Prevalence and Factors Associated with Depression and Anxiety of Hospitalized Patients with COVID-19 in St. Peter Specialized Hospital Treatment Centers

Research Article

Austin Psychiatry. 2021; 4(1): 1009.

Prevalence and Factors Associated with Depression and Anxiety of Hospitalized Patients with COVID-19 in St. Peter Specialized Hospital Treatment Centers

Dereseh BA¹*, Abraha M², Haile K³, Fanta T³, Worku A¹, Sebro E¹ and Molla M¹

¹Research Officer, Research & Evidence Generation Directorate, St. Peter Specialized Hospital, Ethiopia

²St. Poulos hospital Millennium College, Ethiopia

³Academic & Research Directorate Director, Amanuel Mental Specialized Hospital, Ethiopia

*Corresponding author: Bizuayehu Assefa Dereseh, Research Officer, Research & Evidence Generation Directorate, St. Peter Specialized Hospital, Addis Ababa, Ethiopia

Received: February 04, 2021; Accepted: February 23, 2021; Published: March 02, 2021


Background: Since December 2019, an outbreak of corona virus disease 2019(COVID-19), caused by the Severe Acute Respiratory Syndrome Corona Virus-2 (SARS-CoV-2) has widely and rapidly spread in China and around the world. Since 31 December 2019 and as of 30 April 2020, more than 25,000,000 cases of COVID-19 and 800,000 deaths have been reported. The grim epidemic has caused increasing public panic and mental health stress. Mental health is becoming an issue that cannot be ignored, while trying to control the outbreak. Cross sectional study was conducted to assess magnitude and factors associated depression among patients with COVID-19 in St. Peter Specialized Hospital Treatment Centers Addis Ababa, Ethiopia.

Methods: Institutional based cross-sectional study was conducted among 422 Patients with COVID-19 admitted at St. Peter Specialized Hospital COVID-19 treatment center. The Anxiety and Depression was assessed through face to face interviews by trained psychiatry nurses using 14-items Hospital Anxiety and Depression Scale (HADS).Correlates for depression & anxiety were assessed using a structured questionnaire and Oslo social support scale.

Result: A total of 373 participants were volunteer to be included in the study which makes the response rate88.4%. The mean age of the respondents was 37.46 (±SD=16.09) years. This study revealed that the Magnitude of Depression 36.5 % (136) and Anxiety 21.2 % (79) among COVID-19 patients. By using Multivariate (Anxiety) Logistic Regression, Patients who were Male (AOR 5.01, 95%CI (2.11, 11.87)), Housewife (AOR 11.43, 95%CI ( 2.67, 48.90)), Selfemployed (AOR 2.45,, 95%CI (1.07, 5.60)), having Diagnosed Chronic illness (AOR 2.56, 95%CI (1.19, 5.53)), having COVID-19 Symptoms for below 7 days and for 8-14 days ((AOR 3.21, 95%CI (1.21, 8.58)) & AOR 3.70, 95%CI (1.55, 8.84)) respectively) and those who had Poor/low Social Support (AOR 3.42, 95%CI (1.21, 9.63)) had Statistically Significant Association with Anxiety.

By using Multivariate (Depression) Logistic Regression, Patients who were 41 and above years of old (AOR 3.95, 95% CI (1.80, 8.69)), had Monthly Income of less than 1000 birr (AOR 2.99, 95%CI (1.11, 8.05)), Having COVID-19 Symptoms for 8-14 days (AOR 2.63, 95% CI (1.34, 5.17)) and who had Poor Social Support (AOR 3.13, 95% CI (1.34, 7.30)) were Statistically Significant Associated with Depression.

Conclusion: In the current study area the magnitude of depression and anxiety was high. Factors like sex, Job, having Diagnosed Chronic illness, Duration of COVID-19 symptom and social support with anxiety and factors such as age, income, duration of COVID-19 symptom and social support had statistically significant associated with depression.


SPSS: Statistical Package for Social Science; WHO: World Health Organization; HADS-Hospital Anxiety and Depression Scale; NAT: Nucleic Acid Testing; COVID: Corona Virus Infectious Diseases; CT: Computed Tomography; COPD: Chronic Obstructive Pulmonary Disease; PSSS: Perceived Social Support Scale; SDS: Self Rating Depression Scale; SAS: Self Rating Anxiety Scale; GAD-7: Generalized Anxiety Disorder-7; PSQI: Pittsburgh Sleep Quality Index



The novel coronavirus (COVID-19) is a new infectious disease that is mainly transmitted by respiratory droplets and contact and is generally infectious to human beings [1]. On January 11, 2020, after pathogenic Nucleic Acid Testing (NAT), China reported 41 cases of pneumonia infected with the novel coronavirus (SARS-CoV-2) [2], for the first time in the world of human infection with the novel coronavirus. On January 30, 2020, the World Health Organization listed the novel coronavirus epidemic as a Public Health Emergency of International Concern (PHEIC) [3]. As of February 20, 2020, a total of 75, 465 confirmed cases and 2, 236 deaths have been reported in mainland China [4].WHO stated that there is a high risk of COVID-19 spreading to other countries around the world [5]. Now it becomes a major pandemic, once after it was detected in Wuhan, China, to clusters of cases in many countries of the world [6].

The symptoms of COVID-19 are non-specific, ranging from asymptomatic to severe pneumonia and death. Fever and cough are the most common clinical symptoms. Abnormal chest Computed Tomography (CT) has been used to diagnose 67.4-88.0 % cases of COVID-19, indicating that pneumonia is the most common manifestation of the disease [7-9]. The disease is rapidly spreading in areas with high population densities, including urban areas, camps and camp-like settings, and often overburdening weak health systems. It is now clear that the virus does not differentiate between setting and season. Without decisive action, massive outbreaks will happen around the world, because many countries have insufficient resources to augment health-care staff, and do not have enough space or the necessary supplies to treat the sick [6].

Mortality is higher in patients with hypertension, cardiac disease, diabetes mellitus, cancer, and COPD as well as elderly patients are more susceptible to severe disease and death, while children seem to have lower rates of infection and lower mortality. The approach to diagnosis is still very variable from region to region, country-tocountry, and even among different hospitals in the same city. The importance of a clinical pathway to implement the most effective and relevant diagnostic strategy is of critical importance to establish the control of this virus that is responsible for more and more deaths each day [10].

Currently, global statistics shows above 12 million people affected by covid-19 and In Ethiopia, more than 12,300 people are affected by covid-19, during the study period.

Statement of the problem

The evidences highlighted that depression and stress are interrelated to each other and the overlapping symptoms of these psychological problems can lead to a wide range of clinical and personal problems which negatively impact on the quality people’s overall life. Depression is an individual experience and a complex phenomenon as the feeling of despair is dominant [11]. Even if, the physicians of Filipinos chose adaptive coping in response to the COVID-19 outbreak there is low Psychiatric morbidity, which ranges 17.7% to 18.8% on the General Health Questionnaire (GHQ 28) [12]. Further, the survey that was conducted during the initial outbreak of COVID-19in China, reported 53.8% of respondents rated the psychological impact of the outbreak as moderate or severe; 16.5% as moderate to severe depressive symptoms; 28.8% as moderate to severe anxiety symptoms, and 8.1% reported moderate to severe stress levels [13]. The psychological fear is perhaps more intensified now compared to previous viral respiratory outbreaks, with increased air travel and enhanced global connectedness that make the spread of a pandemic much more effortless. Extensive media coverage of the epidemic can now influence the public’s psychological response to the infectious disease threat [14,15].

In addition, the systematic review mentioned that pooled prevalence anxiety, depression, acute stress disorder, burnout and post-traumatic stress disorder was 45%, 38%, 31%, 29%, and 19% respectively. Factorssuch as sociodemographic like younger age and female gender; social like lack of social support, social rejection or isolation, stigmatization; and occupational like working in a high risk environment (frontline staff), specific occupational roles ( nurse), and lower levels of specialized training, preparedness and job experience have an association with the likelihood of developing those problems [16,17].

Further, being a student, had specific physical symptoms and poor self-rated health status have significantly associated with a greater psychological impact of the outbreak and higher levels of stress, anxiety, and depression. Whereas, receiving specific up-to-date and accurate health information about treatment, local outbreak situation and taking particular precautionary measures (e.g., hand hygiene, wearing a mask) associated with a lower psychological impact of the outbreak and lower levelthese psychological problems [17].

Therefore, designing psychological interventions to improve mental health of the society during epidemics is essential. Raising people’s awareness about the measures taken by the government to counter the spread of rumors, applying optional to mandatory restrictions, and raising public awareness by providing information on the patients’ recovery process can reduce these psychological problems in society [18].

Deploying a mental health science perspective’ to the pandemic will also inform population-level behavior change initiatives aimed at reducing the spread of the virus. Ethiopia, being one of the developing countries trying to address the diverse needs of its people, is currently at the verge of the epidemic. The government is currently showing high commitment to contain the epidemic before it causes significant damage to the community by taking the actions like case identification, contact tracing, isolation and quarantine. To mitigate the spread of the disease, also it uses to the preventive measures like promoting social distancing and sanitary measures [19].

However, to our knowledge, most of the current studies related to this outbreak mainly focus on identifying the clinical or epidemiological characteristics of the infected cases, there is no relevant research examining the mental health burden on the COVID-19 on the general public in Ethiopia. So, in the present study, we aimed to explore the Prevalence and factors linked to Anxiety and Depression in Hospitalized patients with COVID-19. This study may draw more attention to the psychological state of patients with COVID-19, and assist health workers to provide more appropriate treatment and psychological interventions to improve mental and physical health of patients.

Literature reviews

Prevalence and associated factors of depression and anxiety: The cross-sectional study which was done among 144 patients with confirmed COVID19 who were Huoshenshan Hospital of Wuhan, China during the COVID-19 epidemic to explore the prevalence and factors linked to anxiety and depression by using the Hospital Anxiety and Depression Scale (HADS), and social support using the Perceived Social Support Scale (PSSS) reported that 34.72% and 28.47% patients with COVID-19 had symptoms of anxiety or depression, respectively. Further, those who had less social support were correlated with more anxious and depressive symptoms. Specifically factors like gender (β=1.446, p=0.034), older age (β=0.074, p=0.003), having less oxygen saturation (β=-2.140, p=0.049), and social support (β =-1.545, p=0.017) were associated with anxiety and age (β=0.084, p=0.001), family infection with SARS-CoV-2 (β=1.515, p=0.027) and social support (β=-2.236, p<0.001) were the factors associated with depression [20].

The study was done in the Second Affiliated Hospital of Harbin Medical University, by single-center cross-sectional study focused on measuring depression and anxiety using self-report scales. Linear regression was used to determine independent predictors for depression and anxiety. A total of 78 patients who were confirmed to have COVID-19 were enrolled in the study. Prevalence of depression and anxiety symptoms were diagnosed in 35.9% and 38.5% of the patients, respectively.

Multivariate linear regression analysis found female gender was an independent predictor for higher depression severity index. Having family members who were diagnose with COVID-19 and family members who died from COVID-19 were independently associated with higher depression severity index and anxiety score. Depression was assessed using the Zung Self-rating Depression Scale (SDS), consists of 20 items that measure symptoms of depression and Anxiety was assessed using the Zung Self-rating Anxiety Scale (SAS), is a 20-item self-report scale [4].

A cross-sectional study was conducted in southeastern China, including Sichuan Province, Chongqing City, Guizhou Province, and Yunnan Province, Data were collected using the Self-rating Anxiety Scale (SAS) and the self-rating depression scale (SDS) administered to 1593 respondents aged 18 years and above. The respondents were grouped as ‘affected group’ and ‘unaffected group’ on the basis of whether they or their families/colleagues/classmates/neighbors had been quarantined. So that, the prevalence of anxiety and depression was approximately 8.3% and 14.6%, respectively, and the prevalence in the affected group (12.9%, 22.4%) was significantly higher than that in the un-affected group (6.7%, 11.9%). Lower average household income, lower education level, having a higher self-evaluated level of knowledge, being more worried about being infected, having no psychological support, greater property damage, and lower selfperceived health condition were significant associated with higher scores on the SAS and SDS. People living in Chongqing had higher SAS and SDS scores than those living in Yunnan Province. Study was conducted from 4 Feb to 10 Feb 2020 [5].

The study was short review on the psychological effects of COVID-19 and its association with anxiety by using the electronic databases, including PubMed, Medline, Elsevier, and Science Direct as a source of data mentioned that 1210 participants from 194 cities in China answered an online questionnaire and 53.8% of these people experienced severe psychological impacts of the outbreak. Moreover, 16.5%, 28.8%, and 8.1% of the respondents reported moderate to severe levels of depression, anxiety, and stress, respectively [18].

A cross-sectional study which was conducted among 4872 Chinese citizens aged 18 years old to assess the prevalence of mental health problems and examine their association with social media exposure by using online survey was used to do rapid assessment, depression was assessed by the Chinese version of WHO-Five Well- Being Index (WHO-5) and anxiety was assessed by Chinese version of Generalized Anxiety Disorder scale (GAD-7)and finally described that the prevalence of depression, anxiety and Combination of Depression and Anxiety (CDA) was 48.3% (95% CI: 46.9-49.7 %), 22.6% (95% CI: 21.4-23.8 %) and 19.4% (95% CI: 18.3-20.6 %) respectively during COVID-19 outbreak in Wuhan, China. In addition more than 80% (95% CI: 80.9-83.1 %) of participants reported frequently exposed to Social Media (SME) and the frequently SME was positively associated with high odds of anxiety (OR=1.72, 95% CI: 1.31-2.26) and CDA (OR=1.91, 95% CI: 1.52-2.41) compared with less SME. Further, there are high prevalence of mental health problems, which positively associated with frequently SME during the COVID-19 outbreak [21].

A web-based cross-sectional survey was implemented to assess the population mental health burden during the epidemic, and to explore the potential influence factors, among 7, 236 & 24 self-selected volunteers to collect information about demographic information, COVID-19 related 25 knowledge, Generalized Anxiety Disorder-7 (GAD-7), Center for Epidemiology Scale 26 for Depression (CES-D), and Pittsburgh Sleep Quality Index (PSQI) reported that the overall prevalence of GAD, depressive 30 symptoms, and sleep quality were 35.1%, 20.1%, and 18.2%, respectively. Determinates such as young 31 years of aged peoples reported a higher prevalence of GAD and depressive symptoms than older 32 people (P<35 years) and times to focus on the COVID-19 (≥3 hours per day) 35 were associated with GAD, and healthcare workers were associated with poor sleep 36 quality. Generally, participants of young people, people who spent too much time on the 39 epidemic, and healthcare workers were at high risk for mental illness [22].

A review of the existing literature was conducted by using a search of the PubMed electronic database a total of 47 citations were retrieved to see the relation between COVID-19 and mental health summarized that symptoms of anxiety and depression was 16-28 % and self-reported stress was 8% that are common psychological reactions to the COVID-19 pandemic, and may be associated with disturbed sleep [23].

A web-based cross-sectional survey based on the Internet Survey on Emotional and Mental Health (ISEMH) was done to identify high-risk groups whose mental health conditions 7236 vulnerable to the COVID-19 outbreak by using anxiety symptoms, depressive symptoms, and sleep quality ongoing, online psychologicalrelated behavior survey of Chinese public, mentioned that the overall prevalence of anxiety symptoms, depressive symptoms, and poor sleep quality were 35.1%, 20.1%, and 18.2%, respectively. In addition, people aged <35 years reported a higher prevalence of anxiety symptoms and depressive symptoms than people aged ≥35 years. Healthcare workers/younger people who spent a high level of time (≥3 hours/day) had a particular higher prevalence of anxiety symptoms than in those who spent less time (<1 hours/day and 1-2 hours/day) on the outbreak. So, during the COVID-19 outbreak, healthcare workers and younger people were at an especially highrisk of displaying psychological impact when they spent too much time thinking about the outbreak [24].

Conceptual frame work: (Figure 1).