Journal of Education and Health Promotion

Abstract During the COVID‑19 pandemic, people are using social media more than usual routine because they
rely on online sources to seek health information for themselves and their loved ones. The spread of
inaccurate and misleading information via social media has a number of detrimental psychological
effects on members of society. The aim of this systematic review was to describe the impact of social
media on the mental health of the general population. An extensive systematic search was done till the
last month of 2021 for collecting the evidence using the PRISMA technique. The search was mainly
focused on the article leading with keywords and search engines used during the course of the study
were Pubmed, Semantic Scholar, Mendeley, and Science direct. Articles for this study were selected
based on the predetermined eligibility criteria and performed quality assessment by using the NHLBI
quality assessment tool. Most of the studies included in this review are found fair (score between
9 and 12) quality. Out of 866 publications, 533 articles were included in the initial screening, after
duplication removal 46 full‑text articles were assessed for eligibility and 14 studies were selected for
systematic review. In most of the studies, maximum participants used social media as a primary source
of information. Relatively high rates of symptoms of depression (14.14% to 48.3%), anxiety (7.4% to
47.82%), and prevalence of stress increased to 37.67% are reported after exposure to social media
for coverage of COVID‑19 news in the general population. Risk factors of psychological distress are
associated with female gender, younger age group, marital status, staying alone, and duration of
exposure to mass media. Increased exposure to COVID‑19 information through mass/social media
is associated with highly significant levels of psychological health issues; mitigating the hazardous
effect of social media exposure during the COVID‑19 pandemic on the psychological health of the
general population is an international public health priority.

Abstract BACKGROUND: Human survival requires the ability to communicate. Today’s students’ use of
social media has opened up a slew of new possibilities; nevertheless, it is hard to say how many
more may emerge in the future. As the years have gone by, the use of social networking sites has
grown in popularity among teenagers. This research investigates both the ways in which social
media draws in users and the ways in which it hooks users by revealing the gimmicky worlds that
they inhabit. Depending more on social media than on oneself causes a tremendous problem. It is
quite challenging to separate human beings from their many electronic devices in today’s world. The
use of devices gradually began to take over the world.
MATERIALS AND METHODS: Qualitative research approaches were used in this research. The
qualitative study’s findings were gathered from a variety of secondary sources, including media
articles, academic journal articles, and past theses. Throughout the course of this study, a discourse
analysis method was employed, and several case studies were gathered from news articles and
journals.
RESULTS: According to the results of the research, addiction to the Internet has been defined as
a decrease in an individual’s ability to exercise self‑control within the context of the social‑cognitive
framework. The research is based on true events that occurred in and around India. This research
article focuses on the various positive and negative effects that social media may have on education
and students. It is critical to figure out how to tackle this issue.
CONCLUSION: One effective strategy is to restrict their access to social media. The bulk of the
disadvantages may be mitigated by reducing the amount of time spent on social media sites. Keeping
track of their academic progress and dealing with any problems early on can help them avoid the
negative effects of social media on their education.

Abstract BACKGROUND: Physical changes in high‑risk pregnancy (HRP) can lead to changes in mood and
social relationships and negative effects on women’s well‑being. Individuals in different sociocultural
contexts have different perceptions of well‑being. Yet, there is limited information about perceptions of
well‑being in HRP. This study aimed to explore the Iranian women’s experiences of well‑being in HRP.
MATERIALS AND METHODS: This qualitative study was conducted in 2019–2020 through directed
content analysis based on the conceptual framework of well‑being in HRP. Participants were 26
women with HRP purposively recruited from public and private healthcare settings in Mashhad, Iran.
Face‑to‑face semistructured interviews were held for data collection until data saturation. Data were
analyzed through directed content analysis proposed by Elo and kyngäs (2008) and were managed
using the MAXQDA (v. 10) program.
RESULTS: Well‑being in HRP had seven attributes in the five main dimensions of physical,
mental‑emotional, social, marital, and spiritual well‑being. The seven attributes of well‑being in HRP
were controlled physical conditions, controlled mood, emotions, and affections, perceived threat,
self‑efficacy, and competence for multiple role performance, maintained social relationships, meaning
seeking and relationship with the Creator, and positive marital relationships.
CONCLUSION: The present study provide an in‑depth understanding about well‑being in the Iranian
women with HRP. It is a complex and multidimensional concept with physical, mental‑emotional,
social, marital, and spiritual dimensions. Comprehensive multicomponent interventions are needed to
promote well‑being among women with HRP and designed the guidelines to provide woman‑centered
care.

Abstract Infertile couples experience a lot of psychological stress due to the inability to achieve the desired
social role. Couples who decide to continue assisted reproductive therapy (ART) during the epidemic
also experience the psychological impact of the COVID-19 epidemic, which affects their daily lives
due to social isolation, quarantine, travel restrictions, and cancellation of treatment. Therefore, the
purpose of this study was to assess the mental health of infertile couple pausing or delaying their
treatment due to the COVID-19 pandemic. PubMed, Scopus, Cochrane, Embase, Web of Science,
ScienceDirect, Google Scholar, Research Gate, and the World Health Organization databases and
websites were systematically searched for original studies concerning abortion in the era of COVID-19
pandemic published by August 15, 2021. We used the following keywords: “COVID-19 Corona
virus, infertility, reproductive technique, fertilization, assisted reproduction, pregnant termination,
psychological, in vitro mental status, depressive symptoms, and anxiety.” In sum, after automatically
and manually search and excluding duplicates, 269 articles were found. In final, after screening, 18
articles were selected. Most patients experienced negative emotions during the COVID-19 epidemic.
When reproductive services were re-established, participants showed higher levels of anxiety and
lower quality of life than before quarantine. Women who thought pregnancy was more important
than getting COVID-19 had higher levels of anxiety than women who thought otherwise (P < 0.05).
The COVID-19 pandemic has negative impacts on the mental health and quality of life of patients
seeking fertility services and coping with it requires timely and appropriate psychological intervention,
accurate information, and social and organizational support.

Abstract BACKGROUND: Few researchers have examined the effectiveness of cognitive behavioral therapy
in treating aggressive behaviors among individuals with dual diagnosis (intellectual disability and
mental health conditions) due to the relatively recent interest in the field of psychopathology in
intellectual disability. This study investigated the effectiveness of cognitive behavioral therapy in
treating aggressive behaviors among clients with dual diagnoses in a community rehabilitation
center, Ibadan, Oyo state, and the moderating effects of parenting style and socioeconomic status
in the associations.
MATERIALS AND METHOD: A 2 × 2 × 2 pre‑test post‑test factorial design was used. Parenting style
and socioeconomic status at two levels each moderated the associations. A sample of 22 participants
purposively selected was exposed to treatment using cognitive behavioral therapy, while the other
five were exposed to placebo treatment all for 8 weeks. Data collected were analyzed using Line
Chart and Analysis of Covariance (ANCOVA).
RESULTS: Improvements were found in the post‑treatment scores obtained on the Aggressive Scale
for Youths. A reduction in the Aggressive Incidents chart was recorded for each participant in the
treatment group when compared with the control group, using a line chart and Analysis of Covariance
(ANCOVA). Evidence also demonstrated that parenting style (authoritarian and authoritative), F (1,14)
= 0.75, P <.05, η2 =0.05), and socioeconomic status (high and low), F (1,14) = 0.01, P =0.020, η2
=.00), moderated the associations.
CONCLUSION: Cognitive behavioral therapy is seen as a treatment intervention for individuals with
intellectual disability co‑existing with mental health manifesting aggressive behaviors in the community
or other settings. This should be used to improve the client’s quality of life under these conditions.

Abstract The COVID‑19 pandemic has disordered the lives of millions in an unprecedented way. A state of
mental health crisis has emerged across the globe. The lifestyle and well‑being of the individual and
social integrity have been adversely affected. One‑third of US citizens and one in five Indian citizens
suffer from depression due to this pandemic. This scoping review aimed to estimate the mental health
challenges and their possible solutions in the recent two years (2020–2021). Our search strategy
used search engines such as Medline, Google Scholar and PubMed. The search strategy used the
MeSH keywords “Mental Health AND Covid‑19”. The findings emerged in the following key points:
anxiety and depression, social isolation and quarantine, and vulnerable or high‑risk groups. Out
of 216 articles screened, 20 were found eligible to meet the inclusion criteria. Most of the studies
focused on psychological anxiety, stress and mental disorder during the pandemic. Psychosocial
assessment and monitoring in the context of COVID‑19 should include inquiries about stressors
related to COVID‑19, like exposure to infected sources, infected family members, loss of loved ones,
physical distance; secondary adverse events like economic loss, psychosocial effects like depression,
anxiety, psychosomatic preoccupations, insomnia, increased substance use, domestic violence; and
indicators of vulnerability like pre‑existing physical or psychological conditions.

Abstract BACKGROUND: Play therapy is an intelligent tool in cognitive–behavioral therapies. In today’s world,
the Internet and technology play a key role in all aspects of people’s life including mental health.
The present study explores the feasibility of using Internet‑assisted play therapy to solve children’s
psychological issues in primary healthcare systems.
MATERIALS AND METHODS: The present qualitative research was conducted by the content
analysis approach on 20 experts working in the healthcare centers, who were selected purposefully.
The sample was saturated with these 20 participants. Data were collected through semi‑structured
interviews and were coded manually. Then, they were analyzed in the Atlas.ti software package.
RESULTS: The results revealed 15 themes and 10 sub‑themes. The themes included (1) safety, (2)
efficiency, (3) client‑orientedness, (4) organizational growth, (5) time, (6) effectiveness, (7)
justice‑orientedness, (8) access, (9) feedback, (10) analysis, (11) children’s computer game room, (12)
reward, (13) group game, and (14) capability to be integrated into other electronic programs.
CONCLUSION: It seems that Internet‑based play therapy is plausible to be used as a service in
primary healthcare to tackle the psychological problems of children in the target population if the
challenges related to the exploratory themes are taken care of.

Abstract BACKGROUND: Midwifery services help maintain and improve the health of the community. However,
a comprehensive examination reduces students’ psychological well‑being by creating anxiety. For this
purpose, the present study was conducted to determine and compare the effect of two educational
methods based on mindfulness and cognitive emotion strategies on psychological well‑being and
anxiety of eighth‑semester midwifery students before the final clinical trial.
MATERIALS AND METHODS: This study was a quasi‑experimental three‑group study with available
sampling method that was performed on 30 eighth‑semester midwifery students of the School of
Nursing and Midwifery of Isfahan University of Medical Sciences in 2020–2021. Data collection tools
were psychological well‑being and Test Anxiety Questionnaire. Two intervention groups were trained
for eight sessions. The control group did not receive any training program. The data collected by
SPSS version 22 software were analyzed by analytical statistical tests of ANOVA and least significant
difference post hoc test.
RESULTS: The results showed that there was a statistically significant difference between the three
groups in terms of components of test anxiety and psychological well‑being. Furthermore, emotion
regulation training and mindfulness‑based training reduced test anxiety and increased students’
psychological well‑being before the comprehensive test (P = 0.001).
CONCLUSION: It is recommended that educational programs be considered before the comprehensive
examination to promote the mental health and success of these students.

Abstract Health education is a crucial consideration in the healthcare system and has the potential to improve
global health. Recently, researchers have expressed interest in streamlining health education, utilizing
digital tools and flexible curriculums to make it more accessible, and expanding beyond disease and
substance abuse prevention. They have also expressed interest in promoting global health through
health and safety promotion programs. Amidst the COVID‑19 pandemic, climate change, the refugee
crisis, and overpopulation, healthcare crises are erupting all over the world. A lack of health education
has and will continue to have a profound impact on community healthcare indicators, particularly in
low‑income nations. Current priorities within the health education sector include digitization, equity,
and infectious disease prevention. Studies and data from university journals and other academic
databases were analyzed in a literature review. Health education programs have a significant positive
impact on attitudes and behaviors regarding global health. Improving upon these programs by digitizing
them and expanding upon the scope of health education will help ensure that such interventions and
programs make a significant difference.

Abstract BACKGROUND: The Covid‑19 outbreak has led to an unprecedented burden on the healthcare
infrastructure. High morbidity and mortality rates have resulted in a state of stress and distress among
the general population which has also impacted health professionals.
AIMS: This study was conducted to identify mental health disturbances among health professionals
during the Covid‑19 pandemic.
MATERIALS AND METHODS: It was a cross‑sectional study, conducted in a Medical College
in Himachal Pradesh, India. A self‑administered anonymized questionnaire was administered to
the healthcare workers. Mental health status was assessed using Patient Health Questionnaire
Anxiety‑Depression Scale (PHQ‑ADS). In addition, a 15‑item questionnaire was prepared to identify
the probable causes of stress in HCWs during the Covid‑19 Pandemic. A statistical analysis used
t‑test was used to find the significance of the correlation between the PHQ‑ADS score and the
agreement score of different factors.
RESULTS: The response rate for the questionnaire was 27%. Anxiety and depression were seen in
29% of participants, ranging from mild (18.3%), moderate (4.7%), and severe (5.9%). Among females
43.7% of the participants and among males, 13.1% had anxiety and depression. High PHQ‑ADS
scores were seen in nursing staff (70%) and postgraduate students (30%), who were in the third
decade of life. Most (81.7%) of the HCWs were concerned about transmitting the disease to their
near ones. Fear of coming to the hospital and dealing with patients.
CONCLUSION: Even sub‑threshold syndromes among HCWs need to be identified before they
evolve into overt diseases. The psychological needs of healthcare workers should be prioritized as
they are key players in the fight against Covid‑19.

Abstract BACKGROUND: India today is home for the largest youth population in the world. Youth is a 
formative phase transitioning from childhood to adulthood. Relationship is fundamental for a healthy 
and satisfactory life. Relationships assume importance and maturity during adolescence and youth. 
Relationships and mental health have a bidirectional effect. The effect of relationships on mental 
health is stronger than vice versa.
MATERIALS AND METHODS: Two‑year case record analysis of 8595 beneficiaries aged 15–35 years 
attending youth guidance centers (Yuva Spandana Kendras) in Karnataka, India, was undertaken 
to understand factors affecting relationship issues among them. Multivariate logistic regression was 
performed with any beneficiary having a relationship issue as outcome.
RESULTS: Being a student (adjusted odds ratio [AOR] = 1.49; 95% confidence interval [CI] = 
1.18–1.89), occupation (AORbusiness/
salaried = 3.04; 95% CI = 2.10–4.40 and AORothers = 1.72; 95% 
CI = 1.22–2.44), marital status (AORmarried = 1.42; 95% CI = 1.06–1.90 and AORothers = 3.44; 95% 
CI = 1.45–8.15), having health and lifestyle issues (AOR = 3.61; 95% CI = 3.05–4.27), personality 
issues (AOR = 2.88; 95% CI = 2.43–3.41), safety issues (AOR = 6.28; 95% CI = 5.01–7.87), 
gender, sex, and sexuality issues (AOR = 3.10; 95% CI = 1.93–4.98), suicidality (AOR = 1.82; 
95% CI = 1.17–2.85), alcohol use (AOR = 5.43; 95% CI = 3.92–7.41), and different emotions 
experienced (AOR ranging from 0.37 to 3.50), had significant association with relationship issues.
CONCLUSION: Investing in health promotion interventions focusing on these precursors of 
relationship issues among youth seems strategic. Our findings have implications for other states in 
India and other low‑middle‑income countries like India.

Abstract BACKGROUND: The Government of India and State Government authorities are trying their best to 
provide adequate mental health services through various mental health policies and programs. To 
reduce the burden in psychiatric hospitals, Government has decentralized mental health services. 
Although Government has provided mental health services, the utilization has always been low due 
to many reasons. In the present study, an attempt was made to assess the accessibility and the 
barriers to utilizing mental health services with various community stakeholders.
MATERIALS AND METHODS: This is a qualitative study wherein data was collected from youth, 
women, geriatric groups, community key leaders, and Anganwadi workers. The primary data were 
collected through focused group discussions and interview methods. The collected data were 
analyzed using thematic coding.
RESULTS: A total of twenty‑five factors have been identified in the study, which were categorized 
under eight themes. (a) Lack of awareness and misinformation on mental health, illness, and 
available services, (b) Perceived causes for mental illness, (c) Reasons for not approaching health 
professionals, (d) Treatment adherence‑related issues, (e) No multidisciplinary team in private 
hospitals and lack of involvement in government sector (f) Manpower issues, (g) Quality of service 
issues and building confidence among community people, and (h) Belief system and stigma.
CONCLUSIONS: Inadequate mental health services, lack of awareness of mental health, and 
illness are still persist. The District Mental Health Program and other service providers need to reach 
communities, especially in remote areas. Periodical evaluation should be carried out to improve the 
utilization of mental health services.

Abstract BACKGROUND: Students on campus are exposed to drug abuse and mental health disorders due 
to various challenges and motivating factors. This issue requires attention to interventions based on 
coping skills training. The present study was conducted with the aim to investigate the effect of an 
assertiveness program on the drug use tendency, mental health, and quality of life in clinical students 
of Shahrekord University of Medical Sciences in 2020.
MATERIALS AND METHODS: This is a quasi‑experimental study. Seventy clinical students (nursing, 
midwifery, and intern students) attending Ayatollah Kashani and Hajar teaching hospitals of Shahrekord 
were included into the study and randomly assigned into an intervention group and a control group. 
The assertiveness training program was implemented for eight 1‑h sessions (one session per week 
for 2 months) for the intervention group, while the control group received no programs. Both study 
groups completed drug tendency questionnaire, depression, anxiety and stress scale, and quality of 
life questionnaire in pretest, posttest, and 2‑month follow‑up. The data were analyzed using SPSS 
software (v22), analysis of variance repeated measures, and t‑test.
RESULTS: The mean scores of drug use tendency (P = 0.26), stress (P = 0.31), anxiety (P = 0.29), 
depression (P = 0.43), and quality of life (P = 0.33) showed no statistically significant difference
between the intervention and control groups in the pretest, but the scores of the drug use tendency, 
stress, anxiety, and depression were statistically lower and the score of quality of life was statistically 
higher than that of the control group in the posttest and 2‑month follow‑up (P < 0.05).
CONCLUSION: The findings of the study showed that assertiveness skill training as a preventive
program can reduce the students’ tendency to addiction and improve their mental health and quality 
of life. Considering the effectiveness of the program, planners and policymakers can use it to plan 
for reducing the youth tendency to drugs.

Abstract BACKGROUND: Increasing in elderly’s population and their individual and social problems especially
mental health problem in this group need special attention. The aim of this study was evaluation
of health promotion behaviors training program efficacy on general health components in elderlies
referring to health centers in Isfahan city.
MATERIALS AND METHODS: This study was a tri phasic field trial in 2014 in which 72 elderlies
allocated randomly in two case and control groups. Case group participated in 9 training sessions on
stress management and interpersonal relationships and the control group participated in 2 sessions
with a neutral discussion content. Data collection tools were demographic information questionnaire
and general health questionnaire 28. Pretest, posttest, and 2‑month follow‑up were performed in
two groups. Data were analyzed by t‑test, analysis of variance with repeated measurement, least
significant difference post hoc test, and SPSS 20 software.
RESULTS: Findings of this study showed that the average of general health score in case and
control groups had not significant difference before the intervention (P > 0.05). However, the mean
difference of general health score after intervention and 2‑month follow‑up was statistically significant
in two groups (P < 0.001).
CONCLUSIONS: This study showed that interpersonal relationship and stress management training
program are effective on promotion of mental health in elderlies. Hence, the findings of this study
can be used in the field of treatment and care of the elderly by other health‑care categories.

Abstract BACKGROUND: Previous studies have reported that medical students show high rates of depression,
anxiety, and stress levels, but mixed findings were found regarding possible differences between
gender and different years of medical training. This study evaluated depression, anxiety, and stress
levels and psychiatric drug use in students in an Italian medical school and investigated the differences
between gender and year of study.
MATERIALS AND METHODS: This cross‑sectional study included 694 medical students in their
1st (n = 286), 4th (n = 209), and 6th (n = 199) year of study. The questionnaire included demographic
information, self‑report questionnaires regarding depression, anxiety, and stress, and questions
about psychiatric drug use. Data analysis was performed using SPSS/Ver 22 through descriptive and
analytic statistics, including Mann–Whitney U‑test, Fisher’s exact test, and GLM two‑way ANOVA.
RESULTS: Depression, anxiety, and stress symptoms were reported by 365 (52.6%), 428 (61.7%),
and 545 (78.5%) medical students, respectively. Female students in their 4th year of study reported
higher depression levels than males of the same year (P = 0.004), whereas levels of anxiety were
higher in 6th‑year female students compared with those in their 1st and 4th years (P = 0.001; P = 0.025).
Stress levels were consistently higher in females than in males for all 3 years (1st year: P = 0.041;
4th year: P < 0.001; 6th year: P = 0.004). No gender differences were found in the use of psychiatric
and stimulant drugs.
CONCLUSION: This study provides preliminary evidence suggesting the importance of planning
interventions aimed at reducing emotional distress among medical students that should be targeted
on gender and year of the study.

Abstract BACKGROUND: Coronavirus (COVID‑19) is an infectious respiratory disease. Quarantine is often
accompanied by unpleasant experiences for those who go through it. The aim of this study was to
determine the mental health status of people during quarantine in northern Iran.
MATERIALS AND METHODS: This cross‑sectional study was conducted during the quarantine
period of coronavirus. Conventional sampling was done from March 6 to April 6. Six hundred and
forty‑two individuals were included. Inclusion criteria were living in Sari and being home quarantined
during the corona outbreak. Exclusion criteria included hospitalization history due to corona and
unwillingness to participate in the study. In this study, the General Health Questionnaire‑28 was used
online to collect the required data. To analyze the data, descriptive and inferential statistics (t‑test,
analysis of variance, and correlation coefficient) were used.
RESULTS: In this study, individuals were included in the investigation with a mean age of
38.74 ± 11.89 (ranged from 15 to 73). Most of the participants were female (72.85%) and
married (71.34%). According to the results, 21.5% of the participants had poor mental health.
Mean mental health scores have a statistically significant relationship with gender, marital status,
education, occupation, quarantine period, patients with corona, and exposure to a patient with
corona (P ≤ 0.05). Furthermore, a negative correlation coefficient was observed between age and
mental health score (correlation coefficient = −0.31, significance >0.001).
CONCLUSION: The average score of mental health has a significant relationship with gender, marital
status, education, occupation, quarantine period, corona, and exposure to a patient with corona.
Given the high prevalence of mental disorders in people during the COVID‑19 epidemic, educating
people and planning to reduce the psychological effects of the epidemic can be helpful.

Abstract BACKGROUND: The COVID‑19 epidemic is a global health crisis that, in addition to physical health,
has affected the mental health of all individuals, especially health‑care workers, including nurses
and family members. In this regard, the present study aimed to investigate the effect of COVID‑19
epidemic on mental health of nurses’ family members.
MATERIALS AND METHODS: The present descriptive‑analytic and cross‑sectional study was
conducted in 2020 year on family members of nurses working in Hajar Hospital for admission and
hospitalization of patients with COVID‑19, after obtaining the necessary permits and coordination. To
prevent the spread of COVID‑19 through respiratory or contact droplets, a blog was designed to collect
data using software. Participation in this study was voluntary. Data collection tools included consent,
demographic questionnaire, and mental health questionnaire (Patient Health Questionnaire‑9). Data
were analyzed by SPSS version 22.
RESULTS: Findings of this study showed that out of 208 family members of nurses participating
in this study, 96 were male and 112 were female and their mean age was 35.78 years, and 55.3%
of the participants had university education. Their mean mental health score was 12.91 ± 3.75, so
that 22.6% of people had mild depression, 71.4% of people had moderate depression, and 1.8%
of people had severe depression. Independent t‑test showed that there is a statistically significant
relationship between mental health and gender and marital status (P < 0.001). Furthermore, one‑way
analysis of variance test showed that there is a significant relationship between mental health and
age (P < 0.001); this test also showed that there is no relationship between education and mental
health (P = 0.75).
CONCLUSION: The results indicate that the mental health of nurses’ family members is affected
by the challenges of COVID‑19 epidemic time, so that many of them suffer from some degree of
depression. Therefore, supporting this population requires urgent action.

Abstract BACKGROUND: The COVID‑19 pandemic has negatively impacted the mental health of health‑care
workers worldwide. This study aimed to estimate the prevalence of psychological distress in medical
interns during the pandemic and examine the factors influencing it.
MATERIALS AND METHODS: A cross‑sectional online survey was conducted using snowball
sampling among 764 medical interns across India, who were evaluated using the Kessler
Psychological Distress Scale, Fear of COVID‑19 Scale, and semi‑structured questionnaires. Univariate
analysis was done using Chi‑square test, unpaired t‑test, and ANOVA, while multivariate analysis
was conducted using binary logistic regression.
RESULTS: 57.5% of the interns reported psychological distress, with 39.8% having moderate‑to‑severe
distress. Past consultation with a mental health professional (odds ratio [OR]: 2.15; 95% confidence
interval [CI]: 1.42–3.26) and perceived lack of support from friends (OR: 2.33; 95% CI: 1.33–3.99)
and faculty (OR: 2.15; 95% CI: 1.41–3.28) were the most significant predictors of distress. Fear
of COVID‑19 was higher in interns who were female, were medically ill, were dissatisfied with the
pandemic preparedness at the hospital, and perceived the faculty to be less approachable and
supportive. Majority of the interns felt that the pandemic had hampered their learning and were
worried about an extension to their internship and their performance in the postgraduate entrance
examinations.
CONCLUSIONS: Psychological distress was highly prevalent among interns, with several workplaces
and personal factors affecting the distress levels. Most interns perceived a negative impact of the
pandemic on their learning and career. Addressing these issues could help alleviate the distress
and bolster the mental health of interns.

Abstract BACKGROUND: As shown in previous persons that used the effective coping strategies are more
aware to recent stressful life events in their live, this study conducted to investigate the main stressful
life events and common coping styles in adult’s population.
MATERIALS AND METHODS: This cross‑sectional study was conducted in 2018. In overall, 345
persons aged 18 years and more by stratified cluster sampling were enrolled in the study. The valid
questionnaires including the coping inventory for stressful situations‑21, the Holmes‑Rahe Stress
Inventory, and 28‑item General Health Questionnaire (GHQ‑28) were used to interview. The analysis
of variance and t‑student (t‑test) was used to determine the association between the two variables.
The statistical significance level was considered <0.05.
RESULTS: The top three importance events among 43 stressful items in our study were change
in financial state, gain of a new family member, and death of close family member. We found that
task‑oriented coping (P < 0.001) and avoidance‑oriented coping (P = 0.021) significantly more used
in males compered to females. According to Holmes‑Rahe life stress inventory instructions only 4.7%
of participants are prone to getting ill in next 2 years.
CONCLUSION: The results of this study showed a positive relationship between coping styles and
lower risk of mental health problems and stressful life events. Hence, activities and training programs
aiming to enhance personal approach coping skills is important to reduce of side effects of stressful
life events especially those recently exposed to negative life events and stresses.

Abstract BACKGROUND: Before the COVID-19 pandemic, medical students had reported experiencing high
rates of distress, burnout, anxiety, and depression. The psychological impact of the COVID-19 in the
general population suggested that the mental health impact was increased anxiety, depression, and
stress. There were no exceptions if medical students also experience the same psychological impact.
The aimed to this study is analyze the mental and emotional effects of the COVID-19 pandemic
among medical students.
MATERIALS AND METHODS: An observational analytic study was used with a cross-sectional
approach. Data were obtained with questionnaires distributed through social media platforms from
July 14, 2020, to July 21, 2020. This study using the Fear of COVID-19 (FCV-19) Scale and the
Depression, Anxiety, and Stress Scale-21 to assess FCV-19, anxiety, stress, and depression.
statistical analysis used IBM SPSS Statistics 24 was used to analyze the two-tailed Chi-square test,
the Mann–Whitney test, and the Kruskal–Wallis test, which were used with statistical significance
as P < 0.05 for all tests.
RESULTS: Out of 1027 samples, 44.6% had stressed, 47.8% had anxiety, and 18.6% had depression.
The gender (P = 0.000), educational stage (P = 0.000), and the comorbidity factor (P = 0.001 for
stress and anxiety, P = 0.036 for depression, and P = 0.000 for FCV-19) had a significant association
with stress, anxiety, depression, and FCV-19 in medical students. The hometown that showed zone
risk of infection only showed significant differences in FCV-19 (P = 0.026).
CONCLUSIONS: Protection and psychological support for a medical student is extremely high
importance given that COVID-19 is now a well-established pandemic and there will be other
pandemics in the future.

Abstract BACKGROUND: Several preventive measures were used by governments around the world to
suppress the transmission of SARS‑CoV‑2, including quarantine. During quarantine more people
are at risk of developing mental health problems as social media exposure was increasing.
OBJECTIVES: The objective is to investigate the impact of social media exposure during coronavirus
disease 2019 (COVID‑19) pandemic on depression, anxiety, and stress.
MATERIALS AND METHODS: A cross‑sectional study was conducted between April and May 2020
during the large scale social restriction in Indonesia using online questionnaire Indonesian citizens
over 18 years of age were invited to take part by answering online questionnaire through Google
forms (http://bit.ly/duniamayaCOVID). Data gathered were demographic data, depression, anxiety,
and stress that were assessed using Depression Anxiety Stress Scale‑21, duration of social media
usage, and social media platforms used during COVID‑19 pandemic. Data was analysed using
Pearson Chi‑square and ANOVA. Statistically significant variables and additional risk factors was
analyzed using multinomial logistic regression.
RESULTS: The median age was 24 years (range 17–56 years), 121 (55,0%) samples were female.
The three most frequent social media platforms used by participants were Instagram, WhatsApp, and
YouTube. Female were more likely to suffer from mild‑moderate depression compared to male (odds
ratio [OR]: 2.344; 95% confidence interval [CI]: 1.105–4.972; P = 0.026) and more likely to suffer
from severe‑extremely severe anxiety (OR: 2.066; 95% CI: 1.019–4.187; P = 0.044). Social media
exposure was associated with less likelihood to suffer from severe‑extremely severe depression,
mild‑moderate, and severe‑extremely severe anxiety, mild‑moderate stress.
CONCLUSION: Social media exposure was associated with less depression, anxiety, and stress in
the COVID‑19 pandemic era. Medical professionals and government officials could use social media
to disseminate knowledge about COIVD‑19 to bring positive psychological effect.

Abstract BACKGROUND: Existential anxiety (EA) revolves around the question of ultimate concern related
to life and death. It gets more prominent when there is an exposure to stressful experiences where
the stress is profound and resources seem insufficient. The objective was to measure the prevalence
and magnitude of EA in the study population from the Kashmir valley during the COVID‑19 pandemic.
MATERIALS AND METHODS: In this cross‑sectional study, data were collected through social media.
All the participants belonging to the Kashmir valley were included. EA questionnaire developed by
Weems et al. was used.
RESULTS: A total of 132 subjects were included. The prevalence of EA concerns was death 55%,
fate 62%, emptiness 73%, meaninglessness 32%, guilt 55%, and condemnation 64%. The mean EA
score was 5.0. EA was higher in those who had been diagnosed with mental illness ever in their life
by a psychiatrist than those who had no such history. EA score was much higher in those who had
ever felt a need to visit a psychiatrist than those who had not. There was no statistically significant
difference in the mean scores of EA for those who never felt this need and those who felt this need
since the start of the COVID‑19 pandemic.
CONCLUSION: There was a high prevalence of EA in the study population from the Kashmir valley.
Relative concerns were more prevalent than absolute concerns. EA score was higher among those
who had mental health issues compared to others.

Abstract BACKGROUND: Infertility is one of the main concerns in women’s lives that may lead to psychological
imbalance and disrupt their sexual relationship. The study was conducted with the aim of evaluating
role of mental health in prediction of sexual function in infertile women.
MATERIALS AND METHODS: This analytic‑descriptive study was conducted in 2015–2016 in
424 infertile women referring to Fatemeh Zahraa Infertility and Reproductive Health Center, Babol,
Iran. The participants filled out the Female Sexual Function Index (α = 0.72–0.90), General Health
Questionnaire (GHQ‑28, α = 0.86), and demographics questionnaires. Linear regression used to
analyze the data.
RESULTS: The mean of total GHQ was 23.57 ± 12.06. The highest mean of GHQ subscales was
social dysfunction (8.68 ± 3.69). There was a negative association between GHQ with the overall
sexual function of infertile women (r = −0.397, P < 0.0001). The higher mental health disorder was
associated with lower sexual function. Furthermore, there was an inverse significant association
between all the subscales of mental health and sexual function. Based on the multiple linear regression
analysis, the variables of anxiety and sleep disorder (β = −0.143, P < 0.035), social dysfunction
(β= −0.139, P < 0.003), depression symptoms (β = −0.121, P < 0.046), sexual intercourse frequency
(β = 0.272, P < 0.0001), and educational level (β = −0.110, P < 0.016) were the significant predictors
of perceived sexual dysfunction after adjusting for other variables. The strongest predictor of the
GHQ subscale was anxiety and sleep disorder.
CONCLUSIONS: Undesirable conditions of mental health and its adverse effects on sexual function
and also other predictors emphasize the need to develop more effective screening and supportive
strategies with the help of the psychologists.

Abstract BACKGROUND: To extend our knowledge of social barriers in relation to mental health, the present
study was conducted to investigate the impact of social barriers on mental health help‑seeking among
Saudi Arabians aged 18 years and above.
MATERIALS AND METHODS: This cross‑sectional study was carried out on 1632 participants in
2018 during the months of October and November. The participants completed self‑administered
online surveys about the demographic characteristics, social barriers, and knowledge and attitudes
about mental health.
RESULTS: The majority of the participants agreed that social barriers could prevent them from
seeking mental health help. Stigma was chosen as the most common social barrier among the
participants (76.3%), followed by culture (61.5%) and negative perceptions (56.2%).
CONCLUSION: Social barriers are a challenge in seeking mental health. Increasing public awareness
of available services and resources as well as developing programs to fight stigmatization should be
initiated to create more positive attitudes toward people with mental illness and promote holistic well‑being.

Abstract BACKGROUND: Internet addiction (IA) currently is the major public health concern, especially
in adolescents, although the results of previous reports are not generally uniform. This study was
conducted to determine IA in adolescents and to examine the correlation of IA with mental health
in adolescents.
METHODS: This cross‑sectional study was conducted in 2019 in Ilam city. In this study, 362 persons
were included using stratified cluster sampling; clusters were geographical area and schools. The valid
questionnaires including Internet Addiction Test and 28‑item General Health Questionnaire (GHQ‑28)
were used to interview. The correlation statistical technique was used to determine the association
between the two variables. The significance level was considered <0.05.
RESULTS: The mean ± standard deviation age of the responders was 16.40 ± 2.47 years; the total
score of IA and mental health was 43.02 ± 16.50 and 19.27 ± 9.72, respectively. We found that
5.5% of the adolescents had a severe level of IA. The lack of control with anxiety, neglect work and
social dysfunction, and neglect social life and severe depression in internet users were found to be
statistically significant: r (365) = 0.151, P < 0.033; r (365) = 0.126, P < 0.021; and r (365) = 0.125,
P < 0.033, two‑tailed, respectively.
CONCLUSION: According to the results, the excessive use of internet, lack of control, and neglect
social life are significantly correlated with mental health in adolescents; these results could be
contribute to improve the theoretical models for IA in adolescents.