An investigation of depression, anxiety, and stress and its relating factors during COVID-19 pandemic in Iran

Abstract

Background The COVID-19 (SARS-CoV-2) is an emerging epidemic caused by the new Coronavirus. It has affected more than 200 countries, infected 5,939,234 people, and killed 367,255 in the world until 1 June 2020. While the disease epidemic could affect population mental health, this study aimed to investigate stress, anxiety, and depression during the Corona pandemic in Iran. Methods An online survey was designed using the depression, anxiety, and stress scale (DASS-21) questionnaire. The questionnaire was available for all Iranian population from 18 to 28 April 2020. Finally, 1498 participants filled the questionnaire using snowball sampling. Data were analyzed using multivariate regression models. Results Findings showed that most participants had experienced a normal level of stress (36.6%), anxiety (57.9%) and depression (47.9%). About 2.5% of respondents report an extremely severe level of stress. This amount of anxiety and depression was 6.3 and 7.9%, respectively. Regression model showed being female (CI: − 1.299; − 0.248), living with a high risk family member (CI: 0.325; 1.400), health status (CI: − 0.857; − 0.595), economic status (CI: − 0.396; − 0.141), social capital (CI: − 0.475; − 0.244), risk of disease (CI: 0.081; 0.729), and following COVID-19 news (CI: 0.111; 0.551) have a relation with stress level. Education level (CI: − 0.252; − 0.017), living with a high risk family member (CI: 0.0301; 1.160), health status (CI: − 0.682; − 0.471), social capital (CI: − 0.236; − 0.048), risk of disease (CI: 0.154; 0.674), and following COVID-19 news (CI: 0.046; 0.401) have a relation with anxiety score. Depression score was in relation with education level (CI: − 0.263; − 0.022), having a high-risk family member (CI: 0.292; 1.155), health status (CI: − 0.687; − 0.476), social capital (CI: − 0.235; − 0.048), risk of disease (CI: 0.144; 0.667), and following Covid-19 news (CI: 0.053; 0.408). Conclusions Most of the factors related to depression, anxiety, and stress are related to COVID-19, such as having a vulnerable person in the family, risk of disease, and following COVID-19 news. The findings suggest the factors that should be taken into consideration for improving population mental health during pandemics.

Meaningful activities during COVID-19 lockdown and association with mental health in Belgian adults

“…Research has shown that epidemics can cause severe and variable psychological effects on people [8,9]. The growing literature on COVID-19 has already shown that the pandemic and accompanying measures have had a profound effect on-besides health issues-all aspects of society, including mental health [10,11].…”

“…Several mental health studies on COVID-19 found associations between demographic characteristics and mental health. It seems that younger people (< 30 years, inclusive of students [19,20]) [13,[21][22][23][24][25]; women [9,13,19,20,22,26]; healthcare workers [13,21]; unemployed people [19]; adults who have children [27,28]; people living in rural areas [29]; those having cancer or chronic diseases [23]; those living with family member at high risk for COVID-19 [9]; and those living alone [23] have the highest risk to develop mental health problems such as anxiety or depression during the COVID-19 crisis.…”

The Relationship Between Age and Mental Health Among Adults in Iran During the COVID-19 Pandemic

“… Meng et al, 2020 DASS-21 1498 participants 18 to 28 in Iran, April 2020 31.8% − 10.70% (− 14.88% to − 6.18%) χ 2 (1) = 19.99, p < 0.0001 N.A. Khademian et al ( 2021 ) DASS-21 10,754 individuals from the general population in Iran, March 1–9, 2020 40.4% − 19.30% (− 22.85% to − 15.30%) χ 2 (1) = 71.00, p < 0.0001 Negative Moghanibashi-Mansourieh ( 2020 ) Distress Kessler-6 369 adults in China, Feb 20–21, 2020 6.15% 8.62% (4.48% to 12.65%) χ 2 (1) = 15.73, p = 0.0001 N.S. Zhang et al ( 2020b ) Kessler-10 500 adults in Italy, April 10–13, 2020 18.6% − 3.83% (− 0.87% to 8.49%) χ 2 (1) = 2.559, p = 0.110 Negative Moccia et al ( 2020 ) Kessler-6 1599 adults in China, Feb 1–4, 2020 Mean (SD), 7.7 (± 7.7) 0.62 (− 0.11 to 1.35) df = 2071, p = 0.098 Negative Wang et al ( 2020 ) Kessler-6 2032 adults in the USA, late April 2020 27.7% − 12.93% (− 16.45% to − 8.97%) χ 2 (1) = 34.03, p < 0.001 N.A.…”

“… Liu et al ( 2020 ) DASS-21 1498 participants 18 to 28 in Iran, April 2020 34.7% − 12.76% (− 17.02% to − 8.17%) χ 2 (1) = 27.18, p < 0.0001 N.A. Khademian et al ( 2021 ) Anxiety GAD-2 3088 adults in 32 provinces of China, Feb 20–27, 2020 13.2% 7.9% (4.25% to 11.96%) χ 2 (1) = 20.980, p < 0.001 N.S. Song et al ( 2020 ) GAD-2 3480 adults in Spain, March 21–27, 2020 21.6% 0.50% (− 3.62% to 4.21%) χ 2 (1) = 0.062, p = 0.804 Negative González-Sanguino et al ( 2020 ) GAD-7 103 adults in China, Feb 10–28, 2020 22.3% − 1.20% (− 10.79% to 6.78%) χ 2 (1) = 0.07, p = 0.788 N.A.…”

Socio-demographic correlates of depressive and anxiety symptoms among Jamaicans during the COVID-19 pandemic: A Rapid Online Survey

“…Hence, other factors could contribute to these symptoms such as overall stressor of experiencing a pandemic, among others. 41 This would require additional history beyond the scope of this study. Lastly, being a cross sectional study, it was not possible to establish causality between explanatory and outcome variables; nevertheless, our findings may contribute to the understanding of the mental health effects on the population during a COVID-19 outbreak.…”