Socio-demographic profile and the clinical characteristics of the participants
The socio-demographic profile and the clinical characteristics of the respondents have been presented in Table 1a. 76% (2449), 16% (524) and 7% (241) respondents were within the ‘11–40’, ‘40–60’ and ‘above 60’ age ranges, respectively. Among all respondents, 58.5% (1,880) were male and 41.5% (1,333) were female. 61.3% and 37.8% of participants live in urban versus rural setting, respectively. The vocational characteristics included 46.4% (1,491) students, 34.9% (1,122) employed individual, 14.4% (462) private business and 4.3% (138) retirees. Among all the participants 31.3 % (1,006) were familiar with the word “Quarantine”. 89.1% (2,863) respondents thought that quarantine could be one of the promising ways to fight against COVID-19 and 61.3% (1970) respondents agreed that quarantine might increase the social communication gap. Out of 3,214 respondents, 25.6% (823), 20.1% (643) and 51.4% (1652) reported anger, fear and anxiety & depression, respectively. 59.9% (1,925) of respondents reported having trouble in decision making during quarantine and 58.6% (1,883) of respondents were fearful about the risks associated with returning to normal life after quarantine. 82.8% (2,661) of respondents thought that quarantine hampered their daily activities, whilst 62.4% (2006) reported having difficulty sleeping and 76.9% (2,472) reported experiencing mental symptoms during the social isolation period.
Table 1a
Socio-demographic and clinical characteristics of the sample (N = 3214).
Age groups
11-20 – 6.8 %
21-30 – 54.4 %
31-40 – 15.1 %
41-50 – 6.9 %
51-60 – 9.3 %
61-70 – 5.6 %
Above 70 – 1.3 %
Gender
Female – 41.5 %
Occupation
Student – 46.4 %
Service holder – 34.9 %
Business – 14.4 %
Retired – 4.3 %
Familiar with word ‘Quarantine’ – 31.3 %
Think that quarantine can help to fight against COVID-19 – 89.1 %
Think that quarantine is increasing the social communication gap – 61.3 %
Problem commonly being faced during Quarantine
Anger and mood swing – 25.6 %
Fear or Panic – 20.1 %
Anxiety and Depression – 51.4 %
Health related risk
Diabetes – 7.6 %
Respiratory dysfunction – 4.3 %
Kidney disorder – 1.6 %
Mental disorder – 7.0 %
Hypertension – 16 %
None – 62.5 %
Working from home in quarantine – 51.3 %
Problems in decision making in quarantine – 59.9 %
Can easily come back to the normal life after Quarantine – 58.6 %
Think that quarantine time should be extended – 66.7 %
Think that quarantine life hampers daily life – 82.8 %
Facing insomnia (sleep disorder) during Quarantine – 62.4 %
Mental stress during Quarantine – 76.9 %
Location
Inside Dhaka – 61.3 %
Outside Dhaka – 37.8 %
|
Social Isolation and Insomnia
Out of three groups, insomnia was reported by 61% (1487), 66% (345) and 79% (172) of children/young adults, middle age and older adult groups, respectively (Fig. 1A). The more frequent reporting insomnia is significantly correlated with older age (χ2 = 29.7; p = 3.88 X 10− 6; odds ratio (OR) = 2.34) (Table 1b) who suffered insomnia 2.3 times higher compared to the children/young adult group. Due to theknown association between insomnia and mental symptoms(25, 26), we studied the prevalence of mental symptoms in the three age groups and observed 77% (1882/2440), 84% (434/517) and 70% (154/218) of children/young adults, middle age and older adult groups, respectively, reported experiencing mental wellbeing due to social isolation (Fig. 1A-B). A significant (χ2 = 18.4; p = 0.001) increase (1.5 times) of mental wellbeing was observed in middle age participants compared to the children/young age group. A similar age-related i trend was observed between the groups in experiencing difficulties in decision making in their daily activities (Fig. 1C).
Table 1b
Age-dependent and gender-dependent association study data.
Category
|
Question addressed
|
Age-dependent
|
Gender-dependent
|
|
|
Corrected (Bonferroni) p-value
|
X2 value
|
Corrected (Bonferroni) p- value
|
X2 value
|
MENTAL STRESS
|
Do you find any problems in decision and thinking during Quarantine?
|
1
|
1.29
|
0.23474
|
5.30
|
Do you face insomnia (sleep disorder) during Quarantine life?
|
3.88 X 10-06
|
29.71
|
1
|
1.76
|
Do you face mental stress during Quarantine life?
|
0.0011
|
18.40
|
0.98758
|
2.87
|
VIEW POINT
|
Do you think that Quarantine can help to fight against COVID-19?
|
5.90 X 10-101
|
466.36
|
1
|
1.22
|
Do you think that Quarantine increases the social communication gap?
|
0.014
|
13.31
|
1
|
1.95
|
Do you think you can easily come back to the normal life after Quarantine?
|
1.23 X 10-12
|
59.64
|
1
|
0.01
|
Do you think Quarantine time should be extended?
|
5.33 X 10-19
|
88.94
|
0.089
|
7.00
|
Do you think quarantine life hampers your daily life?
|
1.29 X 10-07
|
36.52
|
6.00 X 10-06
|
25.09
|
KNOWLEDGE
|
Have you been familiar with the word ‘Quarantine’ previously?
|
2.50 X 10-18
|
85.85
|
0.002
|
13.60
|
X2- analysis was used to calculated the p-values for the highest and the lowest number of respondents witnessed among the three groups – Children & young adults, middle aged and old respondents in case of age-dependent data analysis and distribution between male and female respondents in case of gender-dependent data. The p-values were corrected using the Bonferroni correction method. |
We next categorized the self-reported mental distress into three symptom clusters, a) anger and irritability, b) anxiety and depression and c) fear and panic. Children/young age group reported (29%) experiencing the most anger and irritability compared to other age groups (18% and 7% for middle age and older adult groups, respectively) (Fig. 2). The older age group reported (62%) experiencing the highest rates of anxiety and depression compared to the other age groups (51% and 50% for children/young adult and middle age group, respectively). Finally, the middle age group reported (30%) experiencing the highest rate of fear and panic compared to the other age groups ( 17% and 29% for children/young and older adult group, respectively) (Fig. 2).
Regarding comorbidities, 77% participants reported no comorbidities, whereas 8%, 16%, 2%, 7%, and 4% participants have diabetes, hypertension, renal impairments, mental health symptoms (fear or panic disorder), and respiratory dysfunction, respectively (Table 1a; Supplementary Fig. 1–2). Among the comorbid condition participants, 80% (191/239) with diabetes, 87% (442/510) with hypertension, 88% (46/52) with renal impairments, 78% (108/138) people with respiratory dysfunction reported mental wellbeing during this COVID-19 related social isolation (Supplementary Fig. 2). Mental stress is significant high (χ2 = 56.51; p = 5.08 X 10− 27) in participants with any kind of disorder in comparison with the control group (absence of disorders) (Supplementary Fig. 2). People with any kind of health related risk reported 2 times higher (OR 2.06) mental wellbeing than the control group.
We next examined the occurrence of insomnia in relation to vocation. We found that retired individuals reported higher rates of insomnia (72%) compared to students or those in active employment (Supplementary Fig. 3). (χ2 = 36.17; p = 2.79 X 10− 8). The prevalence of mental health symptoms was higher among the participants who ran businesses (χ2 = 11.67; p = 0.005) compared with other groups (Supplementary Fig. 3–4). Prevalence of insomnia among different income groups suggests a correlation between income level and insomnia (Supplementary Fig. 5–6). We also observed participants who live in an urban setting reported a significantly (χ2 = 21.623; p = 0.000006) higher incidence of insomnia compared to their rural counterparts. Additionally, mental symptoms were 1.30 times higher among those living in Dhaka. Next, we analyzed the sleeping time duration among in different aged groups. Consistent with our insomnia association, old adult group showed a reducedsleep duration (3–4 hours) compared to other groups (χ2 = 392.7; p = 3.7016 X 10− 77) (Supplementary Fig. 9).
Correlation of Age with the COVID-19 Social Isolation
We asked respondants whether they felt that social isolation was a helpful strategy to protect against COVID-19 transmission (Fig. 3 and Table 1b). 93% (2,277/2,443) of children/young adults, 88% (456/520) of middle aged and 46% (100/219) old adult respondents agreed with the social isolation strategy (Fig. 3A). In comparison between the three groups the older adult participants showed (16.3 times) a more negative perception regarding social isolation strategy. The same group of participants were less favorable of social isolation and more fearful of coming back to normal life. In contrast children/young adults were the most enthusiastic (63%) regarding going back to normal life as well as being equally comfortable extending (72%) the social isolation if required (Fig. 3D-E). Finally, the children/young aged group were also the most knowledgeable regarding the COVID-19 policies.
Gender association with COVID-19 related social isolation
On the whole there were no gender differences across all questionnaire items, with the exception of daily living impact (χ2 = 25.095; p = 5.4 X 10− 07) (Fig. 4 and Supplementary Fig. 10) indicating that perception about daily life along with quarantine might gender wise.