Prevalence and determinants of anxiety and depression among individuals admitted with covid-19 infection in a tertiary level hospital


  • Christina George Professor and Head, DR SMCSI Medical College, Karakkonam
  • Sreejith Cheruvilakam Senior Resident, Department of Psychiatry, DR SMCSI Medical College, Karakkonam
  • Anu Franco Junior Resident, Department of Psychiatry, DR SMCSI Medical College, Karakkonam
  • Dyuthi Neeraj Junior Resident, Department of Psychiatry, DR SMCSI Medical College, Karakkonam
  • Sam Tom Stephen Senior Resident, Department of Psychiatry, DR SMCSI Medical College, Karakkonam
  • P S Shiburaj Assistant Professor, Department of Medicine, DR SMCSI Medical College, Karakkonam



COVID-19, anxiety, depression, determinants


Background: The COVID 19 pandemic is associated with mental health concerns such as anxiety and depression at multiple levels and has recently been postulated to be linked to the long COVID syndrome. Objectives: To determine the prevalence and factors associated with depression and anxiety in individuals admitted with COVID-19 infection. Methods: 154 individuals admitted with COVID-19 infection were screened for depression and anxiety employing PHQ9 and GAD 7, respectively. Trained interns did the screening on consecutively admitted patients. Results: The proportion of depression and anxiety was 26.6%(n=41) and 20.1%(n=31), respectively. Moderate and above symptoms were present in 3.9% of the individuals(n=6) on both scales. Older age (t=2.124, p=.035), lower educational status (t=3.725, p=0.000), a family member losing their job during the pandemic (t=1.91, p=0.05), presence of fever (t=2.069, p=0.040), oxygen therapy (t=2.19, p=0.030) and treatment with hydroxychloroquine (t=2.122, p=0.035) were found to be significantly associated with high depression scores. Being less educated (t=3.594,p=0.000), admission under non-paying status (t=2.209, p=0.029), a family member losing their job during the COVID pandemic (t=1.946, p=0.05), presence of non-productive cough (t=1.940, p=0.05), fatigue (t=2.418, p=0.017)), myalgia (t=2.015, p=0.046), having Diabetes Mellitus (t=2.151, p=0.033) and requiring oxygen therapy (t=2.030, p=0.040) were significant risk factors for higher anxiety scores.  Conclusions: The feasibility of screening for depression and anxiety by non-mental health professionals in poorly technology-enabled moderately ill inpatient populations within LAMIC settings have been demonstrated. Psychosocial disadvantage and indicators of relatively severe covid infection seem to be risk factors for depression and anxiety. A system for screening for these disorders employing feasible strategies should ideally be incorporated to mitigate both short term and long-term negative consequences of this pandemic, particularly in inpatient populations, who are already subject to various vulnerabilities.


Thankappan KR. Combating corona virus disease 2019 and comorbidities: The Kerala experience for the first 100 days. International Journal of Noncommunicable Diseases. 2020 Apr 1;5(2):36.

Poonia N, Azad S. Short-term forecasts of COVID-19 spread across Indian states until 1 May 2020 [Internet]. [cited 2021 Jun 14]. Available from:

Tang F, Liang J, Zhang H, Kelifa MM, He Q, Wang P. COVID-19 related depression and anxiety among quarantined respondents. Psychol Heal. 2021;36(2):164–78.

Twenge JM, Joiner TE. U.S. Census Bureau-assessed prevalence of anxiety and depressive symptoms in 2019 and during the 2020 COVID-19 pandemic. Depress Anxiety. 2020 Oct 1;37(10):954–6.

Grover S, Sahoo S, Mehra A, Avasthi A, Tripathi A, Subramanyan A, Pattojoshi A, Rao GP, Saha G, Mishra KK, Chakraborty K. Psychological impact of COVID-19 lockdown: An online survey from India. Indian Journal of Psychiatry. 2020 Jul;62(4):354.

Verma S, Mishra A. Depression, anxiety, and stress and socio-demographic correlates among general Indian public during COVID-19. International Journal of Social Psychiatry. 2020 Dec;66(8):756-62.

Spoorthy MS, Pratapa SK, Mahant S. Mental health problems faced by healthcare workers due to the COVID-19 pandemic–A review. Asian journal of psychiatry. 2020 Jun 1; 51:102119.

Du J, Dong LU, Wang T, Yuan C, Fu R, Zhang L, Liu B, Zhang M, Yin Y, Qin J, Bouey J. Psychological symptoms among frontline healthcare workers during COVID-19 outbreak in Wuhan. General hospital psychiatry. 2020 Nov; 67:144.

Mazza MG, De Lorenzo R, Conte C, Poletti S, Vai B, Bollettini I, Melloni EM, Furlan R, Ciceri F, Rovere-Querini P, Benedetti F. Anxiety and depression in COVID-19 survivors: Role of inflammatory and clinical predictors. Brain, behavior, and immunity. 2020 Oct 1; 89:594-600.

Nie XD, Wang Q, Wang MN, Zhao S, Liu L, Zhu YL, et al. Anxiety and depression and its correlates in patients with coronavirus disease 2019 in Wuhan. Int J Psychiatry Clin Pract. 2020;1–6.

Özdin S. Bayrak-Özdin, ?. (2020). Levels and predictors of anxiety, depression and health anxiety during COVID-19 pandemic in Turkish society: The importance of gender. The International Journal of Social Psychiatry.;66(5):504-11.

Nalleballe K, Onteddu SR, Sharma R, Dandu V, Brown A, Jasti M, Yadala S, Veerapaneni K, Siddamreddy S, Avula A, Kapoor N. Spectrum of neuropsychiatric manifestations in COVID-19. Brain, behavior, and immunity. 2020 Aug 1; 88:71-4.

Troyer EA, Kohn JN, Hong S. Are we facing a crashing wave of neuropsychiatric sequelae of COVID-19? Neuropsychiatric symptoms and potential immunologic mechanisms. Brain, behavior, and immunity. 2020 Jul 1; 87:34-9.

Varatharaj A, Thomas N, Ellul MA, Davies NW, Pollak TA, Tenorio EL, Sultan M, Easton A, Breen G, Zandi M, Coles JP. Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study. The Lancet Psychiatry. 2020 Oct 1;7(10):875-82.

SJ Y. Long COVID or post-COVID-19 syndrome: putative pathophysiology, risk factors, and treatments. Infect Dis (London, England) [Internet]. 2021 [cited 2021 Jul 21]; Available from:

Dai LL, Wang X, Jiang TC, Li PF, Wang Y, Wu SJ, et al. Anxiety and depressive symptoms among COVID-19 patients in Jianghan Fangcang Shelter Hospital in Wuhan, China. PLoS One. 2020 Aug 1;15(8 august).

Indu PS, Anilkumar TV, Vijayakumar K, Kumar KA, Sarma PS, Remadevi S, et al. Reliability and validity of PHQ-9 when administered by health workers for depression screening among women in primary care. Asian J Psychiatr. 2018 Oct 1; 37:10–4.

Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.

Jyothi Kantipudi S, Kannan GK, Viswanathan S, Ranganathan S, Menon J, Ramanathan S. Antenatal Depression and Generalized Anxiety Disorder in a Tertiary Hospital in South India. Indian J Psychol Med [Internet]. 2020 Nov 1 [cited 2021 Dec 28];42(6):513–8. Available from:

Verma M, Grover S, Tripathy JP, Singh T, Nagaraja SB, Kathirvel S, et al. Co-existing Non-communicable Diseases and Mental Illnesses Amongst the Elderly in Punjab, India. Eur Endocrinol [Internet]. 2019 Aug 16 [cited 2021 Dec 28];15(2):106–12. Available from:

Obbarius A, van Maasakkers L, Baer L, Clark DM, Crocker AG, de Beurs E, et al. Standardization of health outcomes assessment for depression and anxiety: recommendations from the ICHOM Depression and Anxiety Working Group. Qual Life Res. 2017 Dec 1;26(12):3211–25.

Patel V, Weobong B, Weiss HA, Anand A, Bhat B, Katti B, Dimidjian S, Araya R, Hollon SD, King M, Vijayakumar L. The Healthy Activity Program (HAP), a lay counsellor-delivered brief psychological treatment for severe depression, in primary care in India: a randomised controlled trial. The Lancet. 2017 Jan 14;389(10065):176-85.

Kong X, Zheng K, Tang M, Kong F, Zhou J, Diao L, et al. Prevalence and Factors Associated with Depression and Anxiety of Hospitalized Patients with COVID-19. [Internet]. [cited 2021 Jun 13]; Available from:

Jain VK, Iyengar KP, Vaishya R. Differences between First wave and Second wave of COVID-19 in India. Diabetes & metabolic syndrome. 2021 May 8.

Lessons from the ‘first wave’ - Frontline [Internet]. [cited 2021 Jun 17]. Available from:

Kang E, Lee SY, Kim MS, Jung H, Kim KH, Kim

K-N, et al. The Psychological Burden of COVID-19 Stigma: Evaluation of the Mental Health of Isolated Mild Condition COVID-19 Patients. J Korean Med Sci. 2021 Jan 12;36(3): e33.

Chetterje P. Gaps in India's preparedness for COVID-19 control. The Lancet Infectious Diseases. 2020 May 1;20(5):544.

Kar SK, Ransing R, Arafat SMY, Menon V. Second wave of COVID-19 pandemic in India: Barriers to effective governmental response. eClinicalMedicine [Internet]. 2021 [cited 2021 Jun 18]; 36:100915. Available from:

Milanovi? SM, Erjavec K, Polji?anin T, Vrabec B, Bre?i? P. PREVALENCE OF DEPRESSION SYMPTOMS AND ASSOCIATED SOCIO-DEMOGRAPHIC FACTORS IN PRIMARY HEALTH CARE PATIENTS [Internet]. Vol. 27, Psychiatria Danubina. 2015 [cited 2021 Jun 17]. Available from:

An issue of lives versus livelihoods - The Hindu [Internet]. [cited 2021 Jun 15]. Available from:

Rebooting Economy XXX: Rural India in far deeper crisis than what govt data claims – Business Today [Internet]. [cited 2022 Feb 7]. Available from: economy-economic-pain-in-rural-india-deeper-than-q1-fy21-data-govt-claim-273802-2020-09-23

Putri DU, Tsai YS, Chen JH, Tsai CW, Ou CY, Chang CR, Chen HC, Lu ML, Yu MC, Lee CH. Psychological distress assessment among patients with suspected and confirmed COVID-19: A cohort study. Journal of the Formosan Medical Association. 2021 Aug 1;120(8):1602-10.

Weissman MM, Klerman GL. Sex Differences and the Epidemiology of Depression. Arch Gen Psychiatry. 1977;34(1):98–111.




How to Cite

George, C., Cheruvilakam, S., Franco, A., Neeraj, D., Stephen, S. T. ., & Shiburaj, P. S. (2022). Prevalence and determinants of anxiety and depression among individuals admitted with covid-19 infection in a tertiary level hospital. Kerala Journal of Psychiatry, 35(1), 30–38.



Research Report