4 DISCUSSION
This study provides important data regarding the impact of the pandemic in Turkey. First of all, it was detected that the society was significantly affected by the pandemic. Among the participants in the study; based on moderate and above psychological effects, anxiety was found in 15.8%, depression in 22.6%, stress in 12.9%, and trauma in 20.29%. In a study by the American Psychiatric Association, it was stated that the COVID-19 epidemic caused anxiety in 50% of the society and more than one-third felt that their mental health was seriously affected.17 In the study conducted by Wang et al in the normal population in the second week of the pandemic, it was observed that 53.8% of the participants had a psychological response, 16.5% with depression, 28.8% with anxiety, and 8.1% with high stress.8 Although the data obtained were close to the rates determined in China, they differed in terms of low IES-R rates. This result is probably related to the reduction of the acute effect of the pandemic in the community since the study was performed at the 6th week of the epidemic. On the other hand, the fact that Turkey was not one of the first countries experiencing the outbreak, and had time to establish certain infrastructure related to the outbreak may be associated with lower trauma scores. However, since there is no previous study in our country, such a comparison is not possible to be made.
Epidemiological studies on epidemics or disasters have shown that sociodemographic variables are associated with different levels of psychological response. Women,18-20 young people,21 people with higher education,22 health workers,23students,24 those with low economic income,25 people with or without a history of any disease26 and smokers27 are emphasized in the literature for having higher rates of psychological response.
In our study, in accordance with the literature, young age, being single, an excessive number of people living together, presence of psychiatric disease history, and female gender were identified as higher risk conditions in terms of high psychological responce. However, contrary to the literature, high education levels significantly reduced the risk of anxiety and depression, while smoking, lack of health insurance, or low level of economic income were not associated with psychological exposure. This result may be due to the effects of cultural and/or religious differences among communities on human behavior and perceptions.
While studies in the literature have shown that societies use the internet and social media as a general information source and the posts here play a role in psychological influence.6,28 In our study, it was seen that most of the participants use television/radio as a source of information and this fact is not related to psychological influence. Although Turkish society has high levels of internet usage, the fact that the main source of information is expressed as TV/radio may be due to the low belief in the news on the internet. On the other hand, the feeling of trust towards TV may be resulted from the fact of authorized institutions’ regular and effective TV use during the pandemic. As a matter of fact, the high degree of satisfaction and belief in the information obtained supports this relationship.
Another conclusion drawn from our study is; although very few of the participants were diagnosed with COVID-19, contrary to the literature,29 interestingly, it has been found that being treated for COVID-19 infection is not related to psychological affect. Moreover, being quarantined and having a test reduced the level of psychological response.
On the other hand, although there was no diagnosis of COVID-19, the presence of symptoms suggestive of any infection, and a history of contact with an individual or object infected with COVID-19 were also factors that increased the risk of psychological response in individuals. This result seems to be a reflection of the anxiety developed in accordance with the nature of “uncertainty”. In the literature, “uncertainty” is accepted as causing a series of cognitive, emotional, and behavioral damage in the process of time. It is also considered as a “basic component of all anxiety disorders” which reduces problem-solving ability.30 Accordingly, taking precautions such as regular sharing of information that will eliminate this uncertainty during the days of pandemic intensification, dissemination of diagnostic tests can contribute positively to the mental health of the society.
According to previous studies, despite social differences, there is a relationship between compliance with the measures taken and psychological impact.23 In the study of Wang et al., compliance with precautionary measures has been shown to reduce the psychological response.8 In our study which is consistent with the literature, it was found that the majority of the participants to be complying with the measures taken although Turkish society has been facing such a pandemic for the first time in its history. It has been also remarkable that people’s adaptation with the rules to have a positive effect on psychological response. It is an expected result for a society in which people state that they pay more attention to the health of their relatives rather than their own and that they do not feel psychologically uncomfortable. In addition, it has been observed that regular exercise, a balanced diet, and attention to sleep patterns are protective factors in psychological response. However, it was found that most of the participants complied with these measures at a lower rate. Therefore, raising awareness of the society for these measures which are effective in psychological and biological empowerment seems to provide significant benefits in combating pandemics.
When the areas where the participants are concerned are evaluated, similar to previous pandemic studies,31 the first 3 places respectively were the health of family and relatives, anxiety to infect others, and going to health controls. However, it was seen that the characteristics of the individuals during the pandemic caused anxiety about different issues. For example, academic anxiety was the primary concern among young people aged 18-25. The individuals with the most economic concerns were those with a monthly income of 2500-5000 TL and university graduates. A remarkable result here was that people’s anxiety about taking medications that they had to take constantly increased their stress levels by 75.5%. Biologically at risk of further damage than COVID-1932 this anxiety of the people is an important situation in terms of disruption of the treatments and subsequent serious health problems. Unfortunately, our study on why people bear this concern has not been able to provide a clear explanation. However, in our opinion, presenting information that has not been confirmed about whether or not some drugs can be taken in the media seems to cause more confusion and anxiety. Therefore, preventing information pollution about COVID-19 and making necessary explanations to these people at risk, will contribute to the reduction of anxiety levels, and it seems to contribute positively to the lives of these people with physical illness.