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ORIGINAL ARTICLE
Year : 2021  |  Volume : 10  |  Issue : 4  |  Page : 233-237

A study on anxiety, obsession, and reassurance-seeking behavior due to COVID-19 pandemic


Department of Community Medicine, Katuri Medical College and Hospital, Chinakondrupadu, Guntur, Andhra Pradesh, India

Date of Submission27-Mar-2021
Date of Decision23-Nov-2021
Date of Acceptance30-Apr-2021
Date of Web Publication22-Mar-2022

Correspondence Address:
Dr. Sai SreeValli Sreepada
Department of Community Medicine, Katuri Medical College and Hospital, Chinakondrupadu, Guntur - 522 019, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jdrntruhs.jdrntruhs_38_21

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  Abstract 


Background: Coronavirus disease-2019 (COVID-19) has a devastating impact on public health and requires extensive preventive and precautionary measures to contain its spread. These measures result in dramatic lifestyle changes which might lead to disturbed mental health outcomes among individuals.
Aims and Objective: The aims of this study were to (1) assess anxiety, obsession, and reassurance-seeking behavior due to COVID-19 pandemic, and (2) to compare these outcomes among health-care professionals and the general population.
Settings and Design: This was an online community based cross sectional study done in the month of November, 2020.
Subjects and Methods: The study was conducted in November 2020 among 527 individuals selected randomly. A self-designed, semi-structured questionnaire consisting of 25 questions about demographic details, anxiety, obsession, and reassurance-seeking behavior was applied using Google forms.
Statistical Analysis Used: SPSS version 25.0 (IBM).
Results: Of 527 individuals, 246 (46.7%) were men and 281 (53.3%) were women. Health-care professionals and general population comprised 255 (48.4%) and 272 (51.6%) individuals respectively. Anxiety was found among 14 (2.65%) individuals, obsession in 97 (18%) and reassurance-seeking behavior in 51 (9.67%) individuals. Obsession and reassurance-seeking behavior was found to be significantly higher (p < 0.05) among general population than in health-care professionals. Reassurance-seeking behavior was found to be significantly higher in COVID-19 positive patients. (p < 0.05).
Conclusions: Anxious and obsessive thinking about health during the COVID-19 pandemic stimulating reassurance-seeking behavior was more among the general population in comparison to health-care professionals. This indicates the need for proper health education, guidance, and training regarding the preventive measures and precautions to be taken in order to avoid adverse mental health outcomes.

Keywords: Anxiety, COVID-19, obsession, reassurance-seeking behavior


How to cite this article:
Sreepada SS, Dulipala P, Dara JR. A study on anxiety, obsession, and reassurance-seeking behavior due to COVID-19 pandemic. J NTR Univ Health Sci 2021;10:233-7

How to cite this URL:
Sreepada SS, Dulipala P, Dara JR. A study on anxiety, obsession, and reassurance-seeking behavior due to COVID-19 pandemic. J NTR Univ Health Sci [serial online] 2021 [cited 2022 May 28];10:233-7. Available from: https://www.jdrntruhs.org/text.asp?2021/10/4/233/339820




  Introduction Top


Coronavirus disease-2019 (COVID-19) has not only seized the body, but it has also imprisoned the mind. This fast-spreading infectious disease has caught widespread awareness, causing emotional states such as anxiety and distress, which according to World Health Organization (WHO) are natural psychological responses to the randomly changing state.[1] Adverse psychological consequences among diverse categories of people are expected to increase significantly not only owing to the pandemic alone but also due to the relentless flow of readily available information on the internet, digital media, and other sources. The health outcomes are innumerable and include not just the physical disabilities but also certain emotional difficulties such as anxiety, fear of contracting the virus, spreading it to the loved ones, depression, frustration, lack of reliable information, obsessions to prevent the infection, stigma, and reassurance-seeking behavior from family or friends among many others.[2] In addition, intense fear and stress may arise in individuals experiencing symptoms of other health problems (flu and cold) that are similar to COVID-19 symptoms, and this condition may worsen psychological symptoms.[3] Studies post-SARS pandemic and post-Ebola epidemic indicate that even after recovering physically from the disease, individuals suffered from social and psychological problems and similar could be the impact with this pandemic too.[4],[5] Therefore, assessment of the unprecedented mental health outcomes due to COVID-19 pandemic has become the need of the hour.


  Background Top


This study was conducted to assess anxiety, obsession, and reassurance-seeking behavior among individuals and compare the outcomes among health-care professionals and general population.


  Subjects And Methods Top


Study design

This study is a community-based cross-sectional study and was conducted in November 2020. Informed consent was provided by all survey participants prior to their enrolment. Participants were allowed to terminate the survey at any time they desired. The survey was anonymous, and confidentiality of information was assured. Institutional ethical clearance was obtained on October 15th, 2020 for this study.

Study tool

A self-designed, semi-structured questionnaire consisting of details about demography, anxiety, obsession, and reassurance-seeking behavior was used. The data were collected through Google Forms by sharing the link, electronically. Five items were assessed for anxiety symptoms, four for obsession, and five for reassurance-seeking behavior over the past 2 weeks.

The following three validated scales were used in the questionnaire:

Coronavirus anxiety scale (CAS)

It is a brief self-reported mental health screener to identify probable cases of dysfunctional anxiety associated with the COVID-19 crisis with 90% sensitivity and 85% specificity. It consisted of five questions regarding feelings of dizziness, numbness, nausea, inability to sleep, loss of interest in eating while exposed to information about the coronavirus.[6]

Obsessions with COVID-19 scale (OCS)

It is a self-reported mental health screener of persistent and disturbed thinking about COVID-19 with 81%–93% sensitivity and 73%–76% specificity. It consisted of four questions regarding disturbing thoughts about contracting the virus, about people who they met had the infection, inability to stop thinking about the virus, and dreaming about the virus.[7]

Coronavirus reassurance-seeking behavior scale (CRBS)

Participants indicated how frequently they were engaged in reassurance-seeking behaviors for example, I have taken my temperature to see if I was infected with the coronavirus disease.[8]

All the questions were rated on a 5-point Likert scale ranging from 0 (not at all) to 4 (nearly every day). The total score of Coronavirus Anxiety Scale (CAS) ranged from 0 to 25, the Obsession with Covid-19 scale (OBS) ranged from 0 to 20, and Coronavirus reassurance-seeking behavior scale (CRBS) from 0 to 25 [Figure 1].
Figure 1: Scheme of scoring the study population on various scales (CAS, OBS and CRBS)

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Study population

A total of 527 individuals participated in the study and included people aged 18 years and above. Health-care professionals included medical undergraduate and postgraduate students, medical practitioners, pharmacists, lab technicians, and nurses from various health organizations working in a designated COVID-19 care facility. General population included IT professionals, teachers, college students, housewives, and retired individuals.

Statistical analysis

Data were analyzed by using Statistical Package for the Social Sciences (SPSS) software program, version 25.0 (IBM). Descriptive statistics are expressed as frequencies and percentages. Chi-square test was used to find out the significance. Statistical analysis was performed at 95% confidence intervals with P value <0.05 as statistically significant. The demographic characteristics of participants are tabulated. The scores of anxiety, obsession, and reassurance-seeking behavior scales are presented as numbers and percentages.


  Results Top


[Table 1] shows the demographic details of our respondents. A total score of ≥9 on Coronavirus Anxiety Score (CAS) indicated “probable dysfunctional coronavirus related anxiety” and was seen in 14 individuals (2.65%) of the total population. A total score of ≥7 in the Obsession with COVID-19 Scale (OCS) was considered “probable dysfunctional thinking about COVID-19.” This was seen in 97 (18%) individuals. A total score of ≥12 on Coronavirus Reassurance-seeking behavior scale (CRBS) was considered “above average reassurance-seeking activity” and was found in 51 (9.67%) respondents [Figure 2]. Obsession and reassurance-seeking behavior was found to be significantly higher (P < 0.05) among general population than in health-care professionals. Reassurance-seeking behavior was found to be significantly higher in COVID-19 positive patients (P < 0.05) [Table 2]. [Figure 3] shows a comparison of anxiety, obsession, and reassurance-seeking behavior among health-care professionals and general population. Of the total health-care professionals (n = 255), 1.96% had anxiety, 13.72% had an obsession and 5.88% had reassurance-seeking behavior. Of the total general population (n = 272), 3.31% had anxiety, 22.79% had obsession, and 13.23% had reassurance-seeking behavior [Figure 2].
Table 1: Demographic characters of study population (n=527)

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Figure 2: Percentage of total population (n=527) having Anxiety, Obsession and Reassurance seeking behaviour according to the total scores

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Table 2: Comparison of CBRS among COVID-19 positive and negative individuals

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Figure 3: Comparison of Anxiety, Obsession and Reassurance seeking behaviour among health care professionals (n=255) and general population (n = 272)

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  Discussion Top


Several studies have assessed mental health issues during epidemics focusing mainly on health workers, patients, children, and general population.[9],[10] But not many studies have compared the outcomes among health-care professionals, and general population to the best of our knowledge. Anxiety and fear-related disorders are characterized by excessive fear and anxiety and related behavioral disturbances, with symptoms that are severe enough to result in significant distress or significant impairment in personal, family, social, educational, occupational, or other important areas of functioning.[11] Obsessive-compulsive and related disorders are a group of disorders characterized by repetitive thoughts and behaviors that are believed to share similarities in etiology and key diagnostic validators.[12] Obsessions and reassurance-seeking are thought to be coping methods for temporary relief of anxiety due to any impending threat.[13] But this temporary reduction in anxiety is typically followed by a paradoxical increase in anxiety and a desire to seek additional reassurance, leading to increased frequency of reassurance-seeking over time.[14] In our study, anxiety due to COVID-19 was found among 2.65% of our total respondents, obsession in 18.4%, and reassurance-seeking in 9.67%. As this pandemic is novel to this era, its rapid transmission, high morbidity rate, and concerns about the future might be the cause for high anxiety rates similar to the report of a study by Banerjee et al.[13] A study in Hong Kong by Liao et al.[14] during the H1N1 epidemic showed that anxiety reached the highest point at the peak of the epidemic and decreased with its decline. India is already past its COVID-19 pandemic peak[15]––hence, relatively lesser anxiety was observed among our study population. In spite of this, obsession and reassurance-seeking behavior were found to be significantly high (P < 0.05) which possibly explains that over time, coping mechanisms to prevent COVID-19 infection have become more prevalent among public. So, latest and most accurate information, such as the number of people who have recovered and the progress of medications and vaccines, might reduce anxiety levels to a greater extent.[3] These measures might also be helpful in achieving a sense of public security and potential psychological benefits. The major psychological crisis intervention that can be made by the health sector is to adequately educate the general public regarding the thin line between taking preventive measures appropriately and being excessively obsessed due to the anxiety during the pandemic to avoid adverse mental health outcomes.


  Conclusions Top


Anxious and obsessive thinking about health during the COVID-19 pandemic stimulating reassurance-seeking behavior was more among general population in comparison to health-care professionals. This indicates the need for proper health education, guidance, and training regarding the preventive measures and precautions to be taken in order to avoid adverse mental health outcomes.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
WHO W. Mental health and psychological resilience during the COVID-19 pandemic. World Health Organ [Internet]. 2020 Mar 27. Available from: https://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/news/news/2020/3/mental-health-and-psychological-resilience-during-the-covid-19-pandemic. [Last accessed on 2020 Dec 13].  Back to cited text no. 1
    
2.
Park S-C, Park YC. Mental health care measures in response to the 2019 novel coronavirus outbreak in Korea. Psychiatry Investig 2020;17:85-6.  Back to cited text no. 2
    
3.
Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al. Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. Int J Environ Res Public Health 2020;17:1729.  Back to cited text no. 3
    
4.
Reynolds DL, Garay JR, Deamond SL, Moran MK, Gold W, Styra R. Understanding, compliance and psychological impact of the SARS quarantine experience. Epidemiol Infect 2008;136:997-1007.  Back to cited text no. 4
    
5.
Peng EY-C, Lee M-B, Tsai S-T, Yang C-C, Morisky DE, Tsai L-T, et al. Population-based post-crisis psychological distress: An example from the SARS outbreak in Taiwan. J Formos Med Assoc 2010;109:524-32.  Back to cited text no. 5
    
6.
Lee SA. Coronavirus anxiety scale: A brief mental health screener for COVID-19 related anxiety. Death Stud 2020;44:393-401.  Back to cited text no. 6
    
7.
Lee SA. How much “Thinking” about COVID-19 is clinically dysfunctional? Brain Behav Immun 2020;87:97-8.  Back to cited text no. 7
    
8.
Lee SA, Jobe MC, Mathis AA, Gibbons JA. Incremental validity of coronaphobia: Coronavirus anxiety explains depression, generalized anxiety, and death anxiety. J Anxiety Disord 2020;74:102268.  Back to cited text no. 8
    
9.
Lee AM, Wong JG, McAlonan GM, Cheung V, Cheung C, Sham PC, et al. Stress and psychological distress among SARS survivors 1 year after the outbreak. Can J Psychiatry 2007;52:233-40.  Back to cited text no. 9
    
10.
Chua SE, Cheung V, Cheung C, McAlonan GM, Wong JW, Cheung EP, et al. Psychological effects of the SARS outbreak in Hong Kong on high-risk health care workers. Can J Psychiatry 2004;49:391-3.  Back to cited text no. 10
    
11.
ICD-11-Mortality and Morbidity Statistics. In: ICD-11 Browser contains the ICD-11 (International Classification of Diseases 11th Revision) [Internet]. 11th ed. 2020. Available from: http://id.who.int/icd/entity/1336943699. [Last accessed on 2020 Dec 13].  Back to cited text no. 11
    
12.
Abramowitz JS, Schwartz SA, Whiteside SP. A contemporary conceptual model of hypochondriasis. Mayo Clin Proc 2002;77:1323-30.  Back to cited text no. 12
    
13.
Banerjee D. The COVID-19 outbreak: Crucial role the psychiatrists can play. Asian J Psychiatry 2020;50:102014.  Back to cited text no. 13
    
14.
Liao Q, Cowling BJ, Lam WW, Ng DM, Fielding R. Anxiety, worry and cognitive risk estimate in relation to protective behaviours during the 2009 influenza A/H1N1 pandemic in Hong Kong: Ten cross-sectional surveys. BMC Infect Dis 2014;14:169.  Back to cited text no. 14
    
15.
Chitravanshi R. India past the COVID peak, pandemic could run its course by Feb: Govt panel. 2020 Oct 18. Available from: https://www.business-standard.com/article/current-affairs/india-past-the-covid-peak-pandemic-could-run-its-course-by-feb-govt-panel-120101800407_1.html. [Last accessed on 2020 Dec 14].  Back to cited text no. 15
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2]



 

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Abstract
Introduction
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