Abstract
Context:
In March 2020, Morocco announced the first COVID-19 case and implemented preventive measures, including home confinement.
Aims:
Monitoring the psychological effects and prevalence among high- and middle-school students.
Settings and Design:
This study is cross-sectional, carried online.
Methods and Materials:
The survey was conducted by publishing an online questionnaire between May 14, 2020 and June 14, 2020, which included inquiries about socio-demographic data, the conditions of home confinement, activities carried out during confinement, and medical history and sleep patterns. To assess depressive disorder, anxiety disorders, and stress, the survey employed the “DSRS-c,” “SCARED,” and “PSS10” scales, respectively.
Statistical Analysis Used:
Data were received on Google forms coded by Excel 2010 and analyzed by IBM SPSS Statistics 22.
Results:
Out of the 689 participants, 73.7% were females; the mean age was 16.08 years (standard deviation 1.48). 94.8% of subjects reported changes in sleep habits, and 41.4% of adolescents had high levels of depressive symptoms, while 50.7% had high levels of anxiety symptoms. Several factors were significantly associated with anxiety and depressive symptoms, including being a girl (P = 0.000), being a high-school student (P = 0.011), economic struggles during the pandemic (P = 0.003), doubting the necessity of home confinement (P = 0.000), spending over 3 hours a day on social networks and video games (P = 0.000), dropping out of remote learning (P = 0.000), having a psychiatric history (P = 0.000), having chronic illnesses in the family (P = 0.002), and changes in sleep habits (P = 0.000).
Conclusions:
The study found high prevalence of depression, anxiety, and stress symptoms among students during the pandemic, emphasizing the need for mental health awareness and support.
Keywords: Anxiety symptoms, COVID-19, depressive symptoms, high- and middle-school students, home confinement
INTRODUCTION
The COVID-19 pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to a global outbreak with severe respiratory symptoms and high mortality rates, particularly in vulnerable populations. Governments worldwide have imposed preventive measures such as home quarantine, mask-wearing, and social distancing to limit the spread of the virus. However, these measures have negative effects on mental health, especially in vulnerable individuals, such as teenagers.[1] Investigations on this subject have been conducted across diverse countries.[1,2,3] Given the distinctive socio-cultural and economic characteristics inherent to each region, the repercussions of global events like COVID-19 can exhibit pronounced variations. Centered on the eastern region of Morocco, our study seeks to assess the impact of home quarantine on the mental health of secondary level students, given the significant pressures they face.
SUBJECTS AND METHODS
This study is a cross-sectional study conducted between May 14, 2020 and June 14, 2020 on secondary level students in private and public educational institutions in the eastern region of Morocco. The study population consisted of students between the ages of 10 and 18 years old who voluntarily agreed to complete the online survey. The online questionnaire was created in Google Forms and published on social media platforms (Facebook and WhatsApp mainly) in classic Arabic.
While we could not get a formal IEC clearance and parental consent due to the COVID situation, we have got approval from the Regional Academy of Education of the Oriental Region of Morocco and followed ethical principles of confidentiality and anonymity. Participant consent was obtained exclusively through digital means, directly from the participants themselves.
The questionnaire consisted of five sections and three scales. The first section collected socio-demographic characteristics. The second section collected information on the conditions and opinions about home confinement and the pandemic. The third section dealt with the activities practiced during home confinement and remote learning. The fourth section collected personal and familial medical history, including the history of infection with COVID-19 in the family. The fifth section was about the impact of confinement on mental health.
The mental health status of the respondents was measured using three scales: the Birleson Depression Self-Rating Scale for Children (DSRS) for depression. This scale consists of 18 items that measure various aspects of mood and behavior commonly associated with depression, such as sadness, guilt, loss of interest, and low self-esteem.
Each item is scored on a three-point Likert scale, with responses ranging from “never” to “sometimes” to “always”. The total score ranges from 0 to 36, with higher scores indicating greater severity of depressive symptoms. If the results are less than 15, it indicates that there is no presence of depression disorder.[4]
The Screen for Child Anxiety Related Disorders (SCARED) for anxiety disorders is a self-report questionnaire designed to assess symptoms of anxiety in children and adolescents between the ages of 9 and 18. The scale consists of 41 items that measure various anxiety symptoms across five domains, including generalized anxiety, separation anxiety, social phobia, panic/somatic symptoms, and school phobia.[5]
Each item is scored on a three-point Likert scale, with responses ranging from “not true or hardly ever true” to “very true or often true”. The total score ranges from 0 to 82, with higher scores indicating greater severity of anxiety symptoms. A total score of 25 or higher indicates a likelihood of an anxiety disorder.[5] The cutoff point used in our study was 30.
The Perceived Stress Scale 10 (PSS-10) for perceived stress is a self-report questionnaire designed to measure an individual's perception of stress in their life over the past month. The scale consists of 10 items that assess the degree to which a person has found their life unpredictable, uncontrollable, and overwhelming during the past month.
Each item is scored on a five-point Likert scale, with responses ranging from “never” to “very often”. The total score ranges from 0 to 40, with higher scores indicating greater levels of perceived stress.[6]
The Arabic versions of these scales have been validated and used in research investigating the prevalence and correlates of depression, anxiety, and stress symptoms in Arab youth.[5,6,7]
Data were received on Google forms and imported into Excel 2010 software for coding and then analyzed by Statistical Analysis of Sampled Data (Spss) version 22. Descriptive analyses were carried out with the calculation of percentages for qualitative variables and means and standard deviations for quantitative variables. The Chi-square test (Chi-2 test) was used to compare qualitative variables, and Pearson's test was used for the comparison of quantitative variables, with a significance level of P ≤ 0.05.
RESULTS
Out of the 857 students who completed the online survey, 98 students were excluded from the study as they did not reside in the eastern region of Morocco, and one student did not reside in Morocco. Additionally, 69 students above the age of 18 were also excluded. Therefore, the final sample of the study consisted of 689 secondary level students.
Demographics
In this study, 689 secondary level students were included, with 73.7% of the participants being female and 26.3% being male. The mean age of the students was 16.08 years [standard deviation (SD) 1.48], with most of them being high schoolers (65%) in their final year of study (33.1%). The majority of the students lived with both parents (87.2%), had more than one sibling (60.2%), and lived in urban areas (92.9%). More than half of the participants (56.3%) perceived that their families faced economic struggles during the COVID-19 pandemic.
Opinions about the pandemic and the confinement
Most participants (77.5%) did not know anyone with COVID-19. 84.2% considered it a dangerous pandemic, 4.9% did not, and 10.9% were not sure. 54% did not follow pandemic news, with 35.6% because of feeling anxious and 10.4% simply not caring. 58.9% strictly adhered to home confinement measures, but 43.4% rated the experience as “bad,” citing fear of extended confinement (44.5%), impact on exams (62.6%), missing loved ones (39.4%), and limited outdoor activities (30.5%). 90.7% believed home confinement was necessary.
Activities during the home confinement and opinions about remote learning
72.6% of students had consistent Internet access, with 45% reporting using it and playing video games for over 3 hours daily. During confinement, students engaged in religious practices, studying, household tasks, social media, and film-watching. Nearly 50% followed online lessons regularly, with reasons for not doing so including lack of structure, negative circumstances at home, anxiety due to the pandemic, lack of motivation, and poor time management. 36.1% found remote learning average, 20.8% bad, 19.7% very bad, 13.9% good, and 9.4% very good.
Medical history
The majority (90.3%) had no chronic illness history. 13.9% reported psychiatric disorders. 53.4% had familial history of chronic illness, and 18.1% had mental illness. A few had COVID-19-positive cases in family (3.3%) or substance use (3.6%).
Sleep habits
Most students (76.8%) experienced changes in their sleep habits during the confinement period, mainly due to lack of structure (89.6%). A few used sleep aids (4.2%) or psychoactive substances (0.3%), while 40.9% increased their consumption of food stimulants. Half (50.9%) felt they needed mental health support, while 19.3% did not and 29.8% were unsure.
Mental health of students
Results showed that a large percentage of the students experienced symptoms of depression (41.4%) and exhibited indications of anxiety disorders (50.7%) according to the Self Rating Depression Scale and the Screen for Child Anxiety Related Disorders Scale, respectively. For the possibility of panic disorder or somatic symptoms, a total score of 7 or higher was used. This yielded findings that suggest 336 students (48.8%) might be susceptible to these conditions, while 353 students (51.2%) do not exhibit such tendencies.
For Generalized Anxiety Disorder (GAD), a threshold score of 9 or higher was employed. In this context, 370 students (53.7%) might be at risk of having GAD, whereas 319 students (46.3%) are less likely to experience it.
Regarding Separation Anxiety, a threshold score of 5 or higher was utilized, revealing that 463 students (67.2%) might encounter this issue, while 226 students (32.8%) are less prone to it.
For Social Anxiety, a threshold score of 8 or higher was applied, indicating that 288 students (41.8%) might grapple with Social Anxiety disorder, while 401 students (58.2%) are not as inclined to experience it.
Last, concerning School Phobia, a threshold score of 3 or higher was considered. This implies that 198 students (28.7%) might have School Phobia, while 491 students (71.3%) are less likely to face this condition.
Moreover, 50.8% of the students showed high levels of perceived stress according to the Perceived Stress Scale with an average score of 20.98.
Comparison of data related to students with depression and/or anxiety symptoms and students who are not affected by these disorders:
In this study, the sample of students was divided into two groups: a group with depression symptoms, anxiety symptoms, or both (61.2%) and a group without these symptoms (38.8%). We aimed to identify associated factors.
1 Comparison of demographic data
Gender and age are significantly associated with the incidence of depression and anxiety symptoms. Females were found to be more susceptible to present higher levels of depression and anxiety symptoms than males (P = 0,000). Students who are 16 years old or older (P = 0,003) and enrolled in high school (P = 0,011) are more likely to suffer from depression and/or anxiety symptoms. However, when analyzing the data from the two scales separately, age is only significantly associated with depression symptoms (P = 0.000), not anxiety symptoms (P = 0.055) [Table 1].
Table 1.
Socio-demographic factors and opinions about COVID-19 pandemic and confinement and their association with depression and anxiety symptoms among the participants
| Category | With Depression and or anxiety symptoms 422 (61.2%) | Without Depression and or anxiety symptoms 267 (38.8%) | P |
|---|---|---|---|
| Gender | |||
| Males | 89 (49.2%) | 92 (50.8%) | 0,000 |
| Females | 333 (65.6%) | 175 (34.4%) | |
| Age | |||
| 12-15 years | 127 (53,6%) | 110 (46,4%) | 0,003 |
| 16-18 years | 295 (65,3%) | 157 (34,7%) | |
| Level of education | |||
| Middle schoolers | 132 (54,8%) | 109 (45,2%) | 0,011 |
| High schoolers | 290 (64,7%) | 158 (35,3%) | |
| Economic status | |||
| Faced struggles | 257 (66,2%) | 131 (33,8%) | 0,003 |
| Did not face struggles | 165 (54,8%) | 136 (45,2%) | |
| Opinions about the pandemic | |||
| Dangerous | 349 (60,2%) | 231 (39,8%) | 0,020 |
| Not dangerous | 17 (50,0%) | 17 (50,0%) | |
| I don't know | 56 (74,7%) | 19 (25,3%) | |
| Following COVID-19 updates | |||
| Following | 208 (55,9%) | 164 (44,1%) | 0,000 |
| Not following due to anxiety | 174 (71,0%) | 71 (29,0%) | |
| Not following due to indifference | 40 (55,6%) | 32 (44,4%) | |
| Opinions about the home confinement | |||
| Necessary | 368 (58,9%) | 257 (41,1%) | 0,000 |
| Unnecessary | 18 (90,0%) | 2 (10,0%) | |
| I don't know | 36 (81,8%) | 8 (18,2%) | |
| Rating of the home confinement | |||
| Good | 86 (49,1%) | 89 (50,9%) | 0,000 |
| Average | 100 (51,5%) | 94 (48,5%) | |
| I don't know | 13 (61,9%) | 8 (38,1%) | |
| Bad | 223 (74,6%) | 76 (25,4%) |
2 Comparison of data related to the conditions of home quarantine
Economic struggles during quarantine have a significant association with the incidence of the symptoms of the mentioned mental disorders (P = 0.003). Perceiving the pandemic as serious or avoiding COVID-19 updates due to anxiety correlates with depression and anxiety symptoms (P < 0.05). Living environment, family size, and private space availability showed no significant association. Students who believed home confinement was unnecessary had higher likelihoods of developing these symptoms (P = 0.000). A negative quarantine experience assessment was significantly associated with the occurrence of the symptoms of these disorders (P = 0.000), while adherence to home confinement had no significant correlation [Table 1].
3 Comparison of data related to activities practiced during home quarantine
Additionally, spending more than 3 hours per day on social media and video games (P = 0,000), not attending online classes (P = 0,000), and having a negative assessment of the experience of distance learning (P = 0,000) were found to be significant factors associated with the occurrence of depression and anxiety symptoms among students [Table 2].
Table 2.
Use of social media and video games and opinions about remote learning and their association with occurrence of depression and anxiety symptoms among the participants
| Category | With Depression and or anxiety symptoms 422 (61.2%) | Without Depression and or anxiety symptoms 267 (38.8%) | P |
|---|---|---|---|
| Social media and video games | |||
| <1 h per day | 73 (50,0%) | 73 (50,0%) | 0,000 |
| One to 3 h per day | 134 (57,5%) | 99 (42,5%) | |
| >3 h per day | 215 (69,4%) | 95 (30,6%) | |
| Remote learning | |||
| Attending regularly | 171 (49,7%) | 173 (50,3%) | 0,000 |
| Not attending regularly | 251 (72,8%) | 94 (27,2%) | |
| Rating of remote learning | |||
| Very bad | 98 (72,1%) | 38 (27,9%) | 0,000 |
| Bad | 105 (73,4%) | 38 (26,6%) | |
| Average | 137 (55,0%) | 112 (45,0%) | |
| Good | 47 (49,0%) | 49 (51,0%) | |
| Very good | 35 (53,8%) | 30 (46,2%) |
4 Comparison of data related to medical history
Students with chronic illnesses, psychiatric history, or family history of these illnesses were at higher risk for developing symptoms of the mentioned disorders (P < 0.05). Differences in sleep habits, sleep aids or substance use to help with sleep, food stimulant intake, and need for psychological support were associated with depression and/or anxiety symptoms (P < 0.05). Positive COVID-19 cases in family/friends were also linked to showing symptoms of these disorders (P = 0.009). Psycho-active substance use was associated with depression (P = 0.023) but not anxiety (P = 1.000) [Table 3].
Table 3.
Medical history sleep habits data and their association with depression and anxiety symptoms among the participants
| Category | With Depression and or anxiety symptoms 422 (61.2%) | Without Depression and or anxiety symptoms 267 (38.8%) | P |
|---|---|---|---|
| Chronic illness history | |||
| With | 50 (74,6%) | 17 (25,4%) | 0,018 |
| Without | 372 (59,8%) | 250 (40,2%) | |
| Mental illness history | |||
| With | 90 (93.8%) | 6 (6.2%) | 0,000 |
| Without | 332 (56.0%) | 261 (44.0%) | |
| Chronic illness in family | |||
| With | 245 (66,6%) | 123 (33,4%) | 0,002 |
| Without | 177 (55,1%) | 144 (44,9%) | |
| Mental illness in family | |||
| With | 104 (83,2%) | 21 (16,8%) | 0,000 |
| Without | 318 (56,4%) | 246 (43,6%) | |
| COVID-19-positive cases in family/friends | |||
| With positive cases in the entourage | 109 (70,3%) | 46 (29,7%) | 0,009 |
| Without | 313 (58,6%) | 221 (41,4%) | |
| Sleep habits | |||
| No change | 11 (30,6%) | 25 (69,4%) | 0,000 |
| Small change | 48 (38,7%) | 76 (61,3%) | |
| Significant change | 363 (68,6%) | 166 (31,4%) | |
| Psychoactive substances and sleeping pills use for sleep | |||
| Did not use | 391 (59,4%) | 267 (40,6%) | 0,000 |
| Did use | 31 (100,0%) | 0 (0,0%) | |
| Food stimulants use | |||
| Did not change | 210 (51,6%) | 197 (48,4%) | 0,000 |
| Increase use | 212 (75,2%) | 70 (24,8%) | |
| Need for mental support | |||
| “I do not need mental support” | 154 (43,9%) | 197 (56,1%) | 0,000 |
| “I do need mental support” | 118 (88,7%) | 15 (11,3%) | |
| “I don't know” | 150 (73,2%) | 55 (26,8%) |
5 Comparison of data regarding the PSS10
We found a statistically significant association (P = 0.000) between high levels of stress and the incidence of depression and/or anxiety symptoms in students.
DISCUSSION
Our study was conducted around 2 months after the state of emergency was declared and home quarantine measures were put in place in the country. The primary focus was to monitor the impact of the home quarantine experience on the mental health of students in the Moroccan environment.
We discovered that the prevalence of depression symptoms among the sample of students was 41.4%, while the prevalence of anxiety symptoms was 50.7%. These findings align with the outcomes of previous studies conducted across different regions of the world, such as a cross-sectional study in China with 8079 participants aged 12 to 18 years. In that study, the Patient Health Questionnaire (PHQ-9) was utilized to measure depression symptoms and the Generalized Anxiety Disorder scale (GAD-7) was used to assess anxiety symptoms. The results indicated that 43.7% of participants experienced depression symptoms, while 37.4% had anxiety symptoms.[8] A separate study on a sample of adolescent girls aged 12–18 years found that the incidence of depression was 39.5%.[9] Another online survey was conducted with 1036 children and adolescents aged between 6 and 15 years from April 16 to April 23, 2020. The study discovered that 11.78% of participants experienced depression, while 18.92% suffered from anxiety disorder.[10] These rates are comparatively lower than the ones observed in the present research, which may be explained by the younger age of the participants in that study (6–15 years) compared to ours (13–18 years), and the time of conduction of the study (during the beginning of lifting the quarantine in China). Another study conducted on children and adolescents between the ages of 7 and 18 years old found that anxiety levels during the pandemic were higher compared to pre-pandemic times.[2] Despite variations in depression and anxiety rates during the COVID-19 pandemic and lockdown in different studies due to factors such as study methodology, time of questionnaire publication, targeted population and age groups, COVID19-related measures in each country, and cultural differences, it is evident that the pandemic and its restrictions have had a substantial psychological impact on individuals' mental health, particularly adolescents. Therefore, there is a need for research to identify the factors that might be associated to this psychological impact.
Gender
Our study found higher rates of depression, anxiety, and stress among females during pandemic-related restrictions, consistent with most studies among adolescents and adults.[11,12,13] Women generally have higher lifetime rates of mood and anxiety disorders.[14] A study suggests that girls rely more on social relationships for support during stress;[15] therefore, home confinement and restricted social interaction during the pandemic may have more significant psychological impact on adolescent girls than boys.
Age
Our study found that older students aged 16–18, particularly those in their last and second years of high school, are more prone to depression and anxiety disorders, probably due to the pressure induced by final exams and uncertainty surrounding their dates and framework. It is noteworthy that the exams for the last year of middle school and primary school were exceptionally canceled in Morocco during the 2019/2020 academic year. This is consistent with similar findings in another study that reported higher vulnerability to depression in teenage girls aged 15–18.[9]
Economic status
Financial hardship during the pandemic was associated with higher rates of depression and anxiety symptoms among students, consistent with studies on French students and students in Bangladesh.[16,17] Unemployment and low income have also been identified as risk factors for mental health issues.[18]
Social media and video games
Students spending over 3 hours daily on social media or video games also presented higher risk of depression and anxiety, consistent with a study indicating that excessive smartphone and Internet use were related to increased depression. Prior to the pandemic, participants had spent less time on the Internet, leading probably to lower rates of depression.[2] Kuwaiti and Italian studies also found that spending more time on social media during the pandemic was related to higher levels of anxiety and depression.[13,19]
Remote learning
Our study links discontinuing remote learning to a higher likelihood of developing depression and anxiety among students, which can be explained by the lack of social interaction and communication with peers and teachers; this is supported by prior research.[20,21] School closure and other negative factors can also impact adolescent mental health.[22] Research shows that remote learning difficulties, such as technological problems, comprehension issues, and lack of motivation, contribute to depression, rather than remote learning itself.[11] The inability to ask questions and clarify doubts can lead to discontinuation of learning. School routine is crucial for coping with psychological problems, and its closure can exacerbate symptoms. Anxiety and depression can also hinder academic performance, creating a bidirectional relationship.
Medical history
Chronic illnesses increase the risk of anxiety disorders, confirmed by prior research.[23] Another study found that those with pre-existing conditions such as diabetes and weakened immune systems are more vulnerable to mental health issues during the pandemic.[24] Students with prior mental illness and family history of chronic disease are also at higher risk for psychological disorders, possibly due to concerns for loved ones. A study found that higher worry for family and friends is associated with increased risk of depression and anxiety in students.[25]
Depression correlates with substance abuse history. Previous studies show a higher risk of depression among smokers and those with substance abuse history, increasing likelihood of mental health problems.[13] Anxiety disorders are significantly correlated with personal knowledge of a SARS-CoV-2 infected person, in line with other studies showing such exposure increases anxiety and stress.[2]
Sleep
Our study found that changes in sleep habits during confinement correlated with higher rates of anxiety and depression symptoms among students. The COVID-19 pandemic disrupted many people's daily routines, including their sleep habits, and increased the risk of psychological problems.[26] Sleeping less than 6 hours a day is associated with higher risk of depression in teenage girls,[9] and insomnia rates among teenagers and youth have increased significantly during the pandemic.[27] Factors such as reduced physical activity, decreased exposure to sunlight, and prolonged use of electronic devices may affect their sleep homeostasis.[28,29]
Opinions and perceptions about COVID-19 and home confinement
Students' perception of COVID-19 severity is linked to depression symptoms. Uncertainty, fear of pandemic control difficulties, and hypochondria can trigger mental health problems.[19,30,31,32] Adolescents who experience higher rates of depression and anxiety symptoms tend to avoid pandemic-related news as it causes them distress. This indicates that avoiding the news does not necessarily protect them from anxiety and may even worsen their mental state by leaving them uninformed. Some studies have found that following COVID-19 news for extended periods of time has a negative impact on mental health, with individuals experiencing higher rates of depression and anxiety.[13] In particular, relying on the Internet as a primary source of information has been linked to a greater likelihood of anxiety, as reported in one study.[33] Social media may have a negative impact on mental health due to inaccurate information about COVID-19 and the spread of negative emotions.[34,35] Studies suggest that this impact is greater for young people,[36] but following updates on the pandemic can also have a positive impact by building trust in public health measures and reducing anxiety levels.[11]
Perceived stress scale
In terms of perceived stress, our study found that the average score was 20.98, slightly higher than the score reported among 18–24-year-olds in another study (19.3).[18] It is important to note that scores on this scale during the pandemic are generally higher than those reported before, especially among young people.[37] Additionally, our study showed that those who scored high on the stress scale were more likely to experience depression and anxiety symptoms.
Limitations
This study has several limitations. First, it is a cross-sectional study that cannot establish causal relationships. Second, using the Internet to distribute the questionnaire may exclude participants without Internet access. Third, it is difficult to determine the number of individuals who received the questionnaire link but chose not to participate, making it challenging to accurately determine the response rate. Additionally, the results are subject to response bias as the students' understanding of the questionnaire questions may vary. The geographical distribution and sample size may not be entirely suitable, limiting the generalization of the results. Finally, the rapid implementation of lockdown measures and limitations on gathering data during the pandemic may have influenced sample selection and data collection. Longitudinal studies are needed in the future to obtain more valuable results.
CONCLUSION
This study sheds light on the significant impact of the COVID-19 pandemic and its measures on the mental health of students, which is influenced by various factors such as age, gender, economic status, social media and video games use, remote learning, medical history, and substance use. Although the study has limitations, it provides a basis for further research on adolescent mental health during stressful circumstances such as home confinement, including long-term psychological effects. This research can help in developing more accurate and effective recommendations to prevent psychological problems among adolescents.
Key Messages
COVID-19 and home confinement had a significant impact on mental health of secondary level students in Morocco; changes in sleep habits were common, and many appeard to have depressive and anxiety symptoms. Factors, such as economic struggles, doubting the necessity of confinement, and excessive use of social media, were associated with these symptoms.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
REFERENCES
- 1.Guessoum SB, Lachal J, Radjack R, Carretier E, Minassian S, Benoit L, et al. Adolescent psychiatric disorders during the COVID-19 pandemic and lockdown. Psychiatry Res. 2020;291:113264. doi: 10.1016/j.psychres.2020.113264. doi: 10.1016/j.psychres. 2020.113264. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Duan L, Shao X, Wang Y, Huang Y, Miao J, Yang X, et al. An investigation of mental health status of children and adolescents in china during the outbreak of COVID-19. J Affect Disord. 2020;01(275):112–8. doi: 10.1016/j.jad.2020.06.029. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Jones EAK, Mitra AK, Bhuiyan AR. Impact of COVID-19 on mental health in adolescents: A systematic review. Int J Environ Res Public Health. 2021;18:2470. doi: 10.3390/ijerph18052470. doi: 10.3390/ijerph18052470. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Ivarsson T, Gillberg C. Depressive symptoms in Swedish adolescents: Normative data using the Birleson depression self-rating scale (DSRS) J Affect Disord. 1997;42:59–68. doi: 10.1016/s0165-0327(96)00098-5. [DOI] [PubMed] [Google Scholar]
- 5.Hariz N, Bawab S, Atwi M, Tavitian L, Zeinoun P, Khani M, et al. Reliability and validity of the Arabic screen for child anxiety related emotional disorders (SCARED) in a clinical sample. Psychiatry Res. 2013;209:222–8. doi: 10.1016/j.psychres.2012.12.002. [DOI] [PubMed] [Google Scholar]
- 6.Chaaya M, Osman H, Naassan G, Mahfoud Z. Validation of the Arabic version of the Cohen perceived stress scale (PSS-10) among pregnant and postpartum women. BMC Psychiatry. 2010;10:111. doi: 10.1186/1471-244X-10-111. doi: 10.1186/1471-244X-10-111. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 7.Kolltveit S, Lange-Nielsen II, Thabet AAM, Dyregrov A, Pallesen S, Johnsen TB, et al. Risk factors for PTSD, anxiety, and depression among adolescents in Gaza. J Trauma Stress. 2012;25:164–70. doi: 10.1002/jts.21680. [DOI] [PubMed] [Google Scholar]
- 8.Zhou SJ, Zhang LG, Wang LL, Guo ZC, Wang JQ, Chen JC, et al. Prevalence and socio-demographic correlates of psychological health problems in Chinese adolescents during the outbreak of COVID-19. Eur Child Adolesc Psychiatry. 2020;29:749–58. doi: 10.1007/s00787-020-01541-4. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Zhou J, Yuan X, Qi H, Liu R, Li Y, Huang H, et al. Prevalence of depression and its correlative factors among female adolescents in China during the coronavirus disease 2019 outbreak. Global Health. 2020;28(16):69. doi: 10.1186/s12992-020-00601-3. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Chen F, Zheng D, Liu J, Gong Y, Guan Z, Lou D. Depression and anxiety among adolescents during COVID-19: A cross-sectional study. Brain Behav Immun. 2020;88:36–8. doi: 10.1016/j.bbi.2020.05.061. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Magson NR, Freeman JYA, Rapee RM, Richardson CE, Oar EL, Fardouly J. Risk and protective factors for prospective changes in adolescent mental health during the COVID-19 pandemic. J Youth Adolesc. 2021;50:44–57. doi: 10.1007/s10964-020-01332-9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Qi M, Zhou SJ, Guo ZC, Zhang LG, Min HJ, Li XM, et al. The effect of social support on mental health in Chinese adolescents during the outbreak of COVID-19. J Adolesc Health. 2020;67:514–8. doi: 10.1016/j.jadohealth.2020.07.001. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.Burhamah W, AlKhayyat A, Oroszlányová M, AlKenane A, Almansouri A, Behbehani M, et al. The psychological burden of the COVID-19 pandemic and associated lockdown measures: Experience from 4000 participants. J Affect Disord. 2020;277:977–85. doi: 10.1016/j.jad.2020.09.014. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Riecher-Rössler A. Sex and gender differences in mental disorders. Lancet Psychiatry. 2017;4:8–9. doi: 10.1016/S2215-0366(16)30348-0. [DOI] [PubMed] [Google Scholar]
- 15.Tamres LK, Janicki D, Helgeson VS. Sex differences in coping behavior: A meta-analytic review and an examination of relative coping. Pers Soc Psychol Rev. 2002;6:2–30. [Google Scholar]
- 16.Essadek A, Rabeyron T. Mental health of French students during the Covid-19 pandemic. J Affect Disord. 2020;277:392–3. doi: 10.1016/j.jad.2020.08.042. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 17.Khan AH, Sultana MS, Hossain S, Hasan MT, Ahmed HU, Sikder MT. The impact of COVID-19 pandemic on mental health and wellbeing among home-quarantined Bangladeshi students: A cross-sectional pilot study. J Affect Disord. 2020;277:121–8. doi: 10.1016/j.jad.2020.07.135. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Pieh C, Budimir S, Probst T. The effect of age, gender, income, work, and physical activity on mental health during coronavirus disease (COVID-19) lockdown in Austria. J Psychosom Res. 2020;136:110186. doi: 10.1016/j.jpsychores.2020.110186. doi: 10.1016/j.jpsychores.2020.110186. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 19.Fiorillo A, Sampogna G, Giallonardo V, Del Vecchio V, Luciano M, Albert U, et al. Effects of the lockdown on the mental health of the general population during the COVID-19 pandemic in Italy: Results from the COMET collaborative network. Eur Psychiatry. 2020;63:e87. doi: 10.1192/j.eurpsy.2020.89. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 20.Horton R. Offline: 2019-nCoV—“A desperate plea”. Lancet. 2020;395:400. doi: 10.1016/S0140-6736(20)30299-3. Available from: http://www.sciencedirect.com/science/article/pii/S0140673620302993 . [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Wang G, Zhang Y, Zhao J, Zhang J, Jiang F. Mitigate the effects of home confinement on children during the COVID-19 outbreak. Lancet. 2020;395:945–7. doi: 10.1016/S0140-6736(20)30547-X. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 22.Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al. Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. Int J Environ Res Public Health. 2020;17:1729. doi: 10.3390/ijerph17051729. doi: 10.3390/ijerph 17051729. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Shatla MM, Khafagy AA, Bulkhi AA, Aljahdali IA. Public concerns and mental health changes related to the COVID-19 pandemic lockdown in Saudi Arabia. Clin Lab. 2020:66. doi: 10.7754/Clin.Lab.2020.200614. doi: 10.7754/Clin.Lab. 2020.200614. [DOI] [PubMed] [Google Scholar]
- 24.Pfefferbaum B, North CS. Mental health and the Covid-19 pandemic. N Engl J Med. 2020;383:510–2. doi: 10.1056/NEJMp2008017. [DOI] [PubMed] [Google Scholar]
- 25.Elmer T, Mepham K, Stadtfeld C. Students under lockdown: Comparisons of students' social networks and mental health before and during the COVID-19 crisis in Switzerland. PLoS One. 2020;15:e0236337. doi: 10.1371/journal.pone.0236337. doi: 10.1371/journal.pone.0236337. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 26.Krystal AD, Prather AA, Ashbrook LH. The assessment and management of insomnia: An update. World Psychiatry. 2019;18:337–52. doi: 10.1002/wps.20674. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Zhou SJ, Wang LL, Yang R, Yang XJ, Zhang LG, Guo ZC, et al. Sleep problems among Chinese adolescents and young adults during the coronavirus-2019 pandemic. Sleep Med. 2020;74:39–47. doi: 10.1016/j.sleep.2020.06.001. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 28.Szmyd B, Rogut M, Białasiewicz P, Gabryelska A. The impact of glucocorticoids and statins on sleep quality. Sleep Med Rev. 2021;55:101380. doi: 10.1016/j.smrv.2020.101380. doi: 10.1016/j.smrv. 2020.101380. [DOI] [PubMed] [Google Scholar]
- 29.Whittemore PB. COVID-19 fatalities, latitude, sunlight, and vitamin D. Am J Infect Control. 2020;48:1042–4. doi: 10.1016/j.ajic.2020.06.193. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 30.Furer P, Walker JR, Chartier MJ, Stein MB. Hypochondriacal concerns and somatization in panic disorder. Depress Anxiety. 1997;6:78–85. [PubMed] [Google Scholar]
- 31.Hossain MM, Sultana A, Purohit N. Mental health outcomes of quarantine and isolation for infection prevention: A systematic umbrella review of the global evidence. Epidemiol Health. 2020;42:e2020038. doi: 10.4178/epih.e2020038. doi: 10.4178/epih.e2020038. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 32.Sibley CG, Greaves LM, Satherley N, Wilson MS, Overall NC, Lee CHJ, et al. Effects of the COVID-19 pandemic and nationwide lockdown on trust, attitudes toward government, and well-being. Am Psychol. 2020;75:618–30. doi: 10.1037/amp0000662. [DOI] [PubMed] [Google Scholar]
- 33.Gualano MR, Lo Moro G, Voglino G, Bert F, Siliquini R. Effects of Covid-19 lockdown on mental health and sleep disturbances in Italy. Int J Environ Res Public Health. 2020;17:4779. doi: 10.3390/ijerph17134779. doi: 10.3390/ijerph17134779. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 34.Roth F, Brönnimann G. 3RG Report. ETH Zurich: 2013. [Last accessed on 2023 Nov 03]. Focal Report 8: Risk Analysis Using the Internet for Public Risk Communication [Internet] Available from: https://www.research-collection.ethz.ch/handle/20.500.11850/73314 . [Google Scholar]
- 35.Kramer ADI, Guillory JE, Hancock JT. Experimental evidence of massive-scale emotional contagion through social networks. PNAS. 2014;111:8788–90. doi: 10.1073/pnas.1320040111. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 36.Ahmad AR, Murad HR. The impact of social media on panic during the COVID-19 pandemic in Iraqi Kurdistan: Online questionnaire study. J Med Internet Res. 2020;22:e19556. doi: 10.2196/19556. doi: 10.2196/19556. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 37.Klein EM, Brähler E, Dreier M, Reinecke L, Müller KW, Schmutzer G, et al. The German version of the perceived stress scale – psychometric characteristics in a representative German community sample. BMC Psychiatry. 2016;16:159. doi: 10.1186/s12888-016-0875-9. doi: 10.1186/s12888-016-0875-9. [DOI] [PMC free article] [PubMed] [Google Scholar]