Background: Coronavirus disease (COVID-19) pandemic has led to a deterioration in mental health, with increased levels of stress, anxiety and depression in the population [1]. There are different scales used for measured these symptoms. The Depression, Anxiety and Stress Scale-21 (DASS-21) is one of them, with strong psychometric properties [2,3] and it is validated in Spanish [4]. Due to the increase on mental health problems it is mandatory to look for new parameters that can be used on population as screening tool. Isolation and self-perceived mental health (SPMH) will be studied.
Aims: To study how Spanish lockdown affected mental health during COVID-19 pandemic. Besides, to study the potential of isolation and SPMH as screening tools in mental health symptoms during COVID-19 pandemic in comparison with DASS-21.
Methods: A retrospective observational study was designed using a Spanish telematic anonymous survey from 6th-22nd September 2020 (N=650), created with Google Forms platform. For SPMH, Likert-type scales were used (1-lowest to 10-highest) focusing on isolation, anxiety, stress and depression. As validated scale, DASS-21 was used. Both scales were used to study the items during Spanish lockdown period. Statistical significance was analysed using GraphPad Prism v.6. Receiver operating characteristic (ROC) curves were used, calculating the area under the curve (AUC).
Results: Participants were predominantly young (61.08%, 17-25 years) and female (78%). Based on intrinsic DASS-21 cut-offs, the sample was divided into control (mild or no symptom) and patient groups (moderate, high or extremely high symptom) for each item. DASS-21 showed a high prevalence of stress (50.92%), anxiety (46.31%) and depression (56.00%) symptoms. Regarding stress (9.5 cut-off), the sample was divided into controls (n=319) and patients (n=331). Higher levels of self-perceived stress were found in patient group (mean (M)=7.96±2.01) than in control group (M=5.46±2.54), being the comparison statistically significant (p<0.0001). Concerning anxiety (4.5 cut-off), higher levels of self-perceived anxiety were found in patients (n=301, M=7.65±2.24) than in controls (n=349, M=4.67±2.66), with a statistically significant comparison (p<0.0001). About depression (6.5 cut-off), self-perceived depression had higher levels in patients (n=364, M=6.21±2.58) than in controls (n=286, M=3.30±2.27), being the comparison statistically significant (p<0.0001). ROC curve analysis showed a high diagnostic capacity to differentiate between control and patient in stress (AUC=0.7822, 95% confidence interval (CI)=0.7471-0.8173, p<0.0001), anxiety (AUC=0.7992, IC=0.7653-0.8331, p<0.0001) and depression (AUC=0.7951, IC=0.7609-0.8293, p<0.0001).
Using bimodal DASS-21 (anxiety-depression) and their intrinsic cut-offs, the sample was divided into control (n=243) and patient group (n=407) for self-perceived isolation. The comparison exposed higher levels of self-perceived isolation in patients (M=7.47±2.06) than in controls (M=6.08±2.56), with statistical significance (p<0.0001). ROC curve analysis showed some diagnostic capacity to differentiate control and patient (AUC=0.6590; CI=0.6147-0.7033, p<0.0001).
Conclusions: DASS-21 scale showed high levels (moderate to extremely high) of stress, anxiety and depression during Spanish lockdown period. Self-perceived stress, anxiety and depression have the potential to be used as a mental health screening tool. Moreover, self-perceived isolation could be used to anxiety and depression symptoms. Altogether, SPMH has shown a good diagnostic capacity for mental health symptoms compared with DASS-21.
No conflict of interest
References
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