Indian Journal of Health Social Work
Knowledge, Attitute, Perceived Stress and Psychological Problems of the UndergraduateUniversity Students in Relation to SARS-COV-2 Pandemic: A Descriptive Study from India
Vasudha Chakraborty1, Dipanjan Bhattacharjee2, Ranjan Biswas3
1Student, B.A.LLB (Hons.), School of Law, Manipal University Jaipur 2Associate Professor, Department of Psychiatric Social Work, Central Institute of Psychiatry, Ranchi. 3Associate Professor of Psychiatry, Department of Psychiatry, Bankura Medical College, Bankura, West Bengal
Correspondence: Vasudha Chakraborty, email id: vasudhachakraborty@gmail.comABSTRACT
Background: This study aimed to explore the knowledge, attitude, perceived stress and psychological problems associated with the SARS-CoV-2 of the undergraduate students of a private university located in the Jaipur city, India. This study also aimed to assess the implications of academic discipline and academic year of the undergraduate students on the knowledge, attitude, perceived stress and psychological problems associated with the SARS-CoV-2. Methods: An online survey of 93 undergraduate students was conducted by using the Google Forms. Mails were sent to a total of 244 students and 126 of them responded. Of which, 93 students had filled up the Google Form correctly and their responses were included in the study. The measures were ‘Socio-demographic Data Sheet’, ‘Questionnaire on Knowledge and Attitude Related to SARS-CoV-2 ’, ‘Coronavirus Anxiety Scale (CAS)’ and ‘Depression, Anxiety and Stress Scale-21 Items (DASS-21). Results: Majority of the students was females, from engineering or science background, hailing from urban areas and majority of them had adequate knowledge and positive attitude about SARS- CoV-2. Academic discipline did not have significant implication on the knowledge and attitude, but academic year had. Students of commerce or management were significantly higher coronavirus anxiety than other two disciplines. However, they were not seen to have clinically significant psychological problems. Conclusion: Academic year and discipline of the undergraduate students can significantly influence the knowledge, attitude and level of anxiety associated with SARS-CoV-2.
INTRODUCTION
The SARS-COV-2 pandemic has made everyone edgy due to its extremely high infective potentiality and ability to significant illness sequel. The SARS- CoV-2 has laid down devastating impact on every aspect of human beings which world has never witnessed after 1918 Spanish Flue (1-4). The epicenter of SARS-COV-2 is Wuhan, the capital Central Chinese province, Hubei. This outbreak was started at the end of 2019 and it has been emerged as a global pandemic with catastrophic impact on every sphere of human civilization (5). In India, the first confirmed case of SARS-COV-2 was reported on 30th January 2020 to a student
from the state of Kerala having the travelling history of Wuhan, China. As of now, August, 2020, the total cases in India are 19, 08, 254 with the mortality rate of 2.09% (6). The Government of India had proclaimed the nationwide lockdown on 21st March, 2020 and every activity including regular academic activities in universities, colleges, institutes and schools are advised to shut down for indefinite period. Examinations and evaluations are also being advised to postpone till the situation becomes favorable. Therefore students started to garner apprehensions and disturbing thoughts about their academic and professional careers. University students’ attitude, knowledge and beliefs towards SARS-COV-2 need to be assessed because they are regarded one of the most dynamic forces of the society (7-10). The knowledge, attitudes and perceived stress of the university students toward SARS-COV-2 is important for increasing the effectiveness, compliance and success of public health measures adopted by the government in dealing with the SARS-COV-2 (11-13).
This study was planned with the aim of assessing the knowledge, attitude, perceived stress and psychological stress associated with SARS-CoV-2 outbreak of the undergraduate students’ of an Indian university.
METHODS
This study was carried out on the undergraduate students of a private multidisciplinary university located in the city of Jaipur, Rajasthan. The name of the university is Manipal University. This university was established by Manipal Global Education Services and it is recognized by the University Grants Commission (UGC) and other Statutory Regulatory Bodies functional in India. This university provides diploma, undergraduate, postgraduate and doctoral courses in the disciplines like arts and humanities, social sciences, engineering, science, management, commerce, law and juridical sciences and fine arts. The study was done online by using the Google Forms during the month of May, 2020. The students were selected from the three disciplines, viz., Arts/ Humanities, Science/Engineering and Commerce/ Management. The lists of the students were taken from the respective departments and they were contacted through their e-mail IDs. They were requested to take part in the online survey. Mails were sent to a total of 244 students and 126 of them responded. Of which, 93 students had filled up the Google Form correctly and their responses were included in the study. The Google Form contained ‘Socio-demographic Data Sheet’, ‘Questionnaire on Knowledge and Attitude Related to SARS-CoV-2 ’, ‘Coronavirus Anxiety Scale (CAS)’ (14) and ‘Depression, Anxiety and Stress Scale- 21 Items (DASS-21)’ (15). For statistical analysis Statistical Package for Social Sciences (Windows
version 25) (16) was used. Statistical measures like descriptive statistics, Fisher’s exact test, independent samples t test and one way Anova were used.
The Socio-demographic data sheet included variables like age, gender, academic stream, family’s monthly income, religion, domicile, category and marital status. The questionnaire included basic information regarding transmission, symptoms and preventive options of SARS-COV- 2, attitude towards illness, infected people and SARS-COV-2 fighters or warriors and their opinions about governmental measures and giving voluntary services to people at community level. The Coronavirus Anxiety Scale (CAS) (14) was applied on the selected undergraduate students to assess their anxiety and worry related to SARS- COV-2. The Coronavirus Anxiety Scale (CAS) had been developed as a brief screening measure for identifying probable cases of dysfunctional anxiety associated with the SARS-COV-2. It is a 5-item scale with adequate reliability and validity profiles. Higher scores were linked with coronavirus diagnosis, impairment, use of addictive materials to stave off stress, increase use of negative religious coping, presence of extreme hopelessness and suicidal ideation. The optimized cut-off score of the scale was enumerated to be >9. The Depression, Anxiety and Stress Scale (DASS-21) (15) were applied on the selected students to assess their depression, anxiety and psychological distress. The Depression, Anxiety and Stress Scale-21 (DASS-21) are composed of a set of three self-report scales which measures the emotional states of depression, anxiety and stress. Each of the three DASS-21 scales contains 7 items, divided into subscales with similar content. The depression scale assesses dysphoria, hopelessness, devaluation of life, self-deprecation, and lack of interest/involvement, anhedonia and inertia. The anxiety scale assesses autonomic arousal, skeletal muscle effects, situational anxiety, and subjective experience of anxious affect. The stress scale assesses difficulty relaxing, nervous arousal, and being easily upset/agitated, irritable/ over-reactive and impatient. Scores for depression, anxiety and stress are calculated by summing the scores for the relevant items. The DASS-21 is developed on the dimensional conception of psychological disorder.
RESULTS
Majority of the selected students are females (62.4%), living in urban areas (79.6%), followers of Hinduism (92.5%), belonging to general or unreserved caste (82.8%), none of them is married; belonging to nuclear families (87.9%) and the mean age of them is 21.31 ±2.55 years. In terms of monthly income, majority of them are belonging to families with the monthly income range of Rs. 10,001 to 20,000 and the source of the livelihood of most the families is business (59.1%). In terms of academic background, majority of the selected undergraduate students are from the science/engineering discipline (58.1%) followed by arts/humanities discipline (30.1%). Only 11.8% are from the commerce/ management discipline. In terms of academic level, most of the students are in either mid-level or final level of their respective academic training (53.8% and 36.6% respectively). Only 9.7% of them are in the beginning phase of their academic training (Table-1).
In relation to knowledge and attitude towards SARS-CoV-2 and affected people, it was noted that all of them had basic information about coronavirus as well as SARS-CoV-2. Majority of them had reported that they got information about SARS-CoV-2 from Government Agencies/Social Network Sites (n=74). Only 19 of them reported that they acquired knowledge about this pandemic from media (print and electronic media). Majority of them stated that they main route of transmission of SARS-CoV-2 is ‘close contact with a patient’ (n=84), 4 (4.3%) and 2 (2.2%) students attributed ‘droplets from exerted by the coughs of infected persons’ and ‘touching of contaminated surfaces’ for the transmission of SARS-CoV-2. Only 3 students (3.2%) were found to have comprehensive knowledge about the routes of transmission as they endorsed all those three routes responsible for spreading of SARS-CoV-2. More than one third students viewed remaining in the house and maintaining social distancing is the most effective preventive strategy (79.6%), whereas, 5.4%, 2.2% and 9.7% of them endorsed ‘frequent hand washing with soap and water’, ‘using alcohol (more than 70%) based hand sanitizer’ and ‘using of mask’ respectively. Only 3 students reported that using all those measures simultaneously could be of help. With regards to the symptoms of SARS-CoV-2 , 10.8% identified ‘fever, dry cough and tiredness’ as the symptoms of SARS-CoV-2; 11.8% recognized ‘body aches, headache and pain’ as the distinguishing features of this pandemic; 16.1% held ‘nasal congestion’ and 28.0% held ‘sore throat’ are the symptoms of SARS-CoV-2 . However, 33.3% ascribed all those symptoms as the distinguishing features of SARS- CoV-2. However, many of them had been found to have knowledge about one or two symptoms of SARS-CoV-2, not the entire rubric of the symptoms as such. Majority of them did not favor complete isolation of SARS-CoV-2 patients from the society (n=79), nor do they support the segregation of SARS-CoV-2 warriors (n=81). Most of them were of view of stringent legal action against the individuals and groups for causing harassment to SARS-CoV-2 warriors and enactment of suitable legislation to curb those incidents (n=80 and n=81 respectively). While asking their opinion about the genesis of SARS-CoV-2, i.e., it is a politically motivated war or not, mixed responses were seen from the side of the selected undergraduates. Thirty three students (35.5%) thought that it is a politically motivated vindictive act; 28 students/p>
negated this view and rest of them did not have clear-cut view about this issue or they reported lack of idea about this (34.4%). With regards to adequacy about the governmental actions or measures to contain the SARS-CoV-2, 37.6% students reported that governments (Central and Provincial) have taken necessary measures, whereas, 47.3% reported inadequate measures from the side of governments. Rest of them reported lack of ideas or knowledge about this issue (15.1%). Most of the undergraduate students had reported that they are ready to do voluntary works for raising awareness level about this pandemic and help the administration to deal with the situation. While asking the impact of SARS- CoV-2 on the academic career, most of them reported that this pandemic will have significant negative impact in the long run (58.1%) and 25.8% were found to be unsure about it. However, 16.1% did not think that SARS-CoV-2 will cause significant damage to their academic career. Majority of them think SARS-CoV-2 would cause significant decrease in job opportunities for them in future (69.9%). In terms of post-covid world, 31.2% of the students felt that people would have to develop skills for adjusting with the changing situation; but, 43.0% did not think so. Remaining 25.8% did not have clear-cut view on this issue. An overwhelming number of students expressed the positive aspect of SARS-CoV-2 in the form of increasing basic hygiene, cleanliness and health education in the society (90.3%) and most of them also stated that the world would not be same again in post-covid era (73.1%). A large section of the students expressed that SARS-CoV-2 pandemic has made significant impact on the social life of people (74.2%); however, majority of them also stated that because of SARS-CoV-2, common people tend to be more resilient and motivated to deal with adversities of life.
The Coronavirus Anxiety Scale (CAS), which was developed to assess the dysfunctional anxiety associated with the SARS-COV-2 was applied on the undergraduate students (n=93). The mean and median was enumerated to be 3.80±4.84 and 2.00 respectively. The Depression, Anxiety and Stress Scale (DASS-21) was applied on the undergraduates to assess the depression, anxiety and psychological stress and the means were found to be 5.41±5.60, 4.82±4.71 and 4.65±5.00 respectively. The medians were 3.00, 4.00 and 3.00 respectively.
Significant difference was noted among these three groups of undergraduate students in coronavirus anxiety. Undergraduates of commerce and management had reported significantly higher scores in the Coronavirus Anxiety Scale (CAS) than remaining two groups of students. No significant difference with regards to coronavirus anxiety noted between the students of arts/humanities and science/engineering.
The academic training phase of the selected undergraduate students had not been found to have significant implication on the coronavirus anxiety level. No significant difference was noted among the students of three academic phases, ii.e., ‘Entry level’, ‘Mid level’ and ‘Final level’
The discipline of study of the selected undergraduate students had not been found to have significant implication on the depression, anxiety and psychological stress levels. No significant difference was noted among the students of three academic disciplines, i.e., ‘Arts/ Humanities’, ‘Commerce/Management’ and ‘Science/Engineering’.
The academic training phase of the selected undergraduate students had not been found to have significant implication on the coronavirus anxiety level. No significant difference was noted among the students of three academic phases, i.e., ‘Entry level’, ‘Mid level’ and ‘Final level’ The selected undergraduate students are spreading over three academic disciplines, viz., Arts/ Humanities, Commerce/management and Science/Engineering. Majority of the students were from Science/Engineering (n=50) and least number of students were from Commerce/ Management discipline (n=11). However, no significant difference was noted in any area of the attitude and knowledge questionnaire among the students of these three academic disciplines.
The academic training phase has been found to have significant implications on the knowledge and attitudes of the selected undergraduate students. In current study, most of the students were in mid- level or final level of their respective course of study. Only 9 of them were at the beginning phase of the study. Significant differences were noted in four areas of the knowledge and attitude questionnaire used in present study, i.e., ‘Sources about information about SARS-CoV-2 ’, ‘Ways to prevent SARS-CoV-2 ’, ‘Symptoms of SARS-CoV- 2 ’, ‘SARS-CoV-2 is a politically motivated war’, and ‘SARS-CoV-2 increased sanitation knowledge’. Majority of the students who were in mid level and final level of their academic training reported that, they acquired information about SARS-CoV-2 from the governmental sources and social networking sites. Majority of the mid level and final year students had expressed the importance of ‘staying at home’ in preventing the transmission of this pandemic. Significant difference was also noted among these three groups with regards to understanding about the symptoms of SARS-CoV- 2. A good number of mid level and final year’s students have the knowledge of the gamut of symptoms of this infection; however, some of them do have fleeting knowledge about this infection. Significant difference was noted with regards to viewing SARS-CoV-2 as a mode of political vendetta or done intentionally to show political aggression. A large chunk of students, particularly of mid level and final year students do believe that it is not just a natural pandemic; rather it has complex political linkage or intention. A large segment of the students had expressed that SARS- CoV-2 has brought about some positive changes in the forms of understanding the importance of basic health practices and knowledge of hygiene.
DISCUSSION
The current study was conducted on 93 undergraduate students of an Indian private university located at the Jaipur city, Rajasthan State. This study was carried out online by using the Google Forms during the month of May, 2020. The students were selected from the three disciplines, viz., Arts/Humanities, Science/ Engineering and Commerce/Management. E-mails were sent to a total of 244 students and 126 of them had responded to the authors. However, 33 responses were rejected due to incompleteness or filling up the forms wrongly. Remaining 93 responses were included in the study. The Google Form contained ‘Socio-demographic Data Sheet’, ‘Questionnaire on Knowledge and Attitude Related to SARS-CoV-2 ’, ‘Coronavirus Anxiety Scale (CAS)’ (14) and ‘Depression, Anxiety and Stress Scale- 21 Items (DASS-21)’ (15). In current study majority of the students were females (n=58/62.4%), most of them were pursuing science or engineering courses (n=54), 28 of them were in Arts/ Humanities courses and only 11 were in Commerce or Management courses. Most of the students were found to be in either mid-level or final level of their respective courses (n=50 and n=34 respectively), only 9 of them were found to be the beginners. In terms of religion, most of them were Hindu (n=86), only 5 were Muslim and remaining 2 of them were from Christianity and Sikhism respectively. Majority of them were from urban areas (n=74) and belonging to unreserved upper caste category (n=77). Mean age of the selected students was 21.31±2.55 year (range 18-43 year). All of them were unmarried, from nuclear family background and belonging to either business or salaried families. Most of them had reported the monthly family income within Rs. 20,000 per month (Indian currency) (Table-1). The socio- demographic findings could be explained by the socio-demographic characteristics of the State and the city where the university is located. The university is located in the outskirt of the Jaipur city, the capital of the Indian State of Rajasthan. However, many of the students of this university are from other states and majority of them are from urban areas. Majority of the students were found to be Hindu. As per the census of India of 2011, Hindu are majority in Rajasthan state. Hinduism constitutes 88.49% of Rajasthan population. Hinduism is the mostly prevalent religion in 33 out of 33 districts of the state of Rajasthan. In current study all selected students had reported that they know about the SARS-CoV- 2 and they were also quite familiar with the cardinal symptoms of this pandemic. Majority of them recognized ‘restriction of mobility, social distancing and staying at home’ is the mainstay of prevention. Very few of them (3.2%) had the complete knowledge of prevention which includes ‘social distancing, staying at home, using mask, frequent washing of hands with soaps and water and finally using of alcohol based (at least 70% alcohol v/v.) hand sanitizers’. It could be attributed to mass education about social distancing and restriction of mobility of people by the Governmental agencies and mass media. This pandemic has been appeared as the most unprecedented traumatic event and people find ‘restriction of mobility or staying at home’ is the safest way to deter this pandemic. Since most of the undergraduate students of the present study were from middle- class urbanized nuclear families they might have had adequate understanding about basic hand hygiene, therefore, they identified ‘social distancing’ or ‘staying at home’ is the most attractive and feasible way to deal with this pandemic. Similar kinds of findings were in two studies done in Indonesia and China respectively (20, 21). Majority of the students had been found to be keeping positive attitude towards the patients and healthcare workers (rejected the idea of social isolation of the patients; keeping stigmatizing attitude towards SARS-CoV-2 fighters like doctors, nurses, health workers, policemen, public utility service workers and other persons engaged in healthcare service) (Table-2). Similar findings were noted by Peng et al (21), Maheswari et al (12), Al-Hanawi et al (22) and Khasawneh et al (23). Selected undergraduate students of the current study were found to have adequate knowledge regarding SARS-CoV-2 and they were also seen to have positive attitudes toward the pandemic as well as affected people and healthcare workers. They were also seen to have good knowledge about the preventive measures against SARS-CoV-2. Similar results were noted in studies done on students’ populations (e.g., 10, 11, 20- 23). In present study, academic disciplines of the undergraduate students has not been found to have significant implications on their knowledge and attitude towards SARS-CoV-2 (Table-8); however, significant differences were seen as per the academic training or year levels of the selected undergraduate students (Table-9). Most of the students selected in the current study were in either mid phase or terminal phase (final year) of their respective courses; only 9 of them were at the beginning phase of their course of study (Table- 9). Because of this reason, difference was noted in the knowledge and attitude of the students on this pandemic.
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Conflict of interest: None
Role of funding source: None
