Internalized stigma related to COVID-19 and its psychosocial and mental health correlates: a multicentric health facility based observational study from Nepal.

Introduction: The COVID-19 pandemic has led to physical and psychological complications and social consequences in the form of illness-related stigma. This study aimed (1) to assess the sociodemographic and clinical variable, as well as COVID-19 related knowledge and perception of persons admitted for COVID-19/Suspected COVID-19 in Nepal, (2) to determine their levels of COVID-19- related internalized stigma, depression, and anxiety symptoms, and (3) to evaluate the correlates of COVID-19- related internalized stigma. Materials and methods: It was a cross-sectional exploratory study with a convenience sample of 395 participants (306 confirmed cases, 89 suspected cases) conducted between July-October 2020 in four health facilities in Madhesh and Lumbini provinces of Nepal. We used a semi-structured questionnaire to assess sociodemographic details, clinical information, COVID-19-related knowledge, perception, COVID-19-related internalized stigma, and the Hamilton Anxiety Depression Scale (HADS) in Nepali language. Descriptive statistics, correlation analyses, and linear regression analyses were performed. The level of statistical significance was considered at p < 0.05. Results: Around 23.3% of the patients had anxiety symptoms, 32.9% had depressive symptoms, and 20.3% had high COVID-19-related internalized stigma (mean ISMI score: 2.51-4.00). Linear regression analyses showed a significant positive association of COVID-19-related internalized stigma total score, with the following eight factors, i.e., no income in the past one month (p = 0.013), below average socioeconomic status (p = 0.004), anxiety symptoms (p = <0.001), depressive symptoms (p = <0.001), recent testing positive for COVID-19 (p = <0.001), involuntary admission (p = <0.001), prior experience of being in isolation and quarantine (p = 0.045), and those who blame others for COVID-19 (p = 0.025). Conclusion: COVID-19 survivors and suspects are vulnerable to symptoms of depression, anxiety, and COVID-19-related internalized stigma. For the first time from Nepal, our data suggests that COVID-19-related internalized stigma is associated with anxiety and depression symptoms, perceived below-average socioeconomic status, involuntary admission, prior experience of being in isolation and quarantine, recent COVID-19 positive report, self-blame, below-average socioeconomic status and no income in the past one month. Mitigating and preventing internalized stigma associated with a public health crisis such as COVID-19 is imperative by diagnosing and treating such mental health issues early and designing interventions and policies especially targeting vulnerable populations focusing on their economic background and socio-cultural beliefs.

Depression, Anxiety and Stress among Nepali Health Care Workers during the Coronavirus Disease 2019 Pandemic: A Cross-sectional Survey.

INTRODUCTION: Studies among health care workers from different part of world during the coronavirus disease 19 pandemic have reported substantial impact on their physical, mental and emotional well-being. This study measured the impact of coronavirus disease 2019 on the mental health of Nepali healthcare workers in different parts of the world during the pandemic. METHODS: This cross-sectional survey was carried out from December 25, 2020 to Jan 25, 2021. Ethical approval was taken from the Institutional Review Committee (reference number: 372). Online questionnaire including demographic profiles and Depression, Anxiety, and Stress Scales-21 instrument were sent to Nepali healthcare workers around the world through social media apps using convenience sampling. Data were entered into Microsoft Excel for Mac version 16.49 and analysed. RESULTS: Among 208 who participated in the study, 62 (30%) participants were positive for anxiety, 47 (22.5%) for depression and 25 (12%) for stress. Higher prevalence of depression 18 (30%) and stress 10 (17%) was found in nurses compared to paramedics, among whom depression was seen in 5 (20%) and stress in 4 (16%). Among doctors, depression was found in 24 (19%) and stress in 11 (9%). CONCLUSIONS: This study demonstrated that a high proportion of healthcare workers were suffering from depression, anxiety and stress. Our findings are similar to the data from other national and international studies.