Common mental health problems among patients accessing care at ayurvedic health centers in Udupi Taluk

TL;DR

This study examines mental health issues like stress and depression among patients at Ayurvedic centers in Udupi Taluk, finding a link between lower education and higher stress levels.

Contribution

The study provides insights into mental health prevalence and its association with educational status in a specific regional healthcare context.

Findings

Participants showed some level of perceived stress and depression.

Lower educational status was significantly associated with higher moderate stress levels (p=0.01).

Abstract

Increased work pressure, lifestyle modifications, and deteriorated living conditions brought on by Coronavirus disease 2019 (COVID-19) can exacerbate mental health concerns such as anxiety, sleeplessness, depression, and stress-related illnesses. Recent studies have shown that a high burden of mental health conditions, including depression, anxiety disorders, stress, panic attacks, impulsivity, irrational anger, somatization disorder, sleep disorders, emotional disturbance, symptoms of post-traumatic stress disorder, and suicidal thoughts, may be experienced by COVID-19 survivors. Due to differences in their susceptibility to infection and lifestyle factors, people with different medical conditions and social roles may have various kinds and severities of mental health problems. This study aimed to provide essential insights into the prevalence, types, and linkages of various mental health issues to improve patient outcomes, guide future treatments, and advance holistic well-being.

This cross-sectional study examined the prevalence of common mental health issues among patients receiving treatment at Ayurvedic health centers in Udupi Taluk. Five Ayurvedic centers were chosen randomly from 275 Ayurvedic centers registered in Udupi Taluk. A total of 423 patients aged 18 years and above were selected for this study. The Perceived Stress Scale and Patient Health Questionnaire (PHQ-9) were used to collect data.

The study revealed the presence of some level of perceived stress and depression among the participants. The factor associated with stress was the educational status of participants (p =0.01). The comparison between different stress levels revealed that moderate stress levels were significantly higher among participants with a lower educational status.

According to a study on perceived stress levels and educational status, participants with lower educational status reported feeling more stressed than those with higher educational status.

Tables

Table 1.. Socio-demographic details of the participants.

Variables	Frequency & percentage
Age in years
18–30	144 (33.5)
31–60	265 (61.6)
More than 61	21 (4.9)
Gender
Male	241 (56)
Female	189 (44)
Educational status
Less than PUC	244 (56.7)
Degree and above	186 (43.3)
Marital Status
Single	91 (21.2)
Married	339 (78.8)
Religion
Hindu	368 (85.6)
Muslim	44 (10.2)
Christian	18 (4.2)
Employment Status
Employed	297 (69.1)
Unemployed	100 (23.3)
Student	26 (6.0)
Retired	7 (1.6)

Table 2.. Prevalence of common mental health problems during covid-19 pandemic.

Variable	Frequency (%)
Stress
Low stress	22 (5.1)
Moderate stress	400 (93)
High stress	8 (1.9)
Depression
Minimal depression	178 (41.4)
Mild depression	68 (15.8)
Moderate depression	120 (27.9)
Moderately severe depression	61 (14.2)
Severe depression	3 (0.7)

Table 3.. Association between common mental health problems and demographic characteristics of the participants.

	Low stress	Moderate stress	High stress	p-value
Age
18-30	8 (36.4%)	130 (32.5%)	6 (75.0%)
31-60	13 (59.1%)	250 (62.5%)	2 (25.0%)	0.1
More than 61	1 (4.5%)	20 (5.0 %)	0 (0.0%)
Gender
Male	14 (63.6%)	222 (55.5%)	5 (62.5%)	0.7
Female	8 (36.4%)	178 (44.5%)	3 (37.5%)
Educational status
Less than PUC	7 (31.8%)	236 (59.0%)	1 (12.5%)
Degree and above	15 (68.2%)	164 (41.0%)	7 (87.5%)	0.001 *
Employment Status
Employed	17 (77.3%)	275 (68.8%)	5 (62.5%)
Unemployed	2 (9.1%)	97 (24.2%)	1 (12.5%)	0.1
Student	2 (9.1%)	22 (5.5%)	2 (25.0%)
Retired	1 (4.5%)	6 (1.5%)	0 (0.0%)
Area of residence
Rural	16 (72.7%)	226 (56.5%)	4 (50.0%)	0.3
Urban	6 (27.3%)	174 (43.5%)	4 (50.0%)

Table 4.. Participants’ feelings and thoughts during COVID-19.

Characteristics	Frequency (%)
Afraid of acquiring COVID-19 when going Into the Public
Extremely Afraid	147 (34.2)
Sometimes Afraid	113 (26.3)
Rarely Afraid	145 (33.7)
Not at All Afraid	25 (5.8)
Feeling Worried of Acquiring COVID-19
Always	65 (15.1)
Sometimes	214 (49.8)
Rarely	120 (27.9)
Never	31 (7.2)
Sleep get affected because of thoughts relating COVID-19
Always	85 (19.8)
Sometimes	122 (28.4)
Rarely	179 (41.6)
Never	44 (10.2)
Avoiding conversations on COVID-19 out of fear/anxiety
Always	96 (22.3)
Sometimes	130 (30.2)
Rarely	165 (38.4)
Never	39 (9.1)
Worried acquiring COVID-19 when unknown person coming close
Extremely Afraid	158 (36.7)
Sometimes Afraid	106 (24.7)
Rarely Afraid	147 (34.2)
Not at All Afraid	19 (4.4)
Anxious when knowing information on COVID-19
Extremely Afraid	90 (20.9)
Sometimes Afraid	138 (32.1)
Rarely Afraid	167 (38.8)
Not at All Afraid	35 (8.1)
Concerned of acquiring COVID-19 when people cough or sneeze
Extremely Afraid	174 (40.5)
Sometimes Afraid	70 (16.3)
Rarely Afraid	170 (39.5)
Not at All Afraid	16 (3.7)

Full text

Introduction

According to the World Health Organization (WHO), health is defined as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. ^ 1 ^ A healthy mind is an essential aspect of overall wellness. During an illness, physical limitations could have psychiatric manifestations, causing patients to experience a wide range of psychological problems. ^ 2 ^ This study was conducted to determine the common mental health problems among patients accessing care at Ayurvedic health centers in Udupi taluk.

Coronavirus disease 2019 (COVID-19) was characterized as a pandemic by the World Health Organization (WHO) on March 11, 2020. ^ 3 ^ Hundreds of millions of people’s lives have been impacted, and people’s social, occupational, educational, and lifestyle choices have changed due to individual and governmental reactions to this serious public health catastrophe. Worrying about contracting an infection, increased work pressure, lifestyle changes, and worsened living conditions can all contribute to mental health issues such as anxiety, insomnia, melancholy, and stress-related diseases. ^ 4, 5 ^ People with diverse health conditions and social roles may experience various types and levels of mental health issues due to variances in their vulnerability to infection and lifestyle influences. ^ 6 ^ The COVID-19 pandemic, according to the United Nations, not only compromises physical health but also increases psychological distress. ^ 7 ^ Therefore, it is crucial to understand how communities’ mental health is affected during this pandemic. According to recent research, COVID-19 survivors may experience a high burden of mental health issues, such as depression, anxiety disorders, stress, panic attacks, irrational anger, impulsivity, somatization disorder, sleep disorders, emotional disturbance, post-traumatic stress symptoms, and suicidal ideation. ^ 8 ^ Additional factors associated with mental health problems during COVID-19 include age, gender, marital status, education, occupation, income, place of residence, close contact with COVID-19 patients, comorbid physical and mental health issues, exposure to COVID-19-related news and social media, coping mechanisms, stigma, psychosocial support, health communication, trust in medical services, personal protective measures, and risk of COVID-19 infection. ^ 9 ^

Ayurveda, a millennia-old Indian medical system, exemplifies this holistic concept by recognizing the interdependence of mind, body, and spirit. ^ 10 ^ Ayurvedic wellness centers have become popular as alternative and complementary healthcare destinations, promising physical and emotional renewal. ^ 11 ^ This study investigates the frequency of common mental health disorders among patients seeking care at Ayurvedic health centers in Udupi Taluk, a critical yet understudied subject.

Study location

Udupi Taluk, located in the southwestern coastal region of Karnataka, is known for its rich cultural legacy and traditional practices. Ayurvedic health centers in this area serve a diversified clientele seeking solutions to various health issues. Understanding the mental health landscape of patients seeking care at Ayurvedic centers is critical for individual well-being and optimizing healthcare delivery within this holistic paradigm.

There is a bidirectional relationship between physical health and mental health. Physical issues can lead to psychological distress, whereas mental health issues can manifest as physical symptoms. ^ 12 ^ In the context of Ayurveda, which encourages balance and harmony. Exploring the prevalence of common mental health issues is particularly crucial. Healthcare practitioners, policymakers, and researchers should work together to improve the overall quality of care at Ayurvedic health centers by highlighting this little-studied aspect. Furthermore, the findings of this study may help understand better-integrated healthcare approaches that prioritize mental and physical health holistically.

Given the growing interest in alternative healthcare practices and the global burden of mental health disorders, this study aimed to fill a critical knowledge gap by investigating the common mental health issues encountered by patients seeking care at Ayurvedic health centers in Udupi Taluk. This study sought to provide significant insights into the prevalence, types, and correlations of various mental health problems to inform future therapies, enhance patient outcomes, and promote holistic well-being within the Ayurvedic healthcare framework.

Methodology

This cross-sectional study was conducted at Udupi Taluk. Of 275 Ayurvedic centers registered in Udupi Taluk, five Ayurvedic centers were selected randomly. Data were collected between (June 2022 and December 2022). A total of 423 patients aged ≥ 18 years were selected for this study. The approval has been obtained from Kasturba Medical College and Kasturba Hospital Institutional Ethics Committee (IEC No: 866-2021), The ethical clearance was obtained on May 9, 2022, and written consent from the participants was also obtained. The Patient Health Questionnaire (PHQ-9) and Perceived Stress Scale were used to collect data. ^ 13 ^ Data were analyzed using SPSS version 25.0 (IBM SPSS Bangalore, India). Frequency and percentage were used to describe the descriptive statistics. The chi-square test was used to determine the association between categorical variables.

Results and discussion

Sociodemographic characteristics of the participants are presented in Table 1. Of the 430 participants, 61.6% were in the age group of 31–60 years, and the majority (56%) were male. Most of the participants (56.7%) had less than PUC education. Most participants (78.8%) were married, and 85.5% belonged to the Hindu religion.

Most of the people in the population were between the ages of 31 and 60 (61.6%), followed by people between the ages of 18 and 30 (33.5%), and over 61 (4.9%). There were a slightly higher number of men (56%) than women (44%). Almost half of the people in the country had less than a Pre-University Course (PUC) education (56.7%), while 43.3% had a degree or higher. Seventy-eight percent of people were married, while only twenty-two percent were single. Hindus (85.6%), Muslims (10.2%), and Christians (4.2%). A large part of the population was working (69.1%), while smaller portions were unemployed (23.3%), school (6%), or retired (1.6%). The distribution of demographics revealed the needs and problems of the community.

The prevalence of common mental health problems is presented in Table 2. Regarding stress, most participants (93%) had experienced moderate stress, 5.1% had experienced low stress, and 1.9% had experienced high stress. Regarding depression, 41.4% had experienced minimal depression, 27.9% had experienced moderate depression, 15.8% had experienced mild depression, 14.2% had experienced moderate to severe depression, and 0.7% had experienced severe depression. The numbers show that the intensity of depression is spread out meaningfully. Even though the data do not show a clear link between stress and depression, the fact that moderate stress and depression levels vary every day suggests that there might be one. The data show that tailored mental health interventions are needed because of the wide range of stress and depression levels. The findings point to significant mental health problems that require more research and action from the public health system. Some people experience stress without depression. What factors, such as support groups and ways to deal with stress, might stop this from happening? Stress and depression appear differently in different people, and some signs may overlap, such as tiredness and trouble sleeping. People in this group tended to have mild-to-moderate depression. Social, economic, and environmental factors can cause moderate sadness. How do these factors relate to stress levels? Many people with moderate sadness showed that this group needed help with their mental health.

The associations between common mental health problems and demographic characteristics of the participants are presented in Table 3. The factor associated with stress was the educational status of the participants (p = 0.01). None of these factors was associated with depression.

Stress distribution across age groups

The data suggest that the highest percentage (75%) of high stress is found among the youngest age group (18-30 years), and factors such as career uncertainty, financial instability, or life transitions may contribute to higher stress levels in younger individuals, while the middle-aged group (31-60 years) has a lower percentage (25%) of high stress, which may be due to a decrease in stress with age aligned with possible increases in life experience, stability, or coping mechanisms. The oldest age group (over 61 years) shows no high stress due to the potential influence of retirement on stress levels in the oldest age group. The data showed no significant difference in stress levels between males and females, with a p-value of 0.7. Both genders had similar distributions across the low-, moderate-, and high-stress categories. The p-values for age (0.1) and sex (0.7) indicate that the differences in stress levels across these variables were not statistically significant.

Impact of educational status on stress levels

The data showed a strong link between schooling and stress levels; a p-value of 0.001 indicated that this link was statistically significant. Most people with less than a PUC (Pre-University Course) education (59%) experienced moderate stress, while a higher number of people with a degree or higher (87.5%) experienced high stress. People with a bachelor’s degree or higher may be more stressed because they have more responsibilities, higher career demands, or work pressures. Does this trend have anything to do with job competition, student loans, or the desire to advance your career? Could people with more schooling be more aware of stress and more likely to talk about it? A p-value of 0.001 indicated a statistically significant link between the amount of education and stress. Different levels of schooling seem to cause various types of stress, which can help make remedies more effective. The link between education and stress significantly affects both society and the workplace.

Stress distribution across employment status

These numbers show that people with different types of jobs experience various levels of stress. Working people were mainly in the moderate stress category (68.8%), and unemployed people were also mainly in the moderate stress category (24.2%). Notably, students were more likely than other groups to be in the high-stress category (25%), whereas older adults were the least stressed. People with jobs usually feel moderate rather than high or low stress because of pressures at work, such as meeting deadlines, worrying about job stability, balancing work and life, and meeting performance standards. People who have jobs are more or less stressed depending on how happy they are with their jobs, the type of jobs they have, or the support systems at work.

Stress distribution across rural and urban areas:

The data show that people in rural places mostly feel low to moderate stress, whereas people who live in cities have a relatively even distribution of low, moderate, and high stress. The percentage of people living in high-stress places was the same in both rural and urban areas (50% each). People living in rural locations tended to have low (72.7%) or moderate (56.5%) stress levels. Stress levels are lower in rural areas because of a slower pace of life, more robust community ties, and being closer to nature. Problems with the economy, obtaining medical care, and finding work in rural places can all raise or lower stress levels. Moderate stress was more effective than high stress. With a p-value of 0.3, the differences in stress levels between people who live in rural areas and those who live in cities were not statistically significant.

The participants’ feelings and thoughts during the COVID-19 pandemic are presented in Table 4. Approximately one-third of the participants (34.2%) were extremely afraid, while 33.7% were rarely afraid of acquiring COVID-19 when going into the public. Nearly half (49.8%) of the participants were worried about contracting COVID-19. Approximately 41.6% of the participants reported that sleep was rarely affected because of thoughts related to COVID-19. About 22.3% reported avoiding conversations on COVID-19 because of fear or anxiety. Approximately 36.7% were worried about acquiring COVID-19 when an unknown person came closer to them. Approximately 20.9% were anxious about obtaining information on COVID-19. Approximately 40.5% were concerned about acquiring COVID -19 when people coughed or sneezed.

Prevalence of fear:

The results showed that many of the participants were afraid of contracting COVID-19 in public places. About one-third (34.2%) were very afraid and another third (33.7%) were rarely scared. This indicates that people’s fears are very different. The fact that 34.2% were scared shows how widespread anxiety was during the pandemic. This anxiety may have been caused by news stories, rising case numbers, and lack of knowledge about the virus. This terrible fear comes in the way of everyday activities like work, shopping, and taking the bus. The 33.7% of those who were rarely afraid may have had more faith in protective measures (such as masks and social distancing), or they may have thought they were less at risk because of their age, health, or ability to obtain correct information. Fear levels vary, which means that public health messages need to be adapted to reach terrified people and those who are not worried. For example, reassuring people and giving them clear information might lower their anxiety, while stressing how important it is to take steps might make those who are not afraid of being more alert.

Prevalence of worry:

About 49.8% of the people who took the survey said they were worried about getting COVID-19 “sometimes.” This shows that worry is a normal, if not always present, feeling for many people. Almost half of the people who participated in the study said that they sometimes felt worried. This shows that fear was not overwhelming, but constant worry could change depending on rising case numbers, personal experiences, or news stories. This concern contributes to the general stress level. Coping strategies can be used to address these concerns. Worry could change how people act in public, such as following rules, connecting with others, or deciding to do things in public. This worry that happens “sometimes” changes the way a group works, such as how people help each other or work together.

Prevalence of sleep disruption:

About 41.6% of the participants said that COVID-19 thoughts rarely kept them from sleeping. This shows that COVID-19-related anxiety was present, but it did not keep most people sleeping well. Sleep and Mental Health: The results showed that most participants’ thoughts about COVID-19 did not significantly interfere with their sleep. There may have been things that prevented these people from having trouble sleeping. It is essential to maintain mental and physical health during pandemics. Some people may have been able to sleep better after getting help from the anxiety linked to the pandemic. Examples of these treatments include stress management, cognitive-behavioral therapy, and mindfulness. Long-term worry or sleep problems that come and go can harm mental and general health.

Prevalence of avoidance:

About 22.3% of those who took the survey said that they avoided discussing COVID-19 because they were afraid or anxious about it. This meant that many people felt so bad about the subject that they did not want to discuss it. Avoiding talking about COVID-19 might have been a way to deal with stress, but it could have also made people feel alone or deprived of correct information. This avoidance hurts both emotional health and relationships with others. Because of the steady flow of information and terrible news, some people may have felt that they had too much to take in, making them avoid it. Campaigns for public health strike a balance between informing people and making them feel scared of what this means for society, especially when working together and making communities strong. This avoidance makes people feel bad about themselves or leads to a lack of knowledge of the virus and its effects.

Worry about proximity to unknown persons:

About 36.7% of the participants were worried that they might get COVID-19 if an unknown person got closer to them. This shows that people are concerned about being close to people who might have the disease and the risk of its spread. People may have changed how they interacted with each other because they were afraid of being close to strangers. This may have caused people to physically distance themselves from others, socialize less, and possibly make public places tense. This has changed how people act and follow social rules. Worrying about people that you do not know could also mean that you do not trust others as much, which could divide society. Thus, it is essential to build trust after a pandemic. This worry may have made people more likely to follow public health rules, such as staying away from sick people and wearing masks. Messages about public health address these concerns and encourage people to act safely.

Prevalence of anxiety:

Approximately 20.9% of the participants were nervous when they heard of COVID-19. This shows that the constant news stream and updates caused anxiety. The fact that COVID-19 information makes people anxious shows how media use affects mental health. People should control how much media they use to lower their stress, and media companies should play a role in the spread of knowledge. Some people may have learned to deal with their anxiety by picking up and choosing their knowledge. Public health officials ensure that people who are worried about the news receive essential information. Public Health Communication: To lower anxiety about COVID-19 information, techniques can be used, such as reassuring language, giving helpful advice, or focusing on good outcomes (such as recovery rates or new vaccines).

Prevalence of coughing or sneezing:

Approximately 40.5% of the people who took part were worried that they would get COVID-19 from people who coughed or sneezed near them, which shows an intense fear of symptom transmission. Concerns about coughing or sneezing show that people are more aware of COVID-19 signs, which could make people more careful in public places. This knowledge affects actions such as wearing masks, social distancing, or staying away from areas with many people.

Psychosocial effects:

This worry may have made people more anxious or hypervigilant, especially when they had to cough or sneeze for reasons such as allergies or colds. This changes how people connect, especially at work, school, and public transportation. There is a chance that people who cough or sneeze in public would be judged, even if they were not sick with COVID-19. These issues are dealt with in public health efforts that do not add to stigma.

Discussion

The present study revealed that some level of perceived stress was exhibited by participants, with a very high number of participants experiencing moderate levels of stress during COVID-19. This indicates that the pandemic (COVID-19) has contributed to participants’ perceived stress.

Pandemic-induced stressors

People who took part were probably more stressed because they were always worried about their health, the health of their loved ones, and the chance of contracting the virus. A significant source of stress was worry that they would get sick and have to go to the hospital or die. Many people lost their jobs, had their incomes dropped, or were unsure of where to work in the future because of the pandemic. This lack of financial security probably stressed people, especially those who were already weak. Measures to keep people from getting too close, lockdowns, and limits on meetings all messed everyday social interactions, making people feel lonely, isolated, and disconnected. Not having friends or family during these times could have worsened the worry. People may have been too stressed by the confusing or scary information that kept coming in about the virus, how it spread, and how to stop it. The constant need to handle new information and adjust to new rules may have stressed people.

Psychological impact of prolonged uncertainty

Long-lasting uncertainty about how long the pandemic would last, how well vaccines would work, and the chance of new strains added to stress. Living in a state of long-term uncertainty can be mentally draining and make you feel powerless or burnt out. Significant mental and emotional changes had to be made to deal with sudden and ongoing changes in daily routines, such as working from home or teaching, or changes in social behavior, such as wearing masks and avoiding public places. Getting used to these new rules likely made the volunteers feel more stressed. The fact that many of the people who took part in the study reported moderate amounts of stress suggests that, while not everyone was stressed out, a large part of the population was. There are many signs of mild stress, such as irritability, trouble concentrating, changes in sleep habits, or a general feeling of unease. Moderate stress was expected, which could mean that people were using ways to deal with it, like sticking to routines, getting social support, or doing things that relieve stress. However, these methods are not always sufficient to entirely reduce the stress caused by the pandemic. Different levels of stress among participants could show various levels of vulnerability and resilience. People’s mental health problems, ability to receive social support, ability to handle stress, and coping skills may all affect how they feel and deal with stress during the pandemic.

Mental health interventions

Many people feel moderate worry, which shows how important it is to have easy access to mental healthcare during and after the pandemic. Helping people deal with long-term stress sources could come from counselling, workshops on stress management, and neighborhood support groups. When people talk about public health, they should focus on physical and mental health, giving them tools and tips for dealing with stress. This could mean encouraging people to live healthy lives, make friends, and obtain clear, consistent knowledge to lower uncertainty. Having moderate worry over a long period could lead to more serious mental health problems such as depression or anxiety if not dealt with. It is essential to keep an eye on and help people with mental health problems as part of the overall reaction to the pandemic. Realizing that many people are under moderate stress clarifies how important it is to build group resilience. Communities are vital for helping each other, creating a sense of unity, and sharing tools to deal with stress in a group. When making decisions, policymakers should consider how the pandemic affects people’s mental health, and ensure that mental health services are adequately paid and included in plans for dealing with the pandemic. This includes helping people who may be more influenced than others, such as frontline workers, people with low incomes, and people who already have mental health problems.

The study result is aligned with the study conducted in Kerala, which also reported that most of the participants had experienced moderate levels of stress during COVID–19. ^ 14 ^ In the current study, stress was high among participants aged 31 to 60. Stress levels were low among participants over 60 years of age. Although the finding was not statistically significant, previous research and global perceived stress reported that stressors experienced by older people are lower than those of younger people. ^ 15 ^ The association between gender and perceived stress showed that the moderate level of stress was higher among males than compared to females. This finding contradicts previous literature that reported lower perceived stress levels in men. ^ 16, 17 ^

A comparison between educational status and perceived stress level revealed that perceived stress was higher among participants with lower educational status than among those with higher educational status. The comparison between different levels of stress revealed that moderate levels of stress were higher among participants with lower educational status, and this was found to be statistically significant.

Education and stress resilience:

People with more schooling usually have better access to cognitive resources and ways to deal with problems. People who attend college often learn how to solve problems, think critically, and control their emotions, which makes them better able to handle stress. Higher education levels usually improve people’s ability to find, understand, and use health knowledge, which can help them better deal with stress. They may also have more knowledge about ways to deal with stress, mental health tools, and self-care activities that can help them feel less stressed. A college degree is often linked to better job opportunities, higher income, and more stable finances, which can help lower financial stress, which is a major cause of overall stress. Financially stable people can focus on their health and happiness instead of the day-to-day worries that people with less schooling might have. People with lower levels of education may not have many ways to deal with these problems. They may not know how to handle stressful situations, making them feel more stressed, especially during tough times such as a pandemic. A lower level of education is often linked to jobs that pay less, job insecurity, and less access to healthcare and other helpful tools. Being economically vulnerable is a significant source of stress because it can make people worry about meeting their basic needs, especially during crises, such as the COVID-19 pandemic. People with less schooling may also have to deal with extra social and environmental stresses, such as living in an unsafe or crowded place, not having much social support, and being discriminated against or socially stigmatized. These factors can worsen the levels of worry. The result that people with less education had higher moderate stress levels was statistically significant. This shows a strong link between the level of education and the ability to deal with or understand stress, with less education linked to higher stress levels. Even though moderate stress is not as bad for you as high stress, it can still significantly affect your health and wellbeing. People with less schooling may be more likely to experience moderate stress because they have more trouble with money, fewer friends and family, and less access to mental health resources.

Implications for interventions

Based on these results, it is clear that people with less education require specific support services. Some examples of interventions include classes on how to deal with stress, handle money, and obtain affordable mental health services. Promoting higher education and learning opportunities throughout life can help people deal with stress. Even as an adult, encouraging and helping people keep learning could help vulnerable groups feel less stressed. When planning mental health interventions, public health plans should consider the educational differences. Messages and support services tailored to the needs of people with less schooling can help to close the gap in their ability to deal with stress.

Policy implications:

Reducing educational inequality can help people feel less stressed and better about their general health in the long term. Stress differences could be lessened by policies that ensure equal access to good schools, job training, and adult education. A significant social factor affecting health is education level. Policymakers should consider how education affects health, such as stress, and work to lower hurdles to education, especially in areas that do not receive enough help. Obtaining help and tools for people with less education through community-based programs can be very helpful in lowering stress. Community centers may offer educational classes, counselling for mental health issues, and social support networks as part of these efforts.

A comparison between employment status and perceived stress level revealed that perceived stress was higher among employed participants, although the association was not statistically significant. A comparison between different levels of perceived stress reported that moderate levels of perceived stress were higher among employed participants. As compared to area of residence the rural participants experienced more perceived stress as compared to urban participants. Except for educational status, none of the factors were found to be statistically significant.

The present study revealed that some levels of depression were exhibited by participants during COVID-19. Depression was high among the participants aged 31–60 years. Stress levels were low among participants over 60 years of age. The association between gender and PHQ-9 depression score was higher among males than among females. A comparison between educational status and PHQ-9 scores showed that depression was higher among participants with a lower educational status than among those with a higher educational status. The comparison between employment status and PHQ-9 revealed that depression was higher among employed participants. Depression was higher among rural participants than among urban participants. None of the factors were statistically significant.

Conclusion

This study aimed to determine the prevalence of common mental health problems among patients accessing care at Ayurvedic health centers during the COVID-19 pandemic. The study revealed the presence of some level of perceived stress and depression among the participants. The reasons for perceived stress and depression, and effective measures to overcome these problems need to be explored. The further research needs to be carried out to investigate the reasons and measures to overcome these problems. This may help to overcome stress and depression during crises.

Ethical approval and consent

The approval has been obtained from Kasturba Medical College and Kasturba Hospital Institutional Ethics Committee (IEC No: 866-2021), and written consent from the participants was also obtained. The ethical clearance was obtained on May 9, 2022.