The pandemic of Covid-19 severely affects the lives of individuals around the world. Social contact and individuals’ have been integrated into human’s lives. Disruption to the social norms could therefore drive stress because of loneliness, anxiety, depression, mental disorders, health risks and many other things that affect a person's life (20).
In this study, the effect of factors: SF, MS, mental health, anxiety, depression, corona disease anxiety on the QoL of married women during the epidemic of Covid virus 19 was studied using path analysis. Our results showed the SF, MS, anxiety, general health and corona-related anxiety have a direct effect on women’s QoL. In some studies, sexual dysfunction has been identified as a factor influencing on QoL in individuals, and in fact, the investigate of SF plays an important role in studies related to QoL (21). In the study of Zhang and his colleague, 52.1% of participants felt horror and apprehensive due to the pandemic of COVID-19 and the pandemic was associated with mild stressful impact in participants (22). SF may be negatively affected by any type of stress or emotional distress (23). Therefore, it can be said that stress caused by COVID-19 can affect SF and SF is also one of the factors affecting the QoL.
In our study, MS was identified as an influential factor on QoL and the results of a study by Keramat et al, confirmed this finding. In this study (Keramat), a significant relationship was found between QoL and MS. The study was performed on infertile women (24). Infertility and its treatments, like Corona's pandemic, is a crisis that can affect the MS and then the QoL changes. In studies, MS and SF have been associated with QoL (25). One of the indicators of mental health is MS (26), so it can affect the QoL.
Anxiety and depression are the most important factors influencing on the QoL associated with health and even its impact on QoL has been reported to be stronger than physical conditions such as angina and other chronic diseases (27). Anxiety about COVID-19 is common and seems to be mostly due to uncertainties. Low scientific knowledge about the Covid-19 also exacerbates this anxiety (6). In this study, corona disease anxiety and anxiety had a direct impact on QoL that was in line with the results of a study by Parsamehr et al. In Parsamehr et al.'s study, there was a significant negative relationship between depression and anxiety with patients' QoL who had been undergone coronary artery bypass graft. The researchers said anxiety and depression can reduce the QoL of patients by causing physical and psychological consequences (28).Anxiety is a natural reaction to difficult and threatening situations, but if it is severe and prolonged and causes suffering, it disrupts life and reduces the QoL.
In addition to causing physical harm, Covid-19 also has a serious effect on people's mental health (29). In our study, among the variables affecting QoL, general health has a strong direct impact. QoL has a multidimensional and complex meaning and often as a specific understanding of satisfaction in life, physical health, social and family health, hope, social etiquette, and mental health (30). It is believed that various number of factors might influence the QoL that mental health is one of the important and influential factors in QoL (31).
Anxiety and depression are two important aspects of mental health (32). In present study, anxiety, depression, and corona related anxiety are the main predictors of general health. The results of a study conducted by Alizadeh Fard et al, confirmed our findings. In Alizadeh's study, corona disease anxiety was negatively correlated with mental health. Anxiety is the most fundamental feature of a crisis situation. The critical condition of the corona virus pandemic by increasing negative factors such as anxiety affect mental health (33).
Epidemics of the diseases affect people physically as well as society at different levels which lead to mental disorders such as anxiety and stress.
In our study, depression was also a predictor of general health. In a study conducted by Steger et al, depression is considered to be the strongest predictor of mental health (34).
The results of the study by Wu et al showed that that awareness of COVID-19 significantly increased the prevalence of perinatal depression (35). Also, in the study of Zheng et al, they concluded that prevalence of COVID-19 was presumably to excess the incidence of depression in cancer patients (36). It seems that excessive stress and anxiety in the current situation increase the risk of depressive disorder.
In our study, women with a higher level of SF had better MS. This result is congruent with study of Khazei et al. In this study, there was a significant relationship between sexual dysfunction and low MS. MS is related to the level and quality of general health and life satisfaction (37). MS is impressed by many factors. Safe and enjoyable sexual relationship is one of the most important factors considered in many studies (38). Sexual dysfunction probably affects MS through its impact on QoL and mental health.
In this study, more duration of quarantine, will be associated with higher level of anxiety, depression and QoL. A review of Brooks et al showed that quarantine has negative psychological effects containing post-traumatic stress symptoms, anger, and confusion. During quarantine days, separation from loved ones, loss of liberty, uncertainty about the condition of the disease, and boredom can have impressive effects. Stressors included longer quarantine duration, infection fears, disappointment, fatigue, incomplete supplies, inadequate information, financial loss, and stigma (39).
The result of the present study showed that contamination obsessions were related to more duration of quarantine, and a higher level of corona related anxiety. Among the many psychosocial consequences that have occurred due to the pandemic of COVID-19, the prominence of obsessive-compulsive symptoms has been largely neglected. Uncontrolled obsessions and compulsions can lead to dermatological conditions, chronic stress, insomnia and high risk for suicide (40).
The strengths of the present study include it is the first study conducted in the field in Iran and in the world; and the participants were from a wide range of socioeconomic and geographic backgrounds.