Assessment of the Prevalence of Anxiety and Depression Among Nursing Students in the Middle Euphrates of Iraq in Pandemic Process
DOI:
https://doi.org/10.31149/ijimm.v4i8.2969Keywords:
Anxiety, Depression, COVID-19 pandemic, Nursing students, IraqAbstract
Background: Nursing students experience substantial psychological strain during public health emergencies. However, little is known about the prevalence of anxiety and depression among nursing students in the Middle Euphrates region of Iraq during the COVID-19 pandemic. This study aimed to evaluate the prevalence of anxiety and depression among nursing students in this region during the pandemic and to identify the sociodemographic factors associated with them. Methods: A descriptive, observational study was conducted between March and June 2022 across four government universities in the Middle Euphrates region of Iraq: the University of Karbala, University of Babylon, University of Al-Qadisiyah, and University of Kufa. A sample of 812 nursing students, determined by a priori power analysis, was recruited using simple random sampling. Data were collected online using Google Forms, a Sociodemographic Characteristics Form, the State-Trait Anxiety Inventory (STAI), and the Beck Depression Inventory (BDI). As the data were not normally distributed, the Mann-Whitney U and Kruskal-Wallis tests were used to compare group differences, and Spearman's rho was used to examine correlations at a significance level of 0.05. Results: Most participants were female (57.9%), single (77.4%), and without children (84.0%). The mean STAI state anxiety (TX-1) score was 50.9 ± 10.1, and the mean trait anxiety (TX-2) score was 50.2 ± 10.7. The mean BDI score was 21.00 ± 12.00, corresponding to moderate depression on average; 27.2% of participants had severe depression, and 31.8% had moderate depression. Anxiety scores were significantly higher among unemployed students and those with negative income, current smoking status, chronic disease, or medication use (p < 0.05 for all). Depression was significantly associated with education level, employment status, income, smoking status, and place of residence (P < 0.05). A positive correlation was found between anxiety subscales and depression scores (p < 0.001). Conclusion: Nursing students in the Middle Euphrates region of Iraq reported elevated anxiety and depression during the COVID-19 pandemic, with the highest scores concentrated among unemployed, low-income, smoking, and chronically ill students. These findings support the need for targeted psychological counseling and preventive mental health programmes for nursing students, particularly during public health crises.
References
[1] S. H. Kathem, A. A. Al-Jumaili, M. Noor-Aldeen, N. Najah, and D. A. Khalid, “Measuring depression and anxiety prevalence among Iraqi healthcare college students using hospital anxiety and depression scale,” Pharmacy Practice (Granada), vol. 19, no. 2, 2021.
[2] A. M. Facioli, A. F. Barros, M. C. Melo, I. C. M. Ogliari, and R. J. D. M. Custódio, “Depression among nursing students and its association with academic life,” Revista Brasileira de Enfermagem, vol. 73, 2020.
[3] J. F. Huckins et al., “Mental health and behavior of college students during the early phases of the COVID-19 pandemic: Longitudinal smartphone and ecological momentary assessment study,” Journal of Medical Internet Research, vol. 22, no. 6, Art. no. e20185, 2020.
[4] Y. Li et al., “Mental health among college students during the COVID-19 pandemic in China: A 2-wave longitudinal survey,” Journal of Affective Disorders, vol. 281, pp. 597–604, 2021.
[5] Y. Zhai and X. Du, “Addressing collegiate mental health amid COVID-19 pandemic,” Psychiatry Research, vol. 288, Art. no. 113003, 2020.
[6] W. Tang et al., “Prevalence and correlates of PTSD and depressive symptoms one month after the outbreak of the COVID-19 pandemic in a sample of home-quarantined Chinese university students,” Journal of Affective Disorders, vol. 274, pp. 1–7, 2020.
[7] B. Savitsky, Y. Findling, A. Ereli, and T. Hendel, “Anxiety and coping strategies among nursing students during the COVID-19 pandemic,” Nurse Education in Practice, vol. 46, Art. no. 102809, 2020.
[8] G. Boyraz, D. N. Legros, and A. Tigershtrom, “COVID-19 and traumatic stress: The role of perceived vulnerability, COVID-19-related worries, and social isolation,” Journal of Anxiety Disorders, vol. 76, Art. no. 102307, 2020.
[9] M. W. Gallagher, M. J. Zvolensky, L. J. Long, A. H. Rogers, and L. Garey, “The impact of COVID-19 experiences and associated stress on anxiety, depression, and functional impairment in American adults,” Cognitive Therapy and Research, vol. 44, no. 6, pp. 1043–1051, 2020.
[10] S. Defar et al., “Health related quality of life among people with mental illness: The role of socio-clinical characteristics and level of functional disability,” Frontiers in Public Health, vol. 11, 2023.
[11] P. McGorry, J. Trethowan, and D. Rickwood, “Creating headspace for integrated youth mental health care,” World Psychiatry, vol. 18, no. 2, p. 140, 2019.
[12] J. Firth et al., “A meta-review of lifestyle psychiatry: The role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders,” World Psychiatry, vol. 19, no. 3, pp. 360–380, 2020, doi: 10.1002/wps.20773.
[13] S. Karim, P. Taha, N. Amin, H. Ahmed, M. Yousif, and A. Hallumy, “COVID-19-related anxiety disorder in Iraq during the pandemic: An online cross-sectional study,” Middle East Current Psychiatry, vol. 27, 2020, doi: 10.1186/s43045-020-00067-4.
[14] B. Hadi and S. Mohammed, “Impact of the COVID-19 pandemic on nurses’ mental health status in Iraq,” Journal of Education and Health Promotion, vol. 11, Art. no. 317, 2022, doi: 10.4103/jehp.jehp_637_22.
[15] S. Galea, R. M. Merchant, and N. Lurie, “The mental health consequences of COVID-19 and physical distancing: The need for prevention and early intervention,” JAMA Internal Medicine, vol. 180, no. 6, pp. 817–818, 2020.
[16] M. Fawaz and A. Samaha, “E-learning: Depression, anxiety, and stress symptomatology among Lebanese university students during COVID-19 quarantine,” Nursing Forum, vol. 56, no. 1, pp. 52–57, 2021.
[17] M. A. Aloufi, R. J. Jarden, M. F. Gerdtz, and S. Kapp, “Reducing stress, anxiety and depression in undergraduate nursing students: Systematic review,” Nurse Education Today, vol. 102, Art. no. 104877, 2021.
[18] K. Fowler and M. Wholeben, “COVID-19: Outcomes for trauma-impacted nurses and nursing students,” Nurse Education Today, vol. 93, Art. no. 104525, 2020, doi: 10.1016/j.nedt.2020.104525.
[19] C. D. Spielberger, R. C. Gorsuch, R. E. Lushene, P. R. Vagg, and G. A. Jacobs, Manual for the State-Trait Anxiety Inventory. Palo Alto, CA, USA: Consulting Psychologists Press, 1983.
[20] M. Bahammam, “Validity and reliability of an Arabic version of the State-Trait Anxiety Inventory in a Saudi dental setting,” Saudi Medical Journal, vol. 37, no. 6, pp. 668–674, 2016.
[21] A. M. Abdel-Khalek, “The development and validation of an Arabic form of the STAI: Egyptian results,” Personality and Individual Differences, vol. 10, no. 3, pp. 277–285, 1989.
[22] A. T. Beck, R. A. Steer, and G. K. Brown, Manual for the Beck Depression Inventory-II. San Antonio, TX, USA: Psychological Corporation, 1996.
[23] A. Abdel-Khalek, “Internal consistency of an Arabic adaptation of the Beck Depression Inventory in four Arab countries,” Psychological Reports, vol. 82, no. 1, pp. 264–265, 1998, doi: 10.2466/pr0.1998.82.1.264.
[24] V. Archibong et al., “Anxiety, anger and depression amongst low-income earners in Southwestern Uganda during the COVID-19 total lockdown,” Frontiers in Public Health, vol. 9, Art. no. 590458, 2021, doi: 10.3389/fpubh.2021.590458.
[25] I. Kupcova, L. Danisovic, M. Klein, and S. Harsanyi, “Effects of the COVID-19 pandemic on mental health, anxiety, and depression,” BMC Psychology, vol. 11, Art. no. 108, 2023, doi: 10.1186/s40359-023-01130-5.
[26] D. Sheroun, D. Wankhar, A. Devrani, P. V. Lissamma, and K. Chatterjee, “A study to assess the perceived stress and coping strategies among B.Sc. nursing students of selected colleges in Pune during COVID-19 pandemic lockdown,” International Journal of Science and Healthcare Research, vol. 5, no. 2, pp. 280–288, 2020.
[27] W. Cao, Z. Fang, G. Hou, M. Han, X. Xu, J. Dong, and J. Zheng, “The psychological impact of the COVID-19 pandemic on college students in China,” Psychiatry Research, vol. 287, Art. no. 112934, 2020.
[28] M. Zvolensky, J. Bakhshaie, J. M. Shepherd, et al., “Anxiety sensitivity and smoking among Spanish-speaking Latinx smokers,” Addictive Behaviors, vol. 90, pp. 55–61, 2019.
[29] S. Özdin and Ş. B. Özdin, “Levels and predictors of anxiety, depression and health anxiety during COVID-19 pandemic in Turkish society: The importance of gender,” International Journal of Social Psychiatry, vol. 66, no. 5, pp. 504–511, 2020.
[30] A. Patelarou et al., “Nursing students’ mental health status during COVID-19 quarantine: Evidence from three European countries,” Journal of Mental Health, vol. 30, no. 2, pp. 164–169, 2021.
[31] M. Mosteiro-Diaz, C. Baldonedo-Mosteiro, P. Baptista, A. Gamez-Fernandez, and S. Franco-Correia, “Anxiety and depression among nursing students during the COVID-19 lockdown: A cross-sectional correlational study,” Journal of Clinical Nursing, vol. 32, no. 15, pp. 5065–5075, 2023.
[32] Z. Yu, G. Takagi, K. Toshi, K. Wakashima, and H. Yoshii, “Depression and anxiety among nursing students during the COVID-19 pandemic in Tohoku region, Japan: A cross-sectional survey,” Japan Journal of Nursing Science, vol. 19, no. 3, Art. no. e12483, 2022, doi: 10.1111/jjns.12483.
[33] P. Zhu, T. Xu, H. Xu, Q. Ji, W. Wang, M. Qian, and G. Shi, “Relationship between anxiety, depression and learning burnout of nursing undergraduates after the COVID-19 pandemic: The mediating role of academic self-efficacy,” International Journal of Environmental Research and Public Health, vol. 20, no. 5, Art. no. 4194, 2023, doi: 10.3390/ijerph20054194.
