A total of 618 respondents between the ages of 18 years and 34 years completed the survey, after clicking on their agreement to participate. Of these, 352 (57%) were males and 266 (43%) were females. Nearly 66% (405) young adults hailed from the two states of Uttar Pradesh and Delhi. However there was representation from all regions of India, with 48 respondents from other Northern states (Punjab, Haryana, Himachal Pradesh, Uttarakhand, Jammu and Kashmir, Chandigarh and Rajasthan), 47 from the Western region (Gujarat and Maharashtra), 46 from the Eastern region (Bihar, Odisha and West Bengal), 35 from Southern region (Kerala, Tamil Nadu, Karnataka, Andhra Pradesh and Telangana) and 4 respondents from the North-Eastern region (Assam and Manipur). Most (72%) of the respondents (442) were living in an urban setting at the time of the survey.

Among the 618 respondents, 190 (31%) were students, 123 (20%) were healthcare workers including doctors, nurses technicians and other supporting hospital staff, 58 (9.4%) were professionals like lawyers, architects, technocrats and engineers, 43 (7%) were teachers, 33 (5.5%) were social or religious workers and 21 (3.5%) were businessmen. Only 2% (14) of the young adult population stated they were unemployed. (Fig. 1)

Most of the respondents (97%) had completed high school, and nearly 67% (406) were graduates and above. 65/618 young adults had comorbidities like diabetes mellitus, hypertension, hypothroidism and heart disease.

Further on, only 202/618 respondents (32.8%) accepted they were anxious about contracting COVID-19, but on the other hand nearly 351 (57%) were anxious that a loved one or friend would contract the disease. 220/618 young adults (36%) were anxious and afraid about losing their jobs and livelihood because of the pandemic. Out of the 618 young adults, 82 (14.6%) had contractual jobs, 84 (15%) young adults were daily wage earners, and only 14 (2%) respondents were unemployed. However, nearly 49% (287) claimed that their income had been adversely affected. Besides, 41% (247 respondents) stated that television and newpaper reports and Whatsapp messages only served to add to their anxiety.

After analysis of the GAD-7 scale it was found that a little less than half of the young adults (46%; 281/618) had some level of anxiety or the other. Only 337 (54.5%) had no anxiety at all (Total GAD-7 score of 0), and nearly 161 (26%) had minimal anxiety levels (GAD-7 score of 1-4). Another 80 respondents (13%) qualified to have mild depression, and 40 (6.5%) young adults had dangerously significant anxiety levels (25 with moderate depression and GAD-7 scores10-14; 15 with severe depression and GAD-7 scores 15-21). (Fig. 2) 120 of the total 618 respondents (19.5%) had clinically significant depression levels (GAD-7 cutoff above 5). Nearly 33% of the young adult population had sleep disturbances in the two weeks prior to the survey. However 476/618 young adults claimed that they had been able to adjust wholly or in part to their changing circumstances. As predicted, females were significantly more anxious than males (25.6% vs 14.8%; p 0.001) taking GAD scores of 5 and above as clinically significant anxiety. This difference was seen at all levels of anxiety – minimal (GAD-7: 1-4), mild (GAD-7: 5-9), moderate (GAD-7: 10-14) and severe anxiety (GAD-7: 15-21). (Fig. 3) It was interesting to note that significantly greater number of females were worried about a loved one contracting COVID-19 (63.5 % vs 51.7%; p 0.004). More females said they became more anxious with media and Whatsapp messages than males (44.7% vs 36.4%; p 0.05). Also a significantly greater number of females were able to adjust with the lifestyle modifications than males (80.8% vs 74.1%; p 0.037) (Table 1)

It was interesting to see that those living in cities were more anxious than their counterparts in villages (21.7% vs 13.4%; p 0.02). Young adults with comorbidities had higher levels of anxiety than those who were healthy (33.8% vs 17.5%; p 0.004), and those with income loss tended to be more anxious than the rest (24.4% vs 14.8%; p 0.004). Media reports significantly increased anxiety in the young adult population (p <0.001). However no significant correlation was found between anxiety levels and residing away from family (18.7% vs 19.7%; p 0.89), or living with elderly people aged more than 60 years (23.4% vs 17.6%; p 0.12) or children younger than five years (18.5% vs 19.7%; p 0.83). (Table 2)

After binary logistic regression analysis, female sex (p 0.03), urban setting (p 0.05), presence of comorbidities (p 0.007), income loss (p 0.01) and media reports (p <0.001) were found to be independent predictors of anxiety in the young adult population in India.

Pandemics are notorious for their rapidity of spread and for the death and economic devastation they leave in their wake. The COVID-19 pandemic is also similar. It took less than three months to spread globally, and has till date affected more than five million people worldwide and caused more than three lakh deaths. In our country alone, there are more than a million COVID-19 positive cases with nearly thirty thousand deaths. Though the mortality rate in India is still around 3%, there is widespread anxiety and fear among the people because the coronavirus is highly contagious, and encountering the disease at some time or the other is inevitable. Television reports and other media reports have only added to peoples anxiety levels. This tendency was also noted by Roy et al in their survey on COVID-19 awareness and anxiety on 662 individuals, though their survey catered only to the English reading population, who remain a minority in Nothern India. ⁽⁸⁾

Most of our respondents were highly educated (67% graduates and above) and a majority of the others had completed their high school education (97% of 618), which is similar to the findings documented by Roy et al.⁽⁸⁾ This may be because of selection bias as our survey would have been taken by the eduated young adults within the gambit of our chain-referral sampling method. It was also not possible to include more uneduated young people because of the prevailing ‘lockdown’ at the time. However, unlike their study data which comprised of nearly 50% health professionals, we had a more diverse population group with only 20% healthcare workers.⁽⁸⁾

Our survey results revealed that nearly 46% of the young adults were anxious to some extent about the COVID-19 pandemic. However, clinically significant anxiety level (GAD-7 score >5) was seen in 19.5% of the young adult population. This is very similar to the findings published from China during this COVID-19 pandemic where they documented anxiety in 24.9% of the college students. However, nearly 6.4% of our young adults had moderate and severe anxiety as per the GAD-7 scale, compared to only 3.6% in the Chinese study.⁽⁹⁾ This may be because the survey was done earlier on before COVID-19 had become a pandemic of this proportion, and before extensive media coverage of world-wide mortality and economic slowdown.

A survey done in Mexico during the H1N1 pandemic in 2009-2010, showed that anxiety levels were higher when the pandemic was raging, and gradually reduced. They also noticed higher anxiety levels about bird flu and terrorism which was also receiving media coverage at the time.⁽¹⁰⁾ Similar results were seen in a survey of 315 American college students, where they stated anxiety as being common.⁽¹¹⁾ A survey done on healthcare workers in Singapore during the COVID-19 pandemic revealed anxiety in 14.5 % of the participants.⁽¹²⁾

In our study, only 32.8% of the young adults were anxious about contracting COVID-19 (Compared to nearly 72% in the survey by Roy et al), but 57% reported being anxious about a loved one contracting the disease.⁽⁸⁾ This is very depictive of a natural human tendency of altruism, in which people are more considerate of others with or without assurance of gain.⁽¹³⁾ There are certain gender biases with women considered and expected to be more altruistic, which was corroborated by our study in which 63.5% women were anxious about a loved one contracting COVID-19, compared to only 51.7% of men                         (p 0.004). ⁽¹⁴⁾

The gender bias with respect to anxiety is also well known, with women tending to worry and have more anxiety than men.^(15,16) This has been highlighted in our survey with nearly double the number of females having anxiety compared to males (25.6% vs 14.8%; p 0.001). This gender difference persisted at all levels of anxiety. (Fig. 3). In a study among college students in the United States of America during the swine flu pandemic, they noted that women were more likely to be anxious and wash hands more frequently than men.⁽¹⁷⁾ This gender bias may be due to women balancing multiple reposiblities at the same time, and in a patriarchal society like ours in India being responsible for all housekeeping matters and family, especially children. The pandemic, with its ensuing lockdown and school closures led to children and family members working from home, leading to added work and responsibility on the women-folk.

While analyzing our survey we noted that young adults with co-morbidities were significantly more anxious than healthy people (33.8% vs 17.5%; p 0.004). It is obvious that those with pre-existing diseases which tended to reduce their immunity like diabetes melliuts would be more likely to develop complications if infected with COVID-19. Those with bronchial asthma and other pulmonary diseases would also be more likely to suffer severe disease, adding to their levels of anxiety.

We found that those who had suffered losses in income because of the pandemic tended to be more anxious than those who had stable sources of income or salaries (24.4% vs 14.8%; p 0.004). This may be because a loss of income increases stress and uncertainty about the future, especially for those who are the bread-winners of the family. A population-based study from Canada concluded that reductions in household income was associated with a higher risk of developing mental disorders and even self-harm. ⁽¹⁸⁾

Our study also interestingly revealed that people living in cities were significantly more anxious than those in villages (21.7% vs 13.4%; p 0.02). This may be because of the rapid spread of COVID-19 in major cities like Mumbai, Delhi and other state capitals. All the ‘hot-spots’ are also in major cities, sparking anxiety and fear among city dwellers. This aspect has not been dealt with in other studies, and could be explored in greater detail in a later survey.

Limitations

As the survey questionnaire had to be completed online it could be taken only by those with smartphones or laptops, and those who were educated enough to use them. Internet availabilty and connectivity would be a problem in the rural setting accounting for the significantly lower number of respondents from villages. Also, the representation of young adults from South India and the North-Eastern states was low in our study, which does not make the opinions representative for our entire country.