Impact of COVID-19 Pandemic and Lockdown Measures on the Mental Health of the General Population in the Gulf Cooperation Council States: A Cross-Sectional Study
Background: In the Gulf Cooperation Council (GCC) countries (Kuwait, Qatar, Saudi Arabia, Bahrain, United Arab Emirates, and Oman), as in the rest of the world, the COVID-19 has been spreading since 2019, and it had a significant impact on various aspects of life. The outbreak and the restrictive measures imposed by countries to stop the spread of the virus could harm the mental health condition of the general population. This cross-sectional study aims to assess the impact of the pandemic on mental health and investigate the potential risk factors.
Methods: An online survey was collected from individuals in GCC countries from May to October 2020. The final sample included 14,171 participants, 67.3% females and 60.4% younger than 35 years old. The survey consisted of depression, Anxiety, Insomnia, and post-traumatic stress questionnaires. Crude and adjusted Odds ratios are calculated using simple and multivariable logistic regressions to investigate the association between risk factors and mental health issues.
Results: Endorsement rates for depression were 11,352 (80.1%), 9,544 (67.3%) for anxiety, 8,845 (63.9%) for insomnia and 9,046 (65.2%) for post-traumatic stress. Being female and younger age were associated with a higher likelihood of developing depression, anxiety, insomnia, and post-traumatic stress. In addition, participants with underlying psychological problems were three times more likely to develop depressive and post-traumatic stress symptoms.
Conclusion: According to the findings, women, youth, singles, divorced individuals, and individuals with pre-existing psychological and medical conditions are subject to a higher risk of mental health problems during the pandemic, which policy-makers should consider when imposing restrictive measures.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
AlYousef A, AlGhareeb S, Al Wakeel J, Al-Ghamdi SM, Bieber BA, Hassan M, Al Maimani Y, Alkandari N, Ahmed HZ, Fawzy A, Pisoni RL; GCC-DOPPS 5 Study Group.Saudi J Kidney Dis Transpl. 2016 Nov;27(6 Suppl 1):S42-50. doi: 10.4103/1319-2442.194889.PMID: 27991478
Zhu N, Zhang D, Wang W. A novel coronavirus from patients with pneumonia in China. N Engl J Med (NEJM). (2019) 382:727–33. 10.1056/NEJMoa2001017 - DOI - PMC - PubMed
World Health Organization. WHO Coronavirus Disease (COVID-19) Dashboard. (2020). Available online at: https://covid19.who.int/ (accessed August 28, 2021).
Jartti L, Söderlund-Venermo M, Vuorinen T, Ruuskanen O, Jartti T. New respiratory viruses and the elderly. Open Respir Med J. (2011) 5:61–9. 10.2174/1874306401105010061 - DOI - PMC - PubMed
Moazzami B, Razavi-Khorasani N, Moghadam A. COVID-19 and telemedicine: immediate action required for maintaining healthcare providers well-being. J Clin Virol. (2020) 126:104345. 10.1016/j.jcv.2020.104345 - DOI - PMC - PubMed
London IC. State-level tracking of COVID-19 in the United States. London: Imperial College of London; (2020).
Simoes e Silva AC, Oliveira E, Martelli H. COVID-19 pandemic is a real challenge for Brazil. Front. Public Health. (2020) 8:268. 10.3389/fpubh.2020.00268 - DOI - PMC - PubMed
Rajkumar RP. COVID-19 and mental health: a review of the existing literature. Asian J Psychiatry. (2020) 52:102066. 10.1016/j.ajp.2020.102066 - DOI - PMC - PubMed
Kang L, Ma S, Chen M. Impact on mental health and perception 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. 10.1016/j.bbi.2020.03.028 - DOI - PMC - PubMed
Tan B, Chew N, Grace L. Psychological impact of the COVID-19 pandemic on health care workers in Singapore. Ann Intern Med. (2020) 173:317–20. 10.7326/M20-1083 - DOI - PMC - PubMed
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. 10.1016/j.psychres.2020.112954 - DOI - PMC - PubMed
Wang C, Pan R, Wan X, Tan Y. 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) 17:1729. 10.3390/ijerph17051729 - DOI - PMC - PubMed
Wang C, Pan R, Wan X, Tan Y. A longitudinal study on the mental health of general population during the COVID-19 epidemic in China. Brain Behav Immun. (2020) 87:40–8. 10.1016/j.bbi.2020.04.028 - DOI - PMC - PubMed
Bi K, Zhao S, Ben-Arieh D, Wu C. Modeling learning and forgetting processes with the corresponding impacts on human behaviors in infectious disease epidemics. Comput Ind Eng. (2019) 129:563–77. 10.1016/j.cie.2018.04.035 - DOI
Saadatian-Elahi M, Facy F, Del Sgnore C, Vanhems P. Perception of epidemic's related anxiety in the general French population: a cross sectional study in the Rhne-Alpes region. BMC Public Health. (2010) 10:1–10. 10.1186/1471-2458-10-191 - DOI - PMC - PubMed
Santini Z, Jose P, York Cornwell E, Koyanagi A, Nielson L, Hinrichsen C, et al. . Social disconnectedness, perceived isolation, and symptoms of depression and anxiety among olderAmericans (NSHAP): a longitudinal mediation analysis. Lancet Public Health. (2020) 5:62–70. 10.1016/S2468-2667(19)30230-0 - DOI - PubMed
Löwe B, Decker O, Müller S, Brähler E, Schellberg D, Herzog W. Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Med Care. (2008) 46:266–74. 10.1097/MLR.0b013e318160d093 - DOI - PubMed
AlHadi AN, AlAteeq DA, Al-Sharif E. An arabic translation, reliability, and validation of patient health questionnaire in a Saudi sample. Ann Gen Psychiatry. (2017) 16:32. 10.1186/s12991-017-0155-1 - DOI - PMC - PubMed
Spitzer R, Kroenke K, Williams J. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary care evaluation of mental disorders patient health questionnaire. JAMA. (1999) 282:1737–44. 10.1001/jama.282.18.1737 - DOI - PubMed
Doi S, Ito M, Takebayashi Y, Muramatsu K, Horikoshi M. Factorial validity and invariance of the 7-item Generalized Anxiety Disorder Scale (GAD-7) among populations with and without self-reported psychiatric diagnostic status. Front Psychol. (2018) 9:1741. 10.3389/fpsyg.2018.01741 - DOI - PMC - PubMed
Alghadir A, Manzar M, Anwer S, Albougami A, Salahuddin M. Psychometric properties of the generalized anxiety disorder scale among saudi University male students. Neuropsychiatr Dis Treat. (2020) 16:1427–32. 10.2147/NDT.S246526 - DOI - PMC - PubMed
Löwe B, Kroenke K, Herzog W, Gräfe K. Measuring depression outcome with a brief self-report instrument: sensitivity to change of the Patient Health Questionnaire (PHQ-9). J Affect Disord. (2004) 81:61–6. 10.1016/S0165-0327(03)00198-8 - DOI - PubMed
Kroenke K, Spitzer R, Williams J. The PHQ-9: validity of a brief depression severity measure. Gen Intern Med. (2001) 16:606–13. 10.1046/j.1525-1497.2001.016009606.x - DOI - PMC - PubMed
Suleiman K, Yates B. Translating the insomnia severity index into Arabic. J Nurs Scholarsh. (2011) 43:49–53. 10.1111/j.1547-5069.2010.01374.x - DOI - PubMed
Morin C, Belleville G, Bélanger L, Ivers H. The insomnia severity index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep. (2011) 34:601–8. 10.1093/sleep/34.5.601 - DOI - PMC - PubMed
Zhang C, Yang L, Liu S, Ma S, Wang Y, Cai Z. Survey of insomnia and related social psychological factors among medical staff involved in the 2019 novel coronavirus disease outbreak. Front Psychiatry. (2020) 11:306. 10.3389/fpsyt.2020.00306 - DOI - PMC - PubMed
Beck JG, Grant DM, Read JP, Clapp JD, Coffey SF, Miller LM, et al. . The impact of event scale-revised: psychometric properties in a sample of motor vehicle accident survivors. J Anxiety Disord. (2008) 22:187–98. 10.1016/j.janxdis.2007.02.007 - DOI - PMC - PubMed
Weiss DS, Marmar CR. The impact of event scale - revised. In: Wilson J, Keane TM. editors, Assessing Psychological Trauma and PTSD. New York: Guilford; (1996), 399–411.
Davey C, Heard H, Lennings C. Development of the Arabic versions of the impact of events scale-revised and the posttraumatic growth inventory to assess trauma and growth in Middle Eastern refugees in Australia. Clin Psychol. (2015) 19:131–9. 10.1111/cp.12043 - DOI
Mautong H, Gallardo-Rumbea JA, Alvarado-Villa GE. Assessment of depression, anxiety and stress levels in the Ecuadorian general population during social isolation due to the COVID-19 outbreak: a cross-sectional study. BMC Psychiatry. (2021) 21:212. 10.1186/s12888-021-03214-1 - DOI - PMC - PubMed
Ettman CK, Abdalla SM, Cohen GH, Sampson L, Vivier PM, Galea S. Prevalence of depression symptoms in US adults before and during the COVID-19 pandemic. JAMA Netw Open. (2020) 3:2019686. 10.1001/jamanetworkopen.2020.19686 - DOI - PMC - PubMed
Zeng LN, Zong QQ, Yang Y, Zhang L, Xiang YF, Ng CH, et al. . Gender difference in the prevalence of insomnia: a meta-analysis of observational studies. Front Psychiatry. (2020) 11:577429. 10.3389/fpsyt.2020.577429 - DOI - PMC - PubMed
González-Sanguino C, Ausín B, ÁngelCastellanos M. Mental health consequences during the initial stage of the 2020 Coronavirus pandemic (COVID-19) in Spain. Brain Behav Immun. (2020) 87:172–6. 10.1016/j.bbi.2020.05.040 - DOI - PMC - PubMed
Rodríguez-Rey R, Garrido-Hernansaiz H, Collado S. Psychological impact and associated factors during the initial stage of the Coronavirus (COVID-19) pandemic among the general population in Spain. Front Psychol. (2020) 11:1540. 10.3389/fpsyg.2020.01540 - DOI - PMC - PubMed
Bonanad C, García-Blas S, Tarazona-Santabalbina F, Sanchis J, Bertomeu-González V, Fácila L, et al. . The effect of age on mortality in patients with COVID-19: a meta-analysis with 611,583 subjects. J Am Med Dir Assoc. (2020) 21:915–8. 10.1016/j.jamda.2020.05.045 - DOI - PMC - PubMed
Vahia I, Jeste D, Reynolds C. Older adults and the mental health effects of COVID-19. JAMA. (2020) 324:2253–4. 10.1001/jama.2020.21753 - DOI - PubMed
Laird K, Krause B, Funes C, Lavretsky H. Psychobiological factors of resilience and depression in late life. Transl Psychiatry. (2019) 9:88. 10.1038/s41398-019-0424-7 - DOI - PMC - PubMed
Menon M, Andersen DR, Quilty LC, Woodward TS. Individual factors predicted to influence outcome in group CBT for psychosis (CBTp) and related therapies. Front Psychol. (2015) 6:1563. 10.3389/fpsyg.2015.01563 - DOI - PMC - PubMed
Elovainio M, Hakulinen C, Pulkki-Råback L, Virtanen M, Josefsson K, Jokela M, et al. . Contribution of risk factors to excess mortality in isolated and lonely individuals: an analysis of data from the UK Biobank cohort study. Lancet Public Health. (2017) 2:260–6. 10.1016/S2468-2667(17)30075-0 - DOI - PMC - PubMed
Wright L, Williams S. Veldhuijzen van Zanten J. Physical activity protects against the negative impact of coronavirus fear on adolescent mental health and well-being during the COVID-19 pandemic. Front Psychol. (2021) 12:580511. 10.3389/fpsyg.2021.580511 - DOI - PMC - PubMed
Anda R, Williamson D, Escobedo L, Mast E, Giovino G, Remington P. Depression and the dynamics of smoking. a national perspective. JAMA. (1990) 264:1541–5. 10.1001/jama.264.12.1541 - DOI - PubMed
Loren K, Jamie B, Lion S, Graham M, Marie H, Leonie B. Smoking, distress and COVID-19 in England: cross-sectional population surveys from 2016 to 2020. Prev Med Rep. (2021) 23:101420. 10.1016/j.pmedr.2021.101420 - DOI - PMC - PubMed
Moylan S, Jacka FN, Pasco JA, Berk M. How cigarette smoking may increase the risk of anxiety symptoms and anxiety disorders: a critical review of biological pathways. Brain Behav. (2013) 3:302–26. 10.1002/brb3.137 - DOI - PMC - PubMed
Nunez A, Rhee J, Haynes P, Chakravorty S, Patterson F, Killgore W, et al. . Smoke at night and sleep worse? The associations between cigarette smoking with insomnia severity and sleep duration. Sleep Health. (2021) 7:177–82. 10.1016/j.sleh.2020.10.006 - DOI - PubMed
Fluharty M, Taylor A, Grabski M, Munafò M. The association of cigarette smoking with depression and anxiety: a systematic review. Nicotine Tob Res. (2017) 19:313. 10.1093/ntr/ntw140 - DOI - PMC - PubMed
Neelam K, Duddu V, Anyim N, Neelam J, Lewis S. Pandemics and pre-existing mental illness: A systematic review and meta-analysis. Brain Behav Immun Health. (2021) 10:100177. 10.1016/j.bbih.2020.100177 - DOI - PMC - PubMed
Fiorillo A, Sampogna G, Giallonardo V, Del Vecchio V, Luciano M, Albert U, et al. . Effects of the lockdown on the mental health of the general population during the COVID-19 pandemic in Italy: results from the COMET collaborative network. Eur Psychiatr. (2020) 63:87. 10.1192/j.eurpsy.2020.89 - DOI - PMC - PubMed
Singh S, Roy D, Sinha K, Parveen S, Sharma G, Joshi G. Impact of COVID-19 and lockdown on mental health of children and adolescents: a narrative review with recommendations. Psychiatr Res. (2020) 293:113429. 10.1016/j.psychres.2020.113429 - DOI - PMC - PubMed
Guo Q, Zheng Y, Shi J. 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. 10.1016/j.bbi.2020.05.038 - DOI - PMC - PubMed
Tarsitani L, Vassalini P, Koukopoulos A, Borrazzo C, Alessi F, Di Nicolantonio C, et al. . Post-traumatic stress disorder among COVID-19 survivors at 3-month follow-up after hospital discharge. J Gen Intern Med. (2021) 36:1702–7. 10.1007/s11606-021-06731-7 - DOI - PMC - PubMed
Bridgland V, Moeck E, Green D, Swain T, Nayda D. Why the COVID-19 pandemic is a traumatic stressor. PLoS ONE. (2021) 16:0240146. 10.1371/journal.pone.0240146 - DOI - PMC - PubMed
Agyapong V, Mrklas K, Juhas M, Omeje J, Ohinmaa A, Dursun S, et al. . Cross-sectional survey evaluating Text4Mood: mobile health program to reduce psychological treatment gap in mental healthcare in Alberta through daily supportive text messages. BMC Psychiatry. (2016) 16:378. 10.1186/s12888-016-1104-2 - DOI - PMC - PubMed