key: cord-0914824-isdhyr5f authors: Summaka, Marwa; Zein, Hiba; Naim, Ibrahim; Fneish, Sleiman title: Assessing the psychological impact of COVID-19 outbreak and its related factors on Lebanese individuals with physical disabilities date: 2021-02-18 journal: Disabil Health J DOI: 10.1016/j.dhjo.2021.101073 sha: 50090ff40fae9cc9821e584394c4125a40981de5 doc_id: 914824 cord_uid: isdhyr5f BACKGROUND: In February 2020, the Lebanese authorities announced the first Coronavirus 2019 (COVID-19) case. Since then, the cases increased significantly, but information on the public’s psychological status and specifically individuals with physical disabilities is still limited. PURPOSE: The study aims to assess the psychological impact of the COVID-19 outbreak on Lebanese individuals with physical disabilities and study the associated factors. MATERIALS AND METHODS: This is a cross-sectional study involving 118 individuals with physical disabilities. Each filled out an online survey with three sections: a personal questionnaire, the Arabic versions of the Hopkins Symptom Checklist-25 and the Fear of COVID-19 scale. Data regarding participants’ baseline characteristics, fear, anxiety, and depression were collected and analyzed using the Chi-square test and regressions models. RESULTS: Individuals with physical disabilities exhibited mild fear of COVID-19, with fear being correlated with age, educational level, and employment status. Furthermore, 22.9% of the population was found to be anxious, and 31.5% were depressed. Anxiety was associated with both marital status and employment status. Finally, depression was proved to be influenced by marital status, employment, and educational level. CONCLUSION: Results extracted showed that individuals with physical disabilities require substantial attention in order to manage their psychological state during pandemics. The Coronavirus Disease-2019 (COVID-19)is a transmissible infectious disease caused by SARS-Cov-2, with an incubation period of 1-14 days in most entities (1) . Its most reported clinical symptoms include fever, fatigue, pain, dry cough, and dyspnea (2) . The implementation of effective preventive measures is thought to be the exclusive option to control its spread; such measures included social reactions, quarantine, and distancing (3, 4) . By May 2020, around 1,844,863 cases were confirmed, with 117,021 reported deaths from at least 213 countries (5) . It is safe to say that the worldwide emergence of COVID-19 is currently menacing the well-being of individuals all over the world. Previous studies showed that infection outbreaks induced a profound and wide range of psychological and psychosocial consequences on individuals across different communities (6, 7) . During the COVID-19 pandemic, it has been perceived that mental health problems are increasing among general and vulnerable populations (8) . Anxiety, depression and stress (8, 9) , along with accelerated levels of fear (3) are some of the problems reported during this outbreak. Few studies aimed to assess the psychological outcomes of the COVID-19 pandemic and their impact on the social response (10) (11) (12) . A study conducted in China reported high levels of negative emotional indicators (anxiety and depression) among 17,865 individuals, which lead in turn to ameliorated social risk judgement and deteriorated life satisfaction (12) . Another Canadian study indicated that the anxiety manifested among people influenced their thinking, behaviors and abilities in making decisions within the outbreak (10) . These examples indicate the cruciality of evaluating the psychological impacts of the COVID-19 outbreak, given the negative sequela it may have on the community. As mentioned, limited studies estimated the psychological impact of COVID-19 among the public (10, (12) (13) (14) , healthcare professionals (15, 16) , and vulnerable populations, including elderly patients (17) , homeless individuals (18) , and pregnant women (19) . Evidence is limited regarding the psychological effect of COVID-19 on individuals with physical disabilities (20) . At baseline, these individuals may be more susceptible to mental health distress or have comorbid underlying mental health conditions that increase their vulnerability during this time (21) (22) (23) (24) . Correspondingly, they will face more difficulties in developing and applying appropriate coping strategies (8 Along with the measurement scales, an Arabic written sociodemographic questionnaire was prepared. The questionnaire conveyed three main categories reflecting the general personal information, socioeconomic status, and medical history of participants. The measurement scales J o u r n a l P r e -p r o o f The The Hopkins Symptom Checklist (HSCL) aims to evaluate the patients' psychoneurotic complaints (31) . The scale is available in multiple versions, in which the number of items ranges between 25 and 90 (32) . The HSCL-25 was used within this study; it is a brief self-report screening test that validates the presence of anxiety and depression symptoms (33) . This (35) . The initial authors reported that the cutoff for the total score of the HSCL-25 is 1.75 (35) . However, for the Lebanese population, a cutoff of 2 was conveyed for the anxiety subscale and 2.1 for the depression subscale (34) . It is important to note that, the Lebanese Arabic validated version of the HSCL-25 was used within this study. This study was approved by the Institutional Review Board of the Health, Rehabilitation, Integration, and Research Center (HRIR). Each participant was asked to confirm his approval before participating in the study. The study was conducted based on the Helsinki Declarations for medical research. Data entry and analysis were conducted using the IBM For assessing the relationship between categorical variables and anxiety or depression, a Chisquare test was used. All statistical tests were two-sided, and a p-value less than 0.05 was considered statistically significant. J o u r n a l P r e -p r o o f The In terms of somatic symptoms, results extracted from the A-FCV-19S showed that 9.3% of the participants exhibited an increase in heart rate and 6. J o u r n a l P r e -p r o o f J o u r n a l P r e -p r o o f Different studies have proposed that subjects with physical disabilities can be considered a susceptible population for mental health disorders (21, 22, 24) . Along with such suggestions, the emergence of a pandemic can accelerate the risk of developing mental health disorders expressed by depression, anxiety, fear, and worry among this vulnerable population (8 Furthermore, the anxiety state of the participants was significantly associated with both marital status (X 2 = 5.099, p-value = 0.025) and employment status (X 2 = 2.130, p-value = 0.036). In the logistic regression model, the risk of anxiety among the unemployed group was proved to be 2.088 times more than that of employed participants (95% CI 0.767 to 5.685, pvalue = 0.040). Limited research about the association between employment status and anxiety exists, especially within participants living with physical disabilities. However, the findings observed within this study are consistent with researches highlighting the strong links between anxiety and employment status within the general population (38) . The study conducted by Sunderland in 2013 reported that unemployment is not only correlated with anxiety, but it can also be considered a significant predictor for its diagnosis (38) , which emphasizes the importance of early identification and control of anxiety (39) . Nevertheless, when evaluated within a specific physically disabled population due to traumatic brain injuries, results revealed no relation was verified between anxiety and employment (40) . Such difference in findings can be explained by To our knowledge, this is the first study conducted in Lebanon to assess the psychological status of individuals with physical disabilities and to discuss the influencing factors during a pandemic. In Lebanon, such studies are limited and there is a significant lack of available information on the mental health issues confronted by individuals with physical disabilities. this study's importance can be highlighted by the fact that it can provide supportive and imperative information about a marginalized population during an infectious outbreak. Thus, as the COVID-19 is spreading, this study will encourage establishing the appropriate strategies to support and manage psychological problems and amend mental health in individuals with physical disabilities. As an urgent step, the Lebanese health authorities need to identify individuals with physical disabilities as a high-risk group for psychological distress during this pandemic and apply the required interventions. The targeted management strategies should be adapted to meet this population's needs while considering the different social distancing measures. It is plausible that online psychological approaches can be provided. As for the limitations, the sampling procedure was not random, and a convenient sample was chosen. The recruitment procedure was confined to participants enrolled in therapeutic J o u r n a l P r e -p r o o f programs within specific rehabilitation centers. It is important to note that these is a lack of outburst. This includes fear, anxiety, and depression in populations living with physical disabilities. It also alerts these authorities about the cruciality of further monitoring these individuals during the ongoing pandemic. J o u r n a l P r e -p r o o f The findings of this study advance the understanding of the initial psychological response of Lebanese individuals with physical disabilities during the crucial period of the COVID-19 pandemic. 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