The Impact of COVID-19 on Lifestyle and Mental Stress of the Kuwait Population
Abstract
The outbreak of Covid-19 which occurred towards the end of 2019, marked the start of both a stressful and uncertain period in the existence of human life in the 21st century. The novel virus spread rapidly with millions being infected and losing their lives, destabilizing the work environment, overwhelmed health care systems and lockdowns. The impacts of the pandemic were not without sudden changes in the lives of people around the world. One such change was the change in lifestyles. The purpose of this study is to assess the impacts of Covid-19 on the lifestyle of the Kuwait population. The study objectives include to evaluate the impact of Covid-19 on eating habits, physical activity and on psychological state of the Kuwait population. The study will adopt a cross-sectional research design with the target population being people living in Aseema, Hawalli, Farwaniya, Almadi, Jahra and Mubarak Al Kabeer Governorates. An online structured questionnaire on Google Forms survey platform will be used to collect data. The collected data will be analyzed using SPPS software v27. The response rate was 90% with the total number of participants being 965. The study findings identified several changes in regard to lifestyle, eating habits and mental health. The study established that 38% of the respondents were partially affected in their businesses/jobs and 17% suffered total loss as a result of the pandemic. In regard to physical activity, 25% and 24.2% indicated they participated in physical exercise most of the time and always respectively during the pandemic compared to 18.5% and 18.3% respectively before the pandemic. On physical exhaustion, 27.3% and 18.4% indicated that they most of the time and always respectively experienced physical exhaustion during the pandemic compared to 21.2% and 13.3% respectively before the pandemic. On emotional exhaustion, 27.4% and 22.3% reported that they experienced emotional exhaustion most of the time and always during the pandemic compared to 19.5% and 15.3% respectively before the pandemic. On stress, 27% and 26.8% indicated they were stressed most of the time and always respectively during the pandemic compared to 21% and 14.2% respectively before the pandemic. On irritability, 28.9% and 23.5% indicated they were irritable most of the time and always respectively during the pandemic compared to 21.9% and 15% respectively before the pandemic. The Multinomial logistic model for altered dietary habits and self-reported weight was statistically significant, χ2 (54) = 78.639, p < 0.005; for altered physical activity and self-reported weight was non-statistically significant, χ2 (27) = 19.876, p > 0.005 and for psychological health and food intake was statistically significant, χ2 (72) = 130.705, p < 0.005. The Wilcoxon test indicated that there was a non-statistically significant difference (Z = -1.889, p >0.05) between eating habits before and during the pandemic. The null hypothesis was rejected; a non-statistically significant difference (Z = -0.698, p >0.05) between the physical activity of the Kuwaiti population before and during the pandemic. The null hypothesis was rejected and a statistically significant difference (Z = 130.705, p < 0.005) between the psychological impacts of the Kuwaiti population and thus the null hypothesis was retained. The study contributes to the better understanding of the impacts of Covid 19 on lifestyle and metal health of the Kuwait population. Similar longitudinal studies should be conducted to provide more information on the effects of the pandemic.
Keywords: Covid 19; eating habits; physical activity; mental health; lifestyle; dietary habits
CHAPTER ONE
Introduction
1.1 Introduction
Towards the end of 2019, a novel severe acute respiratory infection was first reported in Wuhan China. The infection and death rates surged in the first two months and by March 11th, 2020, the World Health Organization (WHO) declared it a pandemic. The corona virus proved to be a challenge to scientists and health workers all over the world since much was still unknown on its mode of transmission with no vaccine or cure in sight for the victims. To date, 238 million infections, 215 million recoveries and 4.8 million death cases have been reported. In Kuwait, 412, 079 infections and 2,454 deaths had been reported as of October 11th, 2021 (Worldometer, 2021). Urgent preventative measures were put in place by governments all over the world to contain the pandemic, which included national lockdowns, curfews, safety health protocols and self-isolations. The Kuwait Authorities imposed restrictions ranging from total and partial lockdowns in Khaitan, Nugra, Farwaniya and Hawalli. In an effort to contain virus from spreading, several measures were put in place which included the banning of public gatherings in restaurants, mosques and malls, employees were given paid holidays and studies postponed in all learning institutions (Gasana & Shehab, 2020).
The protective measures imposed by various governments throughout the world were not without impact. Millions of people lost their livelihoods, some started working from their homes except for those who offered essential services. The impact of the restrictions including lockdowns and quarantines were evident in people’s lives. Among these impacts is a reduction in physical activities because of the restrictions in sporting and travelling. The staying at home results in signficant lifestyle changes which affect the eating habits of the people and as a consequence of the lockdowns, changes were witnessed in food purchases and dietary habits (di Renzo et al., 2020). The lockdowns resulted in a situation where there is limited supplies of fresh foods and food varieties (Hobbs, 2020). The loss of income made it necessary to seek cheaper foods to supplement their diets. According to Latif and Karaman (2021) the stay-at-home restrictions resulted in boredom and sometimes this boredom was aggravated by economic challenges occasioned by job losses and an uncertain future. According to Moynihan et al., (2015) boredom can result to emotional issues, food cravings and overeating. In addition, emotions such as sadness and fear have been linked to a reduced desire of eating and enjoyment of the foods.
Hence adjustment changes in lifestyle were an expected outcome of the Covid-19 restrictions. Scanty literature is available on the impacts of Covid-19 on lifestyle prior and during the pandemic. This current study will seek to provide a detailed understanding on how the lifestyle in Kuwait have been affected. Thus, the aim of this study is to assess the impact of Covid-19 on the eating habits, physical activity, and psychological state of the Kuwaiti population in the six Governorates: Aseema, Hawalli, Farwaniya, Almadi, Jahra and Mubarak Al Kabeer.
1.2 Research Statement
The outbreak of the novel virus, Covid-19 and the preventative measures put in place brought about massive changes in the lives of millions of people. Introducing these sudden changes in people’s lives can lead to negative impacts on their mental states and lifestyle behaviour. The changes in eating habits, physical activities and mental states represent a change in lifestyle behaviour. The curtailed freedom and abstention from work have been associated with increased boredom and stress levels which have consequently led to increased food consumption. Alhusseini and Alqahtani (2020) conducted a retrospective study on the impacts of Covid-19 curfews on eating habits and food intakes focusing on Saudi Arabia. Galali (2021) conducted a cross-sectional study to evaluate the impacts of Covid-19 confinements on eating habits in Iraq Kurdistan. Since there is no such investigation has been conducted in Kuwaiti population, an in-depth appreciation of the pandemic's effects on dietary habits can provide a platform to guide physiological and behavioral measures focusing on individuals and communities. Thus, this study aims at assessing the impacts of the Covid-19 pandemic on eating habits, psychological state and physical activities of the Kuwait population.
1.3 Rationale of the Study
Pandemics and natural disasters have become a common occurrence in the current world and the outbreak of the novel Corona virus was one such incidence. However, the rapid spread, the huge number of infections, the rising number of deaths with an overwhelmed health system across the world caused fear, panic and distress. Pandemics appear unannounced, catching people in unexpected situations. Consequently, individuals are forced to change their lifestyles and adopt new behaviors instantly. Therefore, it is critical to document the changes in eating habits in such situations with the aim of evaluating the overall wellbeing of the population. This study will therefore provide insights on the Kuwaiti population eating habits, physical activity and mental health during the Covid 19 outbreak and assist in ensuring that safe and healthier eating habits, physical activities and psychological state interventions are embraced during pandemics.
1.4 Hypothesis
The imposed Covid-19 restrictions such as lockdowns and quarantines disrupted the food supply system consequently leading to food shortages in the markets. Panic purchases and stockpiling of foodstuff were witnessed. Against this developing scenario of non-availability of some foods, people had more time at their disposal to prepare and cook their meals. On the contrary, most people were prone to spend more time on entertainment and would rather snack as opposed to cooking proper meals. This study, therefore, hypothesizes that there are substantial differences in the Kuwaiti people’s eating habits as a consequence of the Covid-19 pandemic's lockdowns. The lockdowns to curtail the pandemic called for social distancing and quarantines resulted in limited freedom of movement. Thus, we further hypothesize that there will be a substantial decrease in the physical activity of Kuwaiti people. Furthermore, because of the restrictions, the participants could be prone to psychological problems. The study thus also hypothesizes an increase in the psychological stress of the Kuwait population during the Covid-19 pandemic.
1.5 Research Aim and Specific Objectives
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To evaluate the impact of Covid-19 on eating habits of the Kuwaiti population
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To evaluate the impacts of Covid-19 on physical activity of the Kuwait Population.
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To evaluate the impacts of Covid-19 on psychological state of the Kuwait Population.
1.6 Research Questions
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Did the extended lockdown affect eating habits of the Kuwaiti population?
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Did the lockdown affect physical activity of the Kuwait Population?
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Did Covid-19 lockdown impact mental health of the people?
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Was altered dietary habit associated with self-reported body weight?
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Was altered physical activity associated with self-reported body weight?
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Was psychological health associated with food intake?
CHAPTER TWO
Literature Review
2.1 Eating Habits
The lockdowns imposed in different countries were not without effect on the lives and livelihoods of millions of people in various ways. According to Gupta et al. (2020) migrant workers in South Asian countries like Nepal, India and Pakistan lost their source of income. According to HLPE (2020) the unfolding pandemic impacted food systems hence threatening access to food through multiple sources. The crisis caused by the pandemic resulted in a dynamic and fluid situation marked by greater levels of uncertainty with many health experts predicting that the situation will persist for up to two years (Scudellari, 2020).
During the pandemic, eating habits underwent drastic changes due to the mandatory isolations and lockdowns. The dynamic interactions sparked by the Covid-containment lockdowns created scenarios for disturbances in food systems, resulting in a marked surge in hunger. According to the most current projections, anywhere from 83 to 132 million more persons would face food insecurity as a primary consequence of the pandemic (FAO, 2020) and this includes millions of individuals in developing countries who rely on importation of food (Torero, 2020). According to Hobb (2020) the lockdowns resulted in limited access to food varieties which in turn led to people turning to processed food that they bought from the supermarkets. Most of these foods have high energy levels but low nutrition values. The fact that most people found themselves working from home or without jobs resulted in cases of boredom and stress (Gao et al., 2020). According to Moynihan et al. (2015) boredom can result in overeating coupled with craving for food with high energy level contents.
Another aspect of changes in eating habits was the increased awareness of the role played by the body immunity against coronavirus infections in terms of protection and overcoming. According to a study carried out by Enriquez-Martinez et al. (2021) on dietary and lifestyle changes in Ibero-American countries during the Covid-19 pandemic, it was observed that higher proportions of residents of Argentina (28.8%), Brazil (26.4%) and Mexicans (22.4%) adopted healthier eating habits during the pandemic. On the other hand, 21.6% of Mexicans and 19.4% of Peruvians adopted less healthy eating habits.
The disruptions in the food security systems will result in changes in the eating habits of people. This will be the case since most people will not be able to access different food varieties for their nutritional intake. In addition, the reduced food volumes available will be costly which will also have an impact on people’s eating habits. There is paucity of literature on how the eating habits of the Kuwait population changed through the coronavirus pandemic. Accordingly, within this context, the changes in the eating habits of the Kuwait population should be examined.
2.2 Psychological Impacts
The COVID-19 pandemic has had a significant emotional impact on many millions of people worldwide, resulting in concerns of steadily increasing psychological health burden (Sinyor et al., 2021). The global responses to the outbreak and spread of Covid-19 including lockdowns, restriction of movements, closure of learning institutions and workplaces resulted in significant repercussions on the wellbeing of human beings (Wang et al., 2020). Despite the success of the methods such as quarantine in containing the spread of the virus, they have not been without adverse psychological impacts. The restriction of movements, separations from families and friends, curtailed freedom and fears of unknown future are some of the factors that can exacerbate adverse psychological impacts. Past pandemic outbreaks have been shown to result in depression, increased stress levels, emotional disturbance, symptoms of post-traumatic stress and irritableness.
The impact of pandemics has also been associated with psychological problems among health care workers and survivors of the 2003 SARs epidemic. The health workers reported feeling nervous and fearful for their families and colleagues. In 2012, the outbreak of the Middle East respiratory syndrome Coronavirus (MERS-CoV) was linked to increased public anxiety, fear and psychological stress. Extant literature has shown that various stressors such as prolonged quarantine, confinement, distress, scarcity of information, loss of income, fear of contracting the virus and boredom have aggravated poor mental health (Serafini et al., 2020).
In a study carried out in China during the pandemic, the statistics revealed that people suffered from mental health challenges, with anxiety (28.8%), depression (16.5%) and stress (8.1%) being the major causes (Wang et al., 2020). The coronavirus pandemic with rapid transmission patterns, absence of clear treatment protocols and vaccination programs led to increased panic, depression and anxiety around the world. There is scarcity of literature on how Kuwaiti population is coping through the coronavirus pandemic, and the extent of its effects on mental health and lifestyle as a whole. Consequently, it is within this context that the extent of pandemic outbreaks impacts on mental health and lifestyle in general should be understood. Therefore, the research aims at examining the impact of the coronavirus pandemic.
2.3 Physical Activity
The confinements and social distancing measures that were put in place by most countries around the world were not without adverse effects on the wellbeing of different populations. The stressful and sudden circumstances coupled with extended staying at home can result in radical changes in lifestyle behaviours such as physical inactivity. According to Hall et al. (2021), general concerns have been raised on the adverse health implications due to sedentary behaviours and inactivity. According to WHO (2010), adult persons are considered to be moderately or vigorously physically active if they attain 150 minutes or 75 minutes of physical activity each week respectively. As the pandemic ravaged the world, people were forced to stay indoors hence resulting in modification of personal, interpersonal and environmental factors that have an effect on the general population (Bauman et al., 2012).
Notwithstanding the recommendations that even during the lockdown and quarantines, people should remain physically active, these unusual confinements could result in two scenarios: first, a reduction of physical activity among the physically active and second, the physically inactive becoming more active (WHO, 2020). According to a study by Castañeda-Babarro et al. (2020) to evaluate changes in physical activity among the Spanish population, it was observed that young people, men and students had decreased their physical activity while increasing sedentary times during the confinement period.
As stated by Kohl et al. (2012), physical inactivity is ranked as the fourth cause of death globally, a situation that was further exacerbated with the imposed confinements during the Covid 19 pandemic (Hall et al., 2021). Studies have shown that reduced physical inactivity and sedentary behaviours are correlated to adverse mental and physical effects among the elderly (Jiménez-Pavón et al., 2020; Rezende et al., 2014). On a global scale, Kuwait ranks first with the highest prevalence of physical inactivity with approximately 65% of the adult population being physically inactive (Salman, et al., 2020). This situation can be aggravated by the pandemic related confinements. Therefore, it against this background that this study will seek to evaluate the impacts of the Covid pandemic on lifestyle of the Kuwait population in terms of physical activity.
CHAPTER THREE
Materials and Methods
3.1 Study design
A cross-sectional study will be conducted on a sample population drawn from Aseema, Hawalli, Farwaniya, Almadi, Jahra and Mubarak Al Kabeer Governorates using questionnaire prepared to assess eating habits, physical activity and psychological stress factors during the Covid-19 pandemic.
3.2 Recruitment and Ethics
All the study participants will be made aware about the goal of the research and their informed consent will be sought prior to their inclusion and participation. The relevant approvals from the University and the Ethics Committee of Kuwait’s Ministry of Health will be sought.
3.3 Study Population
The study’s target population consists of adults residing in Kuwait with an estimated total population of 4,328,550 people. The required sample size will be 385 based on a 95% confidence level and 3% margin of error based on an estimated 80% outcome response.
The sample size was calculated using the Cochran formula:
no = Z2pq
e2
Where n = Sample Size
Z = Z score
e = Margin of error
P = Standard of deviation
q = 1- P
no = (1.96)2(0.5) (0.5)
(0.5)2
= 385 Respondents
For known population size
n = no
1+ (no – 1)/N
= 385
1+(385-1)/4,328,550
= 385 Respondents