Original Article

COVID-19 Fear Association with Depression, Anxiety, and Insomnia: A National Web-Based Survey on the General Population


Objective: COVID-19 pandemic has influenced almost every country worldwide. Being in a pandemic situation can cause psychological distress to people, which can lead to sleep disorders. The present study aimed to assess prevalence of depression, anxiety, and insomnia among Iranian people and their relations with COVID-19 fear in the early stages of COVID-19 pandemic.

Method: A cross-sectional and population-based online study was designed. We created an online form and used Fear of COVID-19 scale (FCV-19), Generalized Anxiety Disorder 2 scale (GAD-2), Patient Health Questionnaire-2 (PHQ-2), and Insomnia Severity Index (ISI), to assess fear of COVID-19, anxiety, depression, and insomnia, respectively. We sent the link to the online survey to Iranians interested in participating in the study via social media, and 1223 Iranian completed the form.

Results: A total of 1223 individuals with a mean age of 39.82 ± 10.75 years participated in the study. Prevalence of insomnia, depression and anxiety among our participants were 55.2%, 61.5%, and 50.9%, respectively. The mean FCV-19 score among the participants was 19.70 ± 5.08. Insomnia was more common among those who were 50 years or older. Fear of COVID-19 was related to a more risk of progression toward depression, anxiety, and insomnia.

Conclusion: Fear of COVID-19 has a considerable association with depression, anxiety, and insomnia in the pandemic, and strategies to reasonably decrease people’s fears can help to reduce incidence of psychological issues during the pandemic.Anxiety

1. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. New Engl J Med. 2020;29(5):e492-e497
2. Jebril N. World Health Organization declared a pandemic public health menace: A systematic review of the coronavirus disease 2019 “COVID-19”, up to 26th March 2020. Available at SSRN 3566298. 2020.
3. Lu D. Inside Wuhan's lockdown. New Sci. 2020;245(3268):7.
4. Farnoosh G, Alishiri G, Hosseini Zijoud S, Dorostkar R, Jalali Farahani A. Understanding the 2019-novel coronavirus (2019-nCoV) and coronavirus disease (COVID-19) based on available evidence-a narrative review. J Mil Med. 2020;22(1):1-11.
5. Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. Lancet. 2020;395(10223):470-3.
6. World Health Organization. Coronavirus disease 2019 (COVID-19): situation report, 146. 2020.
7. Cullen W, Gulati G, Kelly B. Mental health in the Covid-19 pandemic. QJM-Int J Med. 2020;113(5):311-2.
8. Rajkumar RP. COVID-19 and mental health: A review of the existing literature. Asian J Psychiatr. 2020;52:102066.
9. 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(6):749-58.
10. Shah SMA, Mohammad D, Qureshi MFH, Abbas MZ, Aleem S. Prevalence, Psychological Responses and Associated Correlates of Depression, Anxiety and Stress in a Global Population, During the Coronavirus Disease (COVID-19) Pandemic. Community Ment Health J. 2021;57(1):101-10.
11. Huang Y, Zhao N. Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 outbreak in China: a web-based cross-sectional survey. Psychiatry Res. 2020;288:112954.
12. Zhang F, Shang Z, Ma H, Jia Y, Sun L, Guo X, et al. High risk of infection caused posttraumatic stress symptoms in individuals with poor sleep quality: A study on influence of coronavirus disease (COVID-19) in China. medRxiv. 2020.
13. Segerstrom SC, Miller GE. Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry. Psychol Bull. 2004;130(4):601-30.
14. Taylor DJ, Lichstein KL, Durrence HH. Insomnia as a health risk factor. Behav Sleep Med. 2003;1(4):227-47.
15. Mamun MA, Sakib N, Gozal D, Bhuiyan AI, Hossain S, Bodrud-Doza M, et al. The COVID-19 pandemic and serious psychological consequences in Bangladesh: A population-based nationwide study. J Affect Disord. 2021;279:462-72.
16. Hao F, Tan W, Jiang L, Zhang L, Zhao X, Zou Y, et al. Do psychiatric patients experience more psychiatric symptoms during COVID-19 pandemic and lockdown? A case-control study with service and research implications for immunopsychiatry. Brain Behav Immun. 2020;87:100-6.
17. Adunlin G, Adedoyin ACA, Adedoyin OO, Njoku A, Bolade-Ogunfodun Y, Bolaji B. Using the protection motivation theory to examine the effects of fear arousal on the practice of social distancing during the COVID-19 outbreak in rural areas. J Hum Behav Soc Environ. 2021;31(1-4):168-72.
18. Harper CA, Satchell LP, Fido D, Latzman RD. Functional Fear Predicts Public Health Compliance in the COVID-19 Pandemic. Int J Ment Health Addict. 2020:1-14.
19. Satici B, Gocet-Tekin E, Deniz ME, Satici SA. Adaptation of the Fear of COVID-19 Scale: Its Association with Psychological Distress and Life Satisfaction in Turkey. Int J Ment Health Addict. 2020:1-9.
20. Kroenke K, Spitzer RL, Williams JB. The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care. 2003;41(11):1284-92.
21. Löwe B, Kroenke K, Gräfe K. Detecting and monitoring depression with a two-item questionnaire (PHQ-2). J Psychosom Res. 2005;58(2):163-71.
22. Dadfar M, Lester D. Psychometric characteristics of Patient Health Questionnaire-2 (PHQ-2) in Iranian psychiatric outpatients. Austin J Psychiatry Behav Sci. 2017;4(1):1059.
23. Bastien CH, Vallières A, Morin CM. Validation of the Insomnia Severity Index as an outcome measure for insomnia research. Sleep Med. 2001;2(4):297-307.
24. Yazdi Z, Sadeghniiat-Haghighi K, Zohal MA, Elmizadeh K. Validity and reliability of the Iranian version of the insomnia severity index. Malays J Med Sci. 2012;19(4):31-6.
25. Thorndike FP, Ritterband LM, Saylor DK, Magee JC, Gonder-Frederick LA, Morin CM. Validation of the insomnia severity index as a web-based measure. Behav Sleep Med. 2011;9(4):216-23.
26. Kroenke K, Spitzer RL, Williams JB, Monahan PO, Löwe B. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med. 2007;146(5):317-25.
27. Ahmadi SM, Masjedi Arani A, Bakhtiari M, Davazdah Emamy MH. Psychometric Properties of Persian Version of Patient Health Questionnaires-4 (PHQ-4) in Coronary Heart Disease Patients. Iran J Psychiatry Behav Sci.2019;13(4):e85820.
28. Donker T, van Straten A, Marks I, Cuijpers P. Quick and easy self-rating of Generalized Anxiety Disorder: validity of the Dutch web-based GAD-7, GAD-2 and GAD-SI. Psychiatry Res. 2011;188(1):58-64.
29. Ahorsu DK, Lin CY, Imani V, Saffari M, Griffiths MD, Pakpour AH. The Fear of COVID-19 Scale: Development and Initial Validation. Int J Ment Health Addict. 2020:1-9.
30. Van Buuren S, Groothuis-Oudshoorn K. Multivariate imputation by chained equations in RJ Stat. Softw. 2011 Dec 12;45:1-67.
31. 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(5).
32. Modabernia MJ, Tehrani HS, Fallahi M, Shirazi M, Modabbernia AH. Prevalence of depressive disorders in Rasht, Iran: A community based study. Clin Pract Epidemiol Ment Health. 2008;4:20.
33. Sharifi V, Amin-Esmaeili M, Hajebi A, Motevalian A, Radgoodarzi R, Hefazi M, et al. Twelve-month prevalence and correlates of psychiatric disorders in Iran: the Iranian Mental Health Survey, 2011. Arch Iran Med. 2015;18(2):76-84.
34. Qin X, Wang S, Hsieh C-R. The prevalence of depression and depressive symptoms among adults in China: estimation based on a National Household Survey. China Econ Rev. 2018;51:271-82.
35. Hammen C. Risk Factors for Depression: An Autobiographical Review. Annu Rev Clin Psychol. 2018;14:1-28.
36. Hajebi A, Motevalian SA, Rahimi-Movaghar A, Sharifi V, Amin-Esmaeili M, Radgoodarzi R, et al. Major anxiety disorders in Iran: prevalence, sociodemographic correlates and service utilization. BMC Psychiatry. 2018;18(1):261.
37. Huang Y, Wang Y, Wang H, Liu Z, Yu X, Yan J, et al. Prevalence of mental disorders in China: a cross-sectional epidemiological study. Lancet Psychiatry. 2019;6(3):211-24.
38. Zhong BL, Luo W, Li HM, Zhang QQ, Liu XG, Li WT, 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. Int J Biol Sci. 2020;16(10):1745-52.
39. Sylvers P, Lilienfeld SO, LaPrairie JL. Differences between trait fear and trait anxiety: implications for psychopathology. Clin Psychol Rev. 2011;31(1):122-37.
40. Farris SG, Abrantes AM, Bond DS, Stabile LM, Wu WC. Anxiety and Fear of Exercise in Cardiopulmonary Rehabilitation: PATIENT AND PRACTITIONER PERSPECTIVES. J Cardiopulm Rehabil Prev. 2019;39(2):E9-e13.
41. Kreddig N, Hasenbring MI. Pain anxiety and fear of (re)injury in patients with chronic back pain: Sex as a moderator. Scand J Pain. 2017;16:105-11.
42. McNeil DW, Kennedy SG, Randall CL, Addicks SH, Wright CD, Hursey KG, et al. Fear of Pain Questionnaire-9: Brief assessment of pain-related fear and anxiety. Eur J Pain. 2018;22(1):39-48.
43. Ahmadvand A, Sepehrmanesh Z, Ghoreishi FS, Mousavi SGA. Prevalence of insomnia among 18 years old people and over in Kashan city, Iran in 2008. FEYZ. 2010;13(4):313-20.
44. Stewart R, Besset A, Bebbington P, Brugha T, Lindesay J, Jenkins R, et al. Insomnia comorbidity and impact and hypnotic use by age group in a national survey population aged 16 to 74 years. Sleep. 2006;29(11):1391-7.
45. Kawata Y, Maeda M, Sato T, Maruyama K, Wada H, Ikeda A, et al. Association between marital status and insomnia-related symptoms: findings from a population-based survey in Japan. Eur J Public Health. 2020;30(1):144-9.
46. Voitsidis P, Gliatas I, Bairachtari V, Papadopoulou K, Papageorgiou G, Parlapani E, et al. Insomnia during the COVID-19 pandemic in a Greek population. Psychiatry Res. 2020;289:113076.
IssueVol 17 No 1 (2022) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijps.v17i1.8046
Anxiety COVID-19 Depression Fear Insomnia

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Akbarpour S, Nakhostin-Ansari A, Sadeghniiat Haghighi K, Etesam F, Alemohammad ZB, Aghajani F, Najafi A. COVID-19 Fear Association with Depression, Anxiety, and Insomnia: A National Web-Based Survey on the General Population. Iran J Psychiatry. 2022;17(1):24-34.