INTRODUCTION:

Patients with COVID-19 diagnoses are treated under isolation in hospitals and with high-stress level. Currently, there is little information on the mental health implications of exposure amongst COVID-19 survivors and their family members. Research exploring the psychological impact amongst survivors of exposure to COVID-19 is desperately needed to understand the effects, mental health toll and support required in survivors of COVID-19 (Agnes Yuen-Kwan Lai, 2020).

A recent survey by the Indian Psychiatric Society indicated a twenty percent increase in mental illnesses in the country since the coronavirus outbreak.

Mental health interventions are urgently needed to minimize the psychological sequelae and provide timely care to affected individuals (Sophie Soklaridis, etal, 2020).

In contrast, few reports are available on mental health sequelae among COVID-19 survivors. Two reports from China (Yao et al., 2020; Zhu et al., 2020) and a recent correspondence in the Lancet (Yao et al., 2020) draws attention to the increased vulnerability for infection among those with pre-existing mental illness. Similarly, among the general population, documented factors responsible for mental health issues amidst the pandemic are mostly psychosocial in nature and include social isolation, loneliness, feelings of fear, helplessness as well as legitimate anxiety related to essential supplies, job security and concerns about contracting the virus (Armitage and Nellums, 2020; Brooks et al., 2020).

Psychological resilience in the face of the pandemic is related to modifiable factors (William D.S. Killgore, 2020). Hitherto paucity of nursing literatures abounded on intervention like resilience strategies on mental health sequelae among survivors of COVID-19, besides this study focus on hypothetical testing by examining the impact of resilience strategies on mental health sequelae among survivors of COVID-19.

METHODS:

After obtaining written informed consent, survivors of COVID-19 who fulfilled the inclusion criteria was recruited and enrolled in the study in selected community areas, Namakkal at India. The total sample size was 60 survivors of COVID-19. Study subjects were assigned randomly to either experimental arm (n=30) or control arm (n=30). Subjects were interviewed before intervention by assessing background variables. Mental Health Sequelae was measured by Clinically Administered PTSD Scale (CAPS) in experimental arm & control arm. Experimental arm received resilience strategies & control arm received standard methods of care. Resilience Strategies incorporates the focus on finding trustworthy and compassionate individuals who validate the feelings, which support the skill, capacity to recover from difficult life events.

Resilience strategies focused on five areas including:

· Optimism and effective coping styles

· Emotional awareness & clarity

· Sense of purpose

· Self-efficacy

· Supportive social network

The resilience strategies were rendered on weekly basis for 30 minutes for the period of 1 month. Posttest was conducted by using the same assessment techniques in experimental arm & control arm. Pretest, intervention & posttest were accomplished through electronic & telephone mode.

RESULTS:

Background variables of the survivors of COVID-19:

Majority of the subjects were above 55 years in experimental and control arm. Paramount of the subjects was male in both the arm. Subjects, besides the dietary pattern like vegetarian & non vegetarian were equivalently affected with COVID-19 in both the arms.

Frequency and percentage distribution of pre and posttest PTSD scores in experimental arm and control arm:

In pretest, experimental arm depicted 30% with mild level of PTSD and 70% of the subjects had moderate level of PTSD. Whereas, in posttest, 53% had mild level of PTSD and 47% of subjects showed moderate level of PTSD. In pretest, control arm delineated 37% with mild level of PTSD and 63% of the subjects had moderate level of PTSD. However, in posttest, 40% had mild level of PTSD and 60% of subjects portrayed moderate level of PTSD (Table 1).

Table 1: Frequency and Percentage distribution of pre and posttest mental health sequelae (PTSD) scores in experimental arm and control arm

Level of mental health sequelae (PTSD)	Experiential arm				Control arm
	Pretest		Posttest		Pretest		Posttest
	F	%	F	%	F	%	F	%
Mild / Subthreshold	9	30	16	53	11	37	12	40
Moderate / Threshold	21	70	14	47	19	63	18	60
Severe / Markedly elevated	-	-	-	-	-	-	-	-
Extreme / Incapacitating	-	-	-	-	-	-	-	-

N = 60 (n₁=30, n₂=30)

Table 2: Comparison of mean, Paired ‘t’ test & Unpaired ‘t’ test value with pre and posttest scores of Mental Health Sequelae (PTSD) between experimental and control arm

Variable	Arm	Mean±SE	Significance paired ‘t’ test		Significance unpaired ‘t’ test
			Experimental arm pre-posttest	Control arm pre-post test	Experimental arm posttest	Control arm posttest
Mental Health Sequelae (PTSD)	Experimental pretest	9.36 0.23	t= 8.85 P < 0.0001 S	t = 2.00 P > 0.05 NS	Mean=6.14	Mean=7.16
	Experimental posttest	6.14 0.22			t = 7.23 P < 0.0001 S
	Control pretest	8.16 0.25
	Control posttest	7.16 0.24

N = 60 (n₁=30, n₂=30)

Comparison of mean, Paired ‘t’ test & Unpaired ‘t’ test value with pre and posttest PTSD scores between experimental and control arm:

Comparison of the mean pretest PTSD scores in experimental arm showed 9.36 and posttest revealed 6.14. Likewise, comparison of the mean pretest PTSD scores in control arm reported 8.16 and posttest depicted 7.16 (Table 2). Equated paired t test value of PTSD scores presented in Table 2 evidenced statistical significance (t= 8.85) in experimental arm. Estimated Paired t test value of PTSD scores in the control arm showed not quite statistical significance (t = 2.00).

Unpaired t test value showed statistical significance (t=7.23). Based on posttest PTSD mean score (Mean= 6.14), experimental arm showed reduced PTSD symptoms compared with control arm posttest PTSD mean score (Mean=7.16) (Table 2).

DISCUSSION:

The study findings revealed that administration of resilience strategies were significant in reducing mental health sequelae among survivors of COVID-19. This result is consistent with coping and resilience to stress during pandemic that are protective factors and can mitigate the potential adverse psychological effects. The results show that nurses and physicians experienced higher levels of emergency stress than emergency workers (Tiziana Maiorano, 2020).

An article summarizes the available management strategies to increase resilience in healthcare workers during the COVID‐19 pandemic and beyond. There is more time and opportunity to be pro‐active in implementing measures to mitigate or minimize potential adverse psychological effects and improve, restore and preserve the well‐being of the workforce now and for years to come (C. Heath A. Sommerfield, 2020).

Psychological assistance services, including telephone, internet and application-based counseling or intervention, have been widely deployed by local and national mental health institutions in a response to the COVID-19 outbreak as the availability of transparent appropriate and timely information is vital for the emotional restraint of family members and for keeping the general population calm (Coalition for Disaster Resilient, 2020).

REFERENCES:

1. Agnes Yuen-Kwan Lai, 2020. The Psychological Impact of COVID-19 Outbreak on COVID-19 Survivors and Their Families. Clinical trials government.

2. Armitage R., Nellums L.B. COVID-19 and the consequences of isolating the elderly. Lancet Public Health. 2020.

3. Brooks S.K., Webster R.K., Smith L.E., Woodland L., Wessely S., Greenberg N., Rubin G.J. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020; 395:912–920.

4. Sophie Soklaridis, Elizabeth Lin, Yasmin Lalani, Terri Rodak, Sanjeev Sockalingam. Mental health interventions and supports during COVID- 19 and other medical pandemics: A rapid systematic review of the evidence. Gen Hosp Psychiatry. 2020 September-October; 66: 133–146.

5. William D.S. Killgore, Emily C. Taylor, Sara A. Cloonan, Natalie S. Dailey. Psychological resilience during the COVID-19 lockdown. Psychiatry Res. 2020 Sep; 291: 113216.

6. Tiziana Maiorano. COVID-19: Risk Factors and Protective Role of Resilience and Coping Strategies for Emergency Stress and Secondary Trauma in Medical Staff and Emergency Workers—An Online-Based Inquiry. Sustainability 2020, 12(21), 9004.

7. C. Heath A. Sommerfield. Resilience strategies to manage psychological distress among healthcare workers during the COVID‐19 pandemic: a narrative review. Anaesthesia 2020, 75, 1364–1371.

Received on 15.10.2022 Modified on 08.11.2022

Int. J. Nur. Edu. and Research. 2023; 11(1):27-29.

DOI: 10.52711/2454-2660.2023.00005