The Psychological Impact of COVID-19 Pandemic on the Students of Saudi Arabia

2.1. Design, Setting, and Procedure

The study shows further analysis of a cross-sectional study as part of a larger survey conducted to assess the psychological effect on the general population during the early phase of the COVID19 pandemic in Saudi Arabia [2]. This study shows an extensive analysis of that study with a focus on the impact on students; adult (>18 years old) were included as the earlier study included adult only, individual who identified themselves as a student were included in the analysis, whether they are attending morning or night school, academic level of the sampled students ranges from primary to Ph.D., during early phases of the pandemic. The survey sample was collected based on non-probability sampling, which was available on commonly used social media platforms, including Twitter and WhatsApp. The responses were collected using the online google survey (Google LLC, Mountain View, California, USA). This analysis includes 336 students who were sampled in the original study. The survey was conducted for a period of four days (April 2–5 April 2020). The study protocol was approved by the health researches ethical committee of Qassim University (No.19–08-01)

2.2. Study Instruments

The data collection tool used during the survey was adapted from a previous study carried out in several Chinese cities [6]. The self-administered survey covered many aspects related to respondents’ sociodemographics including, age, gender, marital status, number of children, residential location in the past 14 days, whether the respondent or a family member is a health care worker, family income, housing type, and number of individuals in the house. Self-reported health status, reported chronic medical or psychiatric disorders were covered in the study tool. In addition, it included items on health services use in the last 14 days, including visiting a hospital, admission in a hospital, being quarantined or tested for COVID-19, and if the respondent or his/her relatives was diagnosed with COVID19. Furthermore, aspects related to concerns in response to COVID-19, including perceived susceptibility and severity of SARS-CoV-2 and opinion regarding a statement stating that “there was too much concern regarding COVID-19,” were included. It also covered the history of contacting COVID-19 cases through contaminated surfaces and respondents

were asked to pick the symptoms they have suffered during the last 14 days from a list of physical symptoms that might be related to COVID-19.

To assess the psychological impact of COVID-19, the Impact of Event Scale-Revised (IES-R) and Depression, Anxiety, and Stress Scale (DASS-21) were used. The Arabic versions of IES-R and DASS have been validated and used in previous studies. The IES-R aims to assess the past week experience of posttraumatic stress disorder PTSD symptoms after a traumatic event, while DASS was used to assess mental health status.

Scoring for scales was done as follows: The IES-R total score was divided into normal(0–23), mild (24–32), moderate (33–36), and severe (> 37) psychological impact of an event. The cut-off score for IES-R was >32(2). While for DASS subscales; depression, anxiety, and stress, each one of them included seven questions, and responses were graded as“did not apply to me”(0) and “applied to me most of the time”(3). The DASS subscales grading for depression was(0–9) for normal, (10−12) for mild, (13−20) for moderate, (21–27) for severe, and (28-42) for an extremely severe form of the disease. Scoring for anxiety subscale was 0-6, 7-9, 10-14, 15-19, and 20-42 for the normal, mild, moderate, severe, and extremely severe form of the disease, respectively. For stress, it was categorized as 0-10, 11-18, 19-26, 27-34, and 35-42 for normal, mild, moderate, severe, and extremely severe disease, respectively. Cut-off scores for DASS: stress (score >18), anxiety (score >9), and depression (score >13) were considered as a moderate or more severe form of the disease [7, 10]. Fur- ther details on the study instrument are described elsewhere [2]

2.3. Statistical Analysis

After data processing and sorting, descriptive and analytical analyses were done. Descriptive analysis was done for the various groups of variables such as sociodemographic, health status, health service utilization, and symptoms/contact history, and the results were presented in tables. Univariate statistics was also carried out to assess the presence and magnitude of associations between each factor, including sociodemographic, self-reported health status, health services use, symptoms/contact history variables, and PTSD, stress, anxiety, and depression. The bulk of the univariate analyses consisted of chi-square with Fischer’s exact test conducted where relevant.

Based on the results of univariate analyses, variables with p < 0.25 were selected, and logistic regression models were drawn for each of PTSD, stress, anxiety, and depression to determine the main predictors of each. Statistical analysis was conducted using IBM SPSS Statistics, version 22.0 for Windows (IBM Corporation, Armonk, New York, USA).

3.1. Psychological Impacts of the Coronavirus Disease

As presented in Table 1, a large proportion of the students experienced symptoms of PTSD, stress, anxiety, and depression, respectively. Using the IES-R, 14.9% of the total population had mild symptoms of PTSD, with 7.1% and 23.8% experiencing moderate and severe symptoms, respectively. On the DASS-stress subscale, increased proportions of the students had mild (7.1%), moderate (9.5%), and severe (13.4%) symptoms, respectively. Another 10.7% experienced extremely severe stress. With regards to anxiety, the proportion of students experiencing mild, moderate, severe, and extremely severe symptoms were 5.7%, 12.8%, 6.0%, and 15.8%, respectively. As much as 13.1% of the students experienced mild depression, and 14.0% had moderate symptoms of depression. Severe and extremely severe symptoms were experienced by 11.6% and 17.6%, respectively.

3.2. Sociodemographic Characteristics and Impact of COVID-19 Pandemic on the Psychological Responses

The total population of students was split into males (31.0%) and females (69.0%, Table 2). The majority were in the 18-30 years category (97.6%), with only a few older students (2.4%). A total of 67.9% were undergoing training for a bachelor’s degree, with another sizeable proportion with only a high school education (26.8%). Most were single (93.8%), and few are the married ones, 47.6% had children between one to three. The majority of the students lived in Qassim (44.3%), followed by those who lived in Riyadh (23.2%), Makkah (16.4%), Eastern province (8.3%), and other places. Up to 21.7% of the total participants worked in the field of health and medicine, and 31.8% had a family member that worked in the health sector. The majority of the students earned between 5,000 SAR to 19,999 SAR (44.5%) and lived in villa-type apartments (68.2%). Also, most of the students lived in houses containing six or more people (72.6%).

The extent to which these sociodemographic factors influenced the expression of PTSD, stress, anxiety, and depression was tested using contingency tables (Table 2). With regards to PTSD, sex (p = 0.009), family monthly income (p = 0.034), location of residence (p = 0.036), and housing type (p = 0.036) were the only sociodemographic factors that had statistically significant relationships with PTSD. Females, students with a family income of 15,000-19,999 SAR, and those living in an apartment stand a greater chance of developing PTSD (p < 0.05).

From the DASS stress subscale, sex and location of residence were the only sociodemographic factors that were significantly associated with stress. Up to 38.8% of those who were females experienced stress as compared with only 22.1% of males (p = 0.003). Similarly, those who resided outside Qassim were more likely to have stress (p = 0.011). Also, on the DASS-anxiety subscale, sex and location of residence were again the only sociodemographic factors that significantly influenced the experience of anxiety related to COVID-19 as more females than males actually experienced symptoms of anxiety (p = 0.001), and those who lived in other regions outside Qassim were more likely to have anxiety (p = 0.021). On depression, having a family member working in the field of health/medicine was found to be significantly associated with depression (p < 0.05). As much as 53.3% of those who had family members/relatives that worked in the medical field experienced depression compared with 38.4% of those who did not (p = 0.010).

3.3. Health Status and Influence on the Psychological Responses of COVID-19

Participants in the study were also asked to self-assess their current health status (Table 3). The majority of the students felt their health was in a “good” or “very good” shape (83.3%), and only a small proportion (3.3%) believed that their health was very poor. About 8.3% of the students suffer from a chronic illness, and 16.4% of the total population had been previously diagnosed with a psychiatric disorder. The most prevalent psychiatric disorders among the students were depressive (10.1%) and anxiety disorders (9.2%). Others are obsessive-compulsive disorders (3.9%), bipolar disorders (2.1%), eating disorders (1.5%), personality disorders (1.5%), sleep disorders (0.9%), and psychotic disorders (0.6%).

The health status of the participants was found to be statistically significantly associated with the expression of PTSD, stress, anxiety, and depression. Across the scales/subscales used, students who were in poor to average health were significantly more likely to have PTSD (p = 0.003), stress (p < 0.001), anxiety (p < 0.001), and depression (p < 0.001). Similarly, being previously diagnosed with a psychiatric disorder is associated with a higher chance of developing PTSD (p = 0.001), stress (p < 0.001), anxiety (p < 0.001), and depression (p < 0.001). Across the spectrum of mental illnesses, some of the students had, there were some statistically significant associations with the expression of stress, anxiety, and depression. Those who had been diagnosed with anxiety disorders, depression disorders, obsessive-compulsive disorders, and/or bipolar disorders were significantly more likely to experience stress, anxiety, and/or depression due to the ongoing COVID-19 pandemic (p < 0.05). Eating disorders were significantly associated with stress (p = 0.046) and depression (p = 0.014), and personality disorders were only significantly associated with stress (p = 0.046).

3.4. Health Service Use and Effect on the Psychological Implications of COVID-19

A total of 13.7% of the students had visited a hospital facility within 14 days from the point of data collection, and 0.6% of the total had been admitted (Table 4). With regards to testing for COVID-19, 2.4% of the students had been tested, but none was positive for the disease even though about 1.2% had to be quarantined on the basis of suspicion of COVID-19. Six of the students (1.8%) had relatives who had been diagnosed with the disease. When asked about their chances of being infected and/or recovering, the majority (64.0%) believed their likelihood of being infected with the coronavirus was unlikely, and 73.5% believed that even if infected, their chances of recovering was very or extremely likely. Also, 77.7% of the students disagreed/strongly disagreed with the statement: “I feel that there is a lot of unnecessary worrying regarding COVID-19,” indicating their agreement that there is a lot of necessary worrying relating to the COVID-19 crisis.

Going further to test the influence of these factors on the psychological impacts of COVID-19 itself, visiting a hospital was only strongly associated with anxiety as up to 52.2% of those who visited hospitals within the previous 14 days had anxiety when compared with the 31.7% who did not (p = 0.007). The perception of the students with regards to their chances of recovering was strongly associated with PTSD (p = 0.025), stress (p = 0.031), anxiety (p = 0.002), and depression (p = 0.007). The belief that the chance of recovering was unlikely increases the chances of having any of the psychological outcomes of PTSD, stress, anxiety, and depression (p < 0.05). Similarly, the perceived likelihood of infection with COVID-19 was also strongly associated with PTSD, stress, and depression, but not anxiety. Students who thought they were likely/extremely likely to affect with the disease were more likely to have PTSD (p = 0.021), stress (p = 0.008), and/or depression (p = 0.007). Again, the perception that worries about the COVID-19 crisis was justified was strongly associated with developing stress (p = 0.021).

3.5. Symptoms/Contact History and Psychological Impact

The students were asked about their experience with symptoms related to COVID-19, such as fever, dry cough, and shortness of breath (Table 5). At the time of data collection, 12.2% of the students had experienced at least one of these symptoms. When this proportion was compared with those who had not had any of these symptoms, 61.0% of those who had anxiety versus 30.8% of those who did not, it indicated a statistically significant relationship between anxiety and the experience of COVID-19-related symptoms (p < 0.001).

When asked about their history of contact, only small proportions had positive responses, with 2.1% having had direct contact with someone suspected of COVID-19 and only one student had contact with surfaces and tools infected with COVID-19. None of these had any statistically significant relationship with the occurrence of COVID-19-related PTSD, stress, anxiety, and depression (p > 0.05).