Open Access Open Access  Restricted Access Subscription or Fee Access

Mental health concerns in outpatients during COVID-19 pandemic: Comparison between psychiatric and general hospital clinics in an Indian population

Nilamadhab Kar, MD, DPM, DNB, MRCPsych, Satyakam Mohapatra, MD, Tikina Behera, MBBS, Sujata Sahoo, MBBS


We intended to compare mental health concerns in patients attending a general hospital clinic with that of patients attending a psychiatric clinic during the coronavirus disease 2019 (COVID-19) pandemic. We specially wished to know about the perceived stress, worries, possibility of anxiety and depression, and the quality of life (QOL) of the patients. In a cross-sectional study, we used two screening questions for depression, Generalised Anxiety Disorder-2 (GAD-2) scale for anxiety, Perceived Stress Scale (PSS) for stress, nature and degree of worries in a 0–10 scale, and QOL in a 1–10 scale. Majority (75.5 percent) of outpatients had moderate to high level of stress, 76.5 percent were screen positive for depression, and 42 percent for anxiety. Psychiatric patients had significantly higher perceived stress, level of worry, and lower QOL to those with physical illness and were screen positive for depression (99 percent v 54 percent) and anxiety (68 percent v 16 percent), respectively. Patients with major physical illnesses had significantly higher stress levels and anxiety compared with those without. Fear of getting the infection, loss of job, and financial issues were the major worries along with social stigma. The results highlighted the need for screening mental health concerns in general hospital and psychiatric outpatients during the COVID-19 pandemic and facilitate appropriate interventions.


anxiety, COVID-19, depression, outpatient, physical illness, psychiatry, psychological stress

Full Text:



Yang X, Xiong Z, Li Z, et al.: Perceived psychological stress and associated factors in the early stages of the coronavirus disease 2019 (COVID-19) epidemic: Evidence from the general Chinese population. PLOS ONE. 2020; 15: e0243605. DOI:10.1371/journal.pone.0243605.

Zandifar A, Badrfam R, Yazdani S, et al.: Prevalence and severity of depression, anxiety, stress and perceived stress in hospitalized patients with COVID-19. J Diabetes Metab Disord. 2020; 19: 1431-1438. DOI:10.1007/s40200-020-00667-1.

Das A, Sil A, Jaiswal S, et al.: A study to evaluate depression and perceived stress among frontline Indian doctors combating the COVID-19 pandemic. Prim Care Companion CNS Disord. 22. Epub ahead of print October 8, 2020. DOI:10.4088/PCC.20m02716.

Jia R, Ayling K, Chalder T, et al.: Mental health in the UK during the COVID-19 pandemic: Cross-sectional analyses from a community cohort study. BMJ Open. 2020; 10: e040620. DOI:10.1136/bmjopen-2020-040620.

Kar N, Kar B, Kar S: Stress and coping during COVID-19 pandemic: Result of an online survey. Psychiatry Res. 2021; 295: 113598. DOI:10.1016/j.psychres.2020.113598.

Vindegaard N, Benros ME: COVID-19 pandemic and mental health consequences: Systematic review of the current evidence. Brain Behav Immun. 2020; 89: 531-542. DOI:10.1016/j.bbi.2020.05.048.

Sønderskov KM, Dinesen PT, Santini ZI, et al.: The depressive state of Denmark during the COVID-19 pandemic. Acta Neuropsychiatr. 2020; 32: 226-228. DOI:10.1017/neu.2020.15.

Amerio A, Bianchi D, Santi F, et al.: Covid-19 pandemic impact on mental health: A web-based cross-sectional survey on a sample of Italian general practitioners. Acta Biomed. 2020; 91: 83-88. DOI:10.23750/abm.v91i2.9619.

Sharma R, Sharma SC, Sharma P, et al.: Effect of lockdown on mental health during the COVID-19 pandemic among individuals attending services at a tertiary care center. Indian J Psychiatry. 2020; 62: S431-S437. DOI:10.4103/psychiatry.IndianJPsychiatry_1038_20.

NICE: Depression in adults: Recognition and management | Guidance |. Available at 2009. Accessed December 13, 2020.

Arroll B, Khin N, Kerse N: Screening for depression in primary care with two verbally asked questions: Cross sectional study. BMJ. 2003; 327: 1144-1146. DOI:10.1136/bmj.327.7424.1144.

Kroenke K, Spitzer RL, Williams JBW, et al.: Anxiety disorders in primary care: Prevalence, impairment, comorbidity, and detection. Ann Intern Med. 2007; 146: 317-325. DOI:10.7326/0003-4819-146-5-200703060-00004.

Cohen S, Kamarck T, Mermelstein R: A global measure of perceived stress. J Health Soc Behav. 1983; 24: 385-396. DOI:10.2307/2136404.

Quittkat HL, Düsing R, Holtmann F-J, et al.: Perceived impact of COVID-19 across different mental disorders: A study on disorder-specific symptoms, psychosocial stress and behavior. Front Psychol. 11. Epub ahead of print 2020. DOI:10.3389/fpsyg.2020.586246.

Pedrozo-Pupo JC, Campo-Arias A: Depression, perceived stress related to COVID, post-traumatic stress, and insomnia among asthma and COPD patients during the COVID-19 pandemic. Chron Respir Dis. 17. Epub ahead of print October 1, 2020. DOI:10.1177/1479973120962800.

Muruganandam P, Neelamegam S, Menon V, et al.: COVID-19 and severe mental illness: Impact on patients and its relation with their awareness about COVID-19. Psychiatry Res. 2020; 291: 113265. DOI:10.1016/j.psychres.2020.113265.

Ghosh A, Nundy S, Mallick TK: How India is dealing with COVID-19 pandemic. Sens Int. 2020; 1: 100021. DOI:10.1016/j.sintl.2020.100021.

Kar N, Kar B: Growing social stigma alongside COVID-19 pandemic: Signs of a major concern. J Geriatr Care. Res 2020; 7: 49-50.

Mazza MG, De Lorenzo R, Conte C, et al.: Anxiety and depression in COVID-19 survivors: Role of inflammatory and clinical predictors. Brain Behav Immun. 2020; 89: 594-600. DOI:10.1016/j.bbi.2020.07.037.

Spoorthy MS, Pratapa SK, Mahant S: Mental health problems faced by healthcare workers due to the COVID-19 pandemic–A review. Asian J Psychiatr. 2020; 51: 102119. DOI:10.1016/j.ajp.2020.102119.

Taquet M, Luciano S, Geddes JR, et al.: Bidirectional associations between COVID-19 and psychiatric disorder: Retrospective cohort studies of 62 354 COVID-19 cases in the USA. Lancet Psychiatry. 2021; 8: 130-140. DOI:10.1016/S2215-0366(20)30462-4.

Gentile A, Torales J, O’Higgins M, et al.: Phone-based outpatients’ follow-up in mental health centers during the COVID-19 quarantine. Int J Soc Psychiatry. Epub ahead of print December 9, 2020. DOI:10.1177/0020764020979732.

Romito F, Dellino M, Loseto G, et al.: Psychological distress in outpatients with lymphoma during the COVID-19 pandemic. Front Oncol. 10. Epub ahead of print July 10, 2020. DOI:10.3389/fonc.2020.01270.



  • There are currently no refbacks.

Copyright (c) 2022 Journal of Emergency Management