Effect of individual and provincial levels on stress among general population during the COVID-19 pandemic: a multilevel analysis using mental health survey in Thailand

Pankaew Tantirattanakulchai¹Nuchanad Hounnaklang^1*Tiwa Mahaprom²Aphichaya Polrak³Nada Lukkahatai⁴

• ¹College of Public Health Sciences, Chulalongkorn University, Bangkok, Thailand
• ²College of Nursing, Chiang Mai, Faculty of Nursing, Praboromarajchanok, Chiang Mai, Thailand, Chiang Mai, Thailand
• ³Department of Mental Health, Prasrimahabhodi Hospital, Ubon Ratchathani, Thailand, Ubon Ratchathani, Thailand
• ⁴School of Nursing, Johns Hopkins University, Baltimore, Maryland, United States

Background: The differential effects of the COVID-19 pandemic across various regions and demographic groups underscore the importance of comprehending the role of social determinants of health (SDOH) in shaping mental health disparities. This research seeks to investigate the influence of both individual-level and provincial-level factors on stress experienced by the Thai general population during the second wave of the pandemic. By incorporating the SDOH conceptual framework within a multi-level modeling approach. The focus is on understanding the impact of these factors on mental health concerns, which have significantly increased due to the pandemic. Methods: This study is a secondary data analysis of data collected between December 17, 2020, and February 23, 2021, from the Department of Mental Health, Ministry of Public Health, Thailand. Data for the provincial-level including COVID-19 zone and population density, with 258,830 participants nested within the 77 provinces. Stress was measured with 5-item of Srithanya stress test (ST-5). Multilevel analysis was carried out in HLM 8.2 software. Results: The study found that individual-level factors including male respondents, unemployed, financial hardship, chronic underlying diseases, having older and/or children in family, and having bedridden patients in family tended to report higher stress scores. While, older age respondents, contracted with COVID-19 infection in self and/or family, and having greater resilience showed the lower stress scores. After adjustment for individual-level factors, the respondents who lived in higher and strict control area, and higher population density reported higher stress scores. Conclusion: Individual and provincial factors appear to influence elevated stress levels. Our research indicates that the government should establish effective resilience promotion programs to mitigate the impact of stress on severe physical and psychological illnesses. Implementing these measures will improve the mental health and well-being of the general population and enhance the country's preparedness for future pandemics or emerging outbreaks.