1 Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran, Department of Psychiatry, Shahid Beheshti Hospital, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran

2 Department of Psychiatry, Shahid Beheshti Hospital, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran

3 Medical Informatics Research Center, Institute for Future Studies in Health, Kerman University of Medical Sciences, Kerman, Iran


BACKGROUND: Psychological disorders, such as depression and anxiety, are common among
individuals who have experienced coronavirus disease 2019 (COVID‑19); however, diagnosis may
be challenging and subjected to invalidity. This study aimed to examine agreement between online
self‑assessment and psychiatric telephone interview among COVID‑19 survivors.
MATERIALS AND METHODS: This cross‑sectional descriptive study was carried out from March
to June 2021 in Afzalipour Hospital, Kerman, Iran. The inpatients confirmed with COVID‑19 were
contacted within the first week after discharge and were asked to fill the Hospital Anxiety and
Depression scale (HADS) and socio‑demography questionnaire. They were later interviewed using
Hamilton Depression Rating Scale (HAM‑D) and Hamilton Anxiety Rating Scale (HAM‑A). Agreement
between the data extracted from self‑report and telephone interview was analyzed using Cohen’s
kappa coefficient, sensitivity, and specificity.
RESULTS: Out of 200 post‑COVID patients, 60 participants completed all assessments. Prevalence
of depression was observed to be 88% via telephone interview and 45% via self‑assessment.
Moreover, 83% of the participants were diagnosed with anxiety according to the telephone interview,
in comparison to 31% diagnosed with anxiety using self‑report questionnaire. The agreement between
online self‑assessment and telephone interview for depression and anxiety was not significant
(κ = 0.08 and κ = 0.1, respectively).
CONCLUSION: The discordance between online self‑report and clinician’s assessment via phone
contact interview indicates that using self‑report evaluations is not sufficient as the single assessment
tool for mental health monitoring and reflects the need to employ multiple assessments for diagnosis
of psychiatric problems in pandemics.


1. Organization WH. WHO Coronavirus (COVID‑19) Dashboard
United States of America: World Health Organization; 2020.
Available from:
2. Filatov A, Sharma P, Hindi F, Espinosa PS. Neurological
complications of coronavirus disease (COVID‑19):
Encephalopathy. Cureus 2020;12:e7352.
3. Mazza MG, De Lorenzo R, Conte C, Poletti S, Vai B, Bollettini I,
et al. Anxiety and depression in COVID‑19 survivors: Role
of inflammatory and clinical predictors. Brain Behav Immun
4. Haddad C, Bou Malhab S, Malaeb D, Sacre H, Saadeh D,
Mourtada V, et al. Stigma toward people with COVID‑19 among
the Lebanese population: A cross‑sectional study of correlates
and mediating effects. BMC Psychol 2021;9:1‑15.
5. Kang E, Lee SY, Kim MS, Jung H, Kim KH, Kim K‑N, et al. The
psychological burden of COVID‑19 stigma: Evaluation of the
mental health of isolated mild condition COVID‑19 patients.
J Korean Med Sci 2021;36:e33.
6. Yuan Y, Zhao Y‑J, Zhang Q‑E, Zhang L, Cheung T, Jackson T, et al.
COVID‑19‑related stigma and its sociodemographic correlates:
A comparative study. Global Health 2021;17:1‑9.
7. Pfefferbaum B, North CS. Mental health and the Covid‑19
pandemic. N Engl J Med 2020;383:510‑2.
8. Pierce M, Hope H, Ford T, Hatch S, Hotopf M, John A, et al.
Mental health before and during the COVID‑19 pandemic:
A longitudinal probability sample survey of the UK population.
Lancet Psychiatry 2020;7:883‑92.
9. Shevlin M, McBride O, Murphy J, MillerJG, Hartman TK, Levita L,
et al. Anxiety, depression, traumatic stress and COVID‑19‑related
anxiety in the UK general population during the COVID‑19
pandemic. BJPsych Open 2020;6:e125.
10. Bohmwald K, Galvez N, Ríos M, Kalergis AM. Neurologic
alterations due to respiratory virus infections. Front Cell Neurosci
11. Cuijpers P, Vogelzangs N, Twisk J, Kleiboer A, Li J, Penninx BW.
Comprehensive meta‑analysis of excess mortality in depression
in the general community versus patients with specific illnesses.
Am J Psychiatry 2014;171:453‑62.
12. Sher L. Resilience as a focus of suicide research and prevention.
Acta Psychiatr Scand 2019;140:169‑80.
13. Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S,
Greenberg N, et al. The psychological impact of quarantine
and how to reduce it: Rapid review of the evidence. Lancet2020;395:912‑20.
14. Fox S, Dinur Y. Validity of self-assessment: A field evaluation.
Personnel psychology 1988;41:581-92.
15. Althubaiti A. Information bias in health research: Definition,
pitfalls, and adjustment methods. J Multidiscip Healthc
16. Fernández‑Sanlés A, Smith D, Clayton GL, Northstone K,
Carter AR, Millard LAC, et al. Bias from questionnaire invitation
and response in COVID‑19 research: An example using ALSPAC.
Wellcome Open Res 2021;6:184.
17. Mondal H, Mondal S. Social desirability bias: A confounding
factor to consider in survey by self‑administered questionnaire.
Indian J Pharmacol 2018;50:143‑4.
18. Kaviani H, Seyfourian H, Sharifi V, Ebrahimkhani N. Reliability
and validity of anxiety and depression hospital scales (HADS):
Iranian patients with anxiety and depression disorders. Tehran
Univ Med J 2009;67:379‑85.
19. Rishi P, Rishi E, Maitray A, Agarwal A, Nair S, Gopalakrishnan S.
Hospital anxiety and depression scale assessment of 100 patients
before and after using low vision care: A prospective study in a
tertiary eye‑care setting. Indian J Ophthalmol 2017;65:1203‑8.
20. Sciences KUoM. Demography and self‑assessment questionnaire
Kerman, Iran: Kerman University of Medical Sciences; 2021.
Available from:
A9%DB%8C. [Last accessed on 2022 Jun 25].
21. Bagby RM, Ryder AG, Schuller DR, Marshall MB. The Hamilton
Depression Rating Scale: Has the gold standard become a lead
weight? Am J Psychiatry 2004;161:2163‑77.
22. Shear MK, Vander Bilt J, Rucci P, Endicott J, Lydiard B, Otto MW,
et al. Reliability and validity of a structured interview guide for
the Hamilton Anxiety Rating Scale (SIGH‐A). Depress Anxiety
23. Rogers JP, Chesney E, Oliver D, Pollak TA, McGuire P,
Fusar‑Poli P, et al. Psychiatric and neuropsychiatric presentations
associated with severe coronavirus infections: A systematic
review and meta‑analysis with comparison to the COVID‑19
pandemic. Lancet Psychiatry 2020;7:611‑27.
24. Wu Y, Xu X, Chen Z, Duan J, Hashimoto K, Yang L, et al. Nervous
system involvement after infection with COVID‑19 and other
coronaviruses. Brain Behav Immun 2020;87:18‑22.
25. Cheng SKW, Wong CW, Tsang J, Wong KC. Psychological distress
and negative appraisals in survivors of severe acute respiratory
syndrome (SARS). Psychol Med 2004;34:1187‑95.
26. Lam MH‑B, Wing Y‑K, Yu MW‑M, Leung C‑M, Ma RCW,
Kong APS, et al. Mental morbidities and chronic fatigue in severe
acute respiratory syndrome survivors: Long‑term follow‑up. Arch
Intern Med 2009;169:2142‑7.
27. Desforges M, Le Coupanec A, Dubeau P, Bourgouin A, Lajoie L,
Dubé M, et al. Human coronaviruses and other respiratory viruses:
Underestimated opportunistic pathogens of the central nervous
system? Viruses 2020;12:14.
28. Dantzer R. Neuroimmune interactions: From the brain to the
immune system and vice versa. Physiol Rev 2018;98:477‑504.
29. Netland J, Meyerholz DK, Moore S, Cassell M, Perlman S. Severe
acute respiratory syndrome coronavirus infection causes neuronal
death in the absence of encephalitis in mice transgenic for human
ACE2. J Virol 2008;82:7264‑75.
30. Özdin S, Bayrak Özdin Ş. Levels and predictors of anxiety,
depression and health anxiety during COVID‑19 pandemic in
Turkish society: The importance of gender. Int J Soc Psychiatry
31. Şahan E, Ünal SM, Kırpınar İ. Can we predict who will be more
anxious and depressed in the COVID‑19 ward? J Psychosom Res
32. Kong X, Zheng K, Tang M, Kong F, Zhou J, Diao L, et al.
Prevalence and factors associated with depression and anxiety
of hospitalized patients with COVID‑19. MedRxiv 2020:1‑12. doi:
33. Deng J, Zhou F, Hou W, Silver Z, Wong CY, Chang O, et al.
The prevalence of depression, anxiety, and sleep disturbances
in COVID‐19 patients: A meta‐analysis. Ann N Y Acad Sci
34. Yang L, Wu D, Hou Y, Wang X, Dai N, Wang G, et al. Analysis
of psychological state and clinical psychological intervention
model of patients with COVID‑19. MedRxiv 2020:1‑8. doi:
35. Lu W, Wang H, Lin Y, Li L. Psychological status of medical
workforce during the COVID‑19 pandemic: A cross‑sectional
study. Psychiatry Res 2020;288:112936.
36. Jeong H, Yim HW, Lee S‑Y, Lee HK, Potenza MN, Kwon J‑H, et al.
Discordance between self‑report and clinical diagnosis of Internet
gaming disorder in adolescents. Sci Rep 2018;8:1‑8.
37. Leikauf J, Federman AD. Comparisons of self‐reported and chart‐
identified chronic diseases in inner‐city seniors. J Am Geriatr Soc
38. Wakashima K, Asai K, Kobayashi D, Koiwa K, Kamoshida S,
Sakuraba M. The Japanese version of the Fear of COVID‑19 scale:
Reliability, validity, and relation to coping behavior. PLoS One
39. Ahorsu DK, Lin C‑Y, Imani V, Saffari M, Griffiths MD,
Pakpour AH. The fear of COVID‑19 scale: Development and
initial validation. Int J Ment Health Addict 2020:1‑9. doi: 10.1007/