COVID-19 Mental Health Challenges: A Systematic Review, Logistic Regression and Principal Component Analysis

Background: World Health Organization (WHO)declaredCOVID-19 (SARS-COV2) viral infection as Pandemic on January 31, 2020. The virus is a highly transmittable and pathogenic, displaying primary symptoms of elevated temperature, cough, headache and to some extent loss of taste or smell. However, there are imperceptible psychological effects that are difficult to assess and cure than relevant physical indicators. COVID-19 Positive patients and Medical staff are at high risk to get affected psychologically. Therefore, the mental health status is required to be monitored on priority basis. This study aims to review, synthesize, and analyze published evidence on the prevalence of, anxiety, depression, and insomnia among patients, medical staff, and others (general population) during the COVID-19 outbreak. Method: Based on PRISM Statement systematic search and review of published data till May 2020 on SARS-COV2 related psychological factor analysis was carried out. Logistic regression and PCA was performed to assess the prevalence of specific psychological aspects related to the prevailing COVID-19 pandemic. Findings:


Introduction
COVID-19 or SARS-COV2is an infectious virus newly discovered in the coronavirus family. World Health Organization (WHO) declaredCOVID-19 (SARS-COV2) viral infection as Pandemic on January 31, 2020 [1]. The COVID-19 virus is mainly transmitted by coming in close proximity of a person who is COVID-19 positive. The virus spreads through droplets generated when a person coughs, sneezes, or exhales. To control the spread of viral infection around 4 billion i.e. half of the world population have been ordered by respective Governments to follow home confinement that is apparently the largest psychological experiment ever. Till date, Globally, there have been 4, 904, 413 confirmed cases of COVID-19, including 323,412 deaths, reported to WHO [1]. According to reported researched during epidemic and/or deadly illnesses there are enormous mental pressure on affected population. Social distancing, isolation, and fear of COVID-19, inadequate PPEs are making people vulnerable to mental health problems specifically on patients and frontline medical staff [2,3]. During quarantine, home confinement and while carrying out essential health care duties it's likely that one feels anxious, depressed and concurrently loses sleep [4]. Increased workload, physical exhaustion, inadequate and nosocomial transmission, fear of corona virus is supposed to elevate the most common emotion that is anxiety. Also, persons who had mental health history may face novel psychological challenges or their condition may worsen during Corona Quarantine. A dramatic decline in physical and mental well-being has also triggered some suicide cases related to COVID-19. Therefore, the Psychological support during COVID-19 Pandemic is vital towards enhancing resilience and good mental health. The aim this study is to carry out Review of COVID-19 related mental health issues among the affected population. We have compiled and evaluated data that gives evidence of psychological issues due to COVID in in order to analyse the prevalence of Anxiety, Depression and Insomnia among the affected population. The data analysis will help in crafting precautionary measures to mitigate the toxic mental health effects of COVID-19.

Study design
The study design was Systematic Review of published researched articles, extraction of data based on inclusion and exclu-sion criterion set and result interpretation after statistical analysis. The methodical literature review and selection criteria to extractCOVID-19 data was in accordance with the PRISMA statement depicted in Figure 1.

Data extraction
The psychological data of anxiety, depression, poor sleep, suicidal cases linked to the COVID-19 positive patients, Quarantine population, medical professionals and general population were extracted from published articles on PubMed, Google scholar, Research gate, ScienceDirect, MedRxiv sites [5][6][7][8][9][10][11][12][13]. Further the references from articles were used to increase data base. Only English Language articles were searched and retrieved. The few of the total reviewed journals are listed in Table 1.

Data synthesis and analysis
Microsoft Excel for Windows was utilized in the current study to synthesize and organise data. The data was arranged as Author, publication and year, sample population, evaluation test methods applied, sample size and sample characteristics, age and gender, statistical method applied for assessment, psychological parameters determined and result outcomes. Details are presented in Table 1. The primary psychological parameters retrieved were Anxiety, Depression, Insomnia, Distress ( Figure 1).

Results and Discussion
The statistics of the included sample in the study is shown in the descriptive statistics in Table 2. A total of n= 18,048 samples from the 8 studies where included in the analysis. All the studies reported the psychological factors like anxiety, depression, stress and insomnia in medical staff and general population during the COVID-19 pandemic. Some studies that were reviewed had also reported cases of PSTD, Suicide, fear and social connect factor related to lockdown. Out of 8 studies 6 was in mainland china and one was in Wuhan city and one was in Singapore (Figure 2).  The multiple linear regression analysis (Table 3) showed that sample type (β=-0.41, p<0.05), Sample number (β 0.61, p<0.01), age (β=-0.30, p<0.05), and gender/male (β =0.58, p<0.01) were associated with anxiety for COVID-19. As compared to anxiety, depression and stress affected people due to COVID-19 to a lesser degree. As can be seen from the present analysis that Anxiety, Depression, Stress and Insomnia, amongst other are critical psychological parameters that are affected during painful physical or mental conditions of COVID-19 Pandemic. These four primary parameters of current study that were critically affected during pandemic, were subjected to principal component analysis (PCA). The analysis method of PCA is a dimension reduction procedure by combining a large number of parameters into a smaller set of components based on their correlation or covariance. The PCA analysis was carried out using JASPv0.12.2 and its Scree plot is depicted in Figure 3. The Scree plot shows "elbow" at 2 components. Two principal components PC1 with eigenvalue (Ɛ=2.67) and PC2 having eigenvalue (Ɛ=1.11) were derived. The Path -Analysis plot of is presented in Figure 4. The loadings on the first component PC1 are all positive and loaded across three variables Anxiety, Depression and Insomnia. PC2 have positive and negative loading.

Conclusion
This review indicates that there are many psychological aspects that are affected during the prevailing pandemic which have been evaluated in recent studies. Data analysis reveals that there is considerable evidence to conclude that patients of COVID-19 and general population experienced anxiety and felt unsafe during corona virus pandemic peak period. The Principal Component Analysis allowed, critical Psychological parameters Anxiety, Depression, Stress and Insomnia to be condensed to two factors PC1 and PC2, for assessing COVID-19 mental health. Besides mental health parameters shooting up, there were confirmed cases of suicide under distress of Corona virus which presents an alarming situation. The present study recommends paying added attention towards the mental health of patients, frontline health care workers, in terms of providing good quality protection gears, psychological support and psychological prescription module as well as strong family supportduring and post theCOVID-19 epidemic.It also warrants appropriate professional counselling wherever necessary.