Stress refers to an individual's process of adjustment once faced with external or internal challenges [1]. It can be boiled down to the relationship between an individual and the stimulus-providing environment. As the human body is designed to resist changes and challenges (the Stressors), it yearns for homeostasis via physical and mental responses. But constant and chronic stress can adversely affect both physical and mental well-being [2-3].

Perceived stress can be viewed as the outcome of transactional interaction between the person and his environment. In other words, cognitive appraisal or subjective evaluation of an individuals’ environment has been postulated to be the key process to the stress outcome(s) rather than the single occurrence of an event [4-5].

Taking the COVID 19 pandemic as an example, the psychological strain on the Indian population was no different from the world, but the visibly added burden on the medical system instilled the fear of infection in them along with the fear of infecting your kin (especially in the healthcare workers). The factors like restriction of mobility due to prolonged confinement, difficulties in obtaining daily-life necessary supplies, potential financial losses and access to conflicting and inadequate information on the Internet acts as a psychosocial stressor [6].

Perceived Stress Scale (PSS) which was developed by Cohen, Kamarck and Mermelstein [7] is one of the most widely used tools to measure psychological stress in the world. Instead of focusing on a particular event, the PSS appraises the extent that the participants feel unpredictable, uncontrollable or overloaded in their lives [8].

The present study aims to assess the perceived stress score in the sample population of Himachal Pradesh to highlight the need for prompt destressing modalities in public at large.

Objective of the Study

To assess the perceived stress score during the COVID-19 pandemic in a sample of North Indian Population using a designed online cross-sectional survey.

Research Approach

Descriptive.

Research Design

Cross-sectional survey design.

Study Area

Hilly state of Himachal Pradesh.

Study Duration

Between Jan 2022 to March 2022.

Study Population

Randomly selected population, staying in Himachal Pradesh for 12 months or more.

Sample Size

400 Adults assuming 50% having elevated stress levels, 5% absolute error, 95% confidence interval, and 5% non-response rate.

Sampling Technique

Convenience & snowball sampling technique.

Study Tool

A Google form questionnaire consisted of questions regarding socio-demographic profile and 14 - point Perceived Stress Scale (PSS - 14) to measure perceived stress. The questionnaire was initially pre-tested on a small group of people to identify any difficulty in understanding by the respondents.

Description of Tool

Demographic Data Collection Tool

The demographic form collected information about the background of the participants: age, gender, marital status, religion, employment, education and more.

Questionnaire

The questionnaire included the structured questions of the 14 - point Perceived Stress Scale (PSS-14) to measure perceived stress. It consists of 7 positive and 7 negative items and is scored by reverse-coding the negative items and then summing the scores for all 14 items. Scores range from 0 to 56, with higher scores indicating higher levels of stress.

Inclusive Criteria

who were willing to take part in the study.

Exclusion Criteria

who were not willing to take part in the study.

Data Collection

Data was collected under the guidance of supervisors. The Google questionnaire was disseminated through online modes such as email and social media platforms such as WhatsApp groups, Facebook, Instagram and LinkedIn in both rural and urban areas of Himachal Pradesh until the 400 responses were collected. The responses were then recorded in a Google Excel spreadsheet.

Data analysis

Data was collected and entered in Microsoft excel spread sheet, cleaned for errors and analysed with SPSS v27 software with appropriate statistical tests in terms of frequencies and percentage.

Ethical Considerations

Participants confidentiality and anonymity was maintained.

The present study was cross sectional descriptive study carried out to evaluate prevalence related to perceived stress associated with the COVID-19 pandemic in a sample of North Indian Population using a designed online cross-sectional survey.

A total of 400 respondents, including 240 (60.00%) from urban area and 160 (40.00%) from rural area took part in the study. Among the participants, 189 (47.25%) were males, 162 (40.50%) were between 18 - 30years, 140 (35.00%) were Graduate, 221 (55.25%) were employed, 248 (62.0%) were married and 384 (96.0%) were Hindu. The mean stress score of the participants was 28.06 ± 8.49. 66 (16.50%) respondents who scored ≤13 were classified as under low stress, 277 (69.25%) with a score of 14 to 26 were classified as under moderate stress and 57 (14.25%), with a score of 27 - 40, were considered under high perceived stress Furthermore, female respondents have significantly higher stress score as compared to males, and participants having age ≤30years had significantly higher stress score than those having age >30years (Tables 1-3).

Table 1: Socio-demographic characteristics of study participants

Table 2: The perceived stress scale questionnaire (14)

Table 3: Independent T test results

The respondents for this online state-wide cross-sectional survey conducted in Himachal Pradesh primarily included young adults with a majority of females.

In the present study overall prevalence of stress was 83.4% out of the total 400 participants. Females had significantly higher perceived stress as compared to males. This gender-specific difference might be explained because young females have greater psychological and emotional investment in interpersonal skills than their male counterparts. And they may also have a higher need for approval by peers and are more likely to blame themselves for their problems [9].

In our study age group of ≤30years had mean score of 28.88±8.90 on perceived stress scale indicating higher stress levels in young adults. This group consists mainly of graduates and students preparing for the entrance exams of their respective fields, or unemployed young people looking for a job. Our results were consistent with the finding [10] who suggested inadequate sleep, poor scoring in tests and excessive indulgence in non-productive activities were the reasons of young adolescents having greater stress. Fear of getting or losing a job may also have contributed to their stress levels.

Since our study results showed that 14.2% of people had high perceived stress, we suggest early interventions and effective psychological support at this stage, that would enable them to cope much better with stress in the near future [11].

Limitations

The sample size and duration of the study are limited to 400 respondents and a period of 3 months; thus, the scope and scope of the research undertaken was limited. This survey was conducted in only one state of India and therefore these results cannot be generalized to all of India.

We found a significantly high prevalence of stress in the test population during the COVID era. Psychosocial support and appropriate interventions can help prevent these high levels of stress in the general population.

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7. Cohen, Sheldon et al. “A global measure of perceived stress.” Journal of Health and Social Behavior, vol. 24, 1983, pp. 385–96.

8. Cohen, Sheldon. Perceived Stress in a Probability Sample of the United States. (No full publication details provided.)

9. Rudolph, Karen D. “Gender differences in emotional responses to interpersonal stress during adolescence.” Journal of Adolescent Health, vol. 30, no. 4, 2002, pp. 3–13.

10. Nadeem, Tahira, and Muhammad Zulfiqar U. “Academic performance and perceived stress among university students.” Educational Research and Reviews, vol. 7, no. 5, 2012, pp. 127–32.

11. Demenech, Lauro M. et al. “Invisible villain: High perceived stress, its associated factors and possible consequences in a population-based survey in southern Brazil.” Trends in Psychiatry and Psychotherapy, 5 May 2021.