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\def\RunningAuthor{Rinkle Malani et al.}
\firstPage{1710}
\articleType{Original Article}
\receivedDate{25 Oct 2020}
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\title{Impact of COVID-19 Pandemic lockdown on Mental and Physical health of students: A cross-sectional study}
\author{Tajuddin~Chitapure\textsuperscript{1},  
            Satyam~Bhodaji\textsuperscript{2},  
            Mayuri~Zanwar\textsuperscript{3}, 
            Rinkle~Malani\textsuperscript{*}\textsuperscript{4}~\\[5pt]{\textsuperscript{1}Department of Orthopedic Physiotherapy, MGM School of Physiotherapy Aurangabad, a constituent unit of MGMIHS, Navi Mumbai, Maharashtra, India}~\\{\textsuperscript{2}Department of Community Physiotherapy, MGM School of Physiotherapy Aurangabad, a constituent unit of MGMIHS, Navi Mumbai, Maharashtra, India}~\\{\textsuperscript{3}Bachelor of Physiotherapy, School of Physiotherapy, MGM School of Physiotherapy Aurangabad, a constituent unit of MGMIHS, Navi Mumbai, Maharashtra, India}~\\{\textsuperscript{4}MGM School of Physiotherapy Aurangabad, a constituent unit of MGMIHS, Navi Mumbai, Maharashtra, India}}

\begin{abstract}
COVID-19 outbreak has proven itself as a causative factor of global concern and got declared as global health emergency on 30 January 2020 by WHO resulting in lockdown as a preventive measure by the Government. Due to which there is a massive effect of this COVID-19 pandemic lockdown on the mental and physical health of the population. So we conducted the study to learn about the changes of mental and physical health in the students. A self-administrated questionnaire was prepared; consists of questions pertaining to Personal information related to mental and physical health during COVID-19 pandemic lockdown. A pilot study was done on ten students for validity and reliability for a self-administrative questionnaire. This study was done on 201 college students of MGM Campus Aurangabad. After collecting the data, results were obtained giving the percentage of the population being affected mentally and physically with 67\% of mental health was affected by 80\% of the student population and 41\% of physical health is affected by 80\% of the student population. We concluded that the COVID-19 pandemic had a mild stressful impact in the present study, even though the COVID-19 pandemic is still ongoing. 
\end{abstract}\def\keywordstitle{Keywords}

\begin{keywords}COVID-19,\newline Mental health,\newline Physical health,\newline Lockdown,\newline Students
\end{keywords}
\twocolumn[ \maketitle {\printKwdAbsBox}]
\makeatletter{\raggedright\textsuperscript{*}Corresponding Author\par Name:\ Rinkle~Malani~\\ Phone:\ 9370312412~\\  Email:\ dr.rinklemalani@gmail.com
        \par}\vspace*{-11pt}\hrulefill\par{\fontsize{12}{14}\selectfont ISSN: 0975-7538}\par% 
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\section{Introduction}
The world is currently dominated by the pandemic spread of severe acute respiratory syndrome coronavirus (SARS COV2)\unskip~\citep{968749:21092166}. The virus originated in bats and was transmitted to humans through yet unknown intermediary animals in Wuhan, Hubei province, China in Dec 2019. In December 2019, adults in Wuhan capital city of Hubei provenance and a method transportation hub of China started presenting to local hospitals with severe pneumonia of unknown cause\unskip~\citep{968749:21092168}. On December 31st 2019, China notified the outbreak to the World Health Organization and on 1st January, the Huanan seafood market was closed. The first fatal case was reported on 11 Jan 2020. By 23 Jan 11 million population off was placed under lockdown. WHO (World Health Organization) declared COVID-19 as Global Health concern causing severe respiratory tract infection in humans March 2020. The corona viruses did affect the immunity of patients\unskip~\citep{968749:21102675}. They enveloped positive sense of RNA viruses ranging from 60nm to 190nm in diameter with spike-like projections on the surface, giving it crown-like appearance \unskip~\citep{968749:21092168}.

 COVID-19 cases started to rise by 2nd week of March 2020 in India and more than 1356 cases were reported with 46 deaths by March 31, 2020\unskip~\citep{968749:21102676}. The confirmed cases in India had a history of travelling or being in close contact with COVID-19 patient. So to avoid the community spread, it was important to quarantine these infected people. So the Prime Minister of India took the decision of 'lockdown' in the whole country starting from midnight March 25, 2020, for 21 days. Similar measures were taken from other world countries to limit community spread of COVID-19. The step of `Lockdown' is a result of emergency protocol, which means preventing the mass mobility of public from one area to other. All public gathering institutes including educational institutions, shopping arcades, offices, factory, transport, airports, railways, markets etc. are shut down only hospitals, police station, grocery and emergency services are open\unskip~\citep{968749:21102677}.

COVID-19 is a major reason for psychological stress among people. With the declaration of lockdown, there was a swift rise of fear and anxiety among the general population. Various problems like depression, anxiety and panic disorder arising due to COVID-19 outbreak. Although isolation helps in achieving the goal of reducing infection reduced access to family friends, it increases loneliness and mental issue \unskip~\citep{968749:21102688}. Patients with mental health conditions such as depression and anxiety have been reported relapses in that mental state. They are having fever triggered panic attacks. The COVID-19 crises may increase suicidal rates during and after the pandemic. To reduce the suicides during the COVID-19, it is important to reduce the stress, fear, anxiety and loneliness in the general population\unskip~\citep{968749:21102689}.

The COVID-19 pandemic is leading to social (physical) to distancing policies worldwide. Some of the first actions taken by the government is closing schools and colleges. These measures can reduce the transmission of coronavirus\unskip~\citep{968749:21102690}. To prevent the spread of COVID-19, colleges and universities have taken a decision to shutter down their physical campuses following the flow of courses to remote and online formats in rapid developing fashion. And that's prompted many to discuss the ultimate impact this period of time may have on online learning in higher education\unskip~\citep{968749:21102691}. Based on the present situation, where individuals come to stand on, online learning will depend on where they sit currently. That is, there will be either or both positive and negative impacts on the state of online learning in higher education\unskip~\citep{968749:21102692}.

\textbf{Methodology }

The objectives of this study were to check the general awareness of COVID-19 pandemic in students. Also, to assess the mental health of students during COVID-19 pandemic Lockdown. And to assess the physical health of students during COVID-19 pandemic lockdown.

This was an observational study with a sample size of 201. Method of sampling used was convenient sampling method. The study was performed on the students in MGM campus Aurangabad Maharashtra. The study was conducted during the period of 6th June to 27th June 2020 on various medical and non medical institutional students.

\textbf{Inclusion criteria}


  
  \begin{enumerate}
  \item \relax Both male and female
  \item \relax Age - 18 to 26
  \item \relax Participants who were willing to take participation in the study
  \end{enumerate}
  \textbf{Exclusion criteria }


  
  \begin{enumerate}
  \item \relax Any cognitive deficit
  \item \relax Any communication difficulty
  \item \relax Participants who do not use electronic communication mediums like Whatsapp and E-Mail.
  \item \relax Participants who cannot read or understand the English Language.
  \end{enumerate}
  The questionnaire developed was to assess Mental and Physical health of students, for the period of the past month. This is a newly designed Google document administered questionnaire. In the present study participants' demographic data was taken, which undue their name, age, gender, name of the institute and email I'd. Further, the scale contains three sections a) personal information regarding Physical health containing five questions B) knowledge regarding novel Corona containing five questions c) 6 questions regarding mental health. The response scales comprise of two categories yes and no the maximum score of questionnaires was 16, where yes is interpreted by score one and no by 0.
    
\section{Results}
The study population consisted of young adults, mainly students of age group18-26 years at the time of participation in the study the institute was and MGM campus were randomly chosen by the use of envelope methods. Two well-trained interviewers conducted the study and reported the final data. After collection of the data, it was corrected for minimal bias and underwent statistical evaluation for its reliability. Cronbach's alpha was used as an estimate for the reliability of the overall instrument on its psychometric aspects. In the present study, Cronbach's alpha = 0.975057 was according to the result of Cronbach's alpha 0.9 which is good reliability. Hence our instrument was considered to be acceptable.


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\caption{\boldmath {Illustrating the population perception of physical and mental health affected }}
\label{f-f167cde091d3}
\end{figure}
\egroup

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\caption{\boldmath {Demonstrating the extent of mental health affected}}
\label{f-c97d17be35df}
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\caption{\boldmath {Showing the extent of physical health affected}}
\label{f-aadf63e93347}
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\egroup
89\% of students think there mental and physical health affected due to COVID-19 pandemic lockdown and 11\% of students think their mental and physical health not affected due to COVID-19 pandemic lockdown as illustrated in Figure~\ref{f-f167cde091d3}. 65\% of students involved in Physical activities before this COVID-19 pandemic lockdown and 35\% not involved in any physical activities. 54\% of students not able to perform their Physical activities which they were doing before lockdown and 46\% of students managed their Physical activities in lockdown. 66\% of students don't suffer any musculoskeletal problem and 34\% having musculoskeletal problem due to COVID-19 pandemic lockdown. 57\% of students say that change in routine and environment had led to the emotional instability and emotional instability not affected on 43\% of students. 55\% of students think that COVID-19 lockdown affects their thought process and mental judgment and 45\% of students don't think that their mental judgment and thought process affected of this COVID-19 pandemic lockdown. 60\% of students find themselves spending most of the time on social media and 40\% of students spending time with their family rather than social media.84\% of students say that changes in their sleep patterns due to COVID-19 pandemic lockdown and sleep patterns are not affected 16\% of students. 78\% of students affect their studies duo to this COVID-19 pandemic lockdown and 22\% of students say that they are not affected. 76\% of students are aware of term Pandemic, 24\% don't aware of any pandemic disease. Figure~\ref{f-c97d17be35df} is demonstrating the mental health is being affected by 67\% from the sample size of 201 students during COVID-19 pandemic lockdown. However, Figure~\ref{f-aadf63e93347} is showing that 58\% of students were being affected physically.
    
\section{Discussion}
The present study was a newly designed, self-administered questionnaire. The study tested first on pilot bases the reliability and validity of the newly designed questionnaire on the Mental and Physical health of students. A questionnaire was developed on seven steps, by survey design process for Medical Education Research\unskip~\citep{968749:21102693}. The content of the questionnaire was validated by the bench of expertise and the changes which were asked to be made were done. In its present format, the questionnaire was easy to administer and complete as it had done direct and closed-ended format questions and was in simple languages with no difficult wordings. Study participants did not find the questionnaire too long or too difficult to complete, indeed the comment that it was easy to answer as questions were direct. Also, they commented that it took less time to fill the question as compared to others. Further in the study, we tried to assess the impact of COVID-19 pandemic lockdown on Mental and physical health of students. 

In India, the initial stages of COVID-19 found almost one-third of respondents had a significant psychological impact\unskip~\citep{968749:21102677,968749:21102694,968749:21102695}. This indicates a need for more systematic, deep and extended assessment of the psychological requirements of the population, which can help the government in preparing overall covering interventions for the affected population. Being students the most focused and generating population, the present study scale assessed all the possible causes and risk associated with the mental health and physical health in the student's population. Out of 201 subjects, 88\% of students were aware of the term Pandemic and novel Coronavirus and its sign and symptoms. 89\% of students said that COVID-19 pandemic affected their mental and physical health. This COVID-19 pandemic affected a student's mental health by 67\% and physical health by 41\%. 

During lockdown periods, this course concentrated on the significance of physical activity during the lockdown and the implications of physical inactivity. However, the role of physical activity as part of physiotherapy interventions during COVID-19 is also highlighted. A study In the context of the COVID-19 pandemic predicted substantial increases in depression and anxiety along with loneliness as schools closed. The study further made the impact of domestic violence; substance use and possibilities of the epidemic rise in child abuse\unskip~\citep{968749:21102696,968749:21102697}. Different studies in 2020 revealed that Covid-19 is creating psychological distress among the individuals, as there were restrictions due to lockdown people are forced to stay home\unskip~\citep{968749:21102698,968749:21102699}. Individuals were going through a crisis situation and feeling a lack of control on their lives due to lockdown and restrictions imposed upon them. Young adolescents and adult age group are facing uncertainty with respect to career professional life, and jobs are at sake\unskip~\citep{968749:21102700,968749:21102701}. Because of lack of exposure to the environment, they are not able to go out and do physical activity like aerobics, gyming and other recreational activities which may be the reason there mental and physical health is affected \unskip~\citep{968749:21102672}. Fear of infection is creating a panic situation among them.

Taking into consideration the current situation worldwide with countries in enforced periods of lockdown and isolation, this may potentially have a mammoth impact on the mental well being of many people and even more so if they don't engage in any form of physical activity. Students being the most vulnerable generation for psychological impacts which are rarely diagnosed until emergencies more studies should be focused on awareness in this population and strategies to cope with it by early preventions.
    
\section{Conclusion}
Based on the result of an inter therapist validity of the study is 0.975057. Out of 201 sample size of the student population, 67\% of students have altered their mental health and 41\% altered in their physical health.
\section*{Acknowledgement}We thank the patients who participated and contributed samples to the study.

\textbf{Conflict of interest}

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

\textbf{Funding support}

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

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