Study of Anxiety among Students Depending on the Location of Urban

or Rural Areas during Isolation during a Pandemic and COVID-19

Razin M. Ragimov

, Naida M. Abdullaeva

and Patimat Y. Magomedova

Russia State Budget Educational Institution Dagestan State Medical Academy, Makhachkala, Russia

Keywords: Isolation, Anxiety, Covid 19, Village, City, Depression, Media, Quality of Life, Scale.

Abstract:

The article analyzes the influence of personal and situational anxiety on the quality of life of students of

medical universities in Russia. The purpose of this study was to determine significant differences in students'

anxiety depending on the place of stay in urban or rural areas during the period of isolation. The Spielberger-

Hanin scale (State-Trait Anxiety Inventory - STAI) and the visual analogue scale (VAS) EQ-5D-3L were

used for the study. 183 students took part in the work, of which 36 people (19.67 %) stayed in rural areas, 147

people (80.33 %) – in urban areas during the period of forced self-isolation. Based on the experiment carried

out and the interpretation of the data obtained, we obtained data that in the groups of subjects who were in

urban areas, there were higher indicators of situational and personal anxiety and lower scores on VAS EQ-

5D-3L in comparison with pre-pandemic normative data on Russia in this age group, which indicates the

potential negative impact of the pandemic on the psychological well-being of medical students, the effect of

which can be correlated with the consequences of social isolation, which is higher in urban compared to rural

areas.

1 INTRODUCTION

Most of the population of Russia, to one degree or

another, has undergone a long stay at home with an

alternating weakening of the regime and periods

when quarantine measures were weakened based on

the average statistical indicators of the number of

cases in the country. Many authors associate these

circumstances with significant potential

psychological stress and “pandemic fatigue” among

the population, especially among progressive youth

(Holmes, O'Connor, Perry, Trace, Wessely,

Arseneault, 2020).

The World Health Organization (WHO) has

recognized the negative impact of the pandemic on

society and has emphasized the urgent need to

research mental health issues (Kluge, Malik, Nitzan,

2020). The abundance and activity of negative

information presented in the media, as well as a

closed space in which there is no place for social

activity, plays an important role in the formation of

https://orcid.org/0000-0002-5442-5528

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https://orcid.org/0000-0002-5703-3968

negative mental reactions to the situation of a

pandemic in the world. WHO has called this unique

set of circumstances "infodemic", referring to the

"flow of information about the COVID-19 pandemic"

from governments, scientists, the media, social

media, and friends and family, which makes it

difficult to perceive the correctness of information, its

distortion and a person's loss of orientation between

actual and perceived risks (Wise, Zbozinek,

Michelini, Hagan, Mobbs, D., 2020), (Dryhurst,

Schneider, Kerr, Freeman, Recchia, van der Bles,

2020). Proof of this hypothesis was a study by

Russian scientists on the relationship between

increased media consumption and an increased level

of situational anxiety during the COVID period,

which proved the presence of a correlation

(Nekliudov, Blyuss, Cheung, Petrou, Genuneit,

Sushentsev, 2020).

A large proportion of medical students' fears are

caused by a constant feeling of uncertainty and

anxiety, lack of optimal physical activity, and an

Ragimov, R., Abdullaeva, N. and Magomedova, P.

Study of Anxiety among Students Depending on the Location of Urban or Rural Areas during Isolation during a Pandemic and COVID-19.

DOI: 10.5220/0011111000003439

In Proceedings of the 2nd International Scientiﬁc and Practical Conference "COVID-19: Implementation of the Sustainable Development Goals" (RTCOV 2021), pages 84-88

ISBN: 978-989-758-617-0

abundance of free time to watch the media (students

on self-isolation).

Against this background, it is interesting that there

are situations that at least partially exclude the impact

of the information flurry. Based on this, we

formulated the goal of our study, which was to test

the hypothesis about the existence of significant

differences between the level of anxiety and the

quality of life of students staying in a period of

isolation in rural and urban areas.

“As the devastating effects of COVID-19,

including social distancing, now dominate our daily

lives ... our anxieties and fears must be better

understood and addressed,” notes Dr. Hans Kluge

(Kluge, Malik, Nitzan, 2020). Studying the mental

health of students and the factors of deterioration in

its quality during a pandemic and quarantine will help

predict the consequences of long-term self-isolation.

A study of the impact of the SARS-CoV-1 epidemic

on public health has shown that the pandemic has

made its own adjustments in the psyche of people and

postcoid symptoms are the subject of numerous

studies and they are not limited only to the treatment

of somatic manifestations (Bauerle, Teufel, Musche,

Weismuller, Kohler, Hetkamp, 2020). This may

indicate long-term measures in the prevention of the

negative effects of the impact of quarantine measures

and the virus itself on the livelihoods of the

population.

2 STUDY METHODS

The study was conducted at the end of April 2020 as

part of a study examining the psychosocial impact of

the COVID-19 pandemic on the general population

and was a continuation of international scientific

research (Nekliudov, Blyuss, Cheung, Petrou,

Genuneit, Sushentsev, Levadnaya, Comberiati,

Warner, Tudor-Williams, Teufel, Greenhawt, Galvin,

Munblit, 2020).

For the convenience of interviewing students, we

compiled a questionnaire of 50 items, which included

general questions such as: about protective measures

during the COVID-19 pandemic ("did you take

precautions during the isolation period", "what

personal protective equipment were used");

demographic data (gender, age) so questions from

scales of adapted questionnaires, such as:

1. Spielberger-Hanin scale (State-Trait

Anxiety Inventory - STAI);

2. visual analogue scale (VAS) EQ-5D-3L.

The full Spielberger-Hanin scale includes 20

questions for determining personal anxiety and 20

questions for identifying the level of situational

anxiety. The items identifying anxiety are graded on

a scale of 1-4 and 4-1, with the score multiplied by 20

and divided by 6. A score below 30 points indicates a

low level of anxiety, above 45 – on increased anxiety

(Spielberger, 1983).

The visual analogue scale EQ-5D-3L is used to

assess the quality of patients' health. The first part

assesses an individual's health in 5 dimensions,

including mobility, self-care, daily activities,

pain/discomfort, and anxiety/depression. Possible

answers: 1) no violations; 2) moderate violations; 3)

severe violations. The second part invites the subject

to assess their health on their own (making a mark at

the correct scale level) on a 100-point scale, where 0

means the worst state of health that can be imagined,

and 100 means the best (van Reenen, 2015),

(Sullivan, Ghushchyan, 2006). Out of 5 items, 234

combinations of health conditions are possible. Each

answer includes one of 3 options, with a score of 1-3

to create a unique 5-digit score for a person's health

status. There are standardized sets of values for

converting scores to a composite index, and they exist

for several countries.

The survey was conducted in a remote format.

Each participant filled out the questionnaire

anonymously. To participate in the program,

informed consent was obtained in electronic or oral

form. A total of 183 medical students, aged 18-36,

who have a mobile phone with the ability to send text

messages or access the Internet, took part in the study.

According to the place of residence in the

countryside of the Republic of Dagestan, it was

divided into three districts, which in percentage terms

were — (58.6 % — mountainous, 20.6 % — foothill,

20.8% — flat). The gender distribution in rural areas

during the period of self-isolation was represented by

7 young men (17.5 % of the isolated male students)

and 29 girls (20.2 % of the isolated female students).

The distribution of students in the period of self-

isolation in urban areas (Makhachkala, Astrakhan,

Tomsk, Derbent, Khasavyurt, Kizilyurt) was

represented by 33 boys (82.5 %) and 114 girls (79.8

%).

In accordance with the hypothesis of the study, 4

groups were formed for the experiment:

Group 1 – girls who were in self-isolation in

villages;

Group 2 – girls who were in self-isolation in

cities;

Group 3 – young men who were in self-isolation

in the villages;

Group 4 – young men who were in self-isolation

in cities.

Study of Anxiety among Students Depending on the Location of Urban or Rural Areas during Isolation during a Pandemic and COVID-19

The statistical analysis included the description of

central trends as the mean for continuous quantitative

variables, corresponding to a normal distribution.

Qualitative data are presented in the form of absolute

and their percentage.

For categorical data, the statistical significance of

differences in groups was determined by calculating

the Chi-square test (2), for quantitative data –

Student's t-test. A P-score of less than 0.05 was taken

as critical. Statistical analysis was performed using

SPSS 20 for Windows.

3 STUDY RESULTS

The results of the survey conducted on the STAI scale

are presented in Table 1.

The mean VAS EQ-5D-3L score for group 2 was

0.77±0.027 (CI 0.69-0.82, standard error 2). For

group 4, the average VAS EQ-5D-3L score was

0.83±0.009.

For 5 parameters measured in EQ-5D-3L,

representatives of groups 2 and 4 in 19.8 % indicated

problems (response level 2 for an item on a 1-3 point

scale) with daily activities, 3.1 % with self-care, 26.0

% with mobility, 47.1 % with pain/discomfort, and

53.4 % with anxiety/depression problems. The results

of groups 1 and 3 are shown in Table 3.

The percentage distributions are shown in Figure

Table 1: Percentage of study results on the STAI scale.

Gende

Girls Young men

Anxiety form Situational Personal Situational Personal

Terrain

Degree

Village

(group 1),

City

(group 2),

Village

(group 1),

City

(group 2),

Village

(group 3),

City (group

4), %

Village

(group 3),

City

(group 4),

Low anxiety 13.8 6,9 25.9 6.1 14.1 28.7 17 15

Moderate

anxiety

55.1 37.9 33.9 25.4 70.5 42.5 64 45

Increased

anxiet

31.1 55.2 40.2 68.5 14.4 28.8 17 39

Table 2: Comparison of population mean and study results on the VAS EQ-5D-3L scale.

Gender Girls Young men

Level Village (1 group), from 1.0 City (2 group), from 1.0 Village (group 3), from 1.0 City (4 group), from 1.0

Points 0.84±0.003 0.85±0.012 0.85±0.001 0.77±0.027 0.91±0.001 0.90±0.004 0.90±0.001 0.83±0.009

Table 3: Comparison of the average of each of the five parameters of the EQ-5D-3L.

Indicators

Average indicators for the

population before the

andemic, %

Revealed indicators for the

village (groups 1 and 3), %

Revealed indicators for the

city (groups 2 and 4), %

Mobility 24.8 25.8 26.0

Personal care 4.6 2.2 3.1

Daily activities 13.0 16.5 19.8

Pain and discomfort 38.4 39.4 47.1

Anxiety and depression 38.0 43.1 53.4

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Figure 1: Comparison of VAS EQ-5D-3L results during a

pandemic in rural/urban areas and non-pandemic averages.

4 DISCUSSION OF RESULTS

In girls who were in self-isolation in rural areas

(group 1), we diagnosed a predominantly moderate

level of situational anxiety of 55.1 % (16 people) in

comparison with the second group 37.9 % (38 people)

of girls who were in the period of isolation in urban

areas. Girls of the second group are characterized by

a higher indicator of anxiety, 55.2 % (17 people).

Wherein, personal anxiety as a character trait in

respondents of both groups was increased – 55.2 %

and 68.5 % (group 1 and group 2, respectively),

which does not refute the study results that women

are characterized by increased anxiety in relation to

men. There were no statistically significant

differences in the mean results of anxiety on the STAI

scale at each level.

Young men who were on self-isolation in rural

areas (group 3) and were on self-isolation in cities

(group 4) had a moderate percentage of situational

anxiety: 70 % and 64 %, while a lower percentage of

personal anxiety: 42 % and 45 %. The data obtained

confirm the data that personal anxiety as a character

trait is much higher in women.

It shall be noted that the average indicators of the

increased level of anxiety in group 3 are lower than in

group 4 in situational anxiety (47.5 ± 0.03 versus 69.8

± 0.011, p <0.01) and in personal (50.4 ± 0.07 versus

56.3 ± 0.09, p <0.05). The lowest mean value of

moderate anxiety was shown by group 3 (32.2 ± 0.13

versus 37.5 ± 0.12 in group 4, p <0.05). In the

representatives of the group 4, the indicator of low

personal anxiety is higher than in the group 3 (27.8 ±

0.09 versus 25 ± 0.12, p <0.05).

Comparison of the average statistical distribution

of data obtained according to the results of the VAS

EQ-5D-3L method for group 2 (covid period) is

significantly lower than the average standard score

for the urban population of this age group available in

the pre-covid period (average score -0.85 ± 0.001,

standard error 0.1) (Peng, Lee, Tsai, Yang, Morisky,

Tsai, 2010). For group 4, the average statistical value

obtained during the VAS EQ-5D-3L method is also

lower than the average standard score (mean score

0.90 ± 0.001, standard error 0.2). No significant

gender differences were noted (see Table 2).

For 5 parameters measured in the EQ-5D-3L, the

results of groups 2 and 4 differed significantly from

the population norms of anxiety and depression

(higher, 53.4 % versus 38.0 %, p<0.001), pain and

discomfort (higher, 47.1 % versus 38.4 %, p<0.001)

and everyday activities (lower, 19.8 % versus 13.0

%), p<0.001) (see Table 3). In groups 1 and 3,

significant changes were not observed in comparison

with the average indicators for the population, which

is shown in Figure 1.

5 CONCLUSIONS

Interpretation of the results obtained allowed us to

conclude that the quality of life of students of medical

universities in Russia during the pandemic has

significantly deteriorated as a result of an increase in

situational anxiety. We are not aware of any previous

studies in Russia on the correlation between place of

residence and the level of anxiety, except for the

aforementioned Russian publication on the influence

of the media. In addition, there are studies conducted

during the pandemic in Asia and Germany, which

indicate general negative trends in the psyche of

people associated with COVID (Bauerle, Teufel,

Musche, Weismuller, Kohler, Hetkamp, 2020),

(Rabin, Gudex, Selai, Herdman, 2014).

The results of our study indicate that personal

anxiety, as a constant, does not change depending on

the location during the period of isolation, whether it

is an urban or rural area. Significant indicators were

identified for situational anxiety, which correlates

with the place of residence during a pandemic. The

indicators of situational anxiety among male students

living in rural areas are significantly lower than in the

other three samples.

The COVID-19 epidemic has brought about

dramatic changes to everyone's daily life. Also, like

any global processes, it provoked a rise in the level of

anxiety, depression and other pathological states of

the psyche of people. This poses new challenges for

psycho-prevention and crisis counseling for a wide

range of people, including their future colleagues, for

specialists in the field of psychology and psychiatry.

Based on the results of the study, we believe that it is

Study of Anxiety among Students Depending on the Location of Urban or Rural Areas during Isolation during a Pandemic and COVID-19

necessary to involve psychologists and

psychotherapists in preventive work with medical

students in order to explain the rules of behavior in a

situation of all-round psychological pressure. It is

imperative to develop methods of dealing with the

consequences of prolonged self-isolation. It is also

especially important, if possible, to choose quiet rural

areas and villages remote from cities as a territory for

self-isolation, which plays an important role in

reducing the level of anxiety and depression, as well

as the quality state of health and its subjective

perception.

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