Changes in Social Interaction Anxiety and Health-related Quality of Life among the Inpatients with Stroke in Long Term Care Hospital according to
the COVID-19 Vaccination in Korea
Sung-Min Son1,Han-Na, Hong2*
1Professor, Department of Occupational Therapy, JeonjuKijeon College 267 Jeonjucheonseo-ro, Wansan-gu, Jeonju-si, Jeollabuk-do, 54989, Republic of Korea
2Occupational Therapist, DaeJeonBroram Hospital 35 Inchang-ro, Jung-gu, Daejeon, 34929 Republic of Korea
Corresponding author*: Han-Na, Hong, E-mail: [email protected]
ABSTRACT
This study aimed to analyze the changes in social interaction anxiety and health-related quality of life among inpatients with stroke in long term care hospital according to the COVID-19 vaccination in Korea. Subjects were 14 inpatients with stroke in the hospital. They were vaccinated based on COVID-19 vaccination policy.
Social interaction anxiety assessment was used by Korean ver. of Social Interaction Anxiety Scale and health- related quality of life assessment was used by Short form-8 Health Survey. As the results, according to the vaccination, there was showed statistically significant decreased in the results of social interaction anxiety and there was not showed statistically significant difference in the results of health-related quality of life.
Accordingly, COVID-19 vaccination may contribute to decrease the level of social interaction anxiety and in the case of the changes in the health-related quality of life, the additional analysis should be needed according to the COVID-19 vaccination.
Keywords
COVID-19 vaccination, Health-related quality of life, Inpatient with stroke, Long term care hospital, Social Interaction anxiety
1. Introduction
Coronavirus Disease-19 (COVID-19)is a new type of acute respiratory infection that has spread worldwide after being manifested in Hubei province in China in December in 2019 [1]. Main symptoms of COVID-19 infection are reported as cough, fever, shortness of breath, muscle pain, joint pain and fatigue by various studies [2]. Moreover, gastrointestinal symptoms and the loss of smell and taste are reported to be accompanied with these symptoms above according to the infection of Coronavirus [1].These symptoms are persisted even after recovery, and in the severe case of COVID- 19 infection, the people are died depending on the people’s characteristics [3]. These problems act as a significant threat to the overall daily life [4].
Accordingly, all countries around the world are making their best efforts into the development of COVID-19 vaccination as the effective methods to response of the prolonged COVID-19 pandemic and the intensive investment and efforts are made to inoculate the COVID-19 vaccine [3]. COVID-19 vaccine prevents the infection of coronavirus effectively which is the source of infection for COVID- 19, and it acts to produce antibodies by stimulating the immune cells which eliminate the virus [5].This vaccine is being developed until now continuously. As the results of the development of COVID-19 vaccine, a number of some vaccines, such as Pfizer, Moderna, and Astrazeneca, are being applied [6].
World Health Organization (WHO) reported the efficacy of COVID-19 vaccination will reach at 70%or more, and accordingly, the vaccination is being promoted according to the development of COVID-19 vaccine [3]. In Korea, the vaccination began in the first quarter from February 28 in 2021 and COVID-19 vaccine was inoculated to the inpatients and workers, mainly in the elderly and group facilities of long term care hospital and nursing home for the elderly [6]. Beginning of COVID-19 vaccination increases the expectations to prevent the COVID-19 infection effectively and offers the hope for maintaining a healthy life in response to COVID-19 pandemic. However, the anxiety and fear about the COVID-19 vaccination still exist and the concerns about side effects of vaccination still appear [5].
Social interaction anxiety (SIA)indicates the anxiety that occurs in the process of social interaction with others and SIA is explained as the anxiety that occurs not only in the situations of interaction with others, but also in meeting strangers, and having conversations with the opposite sex, etc [8-7].
Specifically, SIA have a characteristics mainly to occur when the people fail to execute appropriate reactions and behaviors in the process of social interaction with others [9-8]. COVID-19 infection has a characteristics of being transmitted by direct contact with others and by others’ droplets, so the government restricts the social activities and interaction with others[8-7]. In these condition, anxiety is significantly increased in the social interaction with others [9-8] and the number of people complaining the anxiety also increased [1].
According to the COVID-19 National Mental Health survey by the Korean Society for Traumatic Stress Studies, the survey reported that the number of people complaining of anxiety continues to increase as the COVID-19 pandemic prolongs [13-9]. Moreover, based on the Huang & Zhao’ study [14-10], they reported that 35% of subjects complain the anxiety during the social interaction by the COVID-19 pandemic, and that the problems of anxiety could increase further as the people worried about the COVID-19 pandemic. There problems act as a factor to induce the depression and also cause to decrease the level of quality of life and cause the additional problems such as the increasing medical expenses by worsening the physical health level [12-11].
Health-related quality of life (HRQoL)is defined as the awareness of people’s goals, expectations, and interests in relation to health intheir culture and life [15-12] and is used as an important indicator of the social and psychological impact of disease and treatment [16-13]. In addition, HRQoL is explained as a concept that people feel and evaluate their own health rather than improving according to the findings of pathological diseases and medical results [15-12]. COVID-19 pandemic induces the changes significantly in the content of daily life and reduces and limits the social participation and leisure activities [4]. Therefore, COVID-19 pandemic causes the problems in the health continuously and effects on the decrease the health-related quality of life [12-11].
The studies related in the COVID-19 vaccination was reported variously. However, these studies was only focused on the development of COVID-19 vaccine [6] and the process of the vaccination [40- 41/14-15]. However, so far, there have been much few studies for the vaccination subjects. Also, a study reported about the changes in the psychological and physical variables of the subjects according to the COVID-19 vaccination only is a study by Son & Hong [16] that they report the changes in SIA and job commitment of occupational therapist working at the long term care hospital according to the COVID-19 vaccination. Thus, this study aimed to analyze the changes in SIA and health-related quality of life among inpatient with stroke in long term care hospital according to the COVID-19
vaccination in Korea.
2. Methods 2.1 Study subjects and period
Subjects were 14 inpatients in the D long term care hospital in D city, Korea. The inclusion criteria of study subjects were as follows: Only an individual 1) who is diagnosed with stroke based on DSM-5, 2) who is hospitalized in the hospital, 3) who is a vaccination subject through the instruction of the COVID-19 vaccination by the Korea Venters for Disease Control and Prevention (KCDC) 4) who is judged to be mild cognitive impairment level with a score of 12 or more as a results of the Korean ver. of Mini-Mental State Examination (MMSE-K)5) who a person to consent voluntarily the participation in this study after understanding the purpose and methods of this study.
The exclusion criteria of study subjects were as follows: Only an individual 1) who has problems in visual and auditory system, and has neurophysiological and orthopedic problems in physical structures and functions which negative effect directly on the performance of assessment, 2) who is taking any antipsychotic medication affecting directly on the performance and behavior in the assessment process.
Prior tothe participation in this study, the purpose and methods of this study was explained sufficiently by using the visual materials for potential study subjects. Therefore, after these process, if they agreed to participate in this study voluntarily, they were allowed to participate in this study. Consent form of participation in this study was provided in writing. Considering the study subjects were stroke patients, informed consent form was also provided in writing from their caregivers. This study was performed for 8 weeks from March 1 to April 30 in 2021.
2.2 Study procedures
To analyze the changes in the SIA and health-related quality of life among inpatients with stroke in the hospital according to the COVID-19 vaccination in Korea, the single group similar experimental study and pre-post analysis were applied in this study. The COVID-19 vaccination was performed based on the instruction of KCDC COVID-19 vaccination guideline and this was conducted by the doctors and nurses in charge of COVID-19 vaccination working in the D hospital [17].
.
The each assessment of SIA and health-related quality of life was performed by a researcher who is an occupational therapist working in the hospital. Prior to the assessment, the explanation about the methods and context of each assessment was provided to them sufficiently by using the visual materials.
2.3 Social interaction anxiety assessment
To measure SIA, Korean ver. of Social Interaction Anxiety Scale (K-SIAS) was used. K-SIAS was developed in 1988 by Mattick& Clarke [18] and then K-SIAS was translated into Korean based on the Kim [19]’s study. K-SIAS is a sensitive tool to measure the level of SIAoccurring in
the activities of daily living. K-SIAS is consisted of 19 items and it is an assessment as a self- reported survey. The each items of K-SIAS are performed by 5 points Likert scale from 0 to 4 points. The total score of K-SIAS is from 0 to 76 points, and the higher score indicates the higher level of SIA[19]. The Cronbach’s a was showed at .92 in the development process [18] and the Cronbach’s a in this study was showed at .91.
2.4 Health-related quality of life assessment
To analyze the health-related quality of life, the Short form-8 Health Survey (SF-8) was used.
SF-8 was developed in 2001 by the Ware et al. [27]’s medical outcome study in Unites States.
SF-8 is an effective tool for measuring the comprehensive contents related in health-related qualify of life and also SF-8 was developed so as not to be affected by cultural differences, so it has the advantage of being applicable not only to a specific group of subjects, but also to patients with various diseases and the general public [28]. SF-8 is measured by self-report questionnaire by using the 8 items consisted of the items measuring general health, physical function, physical role, body pain, vitality, social function, mental health, emotional role. Each items is measuredby using the 6 points Likert scale from 1 to 5 and the more score indicate the lower level of health- related quality of life. The total score is ranges from 8 to 40 points [29-30]. The Cronbach’s a was reported at .89 in the process of this assessment development [27].
2.5 Statistical analysis
The collected data were coded and then analyzed using SPSS version 23.0. Descriptive statistics were used to analyze the general characteristics of study subjects. To analyze the changes in the SIA and health-related quality of life, Wilcoxon’s Singed Ranked test was used. The significant level was set to 0.05.
3. Results 3.1 General characteristics of study subjects
The results of general characteristics of study subjects were showed at Table 1. Study subjects were total 14inpatients with stroke at D long term care hospital in D city, Korea. Their average age was showed 56.92 years, the average age in male was showed 57.10 years and the average age in female was showed 56.50 years. Their sex was showed 10 males (71.4%) and 4 females (28.6%). The results of their average hospitalization period was showed 67.59 months. The results of their MMSE-K assessment was showed 28.21 points and the points range was showed from 25 to 30 points.
3.2 The results of social interaction anxiety
The results of SIAwere showed at Table 2. The result of SIAbefore the COVID-19 vaccination was showed 21.70 points and the result of them after the vaccination was showed17.30 points and these showed the decrease at the 4.4 average points. Additionally, these results showed statistically significant difference at the 99% significant level (p<0.01). Thus, according to the COVID-19 vaccination, the decrease of the level of SIAof the inpatients with stroke in long term care hospital was showed.
3.3 The results of health-related quality of life
The results of health-related quality were showed at Table 2. The result of health-related quality of life before the COVID-19 vaccination was showed 20.10 points and the result of them after the vaccination was showed 19.60 points and these showed the decrease at the 0.5 average points.
Additionally, these results did not showed statistically significant difference. Thus, according to the COVID-19 vaccination, the changes in the level of health-related quality of life of the inpatients with stroke in long term care hospital were not showed.
Table 1.General characteristics of study subjects (n=14)
Characteristics Items Mean±S.D
Age (years)
Male 57.10±7.10
Female 56.50±15.94
Total 56.92±9.68
Sex (n, %) Male 10 (71.40)
Female 4 (28.6)
Hospitalization period
(months) Average 67.59±58.13
MMSE-K (points)
Average 28.21±1.71
Min 25
Max 30
Table 2Results of variables
Variables Pre Post
Mean S.D Mean S.D Z
Social interaction anxiety (points) 21.70 10.14 17.30 10.18 -3.041**
Health-related quality of life (points) 20.10 5.91 19.60 5.89 -1.342
**p<0.01
4. Discussion
Covid-19 vaccine is considered as a most important measure to prevent effectively the infection from the corona virus in the COVD-19 worldwide pandemic [3][5].Accordingly, a lot of vaccines are continuously being developed in countries around the world, and the vaccination was began to apply restrictively for the inpatients and the elderly at the long term care hospital in the case of Korea [5]. Based on these policy in Korea, this studyanalyzed the changes in the SIA and health- related quality of life among the inpatients in the long term care hospital according to the COVID-19 vaccination. As the results of these analysis, the SIAshowed the statistically significant decrease and in the results of health-related quality of life, there were no statistically significant difference according to the COVID-19 vaccination.
As the results of SIAaccording to the COVID-19 vaccination among the study subjects, there was statistically significantly difference after the vaccination. COVID-19 vaccine plays an important role to block the corona virus and stimulate the immune cells to form the antibodies to eliminate the corona virus that has penetrated the body [6]. Based on these actions, this study suggests that
the risk of infection from corona virus should be reduced significantly. Actually, it is judged that the actions of the vaccination contribute to reducing the anxiety such as infection and spread of corona virus, and transmission through an unspecified number of people. Moreover, in response to these psychological changes, this study determined that the SIAamong the inpatients with stroke admitted in the hospital according to the COVID-19 vaccination.
These results were supported by the various studies previously reported. In the Son & Hong [20]’s study, they reported that the results of the SIAamong the occupational therapists working in the hospital show the decrease after the COVID-19 vaccination. Thus, they indicated that the vaccination contributes to decrease the anxiety among study subjects during COVID-19 pandemic. In the Shin [21]’s study, the vaccination induces the improvement of the belief about the health and psychological stability, and works positively to reduce anxiety about infections.
Accordingly, based on these studies above, it is judged that this study has clinical significance and COVID-19 vaccination should contribute to decrease the SIAamong inpatients with stroke in hospital. Thus, in the process of COVID-19 vaccination, these contents are continuously considered.
As the results of health-related quality of life according to the COVID-19 vaccination among the study subjects, there was not showed the statistically significantly difference after the vaccination.
Inpatients with stroke exhibit vulnerable properties in managements and prevention for COVID- 19 infection in response to the problems such as low level of cognition and physical function impairment, mental confusion, and communication [22]. Based on these characteristics, the hospital was closed in order to reduce the risk of group infection in the hospital for them and the level of visits to inpatients was limited [23]. This precaution induced the negative changes of inpatients in the life environment and condition within the hospital,and reduced the scope of their activities and restricted the contents of their activities[24].Especially, encounters with others were also restricted within the hospital and physical activity and exercise for health and participation in leisure activities were restricted [23].
Moreover, due to the situation and condition within the hospital, also in the case of the doctors, nurses, and the rehabilitation professionals such as occupational and physical therapists working the hospital, their contents and range of work was reduced and additional tasks related in the infection control were given for them. Accordingly, the therapeutic programs and activities for inpatients with stroke were restricted [25]. Actually, in the Tesarik [26]’s study, he reported that these changes within the hospital environment due to the COVID-19 pandemic cause the significant physical and psychological problems in inpatients and the elderly. Thus, he indicated that these problems contribute to act the decrease of healthy life and reduce the health conditions and these changes is persistent in the context of continued COVID-19 pandemic and in the situation of transmission to others and secondary infections.
Alinia et al. [27]’s study also reported that COVID-19 reduces the patient’sHRQoL significantly and COVID-19 is associated with a substantial and measurable decrease in HRQoL. As the results, they reported in the study that patients who suffered from COVID-19 lost an average of 13.7% of their HRQo and the people who are severely affected by the disease lose an average of 20.7% of their HRQoL. Moreover, in the study by Chen et al. [28], they showed that age and length of hospitalization were strongly associated with the patients’ HRQoL which is in agreement with our findings. Accordingly, it is judged that the results do not show the
statistically significant changes in the health-related quality of life among the inpatients with stroke in the hospital despite of the COVID-19 vaccination. Thus, with the COVID-19 vaccination in the COVID-19 pandemic, it is judged that it is necessary to further analyze the effects and various factors on the health-related quality of life among inpatients with stroke..
Study limitations were as follows. This study was performed by applying the pre-post analysis according to the COVID-19 vaccination, in order to analysis of the changes in the SIA and health-related quality of life among the inpatients with stroke in the hospital in Korea.
Accordingly, this study was not explained the continuous changes. Thus, based on this study, it should be necessarythe further studies in order to analyze the changes in SIA and health-related quality of life among the inpatients with stroke in the hospital according to the COVID-19 vaccination. Additionally, this studyis only focused on the suggesting the changes in variables related to COVID-10 vaccination by using in a single study subjects group. Thus, it is determined that it is necessary to verify whether COVID-19 vaccination should affect changes in the study subjects’ SIA and health-related quality of life by using the various statistical analysis methods.
5. Conclusions
The purpose of this study was to analyze the changes in the SIAand health-related quality of life among the inpatients with stroke in the long term care hospital in Korea according to the COVID- 19 vaccination. As the results of these after the COVID-19 vaccination, the results of SIA showed the statistically significant decrease and the results of health-related quality of life did not showed any changes. Accordingly, COVID-19 vaccination may contribute to decrease the level of SIA and in the case of the changes in the health-related qualify of life, the additional analysis should be needed according to the COVID-19 vaccination.
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