on rising case numbers, personal experiences, or news stories. This concern contributes to the general stress level. Coping strategies can be used to address these concerns. Worry could change how people act in public, such as following rules, connecting with others, or deciding to do things in public. This worry that happens “sometimes” changes the way a group works, such as how people help each other or work together.

Prevalence of sleep disruption:

About 41.6% of the participants said that COVID-19 thoughts rarely kept them from sleeping. This shows that COVID-19-related anxiety was present, but it did not keep most people sleeping well. Sleep and Mental Health: The results showed that most participants’ thoughts about COVID-19 did not significantly interfere with their sleep. There may have been things that prevented these people from having trouble sleeping. It is essential to maintain mental and physical health during pandemics. Some people may have been able to sleep better after getting help from the anxiety linked to the pandemic. Examples of these treatments include stress management, cognitive-behavioral therapy, and mindfulness. Long-term worry or sleep problems that come and go can harm mental and general health.

Prevalence of avoidance:

About 22.3% of those who took the survey said that they avoided discussing COVID-19 because they were afraid or anxious about it. This meant that many people felt so bad about the subject that they did not want to discuss it. Avoiding talking about COVID-19 might have been a way to deal with stress, but it could have also made people feel alone or deprived of correct information. This avoidance hurts both emotional health and relationships with others. Because of the steady flow of information and terrible news, some people may have felt that they had too much to take in, making them avoid it. Campaigns for public health strike a balance between informing people and making them feel scared of what this means for society, especially when working together and making communities strong. This avoidance makes people feel bad about themselves or leads to a lack of knowledge of the virus and its effects.

Worry about proximity to unknown persons:

About 36.7% of the participants were worried that they might get COVID-19 if an unknown person got closer to them. This shows that people are concerned about being close to people who might have the disease and the risk of its spread. People may have changed how they interacted with each other because they were afraid of being close to strangers. This may have caused people to physically distance themselves from others, socialize less, and possibly make public places tense. This has changed how people act and follow social rules. Worrying about people that you do not know could also mean that you do not trust others as much, which could divide society. Thus, it is essential to build trust after a pandemic. This worry may have made people more likely to follow public health rules, such as staying away from sick people and wearing masks. Messages about public health address these concerns and encourage people to act safely.

Prevalence of anxiety:

Approximately 20.9% of the participants were nervous when they heard of COVID-19. This shows that the constant news stream and updates caused anxiety. The fact that COVID-19 information makes people anxious shows how media use affects mental health. People should control how much media they use to lower their stress, and media companies should play a role in the spread of knowledge. Some people may have learned to deal with their anxiety by picking up and choosing their knowledge. Public health officials ensure that people who are worried about the news receive essential information. Public Health Communication: To lower anxiety about COVID-19 information, techniques can be used, such as reassuring language, giving helpful advice, or focusing on good outcomes (such as recovery rates or new vaccines).

Prevalence of coughing or sneezing:

Approximately 40.5% of the people who took part were worried that they would get COVID-19 from people who coughed or sneezed near them, which shows an intense fear of symptom transmission. Concerns about coughing or sneezing show that people are more aware of COVID-19 signs, which could make people more careful in public places. This knowledge affects actions such as wearing masks, social distancing, or staying away from areas with many people.

Psychosocial effects:

This worry may have made people more anxious or hypervigilant, especially when they had to cough or sneeze for reasons such as allergies or colds. This changes how people connect, especially at work, school, and public transportation. There is a chance that people who cough or sneeze in public would be judged, even if they were not sick with COVID-19. These issues are dealt with in public health efforts that do not add to stigma.

Pandemic-induced stressors

People who took part were probably more stressed because they were always worried about their health, the health of their loved ones, and the chance of contracting the virus. A significant source of stress was worry that they would get sick and have to go to the hospital or die. Many people lost their jobs, had their incomes dropped, or were unsure of where to work in the future because of the pandemic. This lack of financial security probably stressed people, especially those who were already weak. Measures to keep people from getting too close, lockdowns, and limits on meetings all messed everyday social interactions, making people feel lonely, isolated, and disconnected. Not having friends or family during these times could have worsened the worry. People may have been too stressed by the confusing or scary information that kept coming in about the virus, how it spread, and how to stop it. The constant need to handle new information and adjust to new rules may have stressed people.

Psychological impact of prolonged uncertainty

Long-lasting uncertainty about how long the pandemic would last, how well vaccines would work, and the chance of new strains added to stress. Living in a state of long-term uncertainty can be mentally draining and make you feel powerless or burnt out. Significant mental and emotional changes had to be made to deal with sudden and ongoing changes in daily routines, such as working from home or teaching, or changes in social behavior, such as wearing masks and avoiding public places. Getting used to these new rules likely made the volunteers feel more stressed. The fact that many of the people who took part in the study reported moderate amounts of stress suggests that, while not everyone was stressed out, a large part of the population was. There are many signs of mild stress, such as irritability, trouble concentrating, changes in sleep habits, or a general feeling of unease. Moderate stress was expected, which could mean that people were using ways to deal with it, like sticking to routines, getting social support, or doing things that relieve stress. However, these methods are not always sufficient to entirely reduce the stress caused by the pandemic. Different levels of stress among participants could show various levels of vulnerability and resilience. People’s mental health problems, ability to receive social support, ability to handle stress, and coping skills may all affect how they feel and deal with stress during the pandemic.

Mental health interventions

Many people feel moderate worry, which shows how important it is to have easy access to mental healthcare during and after the pandemic. Helping people deal with long-term stress sources could come from counselling, workshops on stress management, and neighborhood support groups. When people talk about public health, they should focus on physical and mental health, giving them tools and tips for dealing with stress. This could mean encouraging people to live healthy lives, make friends, and obtain clear, consistent knowledge to lower uncertainty. Having moderate worry over a long period could lead to more serious mental health problems such as depression or anxiety if not dealt with. It is essential to keep an eye on and help people with mental health problems as part of the overall reaction to the pandemic. Realizing that many people are under moderate stress clarifies how important it is to build group resilience. Communities are vital for helping each other, creating a sense of unity, and sharing tools to deal with stress in a group. When making decisions, policymakers should consider how the pandemic affects people’s mental health, and ensure that mental health services are adequately paid and included in plans for dealing with the pandemic. This includes helping people who may be more influenced than others, such as frontline workers, people with low incomes, and people who already have mental health problems.

The study result is aligned with the study conducted in Kerala, which also reported that most of the participants had experienced moderate levels of stress during COVID–19.¹⁴ In the current study, stress was high among participants aged 31 to 60. Stress levels were low among participants over 60 years of age. Although the finding was not statistically significant, previous research and global perceived stress reported that stressors experienced by older people are lower than those of younger people.¹⁵ The association between gender and perceived stress showed that the moderate level of stress was higher among males than compared to females. This finding contradicts previous literature that reported lower perceived stress levels in men.^16,17

A comparison between educational status and perceived stress level revealed that perceived stress was higher among participants with lower educational status than among those with higher educational status. The comparison between different levels of stress revealed that moderate levels of stress were higher among participants with lower educational status, and this was found to be statistically significant.

Education and stress resilience:

People with more schooling usually have better access to cognitive resources and ways to deal with problems. People who attend college often learn how to solve problems, think critically, and control their emotions, which makes them better able to handle stress. Higher education levels usually improve people’s ability to find, understand, and use health knowledge, which can help them better deal with stress. They may also have more knowledge about ways to deal with stress, mental health tools, and self-care activities that can help them feel less stressed. A college degree is often linked to better job opportunities, higher income, and more stable finances, which can help lower financial stress, which is a major cause of overall stress. Financially stable people can focus on their health and happiness instead of the day-to-day worries that people with less schooling might have. People with lower levels of education may not have many ways to deal with these problems. They may not know how to handle stressful situations, making them feel more stressed, especially during tough times such as a pandemic. A lower level of education is often linked to jobs that pay less, job insecurity, and less access to healthcare and other helpful tools. Being economically vulnerable is a significant source of stress because it can make people worry about meeting their basic needs, especially during crises, such as the COVID-19 pandemic. People with less schooling may also have to deal with extra social and environmental stresses, such as living in an unsafe or crowded place, not having much social support, and being discriminated against or socially stigmatized. These factors can worsen the levels of worry. The result that people with less education had higher moderate stress levels was statistically significant. This shows a strong link between the level of education and the ability to deal with or understand stress, with less education linked to higher stress levels. Even though moderate stress is not as bad for you as high stress, it can still significantly affect your health and wellbeing. People with less schooling may be more likely to experience moderate stress because they have more trouble with money, fewer friends and family, and less access to mental health resources.

Implications for interventions

Based on these results, it is clear that people with less education require specific support services. Some examples of interventions include classes on how to deal with stress, handle money, and obtain affordable mental health services. Promoting higher education and learning opportunities throughout life can help people deal with stress. Even as an adult, encouraging and helping people keep learning could help vulnerable groups feel less stressed. When planning mental health interventions, public health plans should consider the educational differences. Messages and support services tailored to the needs of people with less schooling can help to close the gap in their ability to deal with stress.

Policy implications:

Reducing educational inequality can help people feel less stressed and better about their general health in the long term. Stress differences could be lessened by policies that ensure equal access to good schools, job training, and adult education. A significant social factor affecting health is education level. Policymakers should consider how education affects health, such as stress, and work to lower hurdles to education, especially in areas that do not receive enough help. Obtaining help and tools for people with less education through community-based programs can be very helpful in lowering stress. Community centers may offer educational classes, counselling for mental health issues, and social support networks as part of these efforts.

A comparison between employment status and perceived stress level revealed that perceived stress was higher among employed participants, although the association was not statistically significant. A comparison between different levels of perceived stress reported that moderate levels of perceived stress were higher among employed participants. As compared to area of residence the rural participants experienced more perceived stress as compared to urban participants. Except for educational status, none of the factors were found to be statistically significant.

The present study revealed that some levels of depression were exhibited by participants during COVID-19. Depression was high among the participants aged 31–60 years. Stress levels were low among participants over 60 years of age. The association between gender and PHQ-9 depression score was higher among males than among females. A comparison between educational status and PHQ-9 scores showed that depression was higher among participants with a lower educational status than among those with a higher educational status. The comparison between employment status and PHQ-9 revealed that depression was higher among employed participants. Depression was higher among rural participants than among urban participants. None of the factors were statistically significant.