The mental health impact of COVID-19 outbreak: a Nationwide Survey in Iran

Reza Shahriarirad1, Amirhossein Erfani1, Keivan Ranjbar1, Amir Bazrafshan2, Alireza Mirahmadizadeh3
1Thoracic and Vascular Surgery Research Center, Shiraz University of Medical Sciences, Zand Street, Shiraz, Iran
2Substance Abuse Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
3Non-Communicable Diseases Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

Tóm tắt

Abstract Background

Disease outbreak not only carries the risk of death to the public due to the infection, but it also can lead to unbearable psychological impact on the mental health of the individuals. This study aims to explore and evaluate the burden of psychological problems on the Iranian general population during the outbreak of COVID-19.

Method

A cross-sectional web-based survey was conducted among the general population of Iran age 15 and above. Demographic variables, depression, and anxiety symptoms were evaluated using the Patient Health Questionnaire-9 and General Anxiety Disorder-7 questionnaires.

Results

Among the 8591 participants, the mean age was 34.37 (± 11.25) years and 66.4% were female while 33.6% were male. Based on our results, 1295 (15.1%) and 1733 (20.1%) of the general population had clinically significant depressive and anxiety symptoms, respectively. Based on the demographic variables, female gender was associated with a higher risk for developing depression and anxiety symptoms, whereas getting information about the disease from medical journals and articles, being older, and being married were considered as associated protective factors. In terms of depression, being a healthcare worker was an associated risk factor. On the other hand, for anxiety, having higher education was a protective factor while a higher number of individuals in a household was considered as a risk factor.

Conclusions

This study identified a major mental health problem in the Iranian population during the time of the COVID-19 outbreak. Therefore, establishing a targeted mental health support program during the time of public emergencies, such as the disease outbreak, is advised.

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Tài liệu tham khảo

Organization WH. Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV). Retrieved; 2020.

Organization WH. Clinical management of severe acute respiratory infection when Middle East respiratory syndrome coronavirus (MERS-CoV) infection is suspected: interim guidance. World Health Organization; 2019.

BNO News. WORLDTracking coronavirus: Map, data and timeline 2020, Feb 26. Available from: https://bnonews.com/index.php/2020/02/the-latest-coronavirus-cases/. Accessed 19 August 2020.

Xiao CJPI. A novel approach of consultation on 2019 novel coronavirus (COVID-19)-related psychological and mental problems: structured letter therapy. Psychiatry Investig. 2020;17(2):175–6. https://doi.org/10.30773/pi.2020.0047.

Shahriarirad R, Khodamoradi Z, Erfani A, Hosseinpour H, Ranjbar K, Emami Y, Mirahmadizadeh A, Lotfi M, Yeganeh BS, Nejad AD, Hemmati A. Epidemiological and clinical features of 2019 novel coronavirus diseases (COVID-19) in the South of Iran. BMC Infect Dis. 2020;20(1):1–2.

Anadolu Agency. Iran confirms first two deaths from coronavirus 2020, Feb 19. Available from: https://www.aa.com.tr/en/health/iran-confirms-first-two-deaths-from-coronavirus/1738679. Accessed 21 August 2020.

Moghanibashi-Mansourieh A. Assessing the anxiety level of Iranian general population during COVID-19 outbreak. Asian J Psychiatr. 2020;18:102076. https://doi.org/10.1016/j.ajp.2020.102076.

Park S-C, Park YCJPI. Mental health care measures in response to the 2019 novel coronavirus outbreak in Korea. Psychiatry Investig. 2020;17(2):85–6. https://doi.org/10.30773/pi.2020.0058.

Mirahmadizadeh A, Ranjbar K, Shahriarirad R, Erfani A, Ghaem H, Jafari K, Rahimi T (2020) Evaluation of students' attitude and emotions towards the sudden closure of schools during the COVID-19 pandemic: a cross-sectional study. BMC Psychology 8(1)

Lau JT, Yang X, Tsui HY, Pang E, Wing YK. Positive mental health-related impacts of the SARS epidemic on the general public in Hong Kong and their associations with other negative impacts. J Infection. 2006;53(2):114–24. https://doi.org/10.1016/j.jinf.2005.10.019.

Lee SM, Kang WS, Cho AR, Kim T, Park JK. Psychological impact of the 2015 MERS outbreak on hospital workers and quarantined hemodialysis patients. Compr Psychiatry. 2018;1(87):123–7. https://doi.org/10.1016/j.comppsych.2018.10.003.

Zhong B-L, Luo W, Li H-M, Zhang Q-Q, Liu X-G, Li W-T, et al. Knowledge, attitudes, and practices towards COVID-19 among Chinese residents during the rapid rise period of the COVID-19 outbreak: a quick online cross-sectional survey. Intern J Biolog Sci. 2020;16(10):1745–52.

Naeinian MR, Shaeiri MR, Sharif M, Hadian M. To study reliability and validity for a brief measure for assessing generalized anxiety disorder (GAD-7). Sci J Clinic Psychol Personal. 2011;2(4):41–50.

Spitzer RL, Kroenke K, Williams JB, et al. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–7. https://doi.org/10.1001/jama.282.18.1737.

Kroenke K, Spitzer RL, Williams JB, et al. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med. 2007;146(5):317–25. https://doi.org/10.7326/0003-4819-146-5-200703060-00004.

Dadfar M, Kalibatseva Z, Lester DJ. Reliability and validity of the Farsi version of the patient health questionnaire-9 (PHQ-9) with Iranian psychiatric outpatients. Trends Psychiatry Psychother. 2018;40(2):144–51. https://doi.org/10.1590/2237-6089-2017-0116.

Ardestani MS, Ashtiani RD, Rezaei Z, et al. Validation of Persian version of PHQ-9 for diagnosis of major depressive episode in psychiatric wards in IRAN. Int J Appl Behav. 2019;5(2):1–8. https://doi.org/10.22037/ijabs.v5i2.21094.

Spitzer RL, Kroenke K, Williams JB, et al. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. JAMA. 1999;282(18):1737–44. https://doi.org/10.1001/jama.282.18.1737.

Kroenke K, Spitzer RL, Williams JBJ. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13. https://doi.org/10.1046/j.1525-1497.2001.016009606.x.

Mak IWC, Chu CM, Pan PC, et al. Long-term psychiatric morbidities among SARS survivors. Gen Hosp Psychiatry. 2009;31(4):318–26. https://doi.org/10.1016/j.genhosppsych.2009.03.001.

Shultz JM, Baingana F, Neria YJJ. The 2014 Ebola outbreak and mental health: current status and recommended response. JAMA. 2015;313(6):567–8. https://doi.org/10.1001/jama.2014.17934.

Ji D, Ji Y-J, Duan X-Z, et al. Prevalence of psychological symptoms among Ebola survivors and healthcare workers during the 2014–2015 Ebola outbreak in Sierra Leone: a cross-sectional study. Oncotarget. 2017;8(8):12784. https://doi.org/10.18632/oncotarget.14498.

Vandad Sharifi M, Hajebi A, Radgoodarzi RJ. Twelve-month prevalence and correlates of psychiatric disorders in Iran: the Iranian Mental Health Survey, 2011. Arch Iran Med. 2015;18(2):76. https://doi.org/10.15182/aim.004.

Noorbala AA, Faghihzadeh S, Kamali K, et al. Mental Health Survey of the Iranian adult population in 2015. Arch Iran Med. 2017;20(3).

Huang Y, Zhao NJ. Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 epidemic in China: a web-based cross-sectional survey. MedRxiv. 2020. https://doi.org/10.1101/2020.02.19.20025395.

Gao J, Zheng P, Jia Y et al. Mental health problems and social media exposure during COVID-19 outbreak. Available at SSRN 3541120. 2020 Feb 17. https://doi.org/10.2139/ssrn.3541120.

Jeong H, Yim HW, Song Y-J, et al. Mental health status of people isolated due to middle east respiratory syndrome. Epidemiol Health. 2016;38:e2016048. https://doi.org/10.4178/epih.e2016048.

Liu S, Yang L, Zhang C, et al. Online mental health services in China during the COVID-19 outbreak. Lancet Psychiatry. 2020;7(4):e17–8. https://doi.org/10.1016/S2215-0366(20)30077-8.

Kessler RC, Birnbaum HG, Shahly V, et al. Age differences in the prevalence and co-morbidity of DSM-IV major depressive episodes: results from the WHO World Mental Health Survey Initiative. Depress Anxiety. 2010;27(4):351–64. https://doi.org/10.1002/da.20634.

Modabernia M, Shodjai TH, Moosavi S-R, et al. The prevalence of depression among high school and preuniversity adolescents: Rasht, northern Iran. Arch Iran Med. 2007;141–146. https://doi.org/10.7102/AIM.003

Mohammadi M-R, Davidian H, Noorbala AA, et al. An epidemiological survey of psychiatric disorders in Iran. Clin Pract Epidemiol Ment Health. 2005;1(1):16. https://doi.org/10.1186/1745-0179-1-16.

Stordal E, Bjartveit Krüger M, Dahl NH, et al. Depression in relation to age and gender in the general population: the Nord-Trøndelag Health Study (HUNT). Acta Psychiatr. 2001;104(3):210–6. https://doi.org/10.1034/j.1600-0447.2001.00130.x.

Vicente B, Kohn R, Rioseco P, et al. Population prevalence of psychiatric disorders in Chile: 6-month and 1-month rates. Br J Psychiatry. 2004;184(4):299–305. https://doi.org/10.1192/bjp.184.4.299.

Su T-P, Lien T-C, Yang C-Y, et al. Prevalence of psychiatric morbidity and psychological adaptation of the nurses in a structured SARS caring unit during outbreak: a prospective and periodic assessment study in Taiwan. J Psychiatr Res. 2007;41(1–2):119–30. https://doi.org/10.1016/j.jpsychires.2005.12.006.

Klein WM, Weinstein ND. Social comparison and unrealistic optimism about personal risk. Health, coping, and well-being: perspectives from social comparison theory. 1997;25–61.

Sjöberg L. Factors in risk perception. Risk Anal. 2000;20(1):1–12. https://doi.org/10.1111/0272-4332.00001.

Weinstein ND. Why it won’t happen to me: perceptions of risk factors and susceptibility. Health Psychol. 1984;3(5):431. https://doi.org/10.1037/0278-6133.3.5.431.

Weinstein ND. The precaution adoption process. Health Psychol. 1988;7(4):355. https://doi.org/10.1037/0278-6133.7.4.355.

Gorji A. Sanctions against Iran: the impact on Health Services. Iran J Public Health. 2014;43(3):381–2.

Gorji A. Health care: medical supplies in Iran hit by sanctions. Nature. 2013;495(7441):314. https://doi.org/10.1038/495314a.

Danaei G, Harirchi I, Sajadi HS, Yahyaei F, Majdadeh R. The harsh effects of sanctions on Iranian health. Lancet. 2019;394(10197):468–9. https://doi.org/10.1016/S0140-6736(19)31763-5.

Murphy A, Abdi Z, Harirchi I, McKee M, Ahmadnezhad E. Economic sanctions and Iran’s capacity to respond to COVID-19. Lancet Public Health. 2020;5(5):e254. https://doi.org/10.1016/S2468-2667(20)30083-9.

Takian A, Raoofi A, Kazempour-Ardebili S. COVID-19 battle during the toughest sanctions against Iran. Lancet (London, England). 2020;395(10229):1035. https://doi.org/10.1016/S0140-6736(20)30668-1.

Sabetian G, Moghadami M, Haghighi LH, Fallahi MJ, Shahriarirad R, Asmarian N, Moeini YS. COVID-19 infection among healthcare workers: a cross-sectional study in southwest Iran.

Gharebaghi R, Heidary F. COVID-19 and Iran: swimming with hands tied! Swiss Med Wkly. 2020;150:1516. https://doi.org/10.4414/smw.2020.20242.

Bloomberg. Alcohol Poisoning Kills 100 Iranians Seeking Virus Protection. https://www.bloomberg.com/news/articles/2020-03-18/alcohol-poisoning-kills-100-iranians-seeking-virus-protection Date: 18 March 2020. Accessed 2020 March 24; in English.

Jahanshahi AA, Dinani MM, Madavani AN, Li J, Zhang SX. The distress of Iranian adults during the Covid-19 pandemic—more distressed than the Chinese and with different predictors. Brain Behave Immun. 2020. https://doi.org/10.1016/j.bbi.2020.04.081.

Erfani A, Shahriarirad R, Ranjbar K, Mirahmadizadeh A, Moghadami M. Knowledge, attitude and practice toward the novel coronavirus (COVID-19) outbreak: a population-based survey in Iran. Bull World Health Organ. 2020;76:648.

Zhong B-L, Chen S-L, Tu X, Conwell Y. Loneliness and cognitive function in older adults: findings from the Chinese longitudinal healthy longevity survey. J Gerontol: Series B. 2017;72(1):120–8.