Prevalence and Severity of Depression, Anxiety, and Stress Among COVID-19 Survivors in Urban Hazaribagh, Jharkhand: A Community-Based Cross-Sectional Study

BACKGROUND: Mental health sequelae following COVID-19 recovery are well-documented in large urban centers, yet community-based data from semi-urban India, particularly Jharkhand, remain scarce. OBJECTIVE: To assess the prevalence and severity of depression, anxiety, and stress among COVID-19 survivors in urban Hazaribagh using the Depression Anxiety Stress Scale-21 (DASS-21) and to identify associated sociodemographic and clinical factors. MATERIALS AND METHODS: A community-based cross-sectional study was conducted from March 2022 to June 2022, following approval from the Institutional Ethics Committee (IEC), RIMS, Ranchi, obtained prior to data collection. Using systematic random sampling from Integrated Disease Surveillance Programme (IDSP) COVID-19 registers, every seventh from 1,065 first-wave cases and every 17th from 7,686 second-wave cases, 601 consenting recovered adults were enrolled from 640 contacted (response rate: 93.9%). The DASS-21 was administered in its validated Hindi version alongside a semi-structured questionnaire. Data were analyzed in JASP using chi-square and Fisher's exact tests; a value of p<0.05 was considered significant. RESULTS: Depression was the most prevalent domain: 337 (56.07%) scored above normal, with 154 (25.62%) moderate, 80 (13.31%) severe, and 44 (7.32%) extremely severe. Anxiety was present at any grade in 260 (43.26%), predominantly mild (211 [35.11%]); stress was elevated in 200 (33.28%). The wave of infection was significantly associated with all three domains (all p≤0.030). Hospitalization was strongly associated with anxiety and stress (both p<0.001). Age was significantly associated with anxiety (p<0.001) and stress (p=0.015); occupation with depression (p=0.045); and smoking with stress (p=0.014). Gender was not significantly associated with any domain. CONCLUSION: COVID-19 survivors in urban Hazaribagh carry a substantial post-recovery psychological burden. Depression at moderate-to-extremely-severe intensity is the most predominant manifestation. Integrating routine DASS-21 screening into community-level post-COVID follow-up care, with priority for high-risk groups, is recommended.