Globally, COVID-19 pandemic has a significant impact on mental health. In Nepal, COVID-19 positive cases have to self-isolate at home in multi-generational and multi-family households. This could be strongly associated with depression, anxiety, and stress-related health outcomes. Additionally, COVID-19 related stigma and fear of transmission may intensify depression, anxiety, and stress symptoms. This study determined the prevalence of depression, anxiety, and stress symptoms and their association with presence of COVID-19 symptoms and comorbid conditions among home isolated COVID-19 positives in the Karnali province, Nepal.
We conducted a cross-sectional study to assess depression, anxiety, and stress symptoms among 402 home isolated COVID-19 patients of Karnali province from January to May 2021 using “Depression, Anxiety and Stress Scale-21 (DASS-21)”. We interviewed patients to collect socio-demographic, DASS-21, COVID-19 symptoms, comorbid conditions, and self-treatment. We conducted a telephonic interview using a standardized questionnaire using Kobotoolbox. We calculated the prevalence of depression, anxiety, and stress symptoms. We utilized univariate and multivariate logistic regression to determine their association with the presence of COVID-19 symptoms and comorbid conditions. In multivariate logistic regression, we adjusted sociodemographic factors (age, gender, ethnicity, marital status, monthly family income, education level), smoking status and history of self-treatment. We reported adjusted odds ratios (aOR) with 95% confidence intervals. All analyses were conducted in R (version: 4.0.3).
The prevalence of depression, anxiety and stress symptoms among home isolated COVID-19 patients were 8.0% (95% CI: 5.5 to 11.1), 11.2% (95% CI: 8.3 to 14.7), and 4.0% (95% CI: 2.3 to 6.4) respectively. Higher odds of depression symptoms (aOR: 2.79; 95% CI: 1.08–7.20, p = 0.03), anxiety symptoms (aOR: 3.65; 95% CI: 1.57 to 8.52; p = 0.003) and stress symptoms (aOR: 7.41; 95% CI: 1.37 to 39.94; p = 0.02) were associated significantly with presence of COVID-19 symptoms in past week. Higher odds of anxiety symptoms were associated with the presence of comorbid conditions (aOR = 2.79; 95% CI: 1.05 to 7.44; p = 0.04).
Depression, anxiety, and stress symptoms were present in a significant proportion of home isolated COVID-19 patients in western Nepal and positively associated with the presence of COVID-19 symptoms. In this global COVID-19 pandemic, it is important to provide timely counseling to high-risk groups like those with comorbidities and COVID-19 symptoms to maintain a high level of mental health among home isolated COVID-19 patients.
There is growing evidence that the current COVID-19 pandemic is causing severe mental health effects on people globally [, , , ]. Studies conducted globally found a positive association between mental health with the presence of COVID-19 symptoms  and comorbid status . The COVID-19 pandemic spread throughout the globe, it instilled significant fear, worry, and concern in the general public, as well as in specific groups such as older individuals, caregivers, and those with underlying health issues . The COVID-19 pandemic is likely to exacerbate social isolation and loneliness which are strongly associated with anxiety, depression, self-harm, and suicide attempts across the lifespan [, , ]. The misinformation from the media, lack of knowledge on COVID-19, lack of effective treatments, and significant economic losses may have resulted in higher levels of depression, anxiety, and stress during the COVID-19 pandemic [11,12]. Anxiety and depression might also be triggered by COVID-19 symptoms such as fever and shortness of breath . Psychological trauma could result in a mixture of emotional surges like nightmares, self-blame, and experiencing recurrent thoughts of trauma . COVID-19 has the potential to cause mental health crises with long-term consequences, particularly in Nepal .
The prevalence of depression symptoms, anxiety symptoms, and stress among home isolated COVID-19 patients of Karnali province were common. They were positively associated with the presence of COVID-19 symptoms whereas anxiety symptoms with comorbid status. One key implication of this study is that, in this global COVID-19 pandemic, Nepal government should provide timely counseling and psychological support to those who are already affected with depression symptoms, anxiety symptoms and stress; and those under high-risk like those with comorbidities and COVID-19 symptoms to maintain a high level of mental health among home isolated COVID-19 patients.