A comparative analysis of COVID-19 related perception and predictors of stress in india versus usa

Rationale: US and India are among the most populous and diverse countries and the worst affected by COVID-19. People of these two countries perceive threats of COVID-19 differently, influenced by their knowledge of the disease, healthcare infrastructure and facilities, and social security. We conducted a survey study with the primary objective of comparing COVID-19 related stress and their predictors between India and USA. Our secondary objectives were to compare knowledge on COVID-19, perception about healthcare facilities, and adherence to preventive COVID-19 recommendations between US and Indian participants. Methodology: A public survey was designed via Redcap, and the survey link was sent out using social media platforms, Research-match and Studyfinder. The data was collected between June to October 2020, with a focus on comparative analyses. Stress-related questions were based on confinement, job-loss, healthcare facility, contracting COVID-19, and risk of death. Knowledge related questionnaire tested the understanding of spreading, prevention, treatment of COVID-19. We also asked about preventive practices like handwashing, facemask, and social distancing, to understand whether disease perception could influence adherence to preventive guidelines. 'Factor analysis' function in 'SPSS' was used to summarize the questionnaire (Likert scale) on stress, knowledge, and guideline adherence into combined normalized scales (0-10), for each of those three categories. T-test and Mann-Whitney test were used to compare between US and Indian participants, as applicable. Results: Redcap captured 531 and 242 responses from the USA and India, respectively. The stress score (mean±SD) was significantly higher (p<0.001∗) in Indian participants (Ind-P) (6.68±1.78), compared to US participants (US-P) (5.30±2.01). Among the sociodemographic factors, sex (p=0.035), age (p=0.016), race (p=0.002) and education level (p=0.025) were significant predictors of stress in US-P, while age(p=0.008) was the only stress predictor in Ind-P. US-P demonstrated better knowledge on COVID-19 compared to Ind-P (7.80±1.30 vs. 5.26±1.98, p<0.001∗). Ind-P were more adherent to preventive guidelines than US-P (9.06±1.23 vs. 8.66±1.82, p<0.002∗). Ind-P, compared to US-P, consistently reported inadequate healthcare facilities, including hospital, ventilator availability, and administrative initiative (p<0.001∗, p<0.001∗, and p=0.008∗ based on Mann-Whitney test). Participants attitude towards future participation in clinical trials were also varied, as US-P were more willing to participate in the ongoing vaccine(p=0.028) and drug trials(p=0.03) compared to Ind-P. Conclusion: Ind-P compared to US-P demonstrated higher stress level, lower knowledge score. Higher stress scores in Indians could be related to dissatisfaction over available healthcare facilities and might have encouraged them to adhere to the preventive measure better than US-based participants.