Introduction
this is the first study assessing the psychological impact on Tunisian general population during the first peak of the COVID-19 pandemic. We aimed to assess the prevalence of anxiety, depressive symptoms and insomnia, as well as associated factors.
Methods
a cross-sectional study was conducted through an online survey of 1615 people during March 23
rd
to May 5
th
, 2020. We used the hospital anxiety and depression scale for anxiety and depression screening, and the insomnia severity index to assess sleep disturbances.
Results
our study revealed a high prevalence of anxiety and depressive symptoms, and insomnia (70.9%, 71.1% and 60.6% respectively). Multivariable statistics showed that anxiety symptoms were correlated to female gender (adjusted odds ratio [aOR] 1.784, 95% confidence interval (CI 1.252-2.542; p=10
-3
), history of mental illness (aOR: 1.680, 95% CI: 1.329-2.125; p<10
-3
), frequently social media exposure (aOR: 1.578, 95%CI: 1.250-1.992; p<10
-3
), times to focus on COVID-19 ≥ 3hours (aOR: 1.840, 95% CI: 1.433-2.362; p<10
-3
), consultation with doctor in the clinic in the past 14 days (aOR: 1.821, 95%CI : 1.220-2.718; p=0.003) and recent traumatic event in the past 14 days (aOR: 1.641,95% CI: 1.331-2.024; p<10
-3
). Principal factors associated with depressive symptoms included female gender (aOR: 1.637, 95% CI: 1.150-2.331; p=0.006), history of mental illness (aOR: 1.498, 95% CI: 1.189-1.888; p=10
-3
), times to focus on COVID-19 ≥ 3hours (aOR: 1.956, 95% CI: 1.555-2.461; p<10
-3
), and recent traumatic event in the past 14 days (aOR: 1.558, 95% CI: 1.265-1.919; p<10
-3
). The main factors correlated to insomnia were younger (age <35years) (aOR: 1.592, 95% CI: 1.17 -2.152; p=0.003), female gender (aOR: 1.864, 95% CI: 1.252-2.775; p=0.002), having organic diseases (aOR: 1.527, 95% CI: 1.131-2.061; p=0.006), history of mental illness (aOR: 1.777, 95% CI: 1.396-2.263; p<10
-3
), students (aOR: 1.931, 95% CI: 1.495-2.495; p<10
-3
), times to focus on COVID-19 ≥3hours (aOR: 1.877, 95% CI: 1.467-2.400; p<10
-3
) and recent traumatic event (aOR: 1.431, 95% CI: 1.144-1.789; p=0.002).
Conclusion
our study revealed a major mental health burden in Tunisia during COVID-19 pandemic. Many factors were correlated to anxiety, depressive symptoms and insomnia, suggesting the need for greater psychological support in general and in certain vulnerable groups.