In total, 929 respondents completed the online survey. Of these, 834 (89.2%) were male, and 101 (10.8%) were female. A total of 314 (33.6%) of the respondents were aged from 30–34 years old. More than half of the respondents, 494 (52.8%), had MSc or MA in educational qualification. The majority of the respondents were ever married 609 (65.1%) and of residency in the Oromia region (531 (56.8%. Just under half of the respondents, 419 (44.8%) were orthodox Christina by religious followers. More than half of the participants, 505 (54%) were university employees, whilst only 15 (1.6%) of respondents had no job (see Table 1).
Table 1
Distribution of psychological distress in relation to the socio-demographic characteristics of respondents among the Ethiopian population, 2020
Variable | N (%) | Psychological distress |
No | Yes |
Age groups (years) |
18–24 | 60 (6.4%) | 51 (7.3%) | 9 (3.8%) |
25–29 | 225(24.2%) | 158 (23.0%) | 66 (27.7%) |
30–34 | 313 (33.7%) | 232 (33.3%) | 82 (34.5%) |
35–39 | 159 (17.1%) | 117 (17.1%) | 41 (17.2%) |
40–44 | 81 (8.7%) | 60 (8.6%) | 23 (9.7%) |
45–49 | 49 (5.3%) | 35 (5.3%) | 12 (5.0%) |
50 and above | 42 (4.5%) | 38 (5.5% | 5 (2.1%) |
Sex |
Female | 101 (10.9%) | 70 (10.6%) | 27 (11.3%) |
Male | 828 (89.1%) | 617 (89.2%) | 210 (88.7%) |
Marital status |
Single | 326 (35.1%) | 246 (35.5%) | 80 (33.6%) |
Ever married | 603 (64.9%) | 445 (64.5%) | 158 (66.4%) |
Educational qualification |
Diploma* | 26 (2.8%) | 21 (3.1%) | 5 (2.1%) |
BSc/BA | 167 (18.0%) | 112 (16.1%) | 55 (23.1%) |
MSc/MA | 493 (53.1%) | 371 (53.6%) | 122 (51.3%) |
MD-GP | 66 (7.1%) | 50 (7.2%) | 16 (6.7%) |
MD-resident | 43 (4.6%) | 34 (4.9%) | 9 (3.8%) |
Ph.D. | 94 (10.1%) | 70 (10.3%) | 24 (10.1%) |
MD-Specialist | 40 (4.3%) | 33 (4.8%) | 7 (2.9%) |
Occupation |
Student | 72 (7.8%) | 58 (8.5%) | 14 (5.9%) |
No Job | 15 (1.6%) | 12 (1.7%) | 3 (1.3%) |
Self and private Employed | 132 (14.2%) | 91 (13.3%) | 41 (17.2%) |
Health workers | 209 (22.5%) | 150 (21.7%) | 59 (24.8%) |
University employed | 501 (53.9%) | 380 (54.8%) | 121 (50.8%) |
Region of residence |
Oromia | 526 (56.6%) | 398 (57.1%) | 133 (55.9%) |
Addis Ababa and Dire Dawa | 150 (16.1%) | 116 (16.6%) | 34 (14.3%) |
SNNPR | 103 (11.1%) | 69 (9.9%) | 34 (14.3%) |
Amhara | 52 (5.6%) | 36 (5.2%) | 16 (6.7%) |
Tigray | 49 (5.3%) | 38 (5.5%) | 11 (4.6%) |
Harari | 24 (2.6%) | 23 (3.3%) | 1 (0.4%) |
Other | 25 (2.7%) | 17 (2.4%) | 9 (3.8%) |
Religion |
Orthodox Christian | 417 (44.9%) | 320 (46.2%) | 97 (40.8%) |
Muslim | 114 (12.3%) | 89 (12.9%) | 25 (10.5%) |
Protestant | 336 (36.3%) | 234 (34.0%) | 102 (42.9%) |
Wakeffeta | 40 (4.3%) | 31 (4.4%) | 9 (3.8%) |
Others | 22 (2.4%) | 17 (2.4%) | 5 (2.1%) |
*respondents with grade 10 + but not obtained university degree |
Means And Source Of Information
Respondents were asked to tick the top two information sources about the pandemic. The majority of respondents (72.5%) got different information about COVID-19 from television, followed by mobile (cellular) data internet (54.4), which is the only mobile service provider in the country. Figure 1 demonstrates the number of respondents using different sources of coronavirus information.
The Prevalence Of Psychological Distress
The prevalence of high psychological distress among the Ethiopian population-based on 10-item Kessler psychological distress scale score ≥ 22 was 238 (25.5%). Of all respondents, 422 (45.1%) had low psychological distress, 275 (29.4%) had moderate psychological distress, 165 (17.6%) had high psychological distress, and 73 (7.3%) had very high psychological distress. High prevalence of psychological distress recorded was among males (88.7%, 95%CI: 84.0–92.4) compared to females (11.3%, 95%CI: 7.6–16.0). Of participants 30–34 years (66.4%, 95%CI: 26.9–29.8) and those ever married in marital status (66.4%, 95%CI: 60.5–72.7) reported the highest prevalence of psychological distress. On the other hand, the psychological distress prevalence was higher among University employee (50.8%, 95%CI: 44.5–57.1) and those who were health workers (24.8%, 95%CI: 19.3–30.3), compared to self or private employed, no job and student (see Table 1).
A total of 1.4% and 3.1% of participants had a hopeless feeling all the time and most of the time respectively. In our study, the participants had a sense of nervousness all the time (2.8%), most of the time (5.9%), and sometimes (19.8%). Of participants, 1.2% had depressed feeling all the time, 4.4% had a depressed feeling most of the time and 16.4% had reduced feelings sometimes.
Table 2
Responses of participants for the Kessler 10 questionnaire among the literate Ethiopian population during COVID-19 pandemic, 2020
Items | All of the time, N (%) | Most of the time, N (%) | Some of the time, N (%) | A little of the time, N (%) | None of the time, N (%) |
Tired out for no good reason | 28 (3.0%) | 72 (7.7%) | 203 (21.7%) | 231 (24.7%) | 401 (42.95%) |
Feeling nervous | 26 (2.8%) | 55 (5.9%) | 185 (19.8%) | 286 (30.6%) | 383 (41.0%) |
Feeling so nervous that there is nothing calm you down | 21 (2.2%) | 21 (2.2%) | 76 (8.1%) | 145 (15.5%) | 667 (71.3%) |
Feeling hopeless | 13 (1.4%) | 29 (3.1%) | 103 (11.0%) | 173 (18.5%) | 617 (66.0%) |
Feeling restless or fidgety | 9 (1.0%) | 51 (5.5%) | 103 (11.0%) | 263 (28.1%) | 509 (54.4%) |
Feeling so restless that you could not sit still | 10 (1.1%) | 28 (3.0%) | 81 (8.7%) | 160 (17.1%) | 656 (70.2%) |
Feeling depressed | 11 (1.2%) | 41 (4.4%) | 153 (16.4%) | 307 (32.8%) | 423 (45.2%) |
Feeling that everything was an effort | 122 (13.0%) | 181 (19.4%) | 210 (22.5%) | 194 (20.7%) | 228 (24.4%) |
Feeling so sad that nothing could make cheer you up | 10 (1.1%) | 43 (4.6%) | 144 (15.4%) | 236 (25.2%) | 502 (53.7%) |
Feeling worthless | 21 (2.2%) | 25 (2.7%) | 117 (12.5%) | 161 (17.2%) | 61165.3 |
The distribution of different variables against the four categories of the psychological status of the respondents indicated that those who trust information sources are under very high psychological distress. Those respondents who were knowledgeable about coronavirus transmission and prevention have either moderate or no psychological distress (Fig. 2).
Multivariable Analysis
The multivariate logistic regression revealed that the odds of psychological distress was higher among participants age of 25–29 (AOR: 3.21; 95%CI: 1.03–10.00),30–34 years old ((AOR: 3.31; 95%CI: 1.10–10.01), 35–39 years old (AOR: 3.42; 95%CI: 1.12–10.41), and 40–44 years old (AOR: 4.27; 95%CI: 1.35–13.56) and in comparison with those the age of 50 years and above.
The likelihood of having psychological distress was highest among those who disagree on washing their hands frequently with water and soap to prevent COVID-19 infection (AOR 4.17, 95%CI: 1.43–12.15) compared to their counterparts. Compared to the rest of the study participants, those who get information from social media had significantly higher odds of having psychological distress (AOR 1.42, 95%CI: 1.02–1.99).
Those who disagree on having the resource (water, soup) to wash their hands (AOR: 2.62; 95%CI: 1.20–5.70) were also found to have higher odds of psychological distress. It was also revealed that participants who disagree on having the skill to follow recommended handwashing practices to prevent COVID-19 infection were found to have higher odds of psychological distress when compared to their counterparts (AOR 5.39, 95%CI: 1.17–24.87) (see Table 3).
Table 3
Independently associated factors with psychological distress among the Ethiopian population during COVID-19 pandemic, 2020
Variable | COR | 95% CI | P-value | AOR | 95% CI | P-value |
Age groups | | | | | | |
18–24 25–29 30–34 35–39 40–44 45–49 50 and above | 1.34 3.13 2.69 2.62 2.91 2.46 1 | 0.42–4.33 1.18–8.32 1.02–7.06 0.96–7.10 1.02–8.32 0.79–7.69 | 0.623 0.022 0.045 0.059 0.046 0.120 | 1.17 3.21 3.31 3.42 4.27 3.17 1 | 0.28–4.82 1.03–10.00 1.10–10.01 1.12–10.41 1.35–13.56 0.90–11.18 | 0.826 0.045* 0.034* 0.030* 0.014* 0.072 |
Sex | | | | | | |
Male Female | 0.93 1 | 0.58–1.48 | 0.755 | 0. 77 1 | 0.45–1.31 | 0. 342 |
Educational qualification | | | | | | |
Diploma BSc/BA MSc/MA MD-GP MD-resident Ph.D. MD-Specialist | 1.10 2.38 1.59 1.55 1.29 1.60 1 | 0.31–3.92 0.99–5.72 0.69–3.68 0.58–4.18 0.43–3.85 0.63–4.07 | 0.878 0.052 0.277 0.382 0.653 0.327 | 1.89 2.11 1.36 1.47 1.20 1.79 1 | 0.43–8.32 0.76–5.85 0.52–3.52 0.46–4.65 0.34–4.28 0.60–5.33 | 0.398 0.152 0.528 0.514 0.773 0.295 |
Occupation | | | | | | |
Student No Job Self and private Employed Health workers University employed | 0.77 0.79 1.43 1.23 1 | 0.41–1.42 0.22–2.86 0.94–2.18 0.86–1.77 | 0.398 0.723 0.096 0.261 | 0.96 0.78 1.22 0.99 1 | 0.42–2.20 0.18–3.43 0.73–2.06 0.61–1.60 | 0.925 0.743 0.447 0.957 |
Current place of residence | | | | | | |
District town Zonal town Regional town Administrative city | 1 0.70 0.67 0.74 | 0.43–1.14 0.38–1.18 0.42–1.30 | 0.157 0.163 0.290 | 1 0.82 0.79 0.93 | 0.46–1.45 0.40–1.56 0.48–1.78 | 0.495 0.499 0.822 |
Getting information from social media | | | | | | |
No Yes | 1 1.31 | 0.98–1.77 | 0.070 | 1 1.42 | 1.02–1.99 | 0.039* |
Getting information from health care workers | | | | | | |
No Yes | 0.66 1 | 0.45–0.99 | 0.044 | 0.71 | 0.45–1.12 | 0.146 |
I am confident that I can wash my hands frequently with soap and water | | | | | | |
Strongly disagree Disagree Neither agree or disagree Agree Strongly agree | 0.61 4.57 1.70 1.79 1 | 0.07–5.00 2.07–10.11 0.87–3.31 1.30–2.46 | 0.642 0.001 0.120 0.001 | 0.19 4.17 1.56 1.43 | 0.01–5.08 1.43–12.15 0.65–3.79 0.91–2.24 | 0.321 0.009* 0.319 0.117 |
Have the resource (water, soup) to wash my hands | | | | | | |
Strongly disagree Disagree Neither agree or disagree Agree Strongly agree | 2.30 3.51 1.36 1.17 1 | 1.07–4.94 1.99–6.21 0.61–3.05 0.84–1.63 | 0.033 0.001 0.451 0.343 | 1.45 2.62 0.98 1.20 1 | 0.53–3.94 1.20–5.70 0.39–2.47 0.76–1.88 | 0.466 0.015* 0.962 0.430 |
Confident that I can stay at home easily to prevent COVID-19 | | | | | | |
Strongly disagree Disagree Neither agree or disagree Agree Strongly agree | 1.94 1.05 0.95 1.13 1 | 1.14–3.32 0.65–1.68 0.55–1.63 0.73–1.75 | 0.015 0.854 0.852 0.577 | 1.50 0.73 0.71 0.99 1 | 0.71–3.17 0.39–1.36 0.36–1.39 0.57–1.70 | 0.283 0.326 0.316 0.958 |
Confident that I can avoid crowed places and close contact | | | | | | |
Strongly disagree Disagree Neither agree or disagree Agree Strongly agree | 1.54 1.36 1.26 1.10 1 | 0.64–3.73 0.77–2.40 0.75–2.13 0.78–1.56 | 0.339 0.291 0.382 0.578 | 0.91 0.76 1.14 1.05 1 | 0.28–2.96 0.34–1.69 0.56–2.32 0.65–1.71 | 0.879 0.500 0.711 0.843 |
Always cover cough using the bend of my elbow | | | | | | |
Strongly disagree Disagree Neither agree or disagree Agree Strongly agree | 2.20 1.71 1.38 0.92 1 | 0.48–10.06 0.85–3.47 0.72–2.64 0.66–1.27 | 0.308 0.135 0.326 0.604 | 0.98 1.11 1.26 1.07 1 | 0.09–10.69 0.41–2.99 0.52–3.05 0.65–1.76 | 0.985 0.837 0.606 0.778 |
Avoid touching my eyes nose and mouth to prevent infection of COVID-19 | | | | | | |
Strongly disagree Disagree Neither agree or disagree Agree Strongly agree | 3.92 1.04 0.95 0.89 1 | 1.21–12.72 0.48–2.24 0.54–1.66 0.64–1.24 | 0.023 0.928 0.851 0.493 | 3.34 0.76 0.75 0.75 | 0.49–22.56 0.27–2.10 0.33–1.70 0.44–1.27 | 0.217 0.594 0.494 0.281 |
Maintain at least 2-meter distance between myself and any other individuals | | | | | | |
Strongly disagree Disagree Neither agree or disagree Agree Strongly agree | 1.36 1.16 1.43 0.91 1 | 0.45–4.06 0.67–2.02 0.86–2.36 0.64–1.31 | 0.587 0.585 0.165 0.629 | 0.73 0.66 1.28 0.79 1 | 0.16–3.33 0.31–1.41 0.66–2.49 0.48–1.32 | 0.684 0.287 0.470 0.374 |
Believing that COVID19 is extremely harmful | | | | | | |
Strongly disagree Disagree Neither agree or disagree Agree Strongly agree | 1.18 0.43 0.83 0.71 1 | 0.66–2.11 0.22–0.85 0.44–1.55 0.51–0.99 | 0.571 0.015 0.552 0.043 | 1.38 0.55 0.70 0.70 1 | 0.71–2.68 0.26–1.14 0.34–1.42 0.48–1.02 | 0.346 0.107 0.323 0.064 |
Have the skill to follow recommended handwashing practices to prevent COVID-19 infection | | | | | | |
Strongly disagree Disagree Neither agree or disagree Agree Strongly agree | 1.03 8.01 2.29 1.32 1 | 0.28–3.81 2.04–31.49 0.63–8.25 0.98–1.79 | 0.964 0.003 0.205 0.070 | 0.81 5.39 2.19 1.14 1 | 0.06–10.47 1.17–24.87 0.45–10.61 0.72–1.81 | 0.873 0.031* 0.331 0.569 |
In addition to the logistic regression, generalized additive model (GAM) was used to predict the psychological distress among the Ethiopian communities. The GAM model demonstrated that psychological distress was significantly (p-value < 0.01) predicted by level of trust on information, practice on coronavirus prevention, perceived severity, perceived collective efficacy, and perceived vulnerability of the participants. Interestingly, those who are practicing coronavirus infection prevention activities, such as social distancing, handwashing, staying at home, and avoiding crowded places, had significantly less psychological distress. We also have identified that, hhen perceived collective efficacy increases, psychosocial distress decrease. Conversely, those who had the highest score of information trust and the highest score perceived vulnerability about coronavirus had the highest score of psychological distress (Fig. 3).