Telangana Journal of Psychiatry

ORIGINAL ARTICLE
Year
: 2021  |  Volume : 7  |  Issue : 1  |  Page : 10--15

Depression, anxiety, and stress among domestic migrants during COVID-19 pandemic in Hyderabad


Lakshmi Keerthana Thatavarthi, Vijay Kumar Modala, Phanikanth Kondaparthi 
 Department of Psychiatry, Institute of Mental Health, Hyderabad, Telangana, India

Correspondence Address:
Phanikanth Kondaparthi
Department of Psychiatry, Institute of Mental Health, Hyderabad, Telangana
India

Abstract

Context: In the current pandemic, migrants face specific stressors like separation from family, un-sanitized housing, overcrowded conditions, financial instability resulting in poor coping strategies and making them more prone to mental illness. It is crucial to address their psychological needs and contribute to the literature. Aim: The study was done to assess depression, anxiety, and stress in domestic migrants along with domestic migration stress and COVID 19-related anxiety. Materials and Methods: It was a cross-sectional study conducted in Hyderabad, Telangana among 70 individuals who have migrated from their home states, chosen after obtaining informed consent. Domestic migration stress questionnaire to evaluate migration stress, depression anxiety stress scale-21 to evaluate depression, anxiety and stress, and the corona anxiety scale to evaluate anxiety-related to pandemic were used. Data were analyzed using the statistical package for the Social Science Version 25.0. Results: The study population was screened and was found to experience symptoms of severe depression (mean 21.43), severe anxiety (mean = 16.80), and moderate stress (20.43). They had considerable domestic migration stress (mean = 41.03) and COVID related anxiety (mean = 9.78). Domestic migration stress and COVID anxiety together had significantly impact on depression, anxiety, and stress. COVID anxiety alone affected depression and anxiety significantly. Domestic migration stress alone when analyzed had impact on the stress experienced. Conclusion: Depression, anxiety, and stress symptoms among the domestic migrant population are very prevalent currently. The mental health of migrants should be made a priority and active awareness programs and screening should be done. Further large-scale studies with adequate funding from the government and appreciable concern from the mental healthcare providers should be done.



How to cite this article:
Thatavarthi LK, Modala VK, Kondaparthi P. Depression, anxiety, and stress among domestic migrants during COVID-19 pandemic in Hyderabad.Telangana J Psychiatry 2021;7:10-15


How to cite this URL:
Thatavarthi LK, Modala VK, Kondaparthi P. Depression, anxiety, and stress among domestic migrants during COVID-19 pandemic in Hyderabad. Telangana J Psychiatry [serial online] 2021 [cited 2021 Dec 2 ];7:10-15
Available from: http://www.:tjpipstsb.org/text.asp?2021/7/1/10/321770


Full Text



 Introduction



Internal migration or domestic migration is human migration within one geopolitical entity, usually a nation-state.[1] Domestic migrant workers comprise workers, migrated as an individual or in groups, mainly on a temporary or seasonal basis in search of the work to urban areas of other state or geographical regions within the country.[2] According to an official employment estimation, Indian industries had about 100 million domestic migrant workers which reflect the unevenly-paced development within a country.[3] The preponderance of evidence suggests that the migration process is associated with many complex inter-relating psychological, social, and cultural factors of both an individual and a collective nature all of which negatively affect people's psychological wellbeing. These include separation from families, confronting with stigma, rejection and marginalization to integrate into the new environment, lacking self-confidence to adjust to the new environment, difficulty to adapt to the expectations and realities of the new surroundings.[4]

The coronavirus disease (COVID-19) pandemic, which originated in the city of Wuhan, China, has spread to various countries including India and impacted millions of people in more than one way. The pandemic has serious physical and tremendous mental health implications. Domestic migrant worker is a vulnerable community for the development of adverse mental health consequences, through various multidimensional factors, many acting concurrently to cause physical, mental, and socioeconomical adversities. Lonely migrant workers subjected to abrupt lockdown and strict quarantine measures are more likely to get affected by the negative cognitive responses and emotions secondary to the COVID-19 pandemic, because of preexisting higher susceptibility to mental stress.

It has the potential to cause chronic psychological manifestations like depression, anxiety, panic disorder, and psychosomatic manifestations.[5]

Worldwide, depression and anxiety disorders are the 2nd leading cause of “disability-adjusted life years” in the age category 15–44 years for both genders. Globally, depression has been identified as the leading cause of illness and disability, with an aggregate point, 1-year and lifetime prevalence of 12.9%, 7.2%, and 10.8%, respectively. In its most severe form, it can lead to suicide. Approximately 800,000 people die from suicide annually.[6] More than 300 migrant workers died during the lockdown, with reasons ranging from starvation, suicides, exhaustion, road and rail accidents, difficulty in availing healthcare. According to the data, 80 people died due to suicide and 45 deaths associated with severe withdrawal symptoms.[7]

According to the psychosocial issues among migrants during COVID-19 listed by the Government of India, internal migrant workers are suffering from high degrees of anxieties and fears due to various concerns in the COVID pandemic, and are in need of psycho-social support.[8]

Stress is a physical, mental, or emotional factor that causes bodily or mental tension caused by external (from the environment, psychological, or social situations) or internal (medical illness) factors. Stress can initiate the “fight or flight” response, a complex reaction of neurologic and endocrinologic systems.[9] The process of migration and the on-going pandemic are the external factors influencing stress levels of the public currently.

Very few studies have assessed stressors that are specifically related to domestic migration. This study aims to understand the complexity of the mental health impact of internal migration in India and in particular during the pandemic.

Aim

To assess depression, anxiety, and stress in domestic migrants along with domestic migration stress and COVID 19-related anxiety.

Objectives:

To assess depression, anxiety, and stress levels in the study population during the COVID 19 pandemicTo assess the domestic migration stress in the study populationTo assess the COVID-related anxiety in the study populationTo assess the factors affecting depression, anxiety, and stress in the migrant population during pandemic.

 Materials and Methods



Study design

Current study is cross-sectional in nature.

Study setting

Participants who have migrated from their home states were recruited from Hyderabad, Telangana. The study population was recruited from the community. They were interviewed in an Anganwadi near the Bharath Nagar flyover, Hyderabad where most of the domestic migrants reside.

Study duration

It was conducted from May 2020 to June 2020.

Tools:

Sociodemographic data sheet and its correlates: This consists of baseline characteristics such as age, gender, marital status, state of migration, and substance historyDepression anxiety stress scale-21 (DASS 21) scale by Lovibond (1995).[10]:- DASS 21 scale developed by Lovibond in 1995 is considered a reliable and quantitative screening tool of depression, anxiety, and stress. It consists of 7 items each for depression, anxiety, and stress. They can be divided into mild, moderate, severe, and very severe categoriesDomestic migration stress questionnaire (2015)[2]:- It was developed by Chen et al. in 2015 to evaluate levels of stress associated with domestic migration. The domestic migration stress was assessed under four subcategories namely separation, rejection, low self-confidence, and maladaptationCorona anxiety scale (CAS) 2020[11]:- CAS developed by Sherman A. Lee in 2020 to evaluate anxiety related to the COVID 19 pandemic. It has 5-items including questions specifically related to COVID 19-related anxiety.

Sample size

Total sample is (N) 70.

Inclusion criteria

Female/male participants with a history of migrationThose who have given informed consent.

Exclusion criteria

Severe physical/medical illnessHistory of mental illnessActive symptoms of corona or history of contact with COVID-positive patient.

Data collection method

Approval from the college ethics committee was takenThe investigator introduced herself to the participants and explained the studyAll the safety precautionary measures and social distancing recommended by standard ICMR guidelines have been followed during the interviewInformed consent was taken and they were explained about the nature of the study. They were assured of anonymity and confidentiality of the information being divulgedData were collected through questionnaire consisting rating scales and sociodemographic datasheet.

Data management and statistical analysis

Data were analyzed and categorized into respective categories using the scoring pattern described by the standard questionnairesMultiple linear regression analysisThe details were analyzed based on descriptive and inferential statistics. Like difference between two means, mean, range, t-test, Chi-square test (P ≤ 0.05 was considered to be statistically significantANOVA testThe frequencies observed were documented in tablesData analysis is performed manually as well as by using the Statistical Package for the Social Sciences Version 25.0.

 Observation and Results



Seventy participants (n = 70) meeting the selection criteria were included whose average age was 33 years. Forty participants of the total study population are males. Out of the study population, fifty were married. About forty-three participants were employed and most of them were unskilled workers. About twenty-six participants have a history of alcohol use.

The mean of the depression component is 21.43 (standard deviation = 5.909) which falls under the severe depression category. The mean of anxiety component 16.80 which falls under the severe anxiety category.

The mean of stress component is 20.43 which falls under the moderate stress category. The mean average of corona anxiety levels is 9.78 [Table 1].{Table 1}

Females showed more depression symptoms than men which is statistically significant (P = 0.003). Unemployed subjects showed higher levels of depression. Participants with no history of substance use had higher levels of depression [Table 2]. Females showed more anxiety symptoms than men which is statistically significant (P = 0.023). Females had higher stress than men which is statistically significant (P = 0.022*) [Table 3]. Unemployed subjects had higher levels of stress compared to employed subjects which were found to be statistically significant (P = 0.015*) [Table 4].{Table 2}{Table 3}{Table 4}

Twenty-six out of the 70 participants had regular consumption of alcohol. During the pandemic, there was a statistically significant increase in alcohol consumption in the participants (P = 0.000*).

The mean domestic migration stress in the participants was found to be 41.03. Each sub-category was evaluated individually as well and the mean level of stress experienced by the participants due to separation was 12.81, rejection was 9.39, low self-confidence was 8.87, and maladaptation was found to be 9.96. A one-way ANOVA test showed that separation component was the most important contributor to overall domestic migration stress which is statistically significant (P = 0.0001*).

Low self-confidence was the least contributor to domestic migration stress [Table 5].{Table 5}

A multiple linear regression method was calculated to assess depression based on domestic migration stress and COVID-19-related anxiety.

A significant regression equation was found (F = 7.83, P = 0.001*), with and R2 = 0.19 which implies that 19% of the variance in depression can be explained by both domestic migration stress and COVID 19 anxiety together which is statistically significant. COVID 19 anxiety alone was found have an impact on depression levels which is statistically significant (P = 0.002*) [Table 6].{Table 6}

A multiple linear regression method was calculated to assess anxiety based on domestic migration stress and COVID 19-related anxiety. A significant regression equation was found (F = 5.1, P = 0.008*), with and R2 = 0.13 which implies that 13% of variance in anxiety can be explained by both domestic migration stress and COVID 19 anxiety together which is statistically significant. COVID 19 anxiety alone was found to have an impact on anxiety which is statistically significant (P = 0.026*) [Table 6].

A multiple linear regression was calculated to assess stress based on domestic migration stress and COVID 19 related anxiety. A significant regression equation was found (F = 5, P = 0.009*), with and R2 = 0.13 which implies that 13 percent of the variance in stress can be explained by both domestic migration stress and COVID 19 anxiety together which is statistically significant. Domestic migration stress alone was found to have an impact on stress levels which is statistically significant (P = 0.028*) [Table 6].

 Discussion



Domestic migrants have had a different set of challenges to contend with since the Indian government implemented lockdown (March–April, 2020) throughout the country resulting in a major mental health crisis. They were found to suffer from a high prevalence of anxiety, psychotic, and posttraumatic disorders due to socioenvironmental adversities, such as loss of social status and discrimination.[12] This is one of the pioneer studies in India which tries to understand the domestic migration stress in detail.

This study evaluated and screened subjects for depression, anxiety, and stress and the factors contributing to it in domestic migrants. The domestic migration stress experienced as a consequence of migration itself and COVID anxiety specifically pertaining to COVID 19 were also evaluated for overall better understanding. All the 70 subjects in the study belong to similar socioeconomic status. Domestic migration stress was evaluated under four components including separation, rejection, low self-confidence, and maladaptation and the most important contributor was separation and the least was low self-confidence.

Depression

The result of this study revealed high prevalence of depressive symptoms (mean 21.43) falling under the severe depression category according to the DASS21 interpretation. According to a study conducted in 98 migrants by Kumar et al. in Chandigarh, 73.5% were found to be screen positive for depression.[13] It was noted that females experienced a higher level of depression than men as most of the women were unemployed and restricted to the home.

Migrants with alcohol use showed lower levels of depression compared to those without alcohol use. No teetotalers have resorted to consuming after the current events have emerged, but the migrants with previous alcohol use have increased the amount of consumption significantly compared to before.

A study conducted in Poland reported that more than 30% changed their drinking habits because of the pandemic, with 14% actually drinking more than usual as it was deemed to be a coping strategy to deal with the stress.[14]

About 10% percent of the participants reported passive suicidal ideation giving the reasons of fear of contracting the virus, not being able to meet their families and financial instability. Both domestic migration stress and COVID anxiety levels together showed to have a significant impact with and (R2 = 0.19, P = 0.001*), on depression experienced. COVID anxiety when assessed alone was also found to have a significant impact (P = 0.002*) enough to influence the overall depression level in the participants. Domestic migration stress alone did not affect depression in subjects.

Anxiety

The result of this study revealed high prevalence of anxiety symptoms (mean 16.8) falling under the severe anxiety category according to the DASS21 interpretation. According to a similar study conducted this year in 98 migrants by Kumar et al. in Chandigarh, 50% were found to be screen positive for anxiety.[13] Females were found to experience significantly higher levels of anxiety compared to men. This is consistent with the National Mental Survey of India, 2016 which reported that females are more likely to be anxious than males.[15]

To screen for the anxiety specifically pertaining to COVID 19, CAS was administered.

The average COVID 19 anxiety was 9.78 which implies that further evaluation and clinical correlation are mandated in the participants. Both domestic migration stress and COVID anxiety levels together showed to have a statistically significant (P = 0.008*, R2 = 0.13) impact on the overall anxiety levels of the study population.

COVID anxiety when assessed alone had a significant impact (P = 0.026*) enough to influence the overall anxiety level in the participants implying that change in COVID anxiety levels will change the anxiety experienced by the participants. Domestic migration stress alone did not affect anxiety in subjects.

According to the National Mental health survey, the community prevalence of mental morbidity is 10.6% for depression and anxiety, it can be said that screen positivity in the present study is significantly more than that implying that there is the higher deterioration of mental health of domestic migrants.[16] Further, the depression and anxiety symptoms are significantly higher than that seen in an online survey of the general population, done during this lockdown period.[13]

Stress

The result also revealed increased levels of stress in the participants with the average being 20.43 which falls under the moderate stress category. Females experienced more stress than male participants. Those who were unemployed had higher levels of stress compared to those with jobs. This can be attributed to their financial vulnerability and job insecurity. Thousands of migrants have lost their jobs as they do not have formal contracts and are outside the reach of the law. Both domestic migration stress and COVID anxiety levels together showed to have a significant impact (P = 0.009*, R2 = 0.13) on the overall stress in the study population. Domestic migration stress when assessed alone had a significant affect (P = 0.028*) enough to influence the overall stress. COVID anxiety when assessed alone did not have any effect on stress.

It is evident by now that the pandemic is not ending anytime soon and its ripple effect on mental health is only going to get worse especially in vulnerable population like domestic migrants. We need to take care of these neglected communities along with the general population

Limitations

The present study has certain limitations. This was a cross-sectional study which makes it difficult to assign the causality. It was done to ease out the interview process and assessment in short span during the pandemic scenario. The sample size was restricted to a small number due to the pandemic. Since the present study was done in Hyderabad, generalization should be done with caution.

 Conclusion



In this study conducted in the domestic migrant population, most of them were screened positive for depression, anxiety and stress which in turn are found to be influenced by levels of domestic migration stress and COVID19 anxiety. The right to mental health care which was declared by the Mental Healthcare Act, 2017 needs to be exercised now more than ever. It is our responsibility to nurture the mental well-being of the domestic migrants of this country, especially in the current scenario.

Future directions

Adequate attention and urgent priority should be given to the mental health of these neglected migrant population by both government and healthcare providersActive screening and treatment will help us prevent more suicidesAppropriate measures and awareness campaigns should be promoted.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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