Mental health, sleep quality and quality of life in individuals with and without multiple health conditions during home quarantine in India due to the COVID-19 pandemic: a cross-sectional study

Ramesh Chandra Patra; Biswajit Kanungo; Parul Bawa

doi:10.12688/f1000research.24321.1

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Research Article

Mental health, sleep quality and quality of life in individuals with and without multiple health conditions during home quarantine in India due to the COVID-19 pandemic: a cross-sectional study

[version 1; peer review: 1 approved, 1 not approved]

Ramesh Chandra Patra ¹, Biswajit Kanungo¹, Parul Bawa¹

PUBLISHED 17 Jul 2020

Author details Author details

¹ Department of Physiotherapy, Lovely Professional University, Jalandhar, Punjab, 144001, India

Ramesh Chandra Patra
Roles: Conceptualization, Data Curation, Formal Analysis, Funding Acquisition, Investigation, Methodology, Project Administration, Resources, Software, Supervision, Validation, Visualization

Biswajit Kanungo
Roles: Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Parul Bawa
Roles: Writing – Review & Editing

OPEN PEER REVIEW

REVIEWER STATUS

This article is included in the Emerging Diseases and Outbreaks gateway.

This article is included in the Coronavirus (COVID-19) collection.

Abstract

Background: Since the World Health Organization declared the COVID-19 outbreak a global pandemic, global spread has created several challenges for the general public and health care workers across the world. The primary aim of this study was to assess the psychological stress, sleep quality, and health-related quality of life (QoL) of individuals with multiple health issues during home quarantine caused by the COVID-19 pandemic.
Methods: 50 individuals were recruited between 28^th March and 30^th April 2020, who have a history of chronic health issues, and 50 individuals with no health issues for this cross-sectional study. Three questionnaires were used to evaluate the mental health [depression anxiety stress scale (DASS-21)], sleep quality [Pittsburgh sleep quality index (PSQI)], and QoL [short form of health-related questionnaire (SF-36)] of participants. Statistical analysis was carried out with Student’s t-test, using SPSS software v16.
Results: Baseline demographic characteristics were homogenous for both groups of participants. Intergroup analysis revealed statistically significant differences in mental health (p<0.001), sleep quality (p<0.001), and QoL (p<0.001) between the two groups.
Conclusion: Our findings indicate that individuals with chronic health issues exhibit higher mental health problems, lower quality of sleep and have a lower health-related QoL. More research needs to be done for this group of individuals and the Government should plan to care of these individuals.

Keywords

COVID-19, Mental Health, Sleep Quality, Quality of Life

Corresponding author: Ramesh Chandra Patra

Competing interests: No competing interests were disclosed.

Grant information: The author(s) declared that no grants were involved in supporting this work.

Copyright: © 2020 Patra RC et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

How to cite: Patra RC, Kanungo B and Bawa P. Mental health, sleep quality and quality of life in individuals with and without multiple health conditions during home quarantine in India due to the COVID-19 pandemic: a cross-sectional study [version 1; peer review: 1 approved, 1 not approved]. F1000Research 2020, 9:718 (https://doi.org/10.12688/f1000research.24321.1) First published: 17 Jul 2020, 9:718 (https://doi.org/10.12688/f1000research.24321.1) Latest published: 29 Jul 2024, 9:718 (https://doi.org/10.12688/f1000research.24321.3)

Introduction

According to the World Health Organization (WHO), the COVID-19 outbreak is a global pandemic that started at the end of November in China and then gradually spread all over the world^1,2. As neither a treatment nor vaccine have been discovered for this disease, it raises concerns among the public about the spread of infection from confirmed COVID-19 positive cases. The WHO suggests that social isolation helps to limit the growing number of cases of COVID-19, and this has also led to significant fear and anxiety related to the spread of infection in the general public. Excessive fear and apprehension about the spread of infection can lead to acute stress, anxiety, and low quality of sleep^3,4. Many organizations are already working to increase awareness about the societal impact of the on-going pandemic⁵. For instance, it has been reported that during this pandemic crisis, various factors that impact the health of inviduals, such as prolonged periods of social isolation, fear of unemployment and economic loss, have the potential to increase due to lockdown^5–7.

The relationship between physical illness and mental health has received increased attention in recent years, and poor mental health is of concern as it may exert a negative effect on an individual's quality of life (QoL)^8,9. Evidence suggests that there is a direct relationship between mental health and sleep quality, a crucial public health issue^10,11. In this study, we aimed to assess thepsychological stress, sleep quality, and health-related QoL of individuals with and without multiple health issues during home quarantine in India due to the COVID-19 pandemic.

Methods

Ethical considerations

During the conduct of the study, all human ethical principles as per the World Medical Association’s Declaration of Helsinki (2013) and the guidelines of Good Clinical Practice (Indian Council of Medical Research) were observed.

We obtained approval for the study from the Institutional Research Ethics Committee of the Lovely Professional University (LPU), Phagwara, India (LPU/IEC/2020/26/03). All the participants were informed about the procedure of data collection, and a written consent form was obtained from all the participants prior to the study start.

Study design and setting

This study was an observational cross-sectional study. The study took place at the Department of Physiotherapy, LPU. The study was conducted from 28^th March to 30^th April 2020. Full lock down in India was initiated from 28^th March to 31^st May 2020. From 31^st May, the lockdown was extended until 30^th June for certain containment zones.

Participant recruitment

A total of 100 participants were recruited for the study. A total of 50 individuals suffering from chronic health issues (Group A; as identified from their clinical records) and 50 individuals with no chronic health issues (Group B) were recruited.

Participants were recruited from individuals undergoing physio treatment at the Department of Physiotherapy, LPU (even though lockdown was ongoing, essential services, such as physio appointments, were ongoing).

Using the convenience sampling method, individuals were contacted via phone to ask if they would like to take part in the study. If the individual consented, in their next physio treatment appointment, they were asked to sign the informed consent form and fill in the three questionnaires (as below).

Group A inclusion criteria: clinically pre-diagnosed with hypertension, diabetics, and chronic musculoskeletal conditions.

Exclusion criteria Groups A and B: history of any malignancy, recent fracture or trauma, osteoporosis, inflammatory arthritis, and/or cauda equine syndrome.

There were no inclusion criteria for Group B.

Outcome measures

Mental health. Depression, anxiety, and stress scale (DASS-21)¹² was used to assess depression, anxiety and stress. The participants were asked to utilize a four-point severity/frequency scale to show the level of depression, anxiety and stress they were experiencing in the past week. The scale consists of 21 questions with three subscales of depression, stress, and anxiety and each subscale comprises seven questions each. Each subscale comprises of seven statements regarding how the test subject was feeling over the last week and four responses ranging from 0- did not apply to me at all, 1- applied to me some of the time, 2- applied to me for a considerable amount of time to 3- applied to me very much/most of the time. The total score for each subscale gives the severity of that very symptom which has a range from 0 to 21 for each subscale.

Sleep quality. Sleep quality was evaluated through the Pittsburgh Sleep Quality Index (PSQI)¹³. This index asked participants to answer questions about their sleep habits in the past month. Participants that scored more than 5 were defined as having a low sleep quality.

Quality of life. Health-related QoL was assessed using the MOS 36-item short-form health survey (SF-36)¹⁴. The 36 items reflect eight health-related aspects that participants are asked to score, where 100 is defined as perfect health less, and any score less than 100 is defined as poor health.

Statistical analysis

Baseline characteristics of categorical variables were evaluated using Chi-square test. Quantitative variables were evaluated using Student's t-test, and quantitative variables without normal distribution were measured using the Mann-Whitney U test. Intergroup outcome measures were evaluated through an unpaired t-test. All analyses were carried out on SPSS software v16.

Results

A total of 110 participants were selected for primary assessment; 10 individuals were excluded as they did not fulfil the inclusion criteria. In total, 50 participants with chronic health issues and 50 without health issues were evaluated for the study.

Demographic characteristics are shown in Table 1. There was no statistical difference between groups for demographic characteristics.

Table 1. Demographic characteristics of all patients.

	Group A (n=50)	Group B (n=50)
Age (years, mean)	53.44	52.76
Weight (kg, mean)	65.87	66.45
Height (cm, mean)	163.33	165.33
Gender (%)
Female	70	50
Male	30	50
Body mass index (kg/m2, mean)	24.15	23.51
Smoking history (%)
No	82	75
Yes	18	25
Marital status (%)
Married	90	85
Not married	10	15
Education history (%)
School level	20	10
Undergraduate	60	40
Postgraduate	20	50
Socioeconomic status
Poor	0	0
Average	60	50
High	40	50

Group A, individuals with chronic health issues; Group B, individuals without chronic health issues. Socioeconomic status was calculated as follows: Poor, below Rs 15000/month; average, Rs 15000–100000/month; high, above Rs 100000/month.

Table 2. Comparison of outcome measures for Group A and Group B.

Outcome measures		Group A (mean)	Group B (mean)	Difference	P value
Mental health (DASS-21)	Depression	11.28	5.23	6.05	0.001
	Anxiety	11.14	3.76	7.38	0.001
	Stress	18.58	4.34	14.24	0.001
PSQI	Sleep quality	9.44	5.24	4.00	0.001
Quality of life (SF-36) *	PF	45.21	90.44	45.23	0.001
	RL-PH	25.50	63.51	38.01	0.001
	RL-EH	32.52	79.46	46.94	0.001
	ENG	30.50	84.43	53.93	0.001
	EWB	42.88	83.96	42.08	0.001
	BP	40.00	80.28	40.28	0.001
	GH	35.52	73.80	38.28	0.001

PF: physical functioning, RL-PH: role of limitation-physical health, RL-EH: role of limitation-emotional health, EN: energy, EWB: emotional wellbeing, BP: Body pain, GH: general health, DASS=Depression Anxiety Stress Scale, PSQI= Pittsburgh Sleep Quality Index, *Social life (SL) domain was not considered for this study.

Group A, individuals with chronic health issues; Group B, individuals without chronic health issues.

Table 2 presents the scores for Groups A and B for the three outcome measures (mental health, sleep quality and health-related QoL). For all DASS-21 items (mental health), Group A scored higher than Group B, showing higher levels of depression, anxiety and stress in Group A individuals. Similarly, for PSQI, Group A scored higher than Group B, showing poorer sleep quality for Group A individuals. For all SF-26 items, Group A scored lower than Group B, revealing lower health-related QoL in Group A individuals. Unpaired t-tests showed statistically significant differences between the groups for all variables (p = 0.001).

Discussion

Since the WHO declared the COVID-19 outbreak a global pandemic, many individuals, even those who have not been infected by the virus, are required to follow government rules where it was mandatory to stay at home. In this cross-sectional study, we sought to identify the correlation between chronic health issues and depression, anxiety, stress, quality of sleep and QoL in a population-based study in India during lockdown due to COVID-19. Our findings showed that poor mental health, low sleep quality, and low health-related QoL were higher in individuals with chronic health issues compared with individuals without chronic health issues at the time of home quarantine in India.

Current evidence reveal that COVID-19 causes fear among the Indian population as they are in home quarantined due to lockdown, which can an impact on well-being, increasing the levels of depression, anxiety, stress, reducing sleep quality, and decreasing QoL^15,16.

Considering that lockdown is likely to last for weeks, there is an urgent need to monitor the psycho-physiological well-being of the population and to collect research data to develop evidence-based strategies to reduce negative psychological effects of these unprecedented changes in individuals’ everyday lives^17,18, especially in those with chronic health conditions.

This study has some potential limitations: participants were recruited in only one area of India, we had a small sample size, and only subjective outcome was considered for the study

Conclusion

The WHO has recommended that individuals with physical and mental disabilities need to take extra care during isolation/quarantine for COVID-19¹⁹. This is supported by the results of this study, which revealed that there is an increased level of depression, anxiety, stress, and reduced sleep quality and QoL shown in individuals suffering from chronic illness compared with individuals without chronic illness during the quarantine period in India.

Data availability

Underlying data

Figshare: Mental Health, Sleep Quality and Quality of Life in Subjects with Multiple Health Conditions during Home Quarantine for COVID-19 Pandemic Attack: A Comparison with Healthy Subjects, https://doi.org/10.6084/m9.figshare.12612833²⁰.

This project contains the following underlying data:

- Group A data
- Group B data

Data are available under the terms of the Creative Commons Zero "No rights reserved" data waiver (CC0 1.0 Public domain dedication).

Acknowledgments

The author would like to express heartfelt thanks to all the participants who were participated in this study.

Faculty Opinions recommended

References

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13. Hita-Contreras F, Martínez-López E, Latorre-Román PA, et al.: Reliability and validity of the Spanish version of the Pittsburgh Sleep Quality Index (PSQI) in patients with fibromyalgia. Rheumatol Int. 2014; 34(7): 929–36. PubMed Abstract | Publisher Full Text
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15. Sood S: Psychological effects of the Coronavirus disease-2019 pandemic. Research & Humanities in Medical Education. 2020; 7: 23–6. Reference Source
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17. Lazzerini M, Putoto G: COVID-19 in Italy: momentous decisions and many uncertainties. Lancet Glob Health. 2020; 8(5): e641–e642. PubMed Abstract | Publisher Full Text | Free Full Text
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19. World Health Organization: Mental health and psychosocial considerations during the COVID-19 outbreak, 18 March 2020. World Health Organization; 2020. Reference Source
20. Patra RC, kanungo B, Bawa P: Mental Health, Sleep Quality and Quality of Life in Subjects with Multiple Health Conditions during Home Quarantine for COVID-19 Pandemic Attack: A Comparison with Healthy Subjects. figshare. Dataset. 2020. http://www.doi.org/10.6084/m9.figshare.12612833.v1

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Version 3

VERSION 3 PUBLISHED 17 Jul 2020

Author details Author details

¹ Department of Physiotherapy, Lovely Professional University, Jalandhar, Punjab, 144001, India

Biswajit Kanungo
Roles: Software, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing

Parul Bawa
Roles: Writing – Review & Editing

Competing interests

No competing interests were disclosed.

Grant information

The author(s) declared that no grants were involved in supporting this work.

Article Versions (3)

version 3

Revised

Published: 29 Jul 2024, 9:718

https://doi.org/10.12688/f1000research.24321.3

version 2

Revised

Published: 30 Jun 2022, 9:718

https://doi.org/10.12688/f1000research.24321.2

version 1

Published: 17 Jul 2020, 9:718

https://doi.org/10.12688/f1000research.24321.1

© 2020 Patra RC et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Patra RC, Kanungo B and Bawa P. Mental health, sleep quality and quality of life in individuals with and without multiple health conditions during home quarantine in India due to the COVID-19 pandemic: a cross-sectional study [version 1; peer review: 1 approved, 1 not approved]. F1000Research 2020, 9:718 (https://doi.org/10.12688/f1000research.24321.1)

NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article.

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Open Peer Review

Version 1

VERSION 1

PUBLISHED 17 Jul 2020

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Reviewer Report 08 Apr 2021

Kanwar Hamza Shuja, National Institute of Psychology (NIP), Quaid-I-Azam University (New Campus), Islamabad, Pakistan; Capital University of Science and Technology (CUST), Islamabad, Pakistan

Not Approved

https://doi.org/10.5256/f1000research.26834.r82045

Firstly thank you for giving me the chance for reviewing the article. It's a well written article though there are places where some sentences needs to be rewritten and checked for grammar. However, my biggest concern with this article is regarding its sample size. My first question is how did authors come up with a sample size of 50? Did they selected it themselves or what was the reason behind it or did they used sampling size calculator. Because a sample of 50 is too low for concluding this study.

Secondly, again with the sample but this time inclusion criteria for the group B was not set by the authors. Having no inclusion criteria could lead to potentially adding participants who may also be medically ill, or were these participants were inquired prior during recruitment if they are medically sound. And if they were asked that would have become their inclusion criteria. But unfortunately, I was unable to find any such thing in demographic information.

Third the instruments used are for measuring psychological variables in general. What I mean by this is that nowhere was I able to find anything where the participants were asked their thoughts on Covid-19 or its effect on them. Now depression, stress or anxiety could be potentially due to multiple factors same with the reasons for disturbed quality of life or sleep. The authors should have added some questions in demographic which could help the participants and the readers to know that the findings here are actually due to Covid-19 and not due to any external factor.

Fourth it would would be nice if the authors can add limitations and recommendations heading before conclusion.
Thank you and good luck.

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Partly
If applicable, is the statistical analysis and its interpretation appropriate?

Yes
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Public Health, Criminal Psychology, Clinical Psychology.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.

CITE

Report a concern

Author Response 07 Sep 2022

Ramesh Patra, Department of Physiotherapy, Lovely Professional University, Jalandhar, 144001, India

07 Sep 2022

Author Response
First, we would like to thank the honourable reviewers and editor for their constructive criticisms and suggestive comments, which were of great help in improving the quality and clarity of ... Continue reading
First, we would like to thank the honourable reviewers and editor for their constructive criticisms and suggestive comments, which were of great help in improving the quality and clarity of the current manuscript. We have read each reviewer’s comments carefully and, accordingly, made utmost efforts to address each comment point-by-point. We much appreciate the reviewer’s time, effort, and detailed explanations. We believe that the revised version of our manuscript is now more focused, scientific, understandable, and better arranged. All changes are highlighted with red color.

Reviewer Comment:

Query 1:
Firstly thank you for giving me the chance for reviewing the article. It's a well written article though there are places where some sentences needs to be rewritten and checked for grammar.
Response:
Thank you for your valuable comments. We have modified the text with proper grammar usage as per your suggestions.

Query 2:
However, my biggest concern with this article is regarding its sample size. My first question is how did authors come up with a sample size of 50? Did they selected it themselves or what was the reason behind it or did they used sampling size calculator. Because a sample of 50 is too low for concluding this study.
Response:
The total sample taken was 100. We have calculated the sample size using G power software 3.1 which was found to be around 51 (95% confidence interval, power of the study was 80% where the effect size was considered as 0.5). The sample size calculation has been added in the revised manuscript under the method section.

Query 3:
Secondly, again with the sample but this time inclusion criteria for the group B was not set by the authors. Having no inclusion criteria could lead to potentially adding participants who may also be medically ill, or were these participants inquired prior during recruitment if they are medically sound. And if they were asked that would have become their inclusion criteria. But unfortunately, I was unable to find any such thing in demographic information.
Response:
As suggested, we have included the inclusion criteria for Group B.

Query 4:
Third, the instruments used, are for measuring psychological variables in general. What I mean by this is that nowhere was I able to find anything where the participants were asked their thoughts on Covid-19 or its effect on them. Now depression, stress or anxiety could be potentially due to multiple factors same with the reasons for disturbed quality of life or sleep. The authors should have added some questions in demographic which could help the participants and the readers to know that the findings here are actually due to Covid-19 and not due to any external factor.
Response:
We have used the following tools to measure all the three measure outcomes.

DASS-21 tool was used to measure the mental health.

PSQI was used to measure sleep quality.

MOS-36 was used to measure the health-related QoL.

We have mentioned the tools in the methodology section and also given references.

Query 5:
Fourth it would be nice if the authors can add limitations and recommendations heading before conclusion.
Response: We have included the limitations and recommendations as per your suggestions.
First, we would like to thank the honourable reviewers and editor for their constructive criticisms and suggestive comments, which were of great help in improving the quality and clarity of the current manuscript. We have read each reviewer’s comments carefully and, accordingly, made utmost efforts to address each comment point-by-point. We much appreciate the reviewer’s time, effort, and detailed explanations. We believe that the revised version of our manuscript is now more focused, scientific, understandable, and better arranged. All changes are highlighted with red color.

Reviewer Comment:

Query 1:
Firstly thank you for giving me the chance for reviewing the article. It's a well written article though there are places where some sentences needs to be rewritten and checked for grammar.
Response:
Thank you for your valuable comments. We have modified the text with proper grammar usage as per your suggestions.

Query 2:
However, my biggest concern with this article is regarding its sample size. My first question is how did authors come up with a sample size of 50? Did they selected it themselves or what was the reason behind it or did they used sampling size calculator. Because a sample of 50 is too low for concluding this study.
Response:
The total sample taken was 100. We have calculated the sample size using G power software 3.1 which was found to be around 51 (95% confidence interval, power of the study was 80% where the effect size was considered as 0.5). The sample size calculation has been added in the revised manuscript under the method section.

Query 3:
Secondly, again with the sample but this time inclusion criteria for the group B was not set by the authors. Having no inclusion criteria could lead to potentially adding participants who may also be medically ill, or were these participants inquired prior during recruitment if they are medically sound. And if they were asked that would have become their inclusion criteria. But unfortunately, I was unable to find any such thing in demographic information.
Response:
As suggested, we have included the inclusion criteria for Group B.

Query 4:
Third, the instruments used, are for measuring psychological variables in general. What I mean by this is that nowhere was I able to find anything where the participants were asked their thoughts on Covid-19 or its effect on them. Now depression, stress or anxiety could be potentially due to multiple factors same with the reasons for disturbed quality of life or sleep. The authors should have added some questions in demographic which could help the participants and the readers to know that the findings here are actually due to Covid-19 and not due to any external factor.
Response:
We have used the following tools to measure all the three measure outcomes.

DASS-21 tool was used to measure the mental health.

PSQI was used to measure sleep quality.

MOS-36 was used to measure the health-related QoL.

We have mentioned the tools in the methodology section and also given references.

Query 5:
Fourth it would be nice if the authors can add limitations and recommendations heading before conclusion.
Response: We have included the limitations and recommendations as per your suggestions.
Competing Interests: No competing interests were disclosed. Close
Report a concern
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COMMENTS ON THIS REPORT

Author Response 07 Sep 2022

Ramesh Patra, Department of Physiotherapy, Lovely Professional University, Jalandhar, 144001, India

07 Sep 2022

Author Response
First, we would like to thank the honourable reviewers and editor for their constructive criticisms and suggestive comments, which were of great help in improving the quality and clarity of ... Continue reading
First, we would like to thank the honourable reviewers and editor for their constructive criticisms and suggestive comments, which were of great help in improving the quality and clarity of the current manuscript. We have read each reviewer’s comments carefully and, accordingly, made utmost efforts to address each comment point-by-point. We much appreciate the reviewer’s time, effort, and detailed explanations. We believe that the revised version of our manuscript is now more focused, scientific, understandable, and better arranged. All changes are highlighted with red color.

Reviewer Comment:

Query 1:
Firstly thank you for giving me the chance for reviewing the article. It's a well written article though there are places where some sentences needs to be rewritten and checked for grammar.
Response:
Thank you for your valuable comments. We have modified the text with proper grammar usage as per your suggestions.

Query 2:
However, my biggest concern with this article is regarding its sample size. My first question is how did authors come up with a sample size of 50? Did they selected it themselves or what was the reason behind it or did they used sampling size calculator. Because a sample of 50 is too low for concluding this study.
Response:
The total sample taken was 100. We have calculated the sample size using G power software 3.1 which was found to be around 51 (95% confidence interval, power of the study was 80% where the effect size was considered as 0.5). The sample size calculation has been added in the revised manuscript under the method section.

Query 3:
Secondly, again with the sample but this time inclusion criteria for the group B was not set by the authors. Having no inclusion criteria could lead to potentially adding participants who may also be medically ill, or were these participants inquired prior during recruitment if they are medically sound. And if they were asked that would have become their inclusion criteria. But unfortunately, I was unable to find any such thing in demographic information.
Response:
As suggested, we have included the inclusion criteria for Group B.

Query 4:
Third, the instruments used, are for measuring psychological variables in general. What I mean by this is that nowhere was I able to find anything where the participants were asked their thoughts on Covid-19 or its effect on them. Now depression, stress or anxiety could be potentially due to multiple factors same with the reasons for disturbed quality of life or sleep. The authors should have added some questions in demographic which could help the participants and the readers to know that the findings here are actually due to Covid-19 and not due to any external factor.
Response:
We have used the following tools to measure all the three measure outcomes.

DASS-21 tool was used to measure the mental health.

PSQI was used to measure sleep quality.

MOS-36 was used to measure the health-related QoL.

We have mentioned the tools in the methodology section and also given references.

Query 5:
Fourth it would be nice if the authors can add limitations and recommendations heading before conclusion.
Response: We have included the limitations and recommendations as per your suggestions.
First, we would like to thank the honourable reviewers and editor for their constructive criticisms and suggestive comments, which were of great help in improving the quality and clarity of the current manuscript. We have read each reviewer’s comments carefully and, accordingly, made utmost efforts to address each comment point-by-point. We much appreciate the reviewer’s time, effort, and detailed explanations. We believe that the revised version of our manuscript is now more focused, scientific, understandable, and better arranged. All changes are highlighted with red color.

Reviewer Comment:

Query 1:
Firstly thank you for giving me the chance for reviewing the article. It's a well written article though there are places where some sentences needs to be rewritten and checked for grammar.
Response:
Thank you for your valuable comments. We have modified the text with proper grammar usage as per your suggestions.

Query 2:
However, my biggest concern with this article is regarding its sample size. My first question is how did authors come up with a sample size of 50? Did they selected it themselves or what was the reason behind it or did they used sampling size calculator. Because a sample of 50 is too low for concluding this study.
Response:
The total sample taken was 100. We have calculated the sample size using G power software 3.1 which was found to be around 51 (95% confidence interval, power of the study was 80% where the effect size was considered as 0.5). The sample size calculation has been added in the revised manuscript under the method section.

Query 3:
Secondly, again with the sample but this time inclusion criteria for the group B was not set by the authors. Having no inclusion criteria could lead to potentially adding participants who may also be medically ill, or were these participants inquired prior during recruitment if they are medically sound. And if they were asked that would have become their inclusion criteria. But unfortunately, I was unable to find any such thing in demographic information.
Response:
As suggested, we have included the inclusion criteria for Group B.

Query 4:
Third, the instruments used, are for measuring psychological variables in general. What I mean by this is that nowhere was I able to find anything where the participants were asked their thoughts on Covid-19 or its effect on them. Now depression, stress or anxiety could be potentially due to multiple factors same with the reasons for disturbed quality of life or sleep. The authors should have added some questions in demographic which could help the participants and the readers to know that the findings here are actually due to Covid-19 and not due to any external factor.
Response:
We have used the following tools to measure all the three measure outcomes.

DASS-21 tool was used to measure the mental health.

PSQI was used to measure sleep quality.

MOS-36 was used to measure the health-related QoL.

We have mentioned the tools in the methodology section and also given references.

Query 5:
Fourth it would be nice if the authors can add limitations and recommendations heading before conclusion.
Response: We have included the limitations and recommendations as per your suggestions.
Competing Interests: No competing interests were disclosed. Close
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Reviewer Report 13 Nov 2020

Shyamal Koley, Department of Physiotherapy, Guru Nanak Dev University, Amritsar, India

Approved

https://doi.org/10.5256/f1000research.26834.r73792

The Abstract, Introduction, Methods, Results, & Discussion Portions of the article are written nicely. The only correction needed is in Acknowledgments where " The author would......" should be written as " The authors would......".
References portion are written as per the style of the journal and adequate and expressive.
The article is timely written and carries sufficient applicability.

Detailed Report:

COVID-19 is a serious global pandemic which affects physical, mental, social and societal aspects of individuals of all strata of the society. The present study attempted justly in this regard. It is a very recent complication, thus not much literature would be available. Considering the above fact, the literature cited in the article was justified. It was quite difficult to collect the samples in the time of Lockdown prevailed then nationwide. Still the work would be considered as technically sound. In such type of study, the controls are not necessarily required, pre- and post-conditions may work. The methods and analyses were sound with proper replicability. Though the sample size was small (n=100), statistical analyses (using Chi-square test, Student’s t-test and Man-Whitney U test) were appropriate. The conclusion drawn in the study was adequately supported by the results. Small sample size was one of the limitations of the study.

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

Yes
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

Competing Interests: No competing interests were disclosed.

Reviewer Expertise: Kinanthropometry, Biomechanics, Public Health & Lectinology.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

CITE

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Author Response 13 Nov 2020

Ramesh Patra, Department of Physiotherapy, Lovely Professional University, Jalandhar, 144001, India

13 Nov 2020

Author Response

Thank You so much for your Valuable response and comments.
Competing Interests: No competing interests were disclosed.
Thank You so much for your Valuable response and comments.
Thank You so much for your Valuable response and comments.
Competing Interests: No competing interests were disclosed. Close
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Author Response 13 Nov 2020

Ramesh Patra, Department of Physiotherapy, Lovely Professional University, Jalandhar, 144001, India

13 Nov 2020

Author Response

Thank You so much for your Valuable response and comments.
Competing Interests: No competing interests were disclosed.
Thank You so much for your Valuable response and comments.
Thank You so much for your Valuable response and comments.
Competing Interests: No competing interests were disclosed. Close
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Version 3

VERSION 3 PUBLISHED 17 Jul 2020

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	1	2	3	4
Version 3 (revision) 29 Jul 24			read	read
Version 2 (revision) 30 Jun 22			read
Version 1 17 Jul 20	read	read

Shyamal Koley, Guru Nanak Dev University, Amritsar, India
Kanwar Hamza Shuja, National Institute of Psychology (NIP), Quaid-I-Azam University (New Campus), Islamabad, Pakistan; Capital University of Science and Technology (CUST), Islamabad, Pakistan
Uzma Zaidi, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
Isabell Wagenhäuser, University Hospital Würzburg, Würzburg, Germany

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Reviewer Report

5 Views

30 Dec 2024 | for Version 3

Isabell Wagenhäuser, University Hospital Würzburg, Würzburg, Germany

5 Views Cite this report Responses(0)

Approved With Reservations

At the beginning of the COVID-19 pandemic in India, the work presented examines the psychological effects of the lockdown on people with chronic illnesses in a controlled study compared to healthy people.

- Since the lockdown conditions were very different from country to country, it would be good to better define what lockdown meant in India in the introduction.
- Please add a clear definition of the inclusion criteria in the methods.
- Table 1: Are groups A and B comparable? If there are differences, this must be interpreted and taken into account statistically. Please compare the items statistically and add p-values.
- The results of the study are extremely brief and incomplete.
- Even if the groups are relatively comparable, statistical consideration of the various factors must be added -> what factors influence the occurrence of sleep disorders, depression, etc. (regression analysis)?
- Please add to the LImitations that unbalanced gender ratio, only short period at the beginning of the pandemic. It is unclear what the situation will be in a second lockdown, e.g. in winter 2020/21, etc.
- Please also discuss whether there is also literature on whether COVID-19 vaccination or infection can cause depression / sleep disorders and whether the lockdown is worth it in terms of mental risk. (e.g. Wagenhäuser I, et al., 2024 [Ref 1] or Athanasiou N, et al., 2023 [Ref 2])

Is the work clearly and accurately presented and does it cite the current literature?

Partly
Is the study design appropriate and is the work technically sound?

Partly
Are sufficient details of methods and analysis provided to allow replication by others?

Partly
If applicable, is the statistical analysis and its interpretation appropriate?

Yes
Are all the source data underlying the results available to ensure full reproducibility?

Partly
Are the conclusions drawn adequately supported by the results?

Yes

References

1. Wagenhäuser I, Reusch J, Gabel A, Mees J, et al.: The relationship between mental health, sleep quality and the immunogenicity of COVID-19 vaccinations.J Sleep Res. 2024; 33 (3): e13929 PubMed Abstract | Publisher Full Text
2. Athanasiou N, Baou K, Papandreou E, Varsou G, et al.: Association of sleep duration and quality with immunological response after vaccination against severe acute respiratory syndrome coronavirus-2 infection.J Sleep Res. 2023; 32 (1): e13656 PubMed Abstract | Publisher Full Text

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Epidemiology, immunology and diagnostics of acute respiratory infections

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.

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Reviewer Report

6 Views

16 Aug 2024 | for Version 3

Uzma Zaidi, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia

6 Views Cite this report Responses(0)

Approved With Reservations

The authors conducted the study on the initial stage of COVID-19; therefore, the significance is undeniable. Moreover, the exploration of psychological or psychologically related factors of QoL and sleep, besides health conditions is a very valuable aspect. The result allows for the recommendation of more comprehensive policymaking for people who are suffering from multiple health conditions. The authors have improved the quality of the manuscript by responding aptly to the comments of reviewers. However, some improvement or explanation is still required for the methodology, statistical analysis, and results section.
Abstract:
The conclusion needs some improvement.
“Our findings indicate that individuals with chronic health ….. More research is required and also the government should plan on taking care of those patients.”
Suggestion: “Our findings indicate that individuals with chronic health issues exhibit higher mental health problems, lower quality of sleep, and have a lower health-related QoL during the COVID-19 pandemic. More research is required and also the government should plan policies for patients with multiple health conditions.”

Methods:
Outcome measure:
Please correct and update the description of the scoring method for MOS 36-item health-related survey. Therefore, the replication of the method will be authentic and easy.
“The 36 items reflect …….., where 100 is defined as perfect health less, and any score less than 100 is defined as poor health.”
Suggestion: I am sharing the description along with the citation.
The scoring is from 0-100. Higher scores indicate better health status, whereas a low score presents poor health. The mean score of 50 has been considered as a cutoff score for all scales.[1]

Statistical Analysis:
Suggestion: In Table 1 add a column presenting the calculation of Chi-square to present statistical difference.

Results:
Suggestion: As researchers, it is wise to report the results in a more precise manner. According to the standardized scoring categories of DASS, mean scores of anxiety and stress of group A fall at an extremely severe level, whereas depression scores are falling in the range of severe levels. The relevant categories of DASS can be discussed in the result description for group B. It will strengthen the study findings. As in the normal population mean score of depression and anxiety is falling within the mild level. For more details check scoring categories: https://www.healthfocuspsychology.com.au/tools/dass-21/
Discussion:
Suggestion: There is another very interesting result related to QoL that needs to be discussed. The highest mean score in group A is in the physical functioning (PF) domain. As all the participants were receiving physiotherapy that could be one of the reasons. Authors can address it better. The lowest mean in both of the groups can be seen in the Role of the limitation-physical health (RL-PH) domain.

References

1. Ware JE: SF-36 health survey update.Spine (Phila Pa 1976). 2000; 25 (24): 3130-9 PubMed Abstract | Publisher Full Text

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Clinical Psychology, Health Psychology, Personality Psychology, Mental Illness, Neuropsychology, Organizational Behavior

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Reviewer Report

31 Views

21 Apr 2023 | for Version 2

Uzma Zaidi, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia

31 Views Cite this report Responses(0)

Approved With Reservations

The authors conducted the study on the initial stage of COVID-19; therefore, the significance is undeniable. Moreover, the exploration of psychological or psychologically related factors of QoL and sleep, besides health conditions is a very valuable aspect. The result allows for the recommendation of more comprehensive policy making for people who are suffering from multiple health conditions. The authors have improved the quality of the manuscript by responding aptly to the comments of reviewers. However, some improvement or explanation is still required for the methodology, statistical analysis, and results section.

Abstract:
The conclusion needs some improvement.

“Our findings indicate that individuals with chronic health ….. More research is required and also the government should plan on taking care of those patients.”

Suggestion: “Our findings indicate that individuals with chronic health ...... More research is required and also the government should plan policies for patients with multiple health conditions.”

Methods:

Outcome measure:
Please correct and update the description of the scoring method for MOS 36-item health-related survey. Therefore, the replication of the method will be authentic and easy.

“The 36 items reflect …….., where 100 is defined as perfect health less, and any score less than 100 is defined as poor health.”

Suggestion: I am sharing the description along with the citation.
The scoring is from 0-100. Higher scores indicate better health status, whereas a low score presents poor health. The mean score of 50 has been considered as a cutoff score for all scales¹.

Statistical Analysis:

Suggestion: In Table 1 add a column presenting the calculation of Chi-square.

Add a source for socioeconomic slabs in the footnote of Table 1.

Authors are reporting that “Quantitative variables were evaluated using Student’s t-test, and quantitative variables without normal distribution were measured using the Mann-Whitney U test.” However, table 2 does not present the student t-test and Mann-Whitney U test explicitly.

Suggestion: Provide an SD column for both groups, remove the difference column, and add a column for 't' or 'U' before the P value.

Results:

Suggestion: As researchers, it is wise to report the results in a more precise manner. According to the standardized scoring categories of DASS, mean scores of anxiety and stress of group A fall at an extremely severe level, whereas depression scores are falling in the range of severity levels. The relevant categories of DASS can be discussed in the result description for group B. It will strengthen the study findings. As in the normal population mean score of depression and anxiety is falling within the mild level. For more details, check scoring categories.

Discussion:
Suggestion: There is another very interesting result related QoL that needs to be discussed. The highest mean score in group A is in the physical functioning (PF) domain. As all the participants were receiving physiotherapy that could be one of the reasons. Authors can address it better. The lowest mean in both of the groups can be seen in the Role of the limitation-physical health (RL-PH) domain.

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Partly
If applicable, is the statistical analysis and its interpretation appropriate?

Partly
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

References

1. Ware JE: SF-36 health survey update.Spine (Phila Pa 1976). 2000; 25 (24): 3130-9 PubMed Abstract | Publisher Full Text

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Clinical Psychology, Health Psychology, Personality Psychology, Mental Illness, Neuropsychology, Organizational Behavior

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Reviewer Report

44 Views

08 Apr 2021 | for Version 1

Kanwar Hamza Shuja, National Institute of Psychology (NIP), Quaid-I-Azam University (New Campus), Islamabad, Pakistan; Capital University of Science and Technology (CUST), Islamabad, Pakistan

44 Views Cite this report Responses(1)

Not Approved

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Partly
If applicable, is the statistical analysis and its interpretation appropriate?

Yes
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Public Health, Criminal Psychology, Clinical Psychology.

Respond to this report

Responses (1)

Author Response

07 Sep 2022

Ramesh Patra, Department of Physiotherapy, Lovely Professional University, Jalandhar, 144001, India

First, we would like to thank the honourable reviewers and editor for their constructive criticisms and suggestive comments, which were of great help in improving the quality and clarity of the current manuscript. We have read each reviewer’s comments carefully and, accordingly, made utmost efforts to address each comment point-by-point. We much appreciate the reviewer’s time, effort, and detailed explanations. We believe that the revised version of our manuscript is now more focused, scientific, understandable, and better arranged. All changes are highlighted with red color.

Reviewer Comment:

Query 1:
Firstly thank you for giving me the chance for reviewing the article. It's a well written article though there are places where some sentences needs to be rewritten and checked for grammar.
Response:
Thank you for your valuable comments. We have modified the text with proper grammar usage as per your suggestions.

Query 2:
However, my biggest concern with this article is regarding its sample size. My first question is how did authors come up with a sample size of 50? Did they selected it themselves or what was the reason behind it or did they used sampling size calculator. Because a sample of 50 is too low for concluding this study.
Response:
The total sample taken was 100. We have calculated the sample size using G power software 3.1 which was found to be around 51 (95% confidence interval, power of the study was 80% where the effect size was considered as 0.5). The sample size calculation has been added in the revised manuscript under the method section.

Query 3:
Secondly, again with the sample but this time inclusion criteria for the group B was not set by the authors. Having no inclusion criteria could lead to potentially adding participants who may also be medically ill, or were these participants inquired prior during recruitment if they are medically sound. And if they were asked that would have become their inclusion criteria. But unfortunately, I was unable to find any such thing in demographic information.
Response:
As suggested, we have included the inclusion criteria for Group B.

Query 4:
Third, the instruments used, are for measuring psychological variables in general. What I mean by this is that nowhere was I able to find anything where the participants were asked their thoughts on Covid-19 or its effect on them. Now depression, stress or anxiety could be potentially due to multiple factors same with the reasons for disturbed quality of life or sleep. The authors should have added some questions in demographic which could help the participants and the readers to know that the findings here are actually due to Covid-19 and not due to any external factor.
Response:
We have used the following tools to measure all the three measure outcomes.

DASS-21 tool was used to measure the mental health.
PSQI was used to measure sleep quality.
MOS-36 was used to measure the health-related QoL.

We have mentioned the tools in the methodology section and also given references.

Query 5:
Fourth it would be nice if the authors can add limitations and recommendations heading before conclusion.
Response: We have included the limitations and recommendations as per your suggestions.

View more View less

Competing Interests

No competing interests were disclosed.

Back to all reports

Reviewer Report

29 Views

13 Nov 2020 | for Version 1

Shyamal Koley, Department of Physiotherapy, Guru Nanak Dev University, Amritsar, India

29 Views Cite this report Responses(1)

Approved

Is the work clearly and accurately presented and does it cite the current literature?

Yes
Is the study design appropriate and is the work technically sound?

Yes
Are sufficient details of methods and analysis provided to allow replication by others?

Yes
If applicable, is the statistical analysis and its interpretation appropriate?

Yes
Are all the source data underlying the results available to ensure full reproducibility?

Yes
Are the conclusions drawn adequately supported by the results?

Yes

Competing Interests

No competing interests were disclosed.

Reviewer Expertise

Kinanthropometry, Biomechanics, Public Health & Lectinology.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard.

Respond to this report

Responses (1)

Alongside their report, reviewers assign a status to the article:

Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested

Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions

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[7] 7. LAW K: COLLEGE Approved by Bar Council of India and affiliated to Karnataka State Law University, Hubli. KLE Society.

[8] 8. Biddle SJ, Ciaccioni S, Thomas G, et al.: Physical activity and mental health in children and adolescents: An updated review of reviews and an analysis of causality. Psychol Sport Exerc. 2019; 42: 146–55. Publisher Full Text

[9] 9. Fox KR: The influence of physical activity on mental well-being. Public Health Nutr. 1999; 2(3a): 411–8. PubMed Abstract | Publisher Full Text

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[11] 11. Spira AP, Covinsky K, Rebok GW, et al.: Poor sleep quality and functional decline in older women. J Am Geriatr Soc. 2012; 60(6): 1092–8. PubMed Abstract | Publisher Full Text | Free Full Text

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[13] 13. Hita-Contreras F, Martínez-López E, Latorre-Román PA, et al.: Reliability and validity of the Spanish version of the Pittsburgh Sleep Quality Index (PSQI) in patients with fibromyalgia. Rheumatol Int. 2014; 34(7): 929–36. PubMed Abstract | Publisher Full Text

[14] 14. Schlenk EA, Erlen JA, Dunbar-Jacob J, et al.: Health-related quality of life in chronic disorders: a comparison across studies using the MOS SF-36. Qual Life Res. 1997; 7(1): 57–65. PubMed Abstract | Publisher Full Text

[15] 15. Sood S: Psychological effects of the Coronavirus disease-2019 pandemic. Research & Humanities in Medical Education. 2020; 7: 23–6. Reference Source

[16] 16. Kazmi SS, Hasan K, Talib S, et al.: COVID-19 and Lockdwon: A Study on the Impact on Mental Health. Available at SSRN 3577515. 2020. Publisher Full Text

[17] 17. Lazzerini M, Putoto G: COVID-19 in Italy: momentous decisions and many uncertainties. Lancet Glob Health. 2020; 8(5): e641–e642. PubMed Abstract | Publisher Full Text | Free Full Text

[18] 18. Brooks SK, Webster RK, Smith LE, et al.: The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020; 395(10227): 912–920. PubMed Abstract | Publisher Full Text | Free Full Text

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[20] 20. Patra RC, kanungo B, Bawa P: Mental Health, Sleep Quality and Quality of Life in Subjects with Multiple Health Conditions during Home Quarantine for COVID-19 Pandemic Attack: A Comparison with Healthy Subjects. figshare. Dataset. 2020. http://www.doi.org/10.6084/m9.figshare.12612833.v1

Mental health, sleep quality and quality of life in individuals with and without multiple health conditions during home quarantine in India due to the COVID-19 pandemic: a cross-sectional study

Abstract

Keywords

Introduction

Methods

Ethical considerations

Study design and setting

Participant recruitment

Outcome measures

Statistical analysis

Results

Table 1. Demographic characteristics of all patients.

Table 2. Comparison of outcome measures for Group A and Group B.

Discussion

Conclusion

Data availability

Underlying data

Acknowledgments

References

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