To examine the prevalence of anxiety and depression disorders in students during COVID-19 lockdown.
To examine the mediating role of depression and anxiety disorders symptoms in the relationship between illness perception and mental health in Pakistan's students during the COVID-19 outbreak lockdown.
Illness perception is positively associated with anxiety and depression disorders symptoms in Pakistani students during the COVID-19 outbreak lockdown.
Anxiety and depression disorders symptoms are negatively associated with mental health among Pakistani students during the COVID-19 outbreak lockdown.
The study combined a snowball sampling technique with a cross-sectional, web-based survey and recruited 500 students from different public and private universities from twin cities, Rawalpindi, and Islamabad from March 23 to April 15, 2020, during the coronavirus outbreak lockdown. This research used a survey method to examine the preventing and suppression policy about severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) through contact or droplet. This study carried out a web-based cross-sectional survey during the COVID-19lockdown from different universities' official internet platforms, including WhatsApp and Facebook. It was helpful because most of Pakistan's students use online social media services like WhatsApp, Facebook. For promoting and recruiting the participation of possible samples, all students in the present study would get a report after completing this examination of their mental health. These online questionnaires were voluntary, and natures were non-commercial.
Sample and Procedure
The study recruited five hundred participants from different public and private universities of twin cities, Rawalpindi and Islamabad, Pakistan, from March 23 to April 15, 2020, during COVID-19 lockdown. Age ranged between 16 to 25 years (M=20.31, SD = 1.51). This present research was conducted in accordance with the ethical guidelines of the American Psychological Association. The Research Ethics Committee also approved it of Shanghai Jiao Tong University (SJTU), China. We approached the participants through online self-reported measures and uploaded on different University official groups, and an online survey platform to gather survey data. The inclusion criteria used for the study included: 1) this study has enrolled only students of the B.S. classes; 2). They were off from their respective Universities due to lockdown because of the COVID-19 outbreak. Those students who fulfilled the selection, as mentioned earlier, the study selected the criteria related to the part of the online survey. We excluded the participants who failed to meet the selection criteria of the survey. All students voluntarily contributed and accepted the electronic, written informed consent for their participation in the present online survey. The sampling technique applied was snowball sampling, and this study identified students through their demographic information, which included their region, gender, age, marital status, education level, and grades.
The survey questionnaire included two parts: (1) necessary demographic information, (2) mental health assessment.
Demographic information comprised of the region, age (years), gender (male or female) marital status (married, unmarried, or divorced), education level, and grades
Mental Health Assessment
This study used four instruments to measure the mental health status of students during the COVID-19 lockdown. This incorporated four standardized instruments in the present research to examine the illness perception, (Cognitive perceptions including the effect on the life duration of illness, Beliefs about the effectiveness of treatment, control over disease, and experience of symptoms), Anxiety disorder, Depression disorder, and Mental Health.
The Beck Depression Scale
TheBeck Depression Scale(BDI-II; Dozois, 2010) is a 21-item self-reporting instrument, which is useful for assessing the severity of depression in the psychiatric and healthy population. Each item of BDI-II is scored on a four-point Likert scale from 0 (symptom absent) to 3 (severe symptoms). The sum of BDI-II scores classification is as follows: Normal depression (0–13), mild depression (14–19), moderate depression (20–28), or severe depression (29–63). The I.P.Q.- R has illustrated adequate reliability and validity. In the current study, the Cronbach alphas (α) is 0.91which indicated sufficient reliability.
The Beck Anxiety Inventory-BAI
The Beck Anxiety Inventory (BAI; Beck, Epstein, Brown, & Steer, 1988) is a 21-item self-reporting instrument, which is useful for evaluating the severity of anxiety in the psychiatric and healthy population. Each item of BAI score shows on a four-point Likert scale from0 (Not at all) to 3 (Severely – it bothered me a lot). The sum of BAI scores classification is as follows: minimal/low anxiety (0–7), mild anxiety (8-15) moderate anxiety (16-25), or severe anxiety (26 or 63). The BAI has illustrated adequate reliability and validity. In the current study, the Cronbach alphas(α) is 0.93, which indicated sufficient reliability.
The RevisedIllness Perception Questionnaire-IPQ
The Revised Illness Perception Questionnaire (I.P.Q.; Moss-Morris et al., 2002) was used to measure cognitive representations of illness of students(Moss-Morris et al., 2002). It also assesses an individual's feelings and beliefs about their disease. It comprises of five subscales: Cognitive perceptions including the effect on the life duration of illness, Beliefs about the effectiveness of treatment, control over sickness, and experience of symptoms. The I.P.Q.- R has illustrated adequate reliability and validity.In the current study, the Cronbach alphas(α) is 0.95, which indicated sufficient reliability.
The Warwick-Edinburgh Mental Well-being Scale-WEMW
The Warwick-Edinburgh Mental Well-being Scale (WEMW; Stewart-Brown, &Jan Mohamed, 2008) is an a14-item self-reporting scale helps evaluate the mental wellbeing in a normal or clinical population. Each item of WEMW indicates scores on a five-point Likert scale from1 (None of the time) to 5(All of the time). The WEMW has illustrated adequate reliability and validity . In the current study, the Cronbach alphas(α) is 0.91, which indicated sufficient reliability.
First, missing values of the revised illness perception questionnaire, beck anxiety inventory, beck depression inventory, the Warwick Edinburgh mental wellbeing scale dealt through an imputation technique on Spss-23 (Field, 2017). The study also performed descriptive analyses to determine the prevalence of anxiety and depression disorders in the sample. Second, this study applied the product-moment correlation analysis to check the association between anxiety, depression, mental health, and illness perception(Field, 2017). Third, mediation analysis performed to analyze potential mediation pathways in anxiety, depression, mental health, and understanding of disease (Baron & Kenny, 1986). Mediation analysis also delivered to evaluate the mediating role of psychiatric features as anxiety or depression in the relationship between illness perception and mental health in Pakistan's students during the COVID-19 outbreak lockdown via the Statistical Software of Structural equation modeling (S.E.M.-23) .