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

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, whereas 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.

No participants over 61 years reported high stress, which may be influenced by retirement and reduced occupational pressure. Statistical analysis revealed no significant association between age and stress level (p = 0.1).

Impact of educational status on stress levels

A statistically significant association was found between education status and stress (p = 0.001). Among participants with less than a PUC education, 59% experienced moderate stress, whereas 87.5% of those with a degree or higher reported 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. These findings suggest that educational attainment influences stress perception and experience, which could inform targeted mental health interventions.

Stress distribution across employment status

The data show that people with different types of jobs experience various levels of stress. The employed individuals experienced moderate stress (68.8%), and approximately 24.2% of the unemployed people were in the moderate stress category. Notably, the students were in the high-stress category (25%). 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.

Stress distribution across rural and urban areas:

The data revealed that 72.7% of the participants from rural areas reported low stress, whereas 27.3% were from urban areas. For moderate stress, 56.5% of the participants were from rural areas, and 43.5% were from urban areas. In the high-stress category, the distribution was equal, with 50% of the participants from rural areas and 50% from urban areas.

Although these figures suggest that rural participants were more likely to report lower levels of stress, differences in stress levels between rural and urban populations 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.

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.

However, these influences should be interpreted as potential background factors rather than definitive causes of the observed stress levels in this study.

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–19.²¹ 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.²² 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.^23,24

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.

Limitations

The cross-sectional design prevents the establishment of causal relationships between COVID-19 and observed stress and depression levels. The study did not differentiate between patients with or without a COVID-19 diagnosis and did not control for potential confounders such as pre-existing health conditions. These factors may have independently influenced participants’ mental health outcomes. Therefore, the results should be interpreted as an assessment of mental health status in the context of the pandemic rather than as direct consequences of COVID-19 itself.