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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 13  |  Issue : 6  |  Page : 1686-1695  

Immediate psychological impact of dental students on COVID-19 epidemic in India – A cross sectional study


1 Department of Oral and Maxillofacial Surgery, Vinayaka Mission's Sankarachariar Dental College, Salem, Tamil Nadu, India
2 Department of Conservative Dentistry and Endodontics, Vinayaka Mission's Sankarachariar Dental College, Salem, Tamil Nadu, India

Date of Submission25-Dec-2020
Date of Decision06-Feb-2021
Date of Acceptance15-Feb-2021
Date of Web Publication10-Nov-2021

Correspondence Address:
Saravanan Kandasamy
Department of Oral and Maxillofacial Surgery, Vinayaka Mission's Sankarachariar Dental College, Salem, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpbs.jpbs_848_20

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   Abstract 


Introduction: The 2019 coronavirus disease (COVID-19) epidemic is a global health threat and is by far the largest outbreak of atypical pneumonia since after SARS over the past few decades. Within weeks of the initial outbreak the total number of cases and deaths exceeded those of SARS. Such mass Casualties often trigger waves of heightened fear and anxiety in many population. Aim: To assess the psychological impact and mental health status among the dental students studying in the Vinayaka Mission's Sankarachariyar Dental College, Salem, India. Materials and Method: A total of 21 psychological state questionnaires along with demographic aspects were distributed to 460 under graduate dental students from Vinayaka Mission's Sankarachariyar Dental College, Salem, Tamilnadu. The Psychological state was assessed using the Depression, Anxiety and Stress Scale (DASS). Results: 404 questionnaires were taken for our study as they responded all questions. The results were calculated based on the responses obtained year wise, gender, Place of residence, Living with family, Steady family income and Acquaintance affected with covid and compared among the three psychological assessments Depression, Anxiety and stress. The results of the study were done using SPSS (V21.0IBM, Chicago) Software. Conclusion: We attempted to correlate the socio demographic datas with psychological status of the dental students' in our university using the DAS scale. This study focused on the need for treating the psychological impact of the society at this outbreak as the mental health is the most important to deal with.

Keywords: Anxiety, COVID-19 studies, depression, psychological impact, questionnaire study, stress, students' health assessment, university students


How to cite this article:
Kandasamy S, John RR, Jayaraman A, Chinnakutti S, Chandrasekar M, Mallikarjunan D Y. Immediate psychological impact of dental students on COVID-19 epidemic in India – A cross sectional study. J Pharm Bioall Sci 2021;13, Suppl S2:1686-95

How to cite this URL:
Kandasamy S, John RR, Jayaraman A, Chinnakutti S, Chandrasekar M, Mallikarjunan D Y. Immediate psychological impact of dental students on COVID-19 epidemic in India – A cross sectional study. J Pharm Bioall Sci [serial online] 2021 [cited 2022 Aug 16];13, Suppl S2:1686-95. Available from: https://www.jpbsonline.org/text.asp?2021/13/6/1686/330148




   Introduction Top


The coronavirus disease (COVID-19) epidemic in India is a global health threat and is by far the largest outbreak of atypical pneumonia since after SARS over the past few decades. Within weeks of the initial outbreak, the total number of cases and deaths exceeded those of SARS. The outbreak was first revealed in late December 2019 when clusters of pneumonia cases of unknown etiology were found to be associated with epidemiologically linked exposure to a seafood market and untraced exposures in the city of Wuhan of Hubei Province.[1] Since then, the number of cases has continued to escalate exponentially within and beyond Wuhan, spreading to all 34 regions of China by 30 January 2020. On the same day, the World Health Organization declared the COVID-19 outbreak a public health emergency of international concern.

COVID-19, similar to SARS, is a beta-coronavirus that can be spread to humans through intermediate hosts such as bats, though the actual route of transmission is still debatable.[1] Human-to-human transmission has been observed via virus-laden respiratory droplets, as a growing number of patients reportedly did not have animal market exposure, and cases have also occurred in healthcare workers.[2] Transmissibility of COVID-19 as indicated by its reproductive number has been estimated at 4.08, suggesting that on average, every case of COVID-19 will create up to 4 new cases.[2] The reporting rate after January 17, 2020, has been considered to have increased 21-fold in comparison to the situation in the first half of January 2020.

As of now April 30, 2020, this novel coronavirus (COVID-19) quickly spread over across the globe, infecting >3,220,346 people in 210 countries and killing 228,236 individuals.[2] Changes in daily lifestyle have been swift and unprecedented, as cases of the virus surge, the death toll escalates, even after several measures to contain the spread of the disease increase across regions of the globe.

These mass tragedies, particularly ones that involve infectious diseases, often trigger waves of heightened fear and anxiety that are known to cause massive disruptions to the behavior and psychological well-being of many in the population. Because of the sudden nature of the outbreak and the infectious power of the virus, it will inevitably cause people anxiety, depression, and other stress reactions. Although there has been substantial attention to identify people with the coronavirus infection, identifying the mental health care needs of people impacted by this pandemic have been relatively neglected. It is necessary to understand and investigate the public psychological states during this tumultuous time.

Therefore, this present study attempted to assess the psychological impact and mental health status among dental students in Salem.

Aim

To assess the psychological impact and mental health status among the dental students studying in the Vinayaka Mission's Sankarachariyar Dental College, Salem, India.


   Materials and Methods Top


A total of 21 psychological state questionnaires along with demographic aspects were distributed to 460 undergraduate dental students from Vinayaka Mission's Sankarachariyar Dental College, Salem, Tamil Nadu. This cross-sectional survey design was presented before Institutional Ethical Committee and Review Board and got approved. The questionnaires were circulated through online Google Form from May 1–4, 2020. Inclusion criteria include the following: (1) 18 years old and above of undergraduate dental students of years I, II, III, IV and Compulsory Residential Internship (CRIs) (2) Willing to participate in the study. (3) Completed questionnaire. Exclusion criteria include the following: (1) In completed questionnaires.

Socio demographics datas

Information about subjects' age, sex, educational level, place of residence, living with family or alone, steady family income, whether acquaintance affected by covid or not were also obtained in the survey.


   Methods Top


The psychological state was assessed using the Depression, Anxiety and Stress Scale. As per this Scale, specific 7 set of questions were used to assess (QnNo.s: 3, 5, 10, 13, 16, 17, 21) depression, (QnNo.s: 2, 4, 7, 9, 15.19, 20) anxiety and (QnNo.s: 1, 6, 8, 11, 12, 14, 18) stress. The depression score obtained was multiplied by two and the final score was disseminated into 5 subscales such as normal with range 0–9, mild depression with range 10–12, moderate depression with range 13–20, severe depression with range 21–27, and extremely severe depression if the range between 28 and 42. The total anxiety subscale score was divided into normal (0–6), mild anxiety (7–9), moderate anxiety (10–14), severe anxiety (15–19), and extremely severe anxiety (20–42). Questions 1, 6, 8, 11, 12, 14, and 18 formed the stress subscale. The total stress subscale score was divided into normal (0–10), mild stress (11–18), moderate stress (19–26), severe stress (27–34), and extremely severe stress (35–42).


   Results Top


404 questionnaires were taken for our study as they responded to all questions. The results were calculated based on the responses obtained year-wise, gender, place of residence, living with family, steady family income, and acquaintance affected with covid and compared among the three psychological assessments depression, anxiety, and stress. The results of the study were done using SPSS (V21.0, IBM, Chicago, US) Software. The results [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11], [Table 12], [Table 13], [Table 14], [Table 15], [Table 16], [Table 17], [Table 18] were computed using Chi-square test.
Table 1: Year of BDS course Depression*

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Table 2: Year of BDS course anxiety*

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Table 3: Year of BDS course stress*

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Table 4: Gender depression*

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Table 5: Gender anxiety*

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Table 6: Gender stress*

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Table 7: Place of residence depression*

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Table 8: Place of residence anxiety*

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Table 9: Place of residence stress*

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Table 10: Steady family income depression*

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Table 11: Steady family income anxiety*

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Table 12: Steady family income stress*

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Table 13: Living with family depression*

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Table 14: Living with family anxiety*

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Table 15: Living with family stress*

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Table 16: Family or acquaintance infected with coronavirus disease 2019 depression*

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Table 17: Family or acquaintance infected with coronavirus disease 2019 anxiety*

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Table 18: Family or acquaintance infected with coronavirus disease 2019 stress*

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Year wise responses

Depression

Among 1st year dental students, the total responses received were 120 (29.7%) on which normal were 101 (25%), mild 4 (1%), moderate 8 (2%), severe 4 (1%), extremely severe 3 (0.7%). Among the 2nd year dental students of 102 (25.2%) responses, the depression levels were normal 91 (22.5%), mild 5 (1.2%), moderate 5 (1.2%), severe 0 (0.0%), extremely severe 1 (0.2%). Among the 3rd year dental students of 70 (17.3%) responses, the depression level were normal 51 (12.6%), mild 5 (1.2%), moderate 8 (2%), severe 3 (0.7%), extremely severe 3 (0.7%). Of 33 (8.2%) responses received from final year students, the depression level showed normal 24 (5.9%), mild 0 (0.0%), moderate 4 (1%), severe 2 (0.5%), extremely severe 3 (0.7%). Of 79 (19.6%) responses received from CRIs, the depression level showed normal 56 (5.9%), mild 9 (2.2%), moderate 11 (2.7%), severe 0 (0.0%), and extremely severe (0.7%). The total number of students who had level of depression as normal were 323 (80%), mild 23 (5.7%), moderate 36 (8.9%), severe 9 (2.2%), extremely severe 13 (3.2%) out of 404 (100%) responses.

Anxiety

Among 1st year dental students, the total responses received were 120 (29.7%) on the anxiety status which were normal 99 (24.9%), mild 5 (1.2%), moderate 7 (1.7%), severe 2 (0.5%), extremely severe 7 (1.7%). Among the 2nd year dental students of 89 (22%) responses, the anxiety level were normal 89 (22%), mild 4 (1.0%), moderate 8 (2.0%), severe 1 (0.2%), extremely severe 0 (0.0%). Among the 3rd year dental students of 70 (17.3%) responses, the anxiety level were normal 54 (13.4%), mild 4 (1.0%), moderate 8 (2%), severe 1 (0.2%), extremely severe 0 (0.0%). Of 33 (8.2%) responses received from final years, the anxiety level showed normal 25 (6.2%), mild 1 (0.2%), moderate 4 (1%), severe 2 (0.5%), extremely severe 1 (0.2%). Of 79 (19.6%) responses received from CRIs, the level showed normal 53 (13.9%), mild 5 (1.2%), moderate 15 (3.7%), severe 1 (0.2%), extremely severe 5 (1.2%).

Stress

Among 1st year dental students, the total responses received were 120 (29.7%) on the stress status which were normal 107 (26.5%), mild 3 (0.7%), moderate 7 (1.7%), severe 3 (0.3%), extremely severe 0 (0.0%). Among the 2nd year dental students of 101 (25%) responses, the stress level were normal 89 (22%), mild 0 (0.0%), moderate 1 (0.2%), severe 0 (0.0%), extremely severe 0 (0.0%). Among the 3rd year dental students of 70 (17.3%) responses, the stress level were normal 60 (14.9%), mild 4 (1.0%), moderate 4 (1.0%), severe 1 (0.2%), extremely severe 1 (0.2%). Of 33 (8.2%) responses received from final year graduates, the stress level showed normal 27 (6.7%), mild 3 (0.7%), moderate 1 (0.2%), severe 2 (0.5%), extremely severe 0 (0.0%). Of 79 (19.6%) responses received from CRIs, the level showed normal 71 (17.6%), mild 2 (0.5%), moderate 3 (0.7%), severe 2 (0.5%), extremely severe 1 (0.2%).

Among the year-wise students, we obtained statistically significant results in depression (P-value 0.017).

Gender

Depression

The gender responses for depression were 111 (27.5%) on male students of which normal 82 (20.3%), mild 6 (1.5%), moderate 18 (4.5%), severe 1 (0.2%), extremely severe 4 (1.0%). Among the female dental students of 293 (72.5%) responses, the depression level were normal 241 (59.7%), mild 17 (4.2%), moderate 18 (4.5%), severe 8 (2.0%), and extremely severe 9 (2.2%).

Gender-wise results showed statistical significance on depression (P value 0.025).

Anxiety and Stress does not show significant results in the gender category.

Place of residence

Depression, anxiety, and stress does not show significant results in this category.

Steady family income

In this category on correlating with depression, 66 students (16.3%) responded negative showing statistically significant results (P-value 0.056).

Stress

Of the 404 responses, 62 (15.3%) students replied negatively giving near significant results (P-value 0.063).

Living with family

Anxiety

396 (98%) dental students showed significant results (P value 0.000).

Family or acquaintance infected with COVID-19

Depression, anxiety, and stress does not show the significant result in this category.


   Discussion Top


Human race face crisis and disaster at several times in history. COVID-19 outbreak is the present threat to humankind. As the disease progressed, the health, economy, and livelihood became major concern. During this pandemic, the general population undergo several psychological reactions like confusions, panic, hysteria, frustration and boredom, loneliness, and uncertainty because of uncontrolled fears related to this infection that finally lead to psychological problems like depression, anxiety, and stress. Several studies[3],[4],[5],[6] were done on assessing the psychological status of the general population and students' community. We correlated the socio-demographic status of the students with depression, anxiety, and stress. Out of 404 responses collected from the questionnaires, most students responded to normal levels of depression, anxiety, and stress on this occasion. But depression prevailed on the internship students from mild to extremely severe on comparing between the remaining years studied. A significant number of females were affected with depression ranging from mild to extremely severe in the gender group. This attributed that they succumbed easily to such disasters. A large number of students felt depressed even they had steady family income compared to those who did not had. The COVID-19 pandemic affected different points in the distribution of income. The fixed income would be sufficient to spend only for the planned expenses. Most families wouldn't have sufficient buffer to whither this disaster. That's why the students who had lived with their family felt more anxious. The standstill nature of the present situation raised several questions in the family and students' mindset about their future career. This study gave the cross-sectional data of assessing the psychological health along with socio-economic aspects on the dental students and their family status. However, the longitudinal one would give the long-term psychological impact of the COVID-19 disease. The other limitation of this study would be the questionnaire type-attempted through online (Google Form) could be biased as under-evaluated/exaggerated. Multicenter studies across countries would be more beneficial rather than single-center study.


   Conclusion Top


We attempted to correlate the socio-demographic data with the psychological status of the dental students in our university using the DAS scale. This study focused on the need for treating the psychological impact of the society at this outbreak as mental health is the most important to deal with. Further studies to be conducted by overcoming our limitations to promote mental health by addressing all age groups is necessary, especially on fighting against such pandemic spread of diseases.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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Wang Y, Di Y, Ye J, Wei W. Study on the public psychological states and its related factors during the outbreak of coronavirus disease 2019 (COVID-19) in some regions of China. Psychol Health Med 2021;26:13-22.  Back to cited text no. 1
    
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Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/media-resources/news. [Last assessed on 2020 Nov 30].  Back to cited text no. 2
    
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Lee SA. Coronavirus anxiety scale: A brief mental health screener for COVID-19 related anxiety. Death Stud 2020;44:393-401. [doi: 10.1080/07481187.2020.1748481].  Back to cited text no. 3
    
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Serafini G, Parmigiani B, Amerio A, Aguglia A, Sher L, Amore M. The psychological impact of Covid-19 on the mental health in the general population. QJM Int J Med 2020;113:529-35.  Back to cited text no. 4
    
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Varshney M, Parel JT, Raizada N, Sarin SK. Initial psychological impact of COVID-19 and its correlates in Indian Community: An online (FEEL-COVID) survey. PLoS One 2020;15:e0233874.  Back to cited text no. 5
    
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Odriozola-González P, Planchuelo-Gómez Á, Irurtia MJ, de Luis-García R. Psychological effects of the COVID-19 outbreak and lockdown among students and workers of a Spanish university. Psychiatry Res 2020;290:113108.  Back to cited text no. 6
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11], [Table 12], [Table 13], [Table 14], [Table 15], [Table 16], [Table 17], [Table 18]



 

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