Change In Risk Perception and Behavior of the People of India during the COVID-19 Pandemic

Background: On 25th March 2020 the COVID-19 pandemic had affected more than 600 individuals across India and a nationwide lockdown was imposed. Although the number of active cases kept on increasing the government had to keep relaxing the lockdown as the months passed expecting people to continue practicing the COVID-19 mitigating behaviours. Various dynamic factors like risk perception are shown to determine the degree to which people practice the mitigating behaviours. We aimed to study the degree to which the practice of COVID-19 related mitigating behaviours has changed amongst people of India over a period of 5 months from lockdown to Unlock and the factors associated with it. The aim of the study was to study and compare the change in behaviour among different groups of people towards the COVID-19 pandemic from the period of the lockdown 1.0 (25th March 2020 to 31st May 2020) to 1st September 2020 onwards in terms of precautions adopted by them. Methodology: The nature of this study is cross-sectional, and it is an online-based survey. We conducted a cross-sectional observational study using an anonymous online questionnaire (which was divided into 3 sections) about demography, change in adoption of protective measures against the COVID-19 infection, change in avoidant behaviour towards the potential sources of infection, change in their perception of risk of the infection, and the probable reasons for this change. In all question participants were asked to choose the answer that best reflects the change in their behaviour that might have occurred from the time of strict nationwide lockdown (25th March – 31st May 2020) to Unlock 4.0 (1st September 2020 onwards). The data was entered and tabulated using EXCEL 2020 and was analysed using SPSS Version 22.0. Comparisons were done using Chi-Square test. Results of analysis have been expressed as percentages. Results: The total number of participants in our survey after applying the inclusion and exclusion criteria was 1030. Subjects demonstrated decreased practice of most COVID-19 mitigating behaviours as the pandemic progressed with the exception of use of sanitises and wearing of masks. The mitigating behaviour which decreased the most was social distancing as almost two third participants went out for non-essential activities more than before. Risk perception of the illness seems to be the most important predictor of health- related protective behaviour. Perceived susceptibility of self and loved ones was not associated with change of behaviours, however, decrease in perceived severity of illness for themselves and family members is associated with significant decrease in practicing COVID-19 behaviours. Conclusion: Our results have implications on our understanding of how mitigating behaviours and risk perception can target public education and health policies.

A comparative study of Quality of Life and factors affecting it in children diagnosed with Attention – deficit/ hyperactivity disorder versus Bronchial asthma

Background and Objectives: Attention deficit hyperactivity disorder (ADHD) is a common childhooddisorder which impairs multiple domains of life. The aim is to study and compare the impact of ADHD andAsthma on Quality of Life (QoL) as measured by child and parent ratings and explore the relationshipbetween QoL and socio – demographic factors, illness variables, severity of symptoms and parenting styles.Methods: Study conducted was of cross sectional design at the outpatient services of a tertiary care hospital.60 children of 8 - 18 years, on treatment (and their parent) were recruited - 30 with ADHD and 30 withAsthma. PedsQL version 4.0 child and parent proxy report was used for QoL, ADHD – RS (ADHD RatingScale) and GINA (Global Initiative for Asthma) guidelines for severity and Parenting PracticesQuestionnaire for parenting stylesResults: Parent and child ratings of QoL in both groups were similar. QoL of Asthma group was worse inPhysical domain, while psychosocial domains and overall QoL were worse in ADHD group. Increasedduration and severity of illness showed reduction in QoL, while treatment showed better QoL in ADHDgroup only. Parenting style had significant impact on QoL in the ADHD group alone.Conclusion: ADHD is a childhood disorder with disability comparable to a physical illness like Asthma.QoL of the child can be significantly improved by treatment and focus on parenting styles.

Psychological consequences in pediatric intensive care unit survivors: the neglected outcome.

OBJECTIVES: To determine whether Pediatric Intensive Care Unit (PICU) hospitalization results in adverse psychological effects and to identify the contributory factors. SETTING: Level III PICU of a tertiary center. DESIGN: Prospective cohort study. METHODS: Consecutive patients 5 years or older admitted to PICU for at least 48 hours constituted the study population. Controls were age and sex matched children hospitalized in the pediatric wards for at least 48 hours. Severity of illness was assessed by the Pediatric Risk of Mortality (PRISM) score. Level of therapeutic intervention was determined by the Therapeutic Interventions Scoring System (TISS--76 score). Temperament Measurement Schedule was used to assess the premorbid temperament. Psychological assessment was performed using Impact of Event Scale (IES), Birleson Depression Scale and the Self-Esteem Scale. Follow-up evaluation was done one month after discharge. RESULTS: There were 30 children each in the study and control groups. They had comparable pre-morbid temperament as well as scores on the self-esteem and depression scales. Significantly higher proportion of patients in PICU had intrusive thoughts (43%) as compared to controls (6.7%). Development of intrusive thoughts correlated significantly with the degree of intervention. Demographic parameters, nature of the disease, duration of hospitalization and severity of illness did not correlate with the psychological outcome. One month after discharge, scores in both groups were comparable. CONCLUSIONS: Children subjected to therapeutic interventions in the PICU develop transient psychological impairment manifested by experiencing intrusive thoughts that resolve within a month.

Psychopathology and coping in parents of chronically ill children.

OBJECTIVE: To evaluate psychopathology and coping mechanisms in parents of children with a chronic illness. METHODS: 30 parents whose children had Thalassaemia were randomly selected from the Thalassaemia Day Care Centre of a teaching general hospital. The parents were interviewed on a semi structured proforma and also rated on SCL-90-R and Mechanisms of Coping scales. The data was analyzed using Pearson's correlation coefficient. RESULTS: The parents were seen to have high psychopathology on SCL-90-R. Depression was the subscale with the maximum elevation. Somatisation was also significantly elevated The GSI (General Symptomatic Index), a measure of general distress was extremely high in about 86.66% of the parents. Most parents were fatalistic in their approach towards the illness. Fatalism positively correlated with somatisation and depression. Avoidant coping strategies were associated with higher scores on various dimensions of the SCL-90-R. CONCLUSION: Chronic illness in children affects the psychological health of the parents. Active coping strategies are associated with fewer distress indices and thus if inculcated may improve the ability to bear the burden of the illness without becoming themselves affected by psychiatric illnesses.

Psychopathology and self-esteem in chronic illness.

OBJECTIVE: To evaluate psychopathology and self-esteem in chronic illness. METHODS: 60 children and their parents were selected to participate in an open study. 30 children had epilepsy and the other 30 had thalassemia. Both the groups consisted of children randomly selected from the Epilepsy Clinic and Thalassemia Centre respectively, of a teaching general hospital. The children and their parents were interviewed and also rated on Childhood Psychopathology Measurement Schedule (CPMS) and Rosenberg's self esteem scale. The data was analysed using Pearson's chi square test and Pearson's correlation coefficient. RESULTS: The children were seen to have high psychopathology on CPMS (average score: thalassemia group = 28.56, epilepsy group = 26.06). Depression was the subscale with the maximum elevation in both groups. Behavior problems were high in epilepsy. In addition, sadness and disinterest in life were common symptoms in thalassemia while irritability and panic were high in epilepsy. Children with epilepsy perceived a change in lifestyle after diagnosis. Self-esteem was moderately affected in both groups and this affected compliance with treatment in thalassemia. CONCLUSION: Chronic illness affects psychological health and self esteem in children. Hence, in addition to the physical aspects it is necessary also, to focus on the psychological health of the child in order to ensure compliance and thus treat the child comprehensively.