[version 1; peer review: 1 approved, 1 not approved]
No competing interests were disclosed.
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
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)
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.
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.
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).
There were no inclusion criteria for Group B.
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.
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
| 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 (%) | ||
|
|
70 | 50 |
|
|
30 | 50 |
| Body mass index (kg/m2, mean) | 24.15 | 23.51 |
| Smoking history (%) | ||
|
|
82 | 75 |
|
|
18 | 25 |
| Marital status (%) | ||
|
|
90 | 85 |
|
|
10 | 15 |
| Education history (%) | ||
| School level | 20 | 10 |
|
|
60 | 40 |
|
|
20 | 50 |
| Socioeconomic status | ||
|
|
0 | 0 |
|
|
60 | 50 |
|
|
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.
| Outcome measures | Group A (mean) | Group B (mean) |
|
|
|
|---|---|---|---|---|---|
| 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.
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
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
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
The WHO has recommended that individuals with physical and mental disabilities need to take extra care during isolation/quarantine for COVID-19
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,
This project contains the following underlying data:
Group A data Group B data
Data are available under the terms of the
The author would like to express heartfelt thanks to all the participants who were participated in this study.
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
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
Is the study design appropriate and is the work technically sound?
Yes
Are the conclusions drawn adequately supported by the results?
Yes
Are sufficient details of methods and analysis provided to allow replication by others?
Partly
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.
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.
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.
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
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
Is the study design appropriate and is the work technically sound?
Yes
Are the conclusions drawn adequately supported by the results?
Yes
Are sufficient details of methods and analysis provided to allow replication by others?
Yes
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.
Thank You so much for your Valuable response and comments.