Introduction

Anxiety can be defined as an intense, excessive and persistent worry and fear about everyday situations. As per WHO, it can be accompanied with fast heart rate, rapid breathing, Sweating and feeling of tiredness. The significant categories of anxiety disorders are Panic disorder, agoraphobia without panic, social phobia, specific phobia, generalised anxiety disorder, acute stress disorder, post-traumatic stress disorder, Obsessive-compulsive disorder and anxiety disorder or not otherwise specified (Trivedi & Gupta, 2010). The cognitive and behavioural approach has been widely used during the last two decades to precise the ecology of GAD (Gosselin & Laberge, 2003) Anxiety disorder side effects are decreased productivity. Increased mortality rates (Bystritsky, 2013)· The COVID 19 pandemic increases global anxiety level (Huang & Zhao, 2020). Mental state concerns of people impacted by the COVID 19 pandemic have not been adequately addressed. The objective of this study was to develop and evaluate the properties of the Coronavirus Anxiety Scale, which is a brief mental health screener to verify probable cases of anxiety associated with the coronavirus crisis. This study which was based on 775 adults with anxiety over the COVID 19, demonstrated solid reliability and validity. Elevated Coronavirus Anxiety Scale scores were found to be associated with coronavirus diagnosis, impairment, alcohol/drug coping, negative religious coping, extreme hopelessness, suicidal ideation, as well as Chinese products (Lee, 2020). Many people suffer from uncertainty a fear of infection, moral distress and grief often experienced alone (Peteet, 2020)· Since coronavirus is a newly emerging disease, more work is needed to find out the strategies to diagnose, prevent and treat the Covid 19 Pandemic. The current pandemic situation of Covid 19 is still severe (Kaijin, 2020). The relatives and acquaintances infected with Covid - 19 are a risk factor for increasing the anxiety levels (Cao, 2020).

In Study by Huang Y et al. about anxiety levels during COVID 19 in China explained about anxiety disorder, depressive symptoms and sleep quality, the author identified a significant mental health burden in the Chinese public during COVID 19 outbreak (Huang et al., 2020). Young people were spending too much time thinking about the outbreak, and the healthcare workers were at high risk of displaying psychological issues (Huang et al., 2020). Although sources of anxiety may not have affected everyone, they can weaken the confidence of health care workers in themselves. The health care delivery source says their ability to stay calm and assure the public is most needed. According to the sources, anxiety allows health care workers and organisations to develop targeted approaches to address these queries and provide specific support to their health care workers (Shanafelt, Ripp, & Trockel, 2020). About 80% of the population feels anxious in the Current Situation (Roy, 2020). In the Study by Stein MB, they found out that there is increased anxiety and depression among people thinking about their future with covid 19 (Stein, 2020). A nationwide survey of more than 50,000 people in China during Covid 19 epidemic showed that 35% of the respondents experience psychological distress (Sher, 2020).

The effects were mostly related to the thoughts of loneliness, anxiety and post-traumatic stress disorder symptoms (Skalski, Uram, & Dobrakowski, 2020). It should be pointed out that the nature of the pandemic has led to constant updating of the media or television on COVID 19, which may increase the level of anxiety. Excessive consumption of knowledge about the spread of communicating diseases may lead to persistent thinking and can affect the mental health of individuals (Skalski et al., 2020). The ability to bring pandemics under control depends on compliance with a warning. One psychological factor capable of affecting adherence to the sign is health anxiety (Özdin & Özdin, 2020). More than 203 countries, areas or territories have been affected by the COVID 19 virus still now, And about 630,000 infected and nearly 30,000 deaths reported by March 29. Iran, after Italy, Spain and China, has had the most significant number of deaths in the entire world. Evidence also shows that individuals may experience symptoms of, anxiety, trauma, suicidal ideation, and panic during outbreaks of infectious diseases (Moghanibashi-Mansourieh, 2020).

Many institution-based studies have been carried out on various oral diseases (Gunasekaran & R, 2016; Krishnan, 2018; Sarbeen & Gheena, 2016; Shree et al., 2019; Sukumaran & Padavala, 2018). There have also been studies done using recent technology to enhance knowledge (Abitha & Santhanam, 2019; Hannah, 2018; Harrita & Santhanam, 2019; Manohar & Abilasha, 2019; Palati et al., 2019). Many surveys were also conducted to improve the level of awareness regarding various diseases and recent development among the general population and the dental students (Ahad & Gheena, 2016; Palati et al., 2020; Prasanna & Gheena, 2016; Sheriff & Santhanam, 2018; Uma, 2020). The current study was conducted in the light of the studies mentioned above to evaluate the knowledge, attitude and practice regarding anxiety level during Covid 19 pandemic among Chennai population.

Methodology

This is a cross-sectional descriptive Survey that is conducted among 108 people in the age group between 20-60 years. This survey consists of 18 self-administered questions. This was done through an online survey (google forms) This survey was carried among Chennai population that consists of both male and female between the age between 20-60 Years. Chi-square analysis to compare the two groups is done using SPSS. Simple Random sampling was done to eliminate response bias. Demographic Information knowledge, Attitude and Practice were the output of variable. Age, gender, physical problems, work were the independent Variables, whereas knowledge, Altitude and Practice were the dependent variables. The results were collected and were tabulated. The results were analysed using statistical analysis.

Results and Discussion

The descriptive data showed that the majority of the population that actively participated in the survey were 18 years of age. In this study, the male population was 34.7%, whereas the female population was 65.3%. The participants engaged in this survey, 44% were students. 5% of the population were retired .3%of the population were teachers.2% of the population were lawyers. 9% of the population were health workers .7% of the population were Entrepreneur.17% of the population were engineers.10% of the population were homemakers. 2% of the population were scientists.1% of the population were farmers.

On assessing the knowledge of the participants, 94% of the participants were aware of COVID 19 pandemic and on comparing between the <30 and >30 age groups, statistically significant increase in awareness was seen among <30 age group Figure 3; Figure 2; Figure 1 shows that Chi square test shows statistical significance (P = 0.009) showing more awareness among <30 years of age.When the participants were asked what measures were taken to contain the spread of virus 6% of the population said Quarantine 15% said lockdown 16% said Social distancing and 63% said all of the above, on comparing between the groups no difference was found Figure 5; Figure 4 shows that Chi square analysis shows no statistical significance (P=0.721). When the participants were asked if the media increased their anxiety level, 56% of the population said yes, and 44% said no. Still, no difference was seen between the groups Figure 7; Figure 6 sows that Chi square test shows no statistical significance with P=0.658 (P>0.05). When the participants were asked which form of media had the most influence in their stress levels, 42% of the population said television, 10% said Newspapers, 26 % said social media and 21% said No influence of media. Still, no difference in response was seen between the groups Figure 9; Figure 8 shows that Chi square test shows no statistical significance with P = 0.056 (P>0.05).

On assessing the attitude of the participants, 78% of the participants felt the need to visit a professional psychologist to help with anxiety issues. Still, Chi-square test did not show a statistically significant difference between the groups Figure 11; Figure 10 shows that Chi square test shows no statistical significance with P =0.781(P>0.05). When the participants were asked if were anxious to step out of the house for essentials, 50% of the population answered yes, but Chi-square test did not show a statistically significant difference between the groups Figure 13; Figure 12 shows that Chi square test shows no statistical significance with P=0.091(P>0.05). When the participants were asked whether the thought of COVID 19 made you feel dizzy, light-headed, shaky or wobbly 25% of the population answered yes, but no significant difference was seen between the groups Figure 15; Figure 14 shows that Chi square test shows no statistical significance with P = 0.88(P>0.05). When the participants were asked if they have had times when they feel like their heartbeat is racing, and they are hot and Sweaty thinking of COVID 19, 34% of the participants answered yes. Still, no significant difference was seen between the groups Figure 17; Figure 16 shows that Chi square test shows no statistical significance P = 0.803(P>0.05). When the participants were asked if their anxiety level has increased since COVID 19, 65% of the population answered yes, Chi-square test showed statistical significance with more increase in anxiety level among the <30 age group Figure 19; Figure 18 shows that Chi square analysis shows statistical significance P = 0.024 (P<0.05). When the participants were asked if lockdown decreased their stress level, 50% of the population said yes, but no significant difference was seen between the groups Figure 21; Figure 20 shows that Chi square test shows no statistical significance with P =0.205(P>0.05). When the participants were asked about their emotion when they hear the words quarantine, lockdown and social distancing. 42% of the population answered sadly, 22 % said happy, 13% said anger and 23% said fear, but no significant difference was seen between the groups Figure 23; Figure 22 shows that Chi square test shows no statistical significance with P =0.539(P>0.05). When the participants were asked if they were apprehensive or paranoid if someone coughs a few times at home, 25% of the population answered yes, and 29% sometimes answered Figure 24. Chi-square analysis shows statistical significance P = 0.012. More anxiety is seen among < 30 age group Figure 25 shows that Chi square analysis shows statistical significance P = 0.012. More anxiety is seen among < 30 age group. When the participants were asked if they fear that the worst will happen to their family members during this pandemic, 25% of the population answered yes Figure 27; Figure 26 shows that Chi square analysis shows statistical significance(p value 0.012). More fear is seen among <30 age group. Chi-square analysis showed statistical significance (p-value 0.012) with more fear seen among <30 age group.

On assessing the Practice, When the participants were asked if they suffered from lack of sleep thinking about COVID 19, 15% of the population said yes, and 64% answered no. Still, no significant difference was seen between the groups Figure 29; Figure 28 shows that Chi square test shows no statistical significance with P = 0.611(P>0.05). When the participants were asked if they get nightmares about COVID 19, 24% of the population answered yes, but no significant difference was seen between the groups Figure 31; Figure 30 shows that Chi square test shows no statistical significance with P = 0.058(P>0.05). When the participants were asked if they were obsessed with news regarding COVID 19, 61% of the population answered yes Figure 32. Chi-square analysis showed statistical significance with more obsession among < 30 age group Figure 33 shows that Chi square analysis shows statistical significance P = 0.049 (P<0.05), More obsession is seen among< 30 age group. When the participants were asked if listening to news regarding COVID 19 cause anxiety, 61% of the population said yes, but no significant difference was seen between the groups Figure 35; Figure 34 shows that Chi square analysis shows no statistical significance with P = 0.236 (P>0.05). When the participants were asked On the scale of 1-10 how anxious they were about COVID 19, 17% of the population said 1, 5% said 2,5% said 3, 5% said 4,16% said5, 9% said 6,10% said 7, 13% said 8,6% said 9,16% said10, but no significant difference was seen between the groups Figure 37; Figure 36 shows that Chi square analysis shows no statistical significance P =0.549 (P>0.05). When the participants were asked if here there were days when they had taken medication to bring their anxiety levels down, 19% of the population answered yes. Still, no significant difference was seen between the groups Figure 39; Figure 38 shows that Chi square analysis shows no statistical significance with P = 0.407(P>0.05).

In our study, 35% of the participants in the Chennai population showed increased anxiety levels amidst COVID 19 pandemic. In contrast, in a study done by Roy D et al. the anxiety level on COVID 19 pandemic in Indian population is 80%. Comparing to Roy D et al. study in our study, the anxiety level is a little lower. The difference may be because, in our research, predominant populations were lesser than 30 years of age (Roy, 2020). In a study done by Huang Y et al. amidst COVID 19 in the Chinese population, he evaluated anxiety disorder, depressive symptoms and sleep quality to be more prevalent. The anxiety level was 30% which is similar to our study, where it is 35%. The knowledge of the participants regarding COVID 19 was good which agreed with research done by Roy D et al. and Huang Y et al. This increased knowledge and awareness can be attributed to increased exposure to media by the participants (Huang et al., 2020; Roy, 2020). COVID 19 is an infectious disease caused by a novel coronavirus, and it causes anxiety and mental stress to people.

Roy et al. in their study deciphered that for 36.5% of the participant's social media was the primary form of media which influenced their stress levels which is similar to the results of our study where media influence 26%. In today's world of living with COVID 19 pandemic, the role of the psychologist seems to be crucial. Roy D et al. in their study showed that 76% of the participants needed to go to see a psychologist, whereas, in contrast, our study results show that only 33% needed to go to the psychologist. The variations in the result may be because of less awareness about the role of psychologists among the Chennai population and also more awareness about the pandemic and coping mechanisms (Roy, 2020). In the study done by Ozdin, the majority of the population needed some psychological support. But in our research, only 33% required support. This variation in the results may be because the study by Ozdin et was carried among people above 60 years of age which is in contrast with our study. Populations above the age group of 60 are known to succumb more to the disease and hence are naturally more apprehensive. So participants are more anxious and need the help of psychological Support (Özdin et al., 2020). Psychologists are trained to diagnose anxiety disorder and teach patients an effective way to cope up. CBT therapy by psychologists is a very effective way to treat anxiety disorder

In the study done by Amir Moghani Bashi, the findings show that more than 94% of people follow the news of COVID 19, but in our study, only 50% of the population follow the news regarding COVID 19. The variation in results may be because the other research was done among the Iran population, and the awareness and social stigma towards COVID 19 may be different from the Indian population. But the anxiety level among the Iran population for COVID 19 is similar to our study, which is 33% (Moghanibashi-Mansourieh, 2020). Some of the measures taken by the participants to combat anxiety associated with covid19 are to take a time out, to eat well-balanced food, to have enough sleep, to pray and meditate.

The limitation of our study is the less sample size, response bias and survey fatigue. It is also done in a homogenous population which may mislead.

The Future scope of this study is to do a survey-based complete survey on the Anxiety level of COVID 19 during the lockdown and its effects on mental health in a larger population and a larger scale.

Conclusion

This study has shown an increase in the anxiety level among the Chennai population in the context of COVID19 pandemic. The manifestation of anxiety level is more among <30 age group, and this is attributed to the increased exposure to information from media. The study reflects a need for more awareness programs about coping with anxiety levels during COVID19 among the Chennai population. There is a need for social support to alleviate anxiety and improve mental health.

Funding Support

The authors declare that they have no funding support for this study.

Conflict of Interest

The authors declare that they have no conflict of interest for this study.