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ORIGINAL ARTICLE
Year : 2022  |  Volume : 66  |  Issue : 5  |  Page : 76-79  

Prevalence of obsessive–Compulsive symptoms and the level of fear due to COVID-19 pandemic among the undergraduate medical students in a tertiary care unit in Southern India


1 4th Year MBBS Scholar, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India
2 Assistant Professor, Department of Community Medicine, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India

Date of Submission08-Aug-2022
Date of Decision25-Aug-2022
Date of Acceptance25-Aug-2022
Date of Web Publication11-Nov-2022

Correspondence Address:
Avani Dinesh
Department of Community Medicine, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijph.ijph_1066_22

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   Abstract 


Background: The emergence of COVID-19 and its consequences is causing widespread fears, anxiety, and worries. To overcome the transmission of COVID-19, people resorted to compulsive behaviors. Objectives: The objectives of this study were to assess the prevalence of obsessive–compulsive symptoms (OCSs) due to COVID-19 pandemic, the prevalence of level of fear due to COVID-19 pandemic, and to assess the factors associated with OCSs due to COVID-19 pandemic among the undergraduate medical students of in tertiary unit in Southern India. Methods: The cross-sectional study was conducted in 250 undergraduate medical students (both MBBS and BDS, from 1st to 4th year) in the institute. Students who had consented in the study were included as study participants. The Yale–Brown Obsessive–Compulsive Scale and Fear of COVID-19 Scale (FCV-19 S) were used in assessing OCSs and the level of fear due to COVID-19. Chi-square test and multiple logistic regression were used to compute the factors associated with OCS. Results: The mean age of the respondents was 21 ± 1.313 years. The prevalence of OCS in undergraduate medical students was 36 (14.4%), and the level of FCV-19 was 107 (42.8%). Male students (17.8%, 44.2%) had higher OCSs and levels of fear as compared to female students (13.6%, 42.4%). Students with FCV-19 were three (adjusted odds ratio-3.418, 95% confidence interval-1.596, 7.319) times more likely to manifest OCSs while factors such as age, gender, and course were not significantly associated with OCS. Conclusion: Psychological counseling for undergraduate students should be pivotal, especially during pandemics and outbreaks.

Keywords: COVID-19, fear, obsessive–compulsive disorder, university


How to cite this article:
Arora A, Chauhan A, Dhonge SS, Pandey N, Dinesh A, OCS FEAR COVID TEAM. Prevalence of obsessive–Compulsive symptoms and the level of fear due to COVID-19 pandemic among the undergraduate medical students in a tertiary care unit in Southern India. Indian J Public Health 2022;66, Suppl S1:76-9

How to cite this URL:
Arora A, Chauhan A, Dhonge SS, Pandey N, Dinesh A, OCS FEAR COVID TEAM. Prevalence of obsessive–Compulsive symptoms and the level of fear due to COVID-19 pandemic among the undergraduate medical students in a tertiary care unit in Southern India. Indian J Public Health [serial online] 2022 [cited 2022 Dec 4];66, Suppl S1:76-9. Available from: https://www.ijph.in/text.asp?2022/66/5/76/360639

OCS FEAR COVID TEAM
Minu Maria Mathew
Biostatistician, Department of Community Medicine, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India

Aparna Ajay, Neeraj V Mohandas, Vineetha Vipin Chandran
Resident, Department of Community Medicine, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India





   Introduction Top


Severe acute respiratory syndrome coronavirus-2 primarily affects the upper and lower respiratory tracts, and the enteric, hepatic, and neurological systems.[1] The primary symptoms comprise severe dyspnea, hypoxemia, fever, sore throat, anosmia, dysgeusia, tachycardia, altered mental status, and functional alterations of organs in humans.[2] Droplet transmission occurs when a person is in close contact [within 1 m] in COVID-19, and to overcome this transmission of COVID-19, people resorted to compulsive behavior such as checking their body temperature repeatedly and refusing to leave home at all in fear of coming in contact with the virus. These actions are indicative of a disorder known as obsessive–compulsive disorder (OCD).[3] Individuals perform these compulsions in response to the distress associated with the content of the obsessions and in individuals experiencing OCD symptoms, the fear of negative episodes, obsessions, and compulsions can be considered stressors and this can be dealt using appropriate coping strategies.[1]

The lifetime prevalence for OCD has been observed worldwide as 2%–3%, and the subclinical obsessive–compulsive symptoms (OCSs), however, are more common and are experienced by over 20% within the general population. According to the International Classification of Disease (ICD-11) definition, obsessions are “thoughts, images, or impulses/urges,” and in Diagnostic and Statistical Manual of Mental Disorders-5 (DSM) 5, obsessions are addressed as “ideas, images, or urges”, and in the latest ICD-11 guidelines, obsessive–compulsive and related disorders are characterized by unwanted thoughts or preoccupations and related repetitive behaviors.[4],[5]

Fear of harboring COVID-19 is another salient problem, that is directly correlated with its transmission rate and mode of spread as well as its morbidity and mortality.[6] Apart from reducing the transmission rate, considering an individual's fear is a crucial aspect for their psychological and physical well-being and it may also, to a great extent, affect the manner, in which an individual may follow the preventive measures which thereby determine the clinical outcome of COVID-19.[7] As according to the latest ICD 11 guidelines,Anxiety and fear related disorders are non-specific physiological arousal with sympathetic autonomic activation and behavioural changes, to varying degrees.[4]

During the recent pandemic of COVID-19 infection globally, the general population and the frontline healthcare workers were vulnerable to emotional impact of the crisis. Medical students being closely associated with the frontline health care workers, were susceptible to experience the similar emotional trauma augmented further by future uncertainties and altered teaching and training programs.[8] Health-care students during disease outbreak times, experience a high risk of infection due to the higher risk of being exposed to virus during clinical training and hence, suffer a higher level of anxiety mostly because of the concern of being infected and infecting their family members and loved ones.[8],[9],[10]

To assess the severity of OCD symptoms, the Yale–Brown Obsessive–Compulsive Scale (Y-BOCS) is being widely used in research and clinical practice to determine severity, and for fear assessment, Fear of COVID-19 Scale (FCV-19 S), a seven-item unidimensional scale is used.[6]

In a prospective cohort study conducted in China on students of Xinxiang Medical University, 11.3% of participants scored ≥16 on the Y-BOCS (defined as possible OCD). These findings indicated that FCV-19 was associated with a greater Y-BOCS score, suggesting that an environment (COVID-19 pandemic) and psychology (fear and/or anxiety) interaction might be involved in OCD and that fear of negative events might play a pivotal role in the etiology of OCD.[1]

However, there is a lack of cross-sectional studies regarding the relationship between the onset of OCD and a fear of negative events during COVID-19 among university students. Henceforth, the study aims to assess the prevalence of OCSs due to COVID-19 pandemic, the prevalence of level of fear due to COVID-19 pandemic, and to assess the factors associated with OCS, due to COVID-19 pandemic among the undergraduate medical students of tertiary unit in Southern India.


   Materials and Methods Top


The cross-sectional study was conducted among 250 undergraduate medical students (MBBS and BDS, 1st year to 4th year) of tertiary unit in Southern India, who were 18 years and above. Institutional ethical committee clearance was obtained. (ECASM-AIMS-2022-029). The study participants included the students who had consented for the study voluntarily. Student's with previous diagnoses of psychiatric or psychological illness, especially OCD, were excluded from the study.

Sample size

Based on the prevalence of OCS, 11.3%[9] in university students, with a 95% confidence interval and 10% precision rate, the minimum calculated sample size was 38. Students who had voluntarily consented were included in the study, selected through convenience sampling and the anonymity was maintained throughout the study period, November 2021.

Data collection

Informed consent (in Google Forms) was obtained before the study onset, and the data collected was through online platforms (WhatsApp) as Google Form questionnaires and included sociodemographic details such as age gender, year, and course. Y-BOCS which is a gold standard 10-item rating scale was used to evaluate the OCS. The scale is divided into two subscales that separately measure obsessions and compulsions, and for each subscale, five aspects of obsessive and compulsive pathology are each rated on the scale ranging from 0 (no symptoms) to 4 (extreme symptoms). The maximum possible score is 40, and the minimum is 0. FCV-19 S 2020, (FCV-19), was used for the assessment of FCV-19. The participants indicate their level of agreement with the statements using a five-item Likert-type scale and the answers included “strongly disagree,” “disagree,” “neutral” “agree,” and “strongly agree.” The minimum score possible for each question is 1, and the maximum is 5. A total score could be calculated by adding up each item score (ranging from 7 to 35).

Statistical analysis

The data collected was then entered in Microsoft Excel, and analyzed using IBM, Statistical Package for Social Sciences for Windows Version 21 (IBM Corp ,Armonk ,N.Y,U.S.A). Descriptive statistics were used to describe the sociodemographic factors of the respondents, which included age, gender, course, and year. The prevalence of OCS and level of fear were computed separately. Chi-square Pearson test and multiple logistic regression were done to establish a relationship between OCSs and sociodemographic factors and the level of fear among the participants.


   Results Top


The mean age of the study participants was 21 ± 1.313 years, and the maximum age was 25 years. Male students included in the study were 52 (20.8%), whereas females were 198 (79.2%), and a majority of them, 211 (84.4%) were from MBBS course and 39 (15.6) were from BDS course. Of this, students who were in their 1st year of course was 70 (28%), in the 2nd year was 64 (25.6%), in the 3rd year was year 81 (32.4%), and in the 4th year was 35 (14%) [Table 1].
Table 1: Profile of study participants

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With the Y-BOCS scores obtained, OCSs were observed in 36 (14.4%) participants, while 214 (85.6%) of the study participants scored ≥16, indicative of the absence of OCS [Figure 1].
Figure 1: Severity of obsessive–compulsive symptoms YBOCS Scale. Y-BOCS: Yale–Brown Obsessive–Compulsive Scale.

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According to the FCV-19 S scores obtained, 143 (57%) of total participants scores implied that they had experienced lower FCV-19, whereas 107 (43%) participants scores revealed that they had experienced a higher FCV-19.

Using the Chisquare test, on assessing the factors associated with OCS, a significant association was noted between OCS and the FCV19 (0.002) .Here ,91.6% participants who had lower fear of Covid 19 & 77.6% of participants who had higher fear of Covid19 according to Fcv -19 S had no OC symptoms according to YBOCS S.Whereas,8.4% of study participants who had lower fear of Covid 19& 22.4% who had higher fear of Covid 19, according to FCV-19 S had OC symptoms according to YBOCS Scale. But no significant association was obtained for age, gender, and academic course with OCS [Table 2].
Table 2: Factors associated with obsessive-compulsive symptoms

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In multiple logistic regression, the independent determinant of OCS was the level of FCV-19. Those study participants who had a high level of FCV-19 (aOR3.418, 95% confidence interval-1.56–7.39) had an increased risk of OCSs. Whereas variables such as age, gender, and course of the participants were also assessed but were not found to be independent determinants of OCSs [Table 3].
Table 3: Independent determinants of obsessivecompulsive symptoms (n=250)

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   Discussion Top


The level of fear brought by the COVID-19 pandemic led to the development of exaggerated, unnecessary, and repetitive practices that prevent the transmission of COVID-19. These OCSs were associated with fear and anxiety.

According to this study, the prevalence of OCSs and the level of FCV-19 among undergraduate medical students were found to be 14.4% and 42.8% and was similar to a study conducted by Ji et al., among 13,478 university students in China with the prevalence rate of OCS as, 11.3%.[1]

In a study conducted among 418 medical students, the presence of symptoms of OCD for further evaluation was found to be in more than half of the study population (225, 53.8%). On the contrary in this study, it was observed in less than half of the study participants (7, 2.8%).[11]

Among males, 17.3% had a score >16 implying more OC symptoms as compared to only 13.6% of females, whereas in a study conducted on 711 Pakistani medical students, they found that the worsening of Y-BOCS score had a significant effect on the female gender (P = 0.02).[12] While in this study, when the fear due to COVID-19 was considered, it was found that 44.2% of males had a score of >14, implying more FCV-19 as compared to 42.4% of females and there was no significant association between fear in males and females. In another study conducted among 717 Iranian participants by Ahorsu et al., it was found that gender did not affect the response pattern of the fear.[6]

In a Turkish study conducted to assess the FCV-19 among medical students, females had a higher fear, i.e., (mean scores-females-18.33 and males-14.33), when compared to their male counterparts. However, in this study, it was observed that males (44.2%) had a slightly higher fear for COVID-19 as compared to females (42.4%).[13]

A study in college students in China, regression analysis it was reported that those with a higher intensity of fear, a higher anxiety level, of male gender, with siblings, had a greater chance of having a higher Y-BOCS score,[1] whereas in this study, a significant association was observed with OCS and FCV-19 (0.002), but not with age, gender, and course.


   Conclusion Top


Undergraduate medical students are at a greater risk for OCS as they are more trained and taught to deal with infectious diseases and their consequences, and henceforth, more social interaction of medical students with patients could also be one of the contributing factors to their increased OCS and FCV-19, to roll out awareness during the COVID-19 pandemic or any other outbreak is thus a key measure to break the chain of transmission and to address the associated psychological issues. However, there are a few limitations and one of these is about the diagnosis of OCD, as it was based only on self-reported responses, it could account for recall bias. Another limitation was the lack of similar studies for literature reference measuring both the OCS and level of fear among medical students conducted during the COVID-19 pandemic in the country.

Acknowledgment

Arathi Santhosh Nair, Swasti Goel, Shreya Raj, Heera Roshan, the Department of Community Medicine, Amrita Institute of Medical Sciences, faculties in the department Dr. Aswathy S, Dr. K. N. Panicker, Dr. Paul T Francis, Dr. Teena Mary Joy, Dr. Chitra Tomy, Dr. Sreelakshmi Mohandas, Ms Minu Maria, and also thank our principal Dr. Col. Vishal Marwaha. Our sincere gratitude to all the participants who cooperated with us by responding to our survey.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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Ji G, wei W, Yue KC, Li H, Shi LJ, Ma JD, et al. Effects of the COVID-19 pandemic on obsessive-compulsive symptoms among university students: Prospective cohort survey study. J Med Internet Res 2020;22:e21915.  Back to cited text no. 1
    
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Malik YS, Kumar N, Sircar S, Kaushik R, Bhat S, Dhama K, et al. Coronavirus disease pandemic (COVID-19): Challenges and a global perspective. Pathogens 2020;9:E519.  Back to cited text no. 2
    
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WHO Coronavirus [COVID-19] Dashboard e. Availablefrom: https://covid19.who.int. [Last accessed on 2022 Jul 19].  Back to cited text no. 3
    
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Reddy YJ, Simpson H, Stein D. Obsessive-compulsive and related disorders in international classification of Diseases-11 and its relation to international classification of diseases-10 and diagnostic and statistical manual of mental disorders-5. Indian J Soc Psychiatry 2018;34:34.  Back to cited text no. 5
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