Participants characteristics
The mean age of the participants was 32.95 (SD=10.53) years (range: 18-90 years). Of the participants, 63.1% were female, 63.4 were young adults, 54.8% were married, 94.7% were resident in urban area (94.7%), 76.1% had university education, 45.5% were employed, and 9.3% had chronic diseases. Other demographic and COVID-19-related characteristics of the participants are presented in Table 1.
Table 1. Demographic and COVID-19-related characteristics of the participants (n=5328).
|
n (%)
|
Age (years)
|
|
Young adults (18-35)
|
3377 (63.4)
|
Middle-aged adults (36-55)
|
1775 (33.3)
|
Older adults (>56)
|
176 (3.3)
|
Sex
|
|
Male
|
1966 (36.9)
|
Female
|
3362 (63.1)
|
Marital status
|
|
Single
|
2407 (45.2)
|
Married
|
2921 (54.8)
|
Place of residence
|
|
Urban
|
5048 (94.7)
|
Rural
|
280 (5.3)
|
Education
|
|
Primary
|
124 (2.3)
|
Secondary
|
1151 (21.6)
|
University
|
4053 (76.1)
|
Occupation
|
|
Employed
|
2424 (45.5)
|
Housewife
|
1040 (19.5)
|
Retired
|
180 (3.4)
|
Student
|
1161 (21.8)
|
Unemployed
|
523 (9.8)
|
Chronic diseases
|
|
No
|
4830 (90.7)
|
Yes
|
498 (9.3)
|
Times to focus on COVID-19 during a day
|
|
<0.5 h
|
2320 (43.5)
|
0.5-1 h
|
1087 (20.4)
|
1-2 h
|
728 (13.7)
|
>2 h
|
1193 (22.4)
|
Contact with suspected or confirmed COVID-19 cases
|
|
No
|
3701 (69.5)
|
Yes
|
1627 (30.5)
|
Families, relatives or friends infected with COVID-19
|
|
No
|
4575 (85.9)
|
Yes
|
753 (14.1)
|
Death of families, relatives or friends due to COVID-19
|
|
No
|
4477 (84.0)
|
Yes
|
851 (16.0)
|
High risk individual in family
|
|
No
|
1781 (33.4)
|
Yes
|
3547 (66.6)
|
COVID-19: Coronavirus Disease 2019.
Distribution of GAD-7 and PHQ-9 scores
The mean GAD-7 and PHQ-9 scores for all respondents were 7.17 (SD=5.42) and 7.80 (SD=6.68), respectively. Table 2 also presents the distribution of scores falling within GAD-7 and PHQ-9 severity cutoffs. Using a cut-off value of 10 for both measures, the prevalence of anxiety, depression, and comorbid anxiety-depression were 30.1% (n=1605), 33.4% (n=1779), and 22.1% (n=1178), respectively. Overall, females and young adults reported anxiety and depressive symptoms more frequently than males and older adults (see Table 2 and Table 3).
Table 2. Distribution of participants across the GAD-7 and PHQ-9 severity ratings (n=5328)
|
Total
|
Sex
|
Age group
|
Male
|
Female
|
Young adults
|
Middle-aged adults
|
Older adults
|
GAD-7 severity
|
|
|
|
|
|
|
No anxiety (0-4)
|
2033 (38.2)
|
863 (43.9)
|
1170 (34.8)
|
1255 (37.2)
|
692 (39.0)
|
86 (48.9)
|
Mild (5-9)
|
1690 (31.7)
|
580 (29.5)
|
1110 (33.0)
|
1124 (33.3)
|
516 (29.1)
|
50 (28.4)
|
Moderate (10-14)
|
962 (18.1)
|
307 (15.6)
|
655 (19.5)
|
606 (17.9)
|
327 (18.4)
|
29 (16.5)
|
Severe (15-21)
|
643 (12.1)
|
216 (11.0)
|
427 (12.7)
|
392 (11.6)
|
240 (13.5)
|
11 (6.2)
|
PHQ-9
|
|
|
|
|
|
|
None-minimal (0-4)
|
2124 (39.9)
|
887 (45.1)
|
1237 (36.8)
|
1232 (36.5)
|
787 (44.3)
|
105 (59.7)
|
Mild (5-9)
|
1425 (26.7)
|
487 (24.8)
|
938 (27.9)
|
902 (26.7)
|
486 (27.4)
|
37 (21.0)
|
Moderate (10-14)
|
835 (15.7)
|
285 (14.5)
|
550 (16.4)
|
570 (16.9)
|
249 (14.0)
|
16 (9.1)
|
Moderately severe (15-19)
|
563 (10.6)
|
163 (8.3)
|
400 (11.9)
|
400 (11.8)
|
153 (8.6)
|
10 (5.7)
|
Severe (20-27)
|
381 (7.2)
|
144 (7.3)
|
237 (7.0)
|
273 (8.1)
|
100 (5.6)
|
8 (4.5)
|
COVID-19: Coronavirus Disease 2019; GAD-7: Generalized Anxiety Disorder-7; PHQ-9: Patient Health Questionnaire-9.
Values are presented as n (%).
Table 3. Prevalence of anxiety, depression and comorbid anxiety-depression in general population in Iran during COVID-19 pandemic (n=5328)
|
Total
|
Sex
|
Age group
|
Male
|
Female
|
Young adults
|
Middle-aged adults
|
Older adults
|
Anxiety
|
1605 (30.1)
|
523 (26.6)
|
1082 (32.2)
|
998 (29.6)
|
567 (31.9)
|
40 (22.7)
|
Depression
|
1779 (33.4)
|
592 (30.1)
|
1187 (35.3)
|
1243 (36.8)
|
502 (28.3)
|
34 (19.3)
|
Comorbidity
|
1178 (22.1)
|
384 (19.5)
|
794 (23.6)
|
774 (22.9)
|
378 (21.3)
|
26 (14.8)
|
Any disorder
|
2206 (41.4)
|
731 (37.2)
|
1475 (43.9)
|
1467 (43.4)
|
691 (38.9)
|
48 (27.3)
|
COVID-19: Coronavirus Disease 2019.
Values are presented as n (%).
Factors associated with anxiety symptoms
Simple and multiple logistic regression analyses were undertaken to examine factor associated with anxiety symptoms among general population (see Table 4). According to adjusted analysis (i.e., multiple logistic regression analysis), females were 1.20 times more likely to have anxiety than males (OR Adj=1.20, 95% CI: 1.03-1.40). Young adults and middle-aged adults reported higher anxiety symptoms compared with older adults (OR Adj=1.69, 95% CI: 1.07-2.65, and OR Adj=1.67, 95% CI: 1.07-2.60, respectively). Compared with employed participants, those who are unemployed and women who are housewife had more anxiety symptoms (OR Adj=1.68, 95% CI: 1.33-2.12, and OR Adj=1.27, 95% CI: 1.03-1.55, respectively). Participants with chronic diseases were 1.68 times more likely to be anxious than other participants (OR Adj=1.68, 95% CI: 1.35-2.08). The odds of anxiety increased with increasing times to focus on COVID-19 per a day. Those who had family members, friends, and/or relatives infected with COVID-19 were more likely to have anxiety symptoms (OR Adj=1.49, 95% CI: 1.21-1.82). Furthermore, those who reported death of families, relatives or friends due to COVID-19 were more likely to have anxiety symptoms (OR Adj=1.26, 95% CI: 1.05-1.51).
Table 4. Association between GAD and demographic/COVID-19-related variables among participants (n=5328).
Variables
|
Prevalence, n (%)
|
Simple logistic regression
|
|
Multiple logistic regression
|
OR Crude (95% CI)
|
P
|
OR Adj (95% CI)
|
P
|
Age
|
|
|
|
|
|
|
Young adults
|
998 (29.6)
|
1.43 (0.99 – 2.04)
|
0.053
|
|
1.69 (1.07 – 2.65)
|
0.024
|
Middle-aged adults
|
567 (31.9)
|
1.60 (1.11 – 2.30)
|
0.012
|
|
1.67 (1.07 – 2.60)
|
0.024
|
Older adults
|
40 (22.7)
|
1
|
|
|
1
|
|
Sex
|
|
|
|
|
|
|
Male
|
523 (26.6)
|
1
|
|
|
1
|
|
Female
|
1082 (32.2)
|
1.31 (1.16 – 1.48)
|
<0.001
|
|
1.20 (1.03 – 1.40)
|
0.016
|
Marital status
|
|
|
|
|
|
|
Single
|
685 (28.5)
|
1
|
|
|
1
|
|
Married
|
920 (31.5)
|
1.16 (1.03 – 1.30)
|
0.016
|
|
0.94 (0.79 – 1.12)
|
0.503
|
Place of residence
|
|
|
|
|
|
|
Urban
|
1540 (30.5)
|
1.45 (1.09 – 1.93)
|
0.010
|
|
1.20 (0.88 – 1.63)
|
0.256
|
Rural
|
65 (23.2)
|
1
|
|
|
1
|
|
Education
|
|
|
|
|
|
|
Primary
|
49 (39.5)
|
1
|
|
|
1
|
|
Secondary
|
347 (30.1)
|
0.66 (0.45 – 0.97)
|
0.033
|
|
0.79 (0.51 – 1.21)
|
0.281
|
University
|
1209 (29.8)
|
0.65 (0.45 – 0.94)
|
0.021
|
|
0.73 (0.48 – 1.11)
|
0.140
|
Occupation
|
|
|
|
|
|
|
Employed
|
701 (28.9)
|
1
|
|
|
1
|
|
Housewife
|
371 (35.7)
|
1.36 (1.17 – 1.59)
|
<0.001
|
|
1.27 (1.03 – 1.55)
|
0.023
|
Retired
|
40 (22.2)
|
0.70 (0.49 – 1.01)
|
0.056
|
|
0.82 (0.53 – 1.28)
|
0.385
|
Student
|
290 (25.0)
|
0.82 (0.70 – 0.96)
|
0.014
|
|
0.99 (0.80 – 1.21)
|
0.892
|
Unemployed
|
203 (38.8)
|
1.56 (1.28 – 1.90)
|
<0.001
|
|
1.68 (1.33 – 2.12)
|
<0.001
|
Chronic diseases
|
|
|
|
|
|
|
No
|
1402 (29.0)
|
1
|
|
|
1
|
|
Yes
|
203 (40.8)
|
1.68 (1.39 – 2.03)
|
<0.001
|
|
1.68 (1.35 – 2.08)
|
<0.001
|
Times to focus on COVID-19 during a day
|
|
|
|
|
|
|
<0.5 h
|
364 (15.7)
|
1
|
|
|
1
|
|
0.5-1 h
|
244 (22.4)
|
1.56 (1.30 – 1.86)
|
<0.001
|
|
1.58 (1.31 – 1.89)
|
<0.001
|
1-2 h
|
267 (36.7)
|
3.11 (2.58 – 3.75)
|
<0.001
|
|
3.18 (2.63 – 3.85)
|
<0.001
|
>2 h
|
730 (61.2)
|
8.47 (7.21 – 9.96)
|
<0.001
|
|
8.26 (7.00 – 9.73)
|
<0.001
|
Contact with suspected or confirmed COVID-19 cases
|
|
|
|
|
|
|
No
|
1067 (28.8)
|
1
|
|
|
1
|
|
Yes
|
538 (33.1)
|
1.22 (1.08 – 1.38)
|
0.002
|
|
0.97 (0.83 – 1.15)
|
0.759
|
Families, relatives or friends infected with COVID-19
|
|
|
|
|
|
|
No
|
1320 (28.9)
|
1
|
|
|
1
|
|
Yes
|
285 (37.8)
|
1.50 (1.28 – 1.78)
|
<0.001
|
|
1.49 (1.21 – 1.82)
|
<0.001
|
Death of families, relatives or friends due to COVID-19
|
|
|
|
|
|
|
No
|
1304 (29.1)
|
1
|
|
|
1
|
|
Yes
|
301 (35.4)
|
1.33 (1.14 – 1.55)
|
<0.001
|
|
1.26 (1.05 – 1.51)
|
0.012
|
High risk individual in family
|
|
|
|
|
|
|
No
|
491 (27.6)
|
1
|
|
|
1
|
|
Yes
|
1114 (31.4)
|
1.20 (1.06 – 1.36)
|
0.004
|
|
1.10 (0.96 – 1.27)
|
0.177
|
Factors associated with depressive symptoms
Simple and multiple logistic regression analyses were undertaken to examine factor associated with depressive symptoms among general population (see Table 5). According to adjusted analysis, females were 1.18 times more likely to have depression than males (OR Adj=1.18, 95% CI: 1.03-1.36). Young adults and middle-aged adults reported higher depressive symptoms compared with older adults (OR Adj=2.03, 95% CI: 1.29-3.19, and OR Adj=1.57, 95% CI: 1.00-2.44, respectively). Depression was less prevalent in married participants compared with those not married (OR Adj=0.77, 95% CI: 0.66-0.91). Those who were resident in urban area reported higher depressive symptoms compared with those who were resident in rural areas (OR Adj=1.65, 95% CI: 1.23-2.20). Compared with employed participants, those who are unemployed and women who are student had more depressive symptoms (OR Adj=2.29, 95% CI: 1.85-2.84, and OR Adj=1.42, 95% CI: 1.18-1.71, respectively). Participants with chronic diseases were 1.81 times more likely to be depressed than other participants (OR Adj=1.81, 95% CI: 1.47-2.23). The odds of depression increased with increasing times to focus on COVID-19 per a day. Those who had family members, friends, and/or relatives infected with COVI-19 were more likely to have anxiety symptoms (OR Adj=1.30, 95% CI: 1.07-1.57). The depression rate in those who reported death of families, relatives or friends due to COVID-19 was more than other participants (OR Adj=1.17, 95% CI: 0.99-1.39), although the difference was not statistically significant (P=0.066). Participants who had high risk individual in their family were more likely to have depressive symptoms than other participants (OR Adj=1.24, 95% CI: 1.09-1.41).
Table 5. Association between depression and demographic/COVID-19-related variables among participants (n=5328).
Variables
|
Prevalence, n (%)
|
Simple logistic regression
|
|
Multiple logistic regression
|
OR Crude (95% CI)
|
P
|
OR Adj (95% CI)
|
P
|
Age
|
|
|
|
|
|
|
Young adults
|
1243 (36.8)
|
2.43 (1.66 – 3.56)
|
<0.001
|
|
2.03 (1.29 – 3.19)
|
0.002
|
Middle-aged adults
|
502 (28.3)
|
1.65 (1.12 – 2.43)
|
0.012
|
|
1.57 (1.00 – 2.44)
|
0.048
|
Older adults
|
34 (19.3)
|
1
|
|
|
1
|
|
Sex
|
|
|
|
|
|
|
Male
|
592 (30.1)
|
1
|
|
|
1
|
|
Female
|
1187 (35.3)
|
1.27 (1.12 – 1.43)
|
<0.001
|
|
1.18 (1.03 – 1.36)
|
0.019
|
Marital status
|
|
|
|
|
|
|
Single
|
927 (38.5)
|
1
|
|
|
1
|
|
Married
|
852 (29.2)
|
0.66 (0.59 – 0.74)
|
<0.001
|
|
0.77 (0.66 – 0.91)
|
0.001
|
Place of residence
|
|
|
|
|
|
|
Urban
|
1711 (33.9)
|
1.60 (1.21 – 2.11)
|
<0.001
|
|
1.65 (1.23 – 2.20)
|
<0.001
|
Rural
|
68 (24.3)
|
1
|
|
|
1
|
|
Education
|
|
|
|
|
|
|
Primary
|
42 (33.9)
|
1
|
|
|
1
|
|
Secondary
|
411 (35.7)
|
1.08 (0.73 – 1.60)
|
0.685
|
|
1.00 (0.66 – 1.52)
|
0.995
|
University
|
1326 (32.7)
|
0.95 (0.65 – 1.38)
|
0.787
|
|
0.83 (0.55 – 1.25)
|
0.373
|
Occupation
|
|
|
|
|
|
|
Employed
|
702 (29.0)
|
1
|
|
|
1
|
|
Housewife
|
331 (31.8)
|
1.15 (0.98 – 1.34)
|
0.091
|
|
1.10 (0.90 – 1.33)
|
0.359
|
Retired
|
31 (17.2)
|
0.51 (0.34 – 0.76)
|
<0.001
|
|
0.69 (0.44 – 1.08)
|
0.106
|
Student
|
452 (38.9)
|
1.56 (1.35 – 1.81)
|
<0.001
|
|
1.42 (1.18 – 1.71)
|
<0.001
|
Unemployed
|
263 (50.3)
|
2.48 (2.05 – 3.01)
|
<0.001
|
|
2.29 (1.85 – 2.84)
|
<0.001
|
Chronic diseases
|
|
|
|
|
|
|
No
|
1571 (32.5)
|
1
|
|
|
1
|
|
Yes
|
208 (41.8)
|
1.49 (1.23 – 1.80)
|
<0.001
|
|
1.81 (1.47 – 2.23)
|
<0.001
|
Times to focus on COVID-19 during a day
|
|
|
|
|
|
|
<0.5 h
|
576 (24.8)
|
1
|
|
|
1
|
|
0.5-1 h
|
323 (29.7)
|
1.28 (1.09 – 1.50)
|
0.003
|
|
1.29 (1.09 – 1.52)
|
0.003
|
1-2 h
|
274 (37.6)
|
1.83 (1.53 – 2.18)
|
<0.001
|
|
1.97 (1.64 – 2.37)
|
<0.001
|
>2 h
|
606 (50.8)
|
3.13 (2.70 – 3.62)
|
<0.001
|
|
3.33 (2.86 – 3.89)
|
<0.001
|
Contact with suspected or confirmed COVID-19 cases
|
|
|
|
|
|
|
No
|
1186 (32.0)
|
1
|
|
|
1
|
|
Yes
|
593 (36.4)
|
1.22 (1.08 – 1.37)
|
0.002
|
|
1.05 (0.90 – 1.22)
|
0.516
|
Families, relatives or friends infected with COVID-19
|
|
|
|
|
|
|
No
|
1487 (32.3)
|
1
|
|
|
1
|
|
Yes
|
301 (40.0)
|
1.40 (1.19 – 1.63)
|
<0.001
|
|
1.30 (1.07 – 1.57)
|
0.007
|
Death of families, relatives or friends due to COVID-19
|
|
|
|
|
|
|
No
|
1464 (32.7)
|
1
|
|
|
1
|
|
Yes
|
315 (37.0)
|
1.21 (1.04 – 1.41)
|
0.015
|
|
1.17 (0.99 – 1.39)
|
0.066
|
High risk individual in family
|
|
|
|
|
|
|
No
|
531 (29.8)
|
1
|
|
|
1
|
|
Yes
|
1248 (35.2)
|
1.28 (1.13 – 1.44)
|
<0.001
|
|
1.24 (1.09 – 1.41)
|
0.001
|
CI: Confidence Interval; OR: Odds Ratio