Original Article

Anxiety, Depression, and Predictors amongst Iranian Students Aged 8 to 18 Years during the COVID-19 Outbreak First Peak

Mental health among adolescents during COVID 19 outbreak


Objective: This study aimed to assess anxiety and depression during the COVID-19 outbreak among students aged 8 to 18 years and to determine related demographic and other related factors.

Method: A descriptive and analytical cross sectional study was conducted through web-based data collection which included 348 students aged 8 to 18 years in the state of Mazandaran, Iran during the first peak of COVID-19. Demographic and Revised Children's Anxiety and Depression Scale (RCADS-P) questionnaires were used to collect the data. The statistical tests including independent sample t test, ANOVA as well as linear regression were employed.

Results: The average age of the subjects was reported to be 12.2 ± 3.59 years. Age, father’s occupation, following COVID-19 related news, and also nervousness related to infection were predictors of anxiety (11%). Moreover, age, mother’s occupation, family communication and also the safety protocols practiced by the family were found to be predictors of depression in students (17%). A significant relationship was also found between the effect of quarantine on family communication and the anxiety and depression in students (P < 0.001).

Conclusion: Demographic characteristics affect student mental health during the COVID-19 outbreak. Moreover, family preventive protocols can predict depression in students aged 8 to 18 years. Better preventive precautions encourage less anxiety and depression.

1. Luan RS, Wang X, Sun X, Chen XS, Zhou T, Liu QH, et al. [Epidemiology, Treatment, and Epidemic Prevention and Control of the Coronavirus Disease 2019: a Review]. Sichuan Da Xue Xue Bao Yi Xue Ban. 2020;51(2):131-8.
2. Şencan I, Kuzi S. Global threat of COVID-19 and evacuation of the citizens of different countries. Turk J Med Sci. 2020;50(Si-1):534-43.
3. Enserink M, Kupferschmidt K. With COVID-19, modeling takes on life and death importance. Science. 2020;367(6485):1414-5.
4. Tavakoli A, Vahdat K, Keshavarz M. Novel Coronavirus Disease 2019 (COVID-19): An Emerging Infectious Disease in the 21st Century. ISMJ. 2020;22(6):432-50.
5. Fegert JM, Vitiello B, Plener PL, Clemens V. Challenges and burden of the Coronavirus 2019 (COVID-19) pandemic for child and adolescent mental health: a narrative review to highlight clinical and research needs in the acute phase and the long return to normality. Child Adolesc Psychiatry Ment Health. 2020;14:20.
6. Lima CKT, Carvalho PMM, Lima I, Nunes J, Saraiva JS, de Souza RI, et al. The emotional impact of Coronavirus 2019-nCoV (new Coronavirus disease). Psychiatry Res. 2020;287:112915.
7. 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(10228):945-7.
8. Rigamer EF. Psychological management of children in a national crisis. Journal of the American J Am Acad Child Psychiatry. 1986;25(3):364-9.
9. Balaban V. Psychological assessment of children in disasters and emergencies. Disasters. 2006;30(2):178-98.
10. Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020;395(10227):912-20.
11. Saurabh K, Ranjan S. Compliance and Psychological Impact of Quarantine in Children and Adolescents due to COVID-19 Pandemic. Indian J Pediatr. 2020;87(7):532-6.
12. Sprang G, Silman M. Posttraumatic stress disorder in parents and youth after health-related disasters. Disaster Med Public Health Prep. 2013;7(1):105-10.
13. Mason F, Farley A, Pallan M, Sitch A, Easter C, Daley AJ. Effectiveness of a brief behavioural intervention to prevent weight gain over the Christmas holiday period: randomised controlled trial. Bmj. 2018;363:k4867.
14. Norredam M, Nellums L, Nielsen RS, Byberg S, Petersen JH. Incidence of psychiatric disorders among accompanied and unaccompanied asylum-seeking children in Denmark: a nation-wide register-based cohort study. Eur Child Adolesc Psychiatry. 2018;27(4):439-46.
15. Santavirta T, Santavirta N, Betancourt TS, Gilman SE. Long term mental health outcomes of Finnish children evacuated to Swedish families during the second world war and their non-evacuated siblings: cohort study. Bmj. 2015;350:g7753.
16. Abel KM, Heuvelman HP, Jörgensen L, Magnusson C, Wicks S, Susser E, et al. Severe bereavement stress during the prenatal and childhood periods and risk of psychosis in later life: population based cohort study. Bmj. 2014;348:f7679.
17. 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.
18. Taylor BE, Chekaluk E, Bennett J. Post-Traumatic Stress Disorder, Depression and Anxiety among North Korean Refugees: A Meta-Analysis. Psychiatry Investig. 2017;14(5):550-61.
19. Chorpita BF, Yim L, Moffitt C, Umemoto LA, Francis SE. Assessment of symptoms of DSM-IV anxiety and depression in children: a revised child anxiety and depression scale. Behav Res Ther. 2000;38(8):835-55.
20. Rasouli, H., Validation Standardization Revised version of the Depression Anxiety Scale for Children, in 8th international conference in Psychology and sociology. 2017: Tehran,Iran.
21. Tang S, Xiang M, Cheung T, Xiang YT. Mental health and its correlates among children and adolescents during COVID-19 school closure: The importance of parent-child discussion. J Affect Disord. 2021;279:353-60.
22. Barker MM, Beresford B, Bland M, Fraser LK. Prevalence and Incidence of Anxiety and Depression Among Children, Adolescents, and Young Adults With Life-Limiting Conditions: A Systematic Review and Meta-analysis. JAMA Pediatr. 2019;173(9):835-44.
23. Xie X, Xue Q, Zhou Y, Zhu K, Liu Q, Zhang J, et al. Mental Health Status Among Children in Home Confinement During the Coronavirus Disease 2019 Outbreak in Hubei Province, China. JAMA Pediatr. 2020;174(9):898-900.
24. Tang X, Tang S, Ren Z, Wong DFK. Prevalence of depressive symptoms among adolescents in secondary school in mainland China: A systematic review and meta-analysis. J Affect Disord. 2019;245:498-507.
25. Schubert KO, Clark SR, Van LK, Collinson JL, Baune BT. Depressive symptom trajectories in late adolescence and early adulthood: A systematic review. Aust N Z J Psychiatry. 2017;51(5):477-99.
26. Sim K, Huak Chan Y, Chong PN, Chua HC, Wen Soon S. Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease. J Psychosom Res. 2010;68(2):195-202.
27. Loades ME, Chatburn E, Higson-Sweeney N, Reynolds S, Shafran R, Brigden A, et al. Rapid Systematic Review: The Impact of Social Isolation and Loneliness on the Mental Health of Children and Adolescents in the Context of COVID-19. J Am Acad Child Adolesc Psychiatry. 2020;59(11):1218-39.e3.
28. Albagmi FM, AlNujaidi HY, Al Shawan DS. Anxiety levels amid the COVID-19 lockdown in Saudi Arabia. Int J Gen Med. 2021;14:2161.
29. Wang J, Lloyd-Evans B, Giacco D, Forsyth R, Nebo C, Mann F, et al. Social isolation in mental health: a conceptual and methodological review. Soc Psychiatry Psychiatr Epidemiol. 2017;52(12):1451-61.
30. 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):1729.
31. Li G, Miao J, Wang H, Xu S, Sun W, Fan Y, et al. Psychological impact on women health workers involved in COVID-19 outbreak in Wuhan: a cross-sectional study. J Neurol Neurosurg Psychiatry. 2020;91(8):895-7.
32. Kang L, Ma S, Chen M, Yang J, Wang Y, Li R, et al. Impact on mental health and perceptions of psychological care among medical and nursing staff in Wuhan during the 2019 novel coronavirus disease outbreak: A cross-sectional study. Brain Behav Immun. 2020;87:11-7.
33. Özdin S, Bayrak Özdin Ş. Levels and predictors of anxiety, depression and health anxiety during COVID-19 pandemic in Turkish society: The importance of gender. Int J Soc Psychiatry. 2020;66(5):504-11.
34. Li X, Yu H, Bian G, Hu Z, Liu X, Zhou Q, et al. Prevalence, risk factors, and clinical correlates of insomnia in volunteer and at home medical staff during the COVID-19. Brain Behav Immun. 2020;87:140-1.
35. Wang Y, Di Y, Ye J, Wei W. Study on the public psychological states and its related factors during the outbreak of coronavirus disease 2019 (COVID-19) in some regions of China. Psychol Health Med. 2021;26(1):13-22.
36. Li X, Dai T, Wang H, Shi J, Yuan W, Li J, et al. [Clinical analysis of suspected COVID-19 patients with anxiety and depression]. Zhejiang Da Xue Xue Bao Yi Xue Ban. 2020;49(2):203-8.
37. Guo Q, Zheng Y, Shi J, Wang J, Li G, Li C, et al. Immediate psychological distress in quarantined patients with COVID-19 and its association with peripheral inflammation: A mixed-method study. Brain Behav Immun. 2020;88:17-27.
38. 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.
39. Ni MY, Yang L, Leung CMC, Li N, Yao XI, Wang Y, et al. Mental Health, Risk Factors, and Social Media Use During the COVID-19 Epidemic and Cordon Sanitaire Among the Community and Health Professionals in Wuhan, China: Cross-Sectional Survey. JMIR Ment Health. 2020;7(5):e19009.
40. Tan W, Hao F, McIntyre RS, Jiang L, Jiang X, Zhang L, et al. Is returning to work during the COVID-19 pandemic stressful? A study on immediate mental health status and psychoneuroimmunity prevention measures of Chinese workforce. Brain Behav Immun. 2020;87:84-92.
41. Zhang Y, Ma ZF. Impact of the COVID-19 Pandemic on Mental Health and Quality of Life among Local Residents in Liaoning Province, China: A Cross-Sectional Study. Int J Environ Res Public Health. 2020;17(7).
42. Hussain W. Role of social media in COVID-19 pandemic. The International Journal of Frontier Sciences. 2020;4(2):59-60.
43. Roth F, Brönnimann G. Risk analysis using the internet for public risk communication. Focal report/Crisis and Risk Network (CRN) no. 2013;8.
44. Kramer AD, Guillory JE, Hancock JT. Experimental evidence of massive-scale emotional contagion through social networks. Proc Natl Acad Sci U S A. 2014;111(24):8788-90.
45. Niederkrotenthaler T, Stack S, Till B, Sinyor M, Pirkis J, Garcia D, et al. Association of Increased Youth Suicides in the United States With the Release of 13 Reasons Why. JAMA Psychiatry. 2019;76(9):933-40.
46. Hölling H, Schlack R, Petermann F, Ravens-Sieberer U, Mauz E. [Psychopathological problems and psychosocial impairment in children and adolescents aged 3-17 years in the German population: prevalence and time trends at two measurement points (2003-2006 and 2009-2012): results of the KiGGS study: first follow-up (KiGGS Wave 1)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2014;57(7):807-19.
47. Compton WM, Conway KP, Stinson FS, Grant BF. Changes in the prevalence of major depression and comorbid substance use disorders in the United States between 1991-1992 and 2001-2002. Am J Psychiatry. 2006;163(12):2141-7.
48. 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 Infect. 2006;53(2):114-24.
49. Gao J, Zheng P, Jia Y, Chen H, Mao Y, Chen S, et al. Mental health problems and social media exposure during COVID-19 outbreak. PLoS One. 2020;15(4):e0231924.
IssueVol 17 No 2 (2022) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijps.v17i2.8909
Anxiety COVID-19 Depression Outbreaks Students

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
Bahrami-Samani S, Firouzbakht M, Azizi A, Omidvar S. Anxiety, Depression, and Predictors amongst Iranian Students Aged 8 to 18 Years during the COVID-19 Outbreak First Peak. Iran J Psychiatry. 2022;17(2):187-195.