After ethical approval from Jinnah Medical and Dental College and Sohail University ethics committee, a cross-sectional study was conducted by a consecutive non-probability sampling technique. The sample size was calculated using Open Epi and a total of 443 samples were collected. The questionnaire was structured by using google forms web survey (Google LLC; Mountain View, CA, USA). The link to the questionnaire was sent out to the permanent resident of Karachi aged between 15–70 years by using social media like Facebook, Instagram, and WhatsApp. However, an electronic consent form was taken by the respondent before proceeding with the questionnaire. To maintain confidentiality the survey was kept anonymous and not attributable to the identity of the respondent. Once the participant clicked “submit” the response was automatically recorded and was not allowed to make any alterations to the recorded response.
The online questionnaires were designed according to standard scoring techniques. DASS-21 (Depression, Anxiety, and Stress Scale) was used for mental health assessment questionnaire that consist of 21 questions in a set of three self-report scales designed to measure 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 assessed dysphoria that is overall disappointment with life, feeling of themselves as useless, devaluation of life, self-depreciation, apathy, lack of attentiveness, dearth of general participation among people in normal daily activities, and not feeling of pleasure in pleasurable situations.
The anxiety scale assessed autonomic provocation, skeletal muscle effects, environmental anxiety, and particular feeling of apprehensive distress.
The stress scale is delicate related to stages of prolonged non-specific arousal. It assessed trouble in comforting, nervous provocation, and being certainly disappointed, disturbed, disconcerted, short-tempered, oversensitive and annoyed.
Scores for depression, anxiety and stress (DAAS) are calculated by summing the scores.
Hypothesis:
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The extension of national lockdown may have caused deleterious effects on one’s mental (health i.e. increased levels of stress, depression and anxiety) and physical health
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The female population was more prone to have mental health issues during the lockdown
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The male population was more likely to had negative impacts on their physical health during the lockdown
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Young adult population was more effected than old adult population.
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People who had children were less prone to negative mental health effects
General population with permanent residency in Karachi of age between 13–70 years and people who had access to online questionnaire were included in the study. While exclusion criteria were people who were not permanent residents of Karachi and those who do not have access to online questionnaire.
There were some limitations of the study that are; due to following standard operating procedure (SOPs) and taking preventions because of pandemic contagion COVID-19, the questionnaire was taken online and those participants who were not computer literate were not able participate in the study but a volunteer (who would be computer literate) were allowed to fill the questionnaire form in place of him/her under their presence.
Data analysis plan:
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Data was analyzed using SPSS Version 21.
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Mean ± SD were calculated for continuous variables.
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Frequency and proportions (%) were calculated for categorical variables.
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Mean scores (mean ± SD) were derived for three defined outcomes (depression, anxiety and stress) of DASS 21 scale.
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The independent t-test and ANOVA were used to assess the mean difference in mean scores of depression, anxiety and stress according to associated independent factors assessed in.
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For statistically significance, the p-value was kept at < 0.05.
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Bar graph/ pie chart were created for three separate scales of DASS 21 i.e. Depression, Anxiety and Stress according to age, gender, income and education where appropriate.
Sample size of your study
197 for 95% confidence
NOTE: Though our calculated sample size was 385 but we included 443 participants in this study.
The sample size for this research was calculated using open epi software. Using the given formula;
Sample size n = 443
Whereas confidence limit percentage selected was 5%, Hypothesized % frequency of outcome factor in the population was 50% and with a population sample of 20711000 (15).