The 2019 Coronavirus (COVID-19) pandemic has created a global health burden that has had major implications for public health worldwide. COVID-19 is a pneumonia-like disease that emerged from the Coronavirus in November 2019 in Wuhan, the capital of Hubei Province, China [1]. Since the beginning of the COVID-19 outbreak, most governments have sought to slow the spread of infection through emergency measures, including public shutdowns, travel cuts, and house quarantine, which resulted in social isolation [2, 3]. Nevertheless, the current COVID-19 pandemic, much like the SARS pandemic of 2003 and other past pandemics, will have long-term impacts on people's mental health. Therefore, it is necessary to actively identify and study the influencing factors related to such pandemics in various contexts [4]. Indeed, many researchers have already studied the psychological impact of pandemics upon various communities and groups, indicating a severe and wide range of mental illnesses [5].

Hope is a dynamic, cognitive, and motivational system that empowers one to set goals, visualize the paths needed to achieve goals, and have the motivation to achieve their goals [6, 7]. The positive emotions which arise from hope increase life satisfaction along with facilitating problem-solving and decision-making, especially in critical situations [8]. Importantly, hope and mental health are related to each other [9-11] and thus may usefully be studied together to better both. Gafari et al. reported a significant inverse correlation between social support scores and total mental health scores among students of Tabriz University of Medical Sciences in Iran, whereby participants’ mental health scores decreased significantly with increasing social support [12]. Yet these academics also recommend conducting similar studies within contexts other than those rooted within Turkish cultures and languages in Iran.

Social support increases emotional well-being, which is one of the best ways to cope with loneliness and despair [13]. Such support has been strongly associated with mental health among various samples, including an aging population [14] and health care workers [15, 16]. However, Fangjun et al. found a weak relationship between social support and mental health in the elderly [17]. In another study, Fiori and Denckla claimed that social support only affects women's mental health and has no effect on men’s mental health [18]. Thus, it will be important to identify which groups' social support may be significant in COVID-19 recovery.

Fig. (1). Graphs of scores of social support among Iranian students during the COVID-19 Pandemic based on its categories (n=312).

Fig. (2). Graphs of scores of hopelessness among Iranian students during the COVID-19 pandemic based on its categories (n=312).

Student life is a stressful period because many expectations in the social and educational fields are placed on students by the family and university [19]. Nevertheless, due to the COVID-19-induced sudden closure of universities, rapid changes in learning and online education, and the significant prevalence of depression among students, such students may now be considered a vulnerable group in need of urgent assessment [20, 21]. The future course of COVID-19 is still unclear, and its reoccurrence is possible [22]. This uncertainty caused by COVID-19 affects all aspects of life, including mental health [23]. However, few studies have been conducted to measure the hopelessness of medical students in developing countries, and those which have been done have not focused on Persian cultures and language, which are most dominant amongst Iranian people. In light of the above, this study aimed to determine the relationship between hopelessness and social support in Persian-speaking students studying at the Iran University of Medical Sciences during the COVID-19 pandemic (Figs. 1 and 2).

The present study aimed to determine the relationship between hopelessness and social support in Persian-speaking students studying at the Iran University of Medical Sciences during the COVID-19 pandemic. In relation to this, diverse and expanding studies conducted since the pandemic outbreak show increased hopelessness and stress scores in different social groups [29-31]. In the present study, the mean score of hopelessness was 6.20 (0-20), with a standard deviation of 4.98. These figures are higher than similar figures in studies conducted in South Africa or the study of Kocalevent et al. (2017) [32, 33]. In the present study, approximately one-third of students reported a minimum level of hopelessness, and 6% reported a high level of hopelessness, which is consistent with the findings of a study by El-Zoghby et al. [34], who reported that more than half of Egyptian adults had severe mental health problems. Nevertheless, in the present study, all participants were students of medical sciences and thus were more exposed to patients with COVID-19, the risk of infection and subsequent transmission. In this study, participants who were members of the treatment team also reported less stress and mental distress than other community members. This lower level of hopelessness may be due to their greater awareness of the disease and methods of transmission and treatment.

In terms of social support, more than half of the students in the present study reported high social support, 39.9% reported moderate social support, and 6.5% reported low social support. In most other studies, it has been proven that hopelessness and social support are inversely related to each other, so hopelessness decreases with increasing support from family, friends or relatives [35]. Indeed, in one study conducted in the Philippines, a moderate level of social support was reported by nurses (3.95), while in our study, slightly more than a third of the samples reported a moderate level of social support, and more than half of them reported a high level of social support [36]. This difference in social support may be because medical students are not formally responsible for patients during a pandemic, while nurses are fully responsible for caring for patients with COVID-19. On the other hand, in the above study, the mean age of nurses was 30.94 years, while in our study, the mean age of participants was 23.6 years, with 219 students being female.

In a study conducted by El-Zoghby et al., a statistically significant relationship was reported between age and female gender in terms of the effect of COVID-19 on mental health [34]. While the findings of a study by Cheung et al. entitled: “The impact of COVID-19 on the mental health of elderly people” showed the important role of aging in increasing mental problems caused by the pandemic [35]. Also, in the study of Kizilkurt et al. in Turkey, women reported lower levels of mental problems than men. Despite the above reports, in another study conducted in South Africa with medical and paramedical students in the Western Cup to assess their level of depression during the COVID-19 pandemic, no statistically significant difference was found in the levels of hopelessness between men and women [32, 36]. Future studies may usefully explore why such differences may be apparent (or not).

The results of the Spearman test showed a significant and inverse relationship between hopelessness and social support among students during the COVID-19 pandemic, so with increasing social support, the level of hopelessness decreased among students. Social support comes from various sources, including family (father, mother, child or spouse), friends, and sometimes from the organization in which people work. In other studies conducted in the same region, people who lived with family and benefited from family support similarly reported a lower level of hopelessness. For example, Adelinejad and Alipour investigated the relationship between perceived social support and preventive behaviors mediated by the variables of life expectancy and mental well-being among women living in Tehran City, Iran. Study results showed a positive and significant relationship between perceived social support and mental well-being, perceived social support and life expectancy, and mental well-being and life expectancy [37]. Among students of Tabriz University of Medical Sciences in Iran, mental health scores decreased significantly with increasing social support scores [12]. Another study conducted elsewhere reported that with increasing support from family or their organization, nurses similarly reported a lower level of anxiety caused by the COVID-19 pandemic [38]. These results are in line with the results of the present study, as are the results of a study by Li et al., which equally showed the important role of support given by family and friends in reducing depression, anxiety and hopelessness [39]. The results of the above studies importantly confirm the current study results, which further adds to rich and contextualized understandings in this area.

In the present study, there was a statistically significant relationship between marital status and hopelessness during the COVID-19 pandemic, as married people had lower levels of hopelessness. Many studies in different parts of the world have reported similar results. Most married people are heads of households and are responsible for providing food, clothing and housing for other family members [35, 39]. Similar results have been found in the study of El-Zoghby et al., in which married Egyptian adults felt more stress than single people during the pandemic [34]. In addition, a descriptive study by Kizilkurt et al. in Turkey supports the findings of our study [36]. In their study, marital status was directly related to hopelessness and anxiety symptoms, as most married people were concerned about food shortages, laundry and disinfection, and even the delay in their children's education due to home quarantine [32]. In addition to all the information about the impact of social support on hopelessness, Labrague et al., in their study, showed a statistically significant and inverse relationship between social support, aggression and hopelessness among nurses, so that social support was able to reduce the harmful and stressful effects of the environment [40]. With increased social support from family and friends, the level of anxiety reduces in nurses working in COVID-19 wards. These nurses have also reported a higher level of resilience against anxiety and better job performance. These results emphasize the need to increase social support during and after a pandemic outbreak.

In the present study, the voluntary presence of students in hospitals during the outbreak of the COVID-19 pandemic did not affect their hopelessness scores. In the case of voluntary presence, people will usually participate in an activity of their own free will, and people who are afraid of illness experience more stress and are less likely to engage in such voluntary activities. Also, the social support reported by students working in hospitals during the pandemic was significantly lower than that of other students. The present study's findings are inconsistent with the study of El-Zoghby et al., in which social support among Egyptian participants increased during the COVID-19 pandemic, and they were more likely to share their concerns and stresses with family and friends [34]. This discrepancy may be explained by the fact that sometimes some people working in the intensive care unit to care for patients with COVID-19 are afraid of transmitting the disease to other people in the community, especially their family and friends, which makes them distance themselves from them. This issue, in turn, causes these people to receive less social support, and people close to them are likely to reduce contact with them for fear of possible infection transmission [39]. Other reasons for this discrepancy may be that our study examined social support in three dimensions (family, friends, and significant others), and the students received the highest level of social support from their families. Such family support may be reduced in the number of participants living in dormitories away from family. Moreover, the length of hospital stay did not affect the score of hopelessness and social support. In the present study, the hopelessness score increased with the degree level. Our research results differ from those El-Zoghby et al., in which people with postgraduate degrees reported a lower level of hopelessness and mental health problems. In addition, a study conducted in South Africa reported that undergraduate students experienced more stress and hopelessness than ordinary people in the community. According to these previous studies, it is predicted that with an increasing level of education, people become more aware of themselves and experience more stress concerning self-care [32, 34]. The results of the present study support the need for more social support for students learning during a pandemic. Nevertheless, one of the limitations of this study is the lack of full access to all students due to the covid-19 pandemic, as they could not attend the university during this time. Additionally, because this study was conducted with students, its results cannot be wholly generalizable. Future research may usefully be conducted following the COVID-19 pandemic and during the quarantine period.

The two components of social support and hopelessness are significantly and inversely related, so hopelessness decreases with increasing social support. Therefore, health care managers must make the necessary plans in this area. Married people also experience a higher level of hopelessness, as we found an inverse relationship between hopelessness and social support. Therefore, we can decrease hopelessness in married people by increasing social support from the authorities and families. Since students working in COVID-19 wards were voluntarily receiving lower levels of social support from their families and relatives, it is expected that by increasing public awareness in this area, we can, in turn, strengthen social support for these people and reduce their level of hopelessness. Given the differences between the present and previous studies, future research may usefully explore gaps in this area.