Psychological Impact of the COVID-19 Outbreak on Mental Health Among Iranians

Rezvan Heidarimoghadam; Mohammad Babamiri; Nasim Alipour; Mehdi Zemestani; Rashid Heidarimoghadam; Mozhde Shekari; Mark D Griffiths

doi:10.5812/ijpbs-131583

IJ Psychiatry and Behavioral Sciences

IJPBS is the Official Journal of Mazandaran University of Medical Sciences

e-ISSN 1735-9287

p-ISSN 1735-8639

Outline

Abstract
Footnotes
References
Copyright

https://doi.org/10.5812/ijpbs-131583

Psychological Impact of the COVID-19 Outbreak on Mental Health Among Iranians

Authors

Rezvan Heidarimoghadam¹, Mohammad Babamiri

^2,*, Nasim Alipour

³, Mehdi Zemestani

^4,**, Rashid Heidarimoghadam

⁵, Mozhde Shekari⁶, Mark D Griffiths⁷

1Science and Research Branch, Islamic Azad University, Tehran, Iran

2Social Determinants of Health Research Center, Department of Ergonomics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran

3Department of Anesthesiology, School of Paramedicine, Hamadan University of Medical Sciences, Hamadan, Iran

4Department of Clinical Psychology, University of Kurdistan, Sanandaj, Iran

5Department of Ergonomics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran

6Hamadan University of Medical Sciences, Hamadan, Iran

7Psychology Department, Nottingham Trent University, Nottingham, UK

Corresponding Authors:

*Corresponding Author: Social Determinant of Health Research Center, Department of Ergonomics, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran. Email: [email protected]

**Corresponding Author: Department of Clinical Psychology, University of Kurdistan, Sanandaj, Iran. Email: [email protected]

IJ Psychiatry and Behavioral Sciences:Vol. 17, issue 1; e131583

Published online:Mar 01, 2023

Article type:Brief Report

Received:Sep 10, 2022

Accepted:Feb 11, 2023

How to Cite:Heidarimoghadam R, Babamiri M, Alipour N, Zemestani M, Heidarimoghadam R, et al. Psychological Impact of the COVID-19 Outbreak on Mental Health Among Iranians. Iran J Psychiatry Behav Sci. 2023;17(1):e131583. doi: https://doi.org/10.5812/ijpbs-131583

Abstract

Background:

The coronavirus disease 2019 (COVID-19) pandemic and its consequences may impact individuals’ mental health.

Objectives:

The present study aimed to investigate the psychological status of individuals during the COVID-19 outbreak in Iran following the government’s social distancing plan.

Methods:

Data from 1,524 people were collected using a cross-sectional web-based survey via social media. Demographic variables and psychological status were evaluated using the General Health Questionnaire, Stress Response Inventory, and Brunel Mood Scale.

Results:

Individuals reported that their mental health functioning decreased during the pandemic. Four factors were associated with increased stress: (1) fear of getting sick; (2) indefinite quarantine duration; (3) impaired daily activities; and (4) reduced social communication. One-third of the participants reported physical symptoms (32.7%), 47% anxiety, 72% social dysfunction, and 28.3% depression. Approximately half of the participants (52.2%) reported mental health disorder symptoms. Detrimental mental health characteristics were higher among females, younger people, and single people.

Conclusions:

Health policies should be implemented to help reduce the psychological burden during and after the Iranian government’s Social Distancing Plan, especially among females, single people, and younger people.

KeywordsCOVID-19 Pandemic Mental Health Psychological Status Social Distancing

1. Background

After the outbreak of coronavirus disease 2019 (COVID-19) in China in December 2019, all healthcare providers worldwide focused on the disease. Fear of contracting has created fear, panic, and stress among millions worldwide (1). Many countries have used quarantine measures to prevent the further spread of the virus. The Iranian government implemented a plan called Social Distancing Plan (SDP). Social distancing refers to remaining out of congregate settings, avoiding mass gatherings, and maintaining distance from others (approximately six feet or two meters).

The quarantine can create loneliness and anger among individuals. Other issues associated with psychological distress are a decline in freedom, separation from loved individuals, the duration of quarantine, uncertainty about illness, fear of infection, frustration, defective equipment to protect against disease, inadequate and/or incorrect information about COVID-19, boredom, and fatigue (2, 3). For those in quarantine, social support decreases and is among the most critical sources of coping with stress. Previous studies examining the consequences of quarantine among individuals have reported emotional disturbance (4), depression (5), stress (6), low mood, irritability, insomnia (7), and traumatic stress symptoms (8).

2. Objectives

The present study investigated a more comprehensive range of psychological effects, symptoms, and mood states of the SDP during the COVID-19 outbreak in Iran compared to other Iranian studies.

3. Methods

3.1. Procedure and Participants

Data were collected using a cross-sectional web-based survey with a link shared via social media (i.e., WhatsApp and Telegram). Before starting the study, individuals were asked if they had any physical or mental illnesses. Only those who had no mental or physical illness and were over 18 years were included in the statistical analysis. The data collection lasted one week, from December 5 to December 11, 2020. A total of 1,524 individuals completed the survey.

3.2. Measures

3.2.1. General Health Questionnaire

The 28-item General Health Questionnaire (GHQ-28) comprises four subscales (physical symptoms, anxiety/insomnia, depression, social dysfunction), each with seven items rated on a five-point scale from 0 (never) to 4 (always). The validity and reliability of the Iranian GHQ-28 are adequate (9).

3.2.2. Stress Response Inventory

The 39-item Stress Response Inventory (SRI) assesses different aspects of stress response with seven subscales. Items are rated on a five-point scale from 0 (not at all) to 4 (absolutely). The reliability and validity were confirmed in previous studies (10).

3.2.3. Brunel Mood Scale

The 32-item Brunel Mood Scale (BRUMS-32) assesses different mood states (depression, tension, fatigue, anger, vigor, confusion, calmness, and happiness). The items are rated on a five-point scale from 0 (not at all) to 4 (extremely). Confirmatory factor analysis has confirmed the construct validity of the Iranian BRUMS-32 (RMSEA = 0.08, CFI = 0.94, TLI = 0.93). Internal consistency (tension = 0.74, vigor = 0.80, confusion =0.72, fatigue = 0.76, happiness = 0.77, calmness = 0.78, depression= 0.70, anger = 0.72, and total = 0.78) and temporal reliability (tension = 0.90, vigor = 0.87, confusion = 0.84, fatigue = 0.86, happiness = 0.87, calmness = 0.86, depression = 0.88, anger = 0.86, and total = 0.88) were confirmed (11).

Descriptive statistics were reported as percentages and means ± SD. The independent t-test and one-way ANOVA were used to investigate the association between participants’ demographic variables and psychological characteristics. The results are presented with 95% confidence intervals. All analyses were performed using SPSS-25.

4. Results

Most participants were males (65.16%) and married (66.7%). Most of them were under the age of 40 years (72%).

Table 1 shows the mental health characteristics of the whole sample. One-third of the participants reported physical symptoms (32.7%), 47% anxiety, 72% social dysfunction, and 28.3% depression. Approximately half of the participants (52.2%) reported at least one mental health disorder. Means and standard deviations of stress response and mood state are shown in Table 2.

Table 1.

Gender and Psychological Characteristics

Psychological Characteristics	Mean ± SD	P-Value
Physical symptoms
Gender		< 0.001
Female	5.90 ± 4.45
Male	4.45 ± 3.99
Marital Status		0.144
Single	5.63 ± 4.45
Married	5.28 ± 4.29
Anxiety/insomnia
Gender		< 0.001
Female	8.02 ± 5.76
Male	5.79 ± 5.15
Marital Status		0.0908
Single	7.22 ± 5.68
Married	7.26 ± 5.65
Social dysfunction
Gender		0.002
Female	9.58 ± 4.62
Male	8.85 ± 4.25
Marital Status		< 0.001
Single	9.97 ± 4.60
Married	9.01 ± 4.43
Depression
Gender		< 0.001
Female	5.27 ± 5.54
Male	3.67 ± 4.75
Marital Status		< 0.001
Single	5.90 ± 5.82
Married	4.11 ± 4.96
GHQ-28 total score
Gender		< 0.001
Female	28.77 ± 16.35
Male	22.76 ± 14.47
Marital Status		< 0.001
Single	28.73 ± 16.19
Married	25.67 ± 15.77
Tension
Gender		< 0.001
Female	5.89 ± 5.01
Male	4.52 ± 4.22
Marital Status		0.002
Single	5.94 ± 4.75
Married	5.15 ± 4.80
Aggression
Gender		0.032
Female	1.59 ± 2.83
Male	1.28 ± 2.42
Marital Status		0.002
Single	1.78 ± 2.96
Married	1.33 ± 2.55
Anger
Gender		< 0.001
Female	6.21 ± 5.64
Male	4.55 ± 4.81
Marital Status		0.091
Single	5.97 ± 5.47
Married	5.47 ± 5.39
Fatigue
Gender		< 0.001
Female	7.01 ± 4.86
Male	5.28 ± 4.27
Marital Status		0.001
Single	6.99 ± 4.95
Married	6.12 ± 4.59
Frustration
Gender		< 0.001
Female	8.09 ± 6.76
Male	5.06 ± 5.26
Marital Status		0.070
Single	7.46 ± 6.43
Married	6.82 ± 6.43
Vigor
Gender		< 0.001
Female	7.34 ± 3.58
Male	8.08 ± 3.56
Marital Status		0.007
Single	7.25 ± 3.71
Married	7.77 ± 3.51
Confusion
Gender		< 0.001
Female	5.33 ± 4.38
Male	4.53 ± 4.09
Marital Status		< 0.001
Single	5.96 ± 4.45
Married	4.59 ± 4.15
Calmness
Gender		< 0.001
Female	6.00 ± 3.78
Male	6.85 ± 3.66
Marital Status		0.049
Single	6.03 ± 3.88
Married	6.43 ± 3.69
Happiness
Gender		0.013
Female	6.86 ± 3.78
Male	7.36 ± 3.68
Marital Status		< 0.001
Single	6.37 ± 3.82
Married	7.36 ± 3.68

Abbreviation: GHQ-28, General Health Questionnaire.

Table 2.

Mental Health Characteristics ^a

Characteristics	Values
General Health Questionnaire
Physical symptoms
Healthy cases	1025 (67.3)
Suspected cases	499 (32.7)
Anxiety/insomnia
Healthy cases	807 (53.00)
Suspected cases	717 (47.00)
Depression
Healthy cases	1093 (71.7)
Suspected cases	431 (28.3)
Social dysfunction
Healthy cases	424 (28.00)
Suspected cases	1098 (72.00)
GHQ-28 total score
Healthy cases	728 (47.8)
Suspected cases	796 (52.2)
Stress Response Inventory
Tension	5.41 ± 4.79
Aggression	1.48 ± 2.70
Anger	5.63 ± 5.42
Fatigue	6.41 ± 4.73
Frustration	7.03 ± 6.44
Brunel Mood Scale
Vigor	7.60 ± 3.59
Confusion	5.05 ± 4.30
Calmness	6.30 ± 3.76
Happiness	7.03 ± 3.75

Abbreviation: GHQ-28, General Health Questionnaire.

^a Values are expressed as No. (%) or mean ± SD.

4.1. Gender, Marital Status, and Psychological Characteristics

Table 1 shows that the mean scores of negative psychological characteristics (physical symptoms, anxiety and insomnia, depression, tension, anger, fatigue, and frustration and confusion) were higher among females than among males, and the mean scores of positive psychological characteristics (vigor, calmness, and happiness) were lower among females than among males. These differences were significant in all the characteristics (P ≤ 0.01).

Based on Table 1, the mean scores of negative psychological characteristics were higher among single participants than among married participants, and in the case of positive psychological characteristics, the trend was reversed. These differences were significant in terms of general health dimensions (social dysfunction and depression), stress response dimensions (tension, aggression, and fatigue), and mood state dimensions (vigor, confusion, and happiness) (P ≤ 0.01).

4.2. Age and Psychological Characteristics

Table 3 shows that the mean scores of negative psychological characteristics among older participants were lower than in younger participants and that the mean scores of positive psychological characteristics were higher among older participants than in younger participants. These differences were significant in all the psychological characteristics (P ≤ 0.01).

Table 3.

Age and Psychological Characteristics

Psychological Characteristics and Age (y)	Mean ± SD	P-Value
Physical symptoms
18 - 30	6.00 ± 4.44	< 0.001
31 - 40	5.18 ± 4.26
41 - 50	5.20 ± 4.43
≥ 51	3.97 ± 3.55
Anxiety and insomnia
18 - 30	7.98 ± 5.73	< 0.001
31 - 40	7.19 ± 5.59
41 - 50	6.76 ± 5.67
≥ 51	4.75 ± 4.53
Social dysfunction
18 - 30	10.51 ± 4.31	< 0.001
31 - 40	9.11 ± 4.51
41 - 50	8.17 ± 4.35
≥ 51	7.27 ± 4.10
Depression
18 - 30	6.41 ± 5.83	< 0.001
31 - 40	4.39 ± 5.08
41 - 50	3.04 ± 4.12
≥ 51	1.96 ± 3.46
GHQ-28 total score
18 - 30	30.92 ± 15.95	< 0.001
31 - 40	25.89 ± 15.78
41 - 50	23.19 ± 15.15
≥ 51	17.95 ± 12.01
Tension
18 - 30	6.35 ± 4.80	< 0.001
31 - 40	5.21 ± 4.72
41 - 50	4.72 ± 4.80
≥ 51	3.05 ± 3.47
Aggression
18 - 30	2.13 ± 3.14	< 0.001
31 - 40	1.30 ± 2.40
41 - 50	1.02 ± 2.39
≥ 51	0.28 ± 1.24
Anger
18 - 30	6.84 ± 5.69	< 0.001
31 - 40	5.44 ± 5.33
41 - 50	4.59 ± 4.93
≥ 51	2.80 ± 3.38
Fatigue
18 - 30	7.57 ± 4.86	< 0.001
31 - 40	6.21 ± 4.53
41 - 50	5.39 ± 4.40
≥ 51	3.67 ± 3.59
Frustration
18 - 30	8.50 ± 6.58	< 0.001
31 - 40	6.68 ± 6.32
41 - 50	5.97 ± 6.23
≥ 51	3.57 ± 4.04
Vigor
18 - 30	7.04 ± 3.65	< 0.001
31 - 40	7.65 ± 3.63
41 - 50	8.25 ± 3.54
≥ 51	8.73 ± 2.88
Confusion
18 - 30	6.07 ± 4.37	< 0.001
31 - 40	4.97 ± 4.34
41 - 50	4.04 ± 3.92
≥ 51	2.60 ± 2.90
Calmness
18 - 30	5.71 ± 3.74	< 0.001
31 - 40	6.31 ± 3.68
41 - 50	6.89 ± 3.86
≥ 51	7.92 ± 3.35
Happiness
18 - 30	6.26 ± 3.67	< 0.001
31 - 40	7.19 ± 3.75
41 - 50	7.77 ± 3.74
≥ 51	8.41 ± 3.29

Abbreviation: GHQ-28, General Health Questionnaire.

5. Discussion

The present study aimed to investigate the psychological status of Iranian individuals who experienced the Iranian government’s SDP to minimize the spread of COVID-19 during the pandemic.

The results showed that approximately half of the participants had at least one mental health disorder (52.2%). Previous studies by Noorbala et al. reported the prevalence of general mental health disorders in Iran in 1999, 2004, 2015, and 2017 as 21%, 21%, 23.4%, and 28.5%, respectively (12-14). In the present study, as in the aforementioned studies, the mean scores of mental disorders were higher among females than males. The present study also found that the mean scores of mental health disorders and negative psychological characteristics were higher among single participants than among married ones, which is inconsistent with some previous studies (12, 14, 15). One reason could be that single individuals were forced to break away from their friendship groups and spend more time with family during the enforcement of the SDP. Furthermore, the SDP meant universities were physically closed, and concerts, celebrations, and parties were canceled. Because younger individuals are more likely to attend such social gatherings, they are more likely to have been affected during the country’s lockdown. This result can be seen when comparing different age groups. The highest rates of mental health disorders and negative psychological characteristics were found among younger individuals, which is inconsistent with previous research (14, 16). Consequently, the psychological state was better among older participants than among younger participants, even though the highest mortality rate for those with COVID-19 is among the elderly (17). This age group received much attention and social support during the implementation of the SDP from relatives and friends, as well as from relevant organizations such as the Ministry of Health. Older individuals are less likely to leave the house, even under normal circumstances, so the SDP was less restrictive for them than for younger individuals. Many older individuals are retired, so the closure of markets, offices, and businesses was less likely to cause psychological harm to them. Previous studies have shown that factors such as receiving information from the media, the internet, etc., can play a role in fear of COVID-19 (18). As young people use these news sources more, the psychological distress caused by COVID-19 has become more common among these people.

The study was cross-sectional, so causal relationships could not be determined. The study was conducted utilizing online data collection, which means some could not participate. This may have led to demographic biases among the final sample of participants, with those in higher education or of higher socioeconomic status being more likely to participate. The self-selecting and self-reporting nature of data collection means that while the sample was relatively large, it was not representative of the Iranian population, and the data were subject to well-known methods biases. Another limitation of this study was that it was not determined if the respondents or one of their relatives had contracted COVID-19 or not.

Footnotes

Authors' Contribution: M. B. and R. H. designed the research and analyzed the data. N. A. and M. Z. participated in planning the work and wrote the manuscript with the supervision of M. B. and R. H. M. S. and R. H. did the data collection. M. D. G. helped to draft and revise the manuscript critically for important intellectual content. All authors read and approved the final manuscript as submitted.
Conflict of Interests: The authors declare no conflict of interests.
Data Reproducibility: The dataset presented in the study is available on request from the corresponding author during submission or after publication.
Ethical Approval: The Research Ethics Committee of Hamadan University of Medical Sciences approved the study (Code: IR.UMSHA.REC.1399030).
Funding/Support: The Vice-Chancellery for Research and Technology of Hamadan University of Medical Sciences funded the study (grant number: 990126184).
Informed Consent: The collected data were anonymous and treated as confidential.

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Copyright

Copyright © 2023, Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

Outline

Psychological Impact of the COVID-19 Outbreak on Mental Health Among Iranians

Abstract

Background:

Objectives:

Methods:

Results:

Conclusions:

1. Background

2. Objectives

3. Methods

3.1. Procedure and Participants

3.2. Measures

3.2.1. General Health Questionnaire

3.2.2. Stress Response Inventory

3.2.3. Brunel Mood Scale

4. Results

4.1. Gender, Marital Status, and Psychological Characteristics

4.2. Age and Psychological Characteristics

5. Discussion

Footnotes

References

Copyright

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