RESEARCH REPORT

"MENTAL HEALTH STATUS OF THE GENERAL

POPULATION OF PAKISTAN DURING THE COVID-
19 PANDEMIC "

TEAM LEADER: Zubair Hassan Khan

STUDENT NAMES: Sidra Tul Zaitoon

Urooj Fatima
Muhammad Salim
Yusra Tahir
Zainab Imdad
Syeda Faiza Amir
Faiqa Bilquees

COURSE NAME: 4th Year M.B.B.S

DEPARTMENT: Department of CHS

SUPERVISOR: Prof Dr. Inayat H.Thaver

____________________(signature)

DATE OF SUBMISSION: 1ST AUGUST 2020

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 DECLARATION BY GROUP OF STUDENTS

In submitting this research report, we certify that we (the supervisor & Team
Leader) have read and understood the rules and regulations of CHS-BUMDC
regarding conducting this research and getting it published in JBUMDC as a first
choice. We also formally declare that all work contained within this document is
the group work headed by the team leader (signed on behalf of the group) apart
from properly referenced quotations.

The students do understand that plagiarism is the use or presentation of any

work by others, whether published or not, and can include the work of other
candidates. The students also understand that any quotation from the published
or unpublished works of other persons, including other candidates, must be
clearly identified as such by being placed inside quotation marks and a full
reference to their source must be provided in proper form.

This research reports the result of an independent investigation by the group and
where our work is indebted to others, we have made acknowledgments.

The students also declare that this work has not been accepted in substance for any other
research report, nor is it currently being submitted in candidature for any other purposes.

__________________________________

Prof Dr. Inayat H.Thaver Zubair Hassan Khan

Designation, Team leader
Supervisor Group #1

Department of Community Health Sciences

BUMDC

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ACKNOWLEDGMENTS:

‘‘We dedicate our research work to the department of Community Health Sciences who
provided us the platform to carry out our study. We thank our Community Health
Sciences Head of department and our dedicated supervisor Dr. Inayat Thaver who had
been supportive throughout the course of our research work.”

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TABLE OF CONTENTS

Abstract

1-INTRODUCTION

2-RESEARCH QUESTIONS

3-OBJECTIVES

4-MATERIAL AND METHODS

5-RESULTS

6-DISCUSSION AND CONCLUSION

7-RECOMMENDATIONS

8- REFERENCES

Appendix: Consent form and Questionnaire

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TITLE: "Mental health status of the general population of Pakistan
during the Covid-19 pandemic "

Abstract:
The COVID-19, has gained intense attention nationwide and globally, infecting 17,271,888
people and causing 671,821 deaths in 213 countries by 30th July, 2020, out of which 277,402
cases and 5,924 deaths have been reported in Pakistan. There is a risk of vast economic loss,
plus a lock-down situation worldwide leading to high psychological risk. No specific cure or
vaccine is yet available. Only preventive measures are being adopted worldwide. Enhanced
surveillance and further investigation are ongoing. This is a descriptive cross-sectional study
having self-administered online questionnaire. Objectives of this study were to assess the
awareness in people as regards the disease and how to protect oneself from this ongoing
pandemic, Determine the anxiety levels and depression levels in the Pakistani population during
the “stay-home” approach and Find out the coping mechanism being practiced.
The sample size was 384 having an assumed prevalence of 50%, Confidence Interval as 95%,
and a precision of 5%.Informed consent was taken from respondents, and standard
psychological scales GAD7, PHQ9, ACQ were used to assess the mental health status . In the
present study, 29.2% of the respondents had depression (PHQ-9 score ≥10) and 18.2% had
anxiety (GAD score ≥10). The prevalence of depression was much higher than that reported in
previous studies. According to our ACQ scale we generated we found out 332 (86.4%) were
able to cope anxiety and the 52 respondents (13.4%) left were not able to cope. Psychological
support, such as brief, home-based psychological interventions, should be provided to citizens
during the pandemic.
Keywords: COVID-19, Anxiety, Depression. Mental Health, Pakistan

1-INTRODUCTION:
The 2019 novel coronavirus (2019-nCoV) pneumonia, believed to have originated in a wet
market in Wuhan, Hubei province, China at the end of 2019, has gained intense attention
nationwide and globally. This outbreak that began in china has turned into a pandemic, infecting
17,271,888 people and causing 671,821 deaths in 213 countries by 30th July, 2020 according to
worldometers.info , out of which 277,402 cases and 5,924 deaths and 246,131 recovered, have
been reported in Pakistan according to covid19.gov.pk. There is a risk of vast economic loss,
plus a lock-down situation worldwide leading to high psychological risk.
Coronaviruses are a large family of viruses that are known to cause illness ranging from the
common cold to more severe diseases such as Middle East Respiratory Syndrome (MERS) and
Severe Acute Respiratory Syndrome (SARS). The disease spreads through respiratory droplets
and the reported illnesses have ranged from mild symptoms to severe. These symptoms may
appear 2-14 days after exposure (based on the incubation period of MERS-CoV viruses) and
includes fever, cough and shortness of breath and can proceed to pneumonia according to
www.cdc.gov. Based on currently available information and clinical expertise, older adults and
people of any age who have serious underlying medical conditions might be at higher risk for
severe illness from COVID-19. Diagnosis is PCR, and no specific cure or vaccine is yet
available. Only preventive measures are being adopted worldwide, which include frequent hand
washing with soap, covering your nose with tissue or flexed elbow when cough or sneeze, use

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of surgical masks and social distancing. Enhanced surveillance and further investigation are
ongoing. [2]
The proposed study aims to assess the protective/preventive measure being taken by the
representative population, including their mental health status. An outbreak of a global
pandemic causes fear and concern among many and reportedly influence the cognitive well-
being of every individual. Fear, worry, and stress are normal responses to perceived or real
threats, and at times when we are faced with uncertainty or the unknown. So it is normal and
understandable that people are experiencing fear in the context of the COVID-19 pandemic.
There is a neuropsychiatric linkage between the outbreak of acute respiratory infections and
mental disorders which date back to the prevalence of influenza and severe acute respiratory
syndrome (SARS) that took place years ago. The people who are in quarantine areas may
experience boredom, anger, and loneliness; the symptoms of the viral infection such as cough
and fever may also cause worsening cognitive distress and anxiety among people due to the
fear of contracting the COVID-19. During the early phase of the manifestation of SARS, several
psychiatric comorbidities such as depression, panic attack, anxiety, psychomotor excitement,
suicidality, delirium, and psychotic symptoms were reported. [1]
The significant changes to our daily lives as our movements are restricted in support of efforts to
contain and slow down the spread of the virus. Faced with new realities of working from home,
temporary unemployment, home-schooling of children, and lack of physical contact with other
family members, friends and colleagues, it is important that we look after our mental, as well as
our physical, health. This research which we conducted basically was done to see how many
people have anxiety or depression during this stay-home period and how many were able to
cope up or not. How many people are known about protective measures or not and how to
protect oneself on their own.
The pandemic of Corona Virus (COVID-19) hit India recently; and the associated uncertainty is
increasingly testing psychological resilience of the masses. When the global focus has mostly
been on testing, finding a cure and preventing transmission; people are going through a myriad
of psychological problems in adjusting to the current lifestyles and fear of the disease. From
26th to 29th March an online survey (FEEL-COVID) was conducted using principles of
snowballing, and by invitation through text messages to participate. The survey collected data
on socio-demographic and clinical variables related to COVID-19 (based on the current
knowledge); along with measuring psychological impact with the help of Impact of Event–
revised (IES-R) scale.  The mean age of the respondents was around 41 years with a male
female ratio of 3:1 and around 22% respondents were health care professionals. Overall
approximately one third of respondents had significant psychological impact (IES-R score > 24).
Higher psychological impact was predicted with younger age, female gender and comorbid
physical illness. Presence of physical symptoms and contact history predicted higher
psychological impact, but did not reach statistical significance. [3]
 A study from China suggesting that more than half of the participants had a significant
psychological impact of the COVID-19 pandemic. Another recent study from Denmark reported
psychological well-being as negatively affected. In the United States nearly half were found to
be anxious as per the survey conducted by the American Psychiatric Association. [4] [5]The
same has not been studied in Indian population systematically; except anecdotal discussions
and case reports. [6]

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The intervention measures that are employed by various health authorities and government
bodies in combating the infection may help in eliminating the threat during the time of
uncertainty; however, the multivariate studies done on the previous outbreaks show that they
have long-term cognitive and mental health effects on the population. It is vital to emphasize the
mental health well-being of the population and take proactive steps to minimize its detrimental
effects during the COVID-19 pandemic. [Ref:4]
RATIONALE OF STUDY:
The general emphasis through social media is how to avoid physical diseases and keep oneself
protected. However, the definition of health also includes the social, mental, and spiritual
wellbeing. This study will explore some of these dimensions so that newer and correct
messages may be produced to ensure the complete well-being of the population during this
pandemic.

2-Research Hypothesis:
People will generally have a high level of anxiety and depression due to this pandemic and
lockdown situation all across the country. General population will not be able to cope anxiety
well during this pandemic.

3-OBJECTIVES:
The objectives of this study are to:
 Assess the awareness in people as regards the disease and how to protect oneself
from this ongoing pandemic.
 Determine the anxiety levels and depression levels in the Pakistani population during
the “stay-home” approach for this COVID-19 pandemic.
 Find out the coping mechanism being practiced for maintaining the overall health of
family during stay-home/self-distancing recommendations

4-MATERIAL AND METHODS:

A)STUDY DESIGN: A Descriptive cross-sectional study.

B)SETTING: Research work was conducted mainly through online questionnaires owing to the
existing limitations. Survey done on website of www.surveylegend.com.

C)DURATION OF STUDY: 1st April 2020 to 30th July 2020.

D)SAMPLE SIZE: sample size was 384 and was calculated based on Epi-info
calculations, having an assumed prevalence of 50%, confidence interval as 95% and
precision of 5%. A total of 538 responses were generated out of which 154 forms were
discarded on the basis of incomplete answers. [Evidence attached in appendix]

SAMPLING TECHNIQUE: Since, this was an online survey, randomization was not possible.

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However different strata (groups) as well as places (cities) were included to invite the
respondents.

SAMPLE SELECTION:
 Inclusion criteria: Adult participants over the age of 18 years. Can atleast understand
English or Urdu.
 Exclusion criteria: less than 18-year old.

Study Variables: The independent variables in our research were anxiety, depression
and ability to cope anxiety. According to our research, dependent variables for anxiety
were gender and age group. Similarly, for depression gender, age group, education,
marital status and people had experienced problem before were dependent variables.
Lastly, gender, occupation and education were dependent variable for ability to cope.

E)DATA COLLECTION PROCEDURE:

Study population was contacted through various contacts in social media and was requested to
join the survey. The questionnaire was made on survey legend. After agreeing to be part of this
study, they filled the data by themselves by just clicking appropriate boxes. Minimum time was
taken to complete this survey to avoid any incomplete responses.

F)DATA ANALYSIS PROCEDURE: The data was coded and entered into spreadsheets and
analysed with the help of IBM SPSS software version 26. Data frequencies were used to
analyse descriptive statistics, including the usage of chi square for further statistical analysis. No
out of range values were found. Bar charts were designed based on frequencies generated. Our
questionnaire consisted of 40 questions. Out of which 7 questions were related to anxiety, we
score those 7 questions using GAD 7 Scoring and Scale. After getting our GAD 7 scores, we
calculated 9 questions on depression using PHQ9 scale. Then to check if people were able
cope with it, we used Anxiety Control Questionnaire(ACQ).It consists of 30 questions but we
took only 11 questions in our research questionnaire. Then we calculated Cronbach’s alpha.
Our score was 0.6, Value of 0.6 indicated it was poor but acceptable. Then we subtracted
mean(i.e 31.5990) from standard deviation(i.e 7.014239) which comes out to be 24.45661.The
people above the value(24.45661) were considered those who were able to cope up with
anxiety and people below them were regarded as those who were not able to cope up with it.

G)ETHICAL CONSIDERATION:
 Research was conducted once approved by the ERC of BUMDC
 No deception was employed.
 Information was only taken after the consent form had been filled by the participants
[Attached Consent Form as Appendix]
 The information provided will be kept highly confidential

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5-RESULTS:

GENERAL CHARACTERISITICS OF THE PARTICIPANTS

A total of 538 responses were generated out of which 154 forms were discarded on the basis of
incomplete answers. So we got our 384 valid responses. Of these 384 respondents, 132 were
male and 252 were female (i.e. 34.4% and 65.6% respectively.) Most of these individuals were
under the age of 25 years (76%). More than half of the participant were socioeconomically
advantaged, belonging to upper class (38.8%) and middle class (57.6%) and very few i.e. 14 out
of 384 participants (3.6%) belonged to lower class. The literacy rate among the participants was
great, 62.2% of these participants were undergraduates, 23.4% were postgraduates and 14.3%
had attended college or bellow. Geographically, the diversity is insubstantial as about 74%
participants belonged to Sindh, 16.9% participants belonged to Punjab and a minority of only
9.1% participants belonged to other areas of Pakistan. Majority of the respondents were married
(76.3%) and unemployed (70.3%). The summary of the participants’ characteristic is given in
the table 1. table 1
Table 1

Variables frequency Valid Percent

Gender
Male 132 34.4
female 252 65.6
Age
Under 25 years 292 76.0
25-45 years 69 18.0
45 years and beyond 23 6.0
Socio-economic status
Upper class 149 38.8
Middle class 221 57.6
Lower class 14 3.6

Education
College and bellow 55 14.3
Undergraduate 239 62.2
Post graduate and beyond 90 23.4
Occupation
Unemployed 270 70.3
Employed 114 29.7
Marital status
Single 89 23.2
Married 293 76.3
Missing 2 0.5
Province
Sindh 284 74.0
Punjab 65 16.9
others 35 9.1

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KNOWLEDGE AND AWARENESS AMONG PEOPLE REGARDING COVID-19
Our first objective was to assess the knowledge and awareness among people so according to
question number 8 which is a close ended question asked in the questionnaire, around 97.9%
participants were aware of the ongoing Covid-19 pandemic whereas 0.5% (i.e. only 2 of the 384
respondents) marked “no” showing unawareness and 6 of 384 participants (1.6%) responded
with not sure option, this indicates that the majority of the people had adequate knowledge of
the pandemic. The extent of their knowledge was evaluated in question 8a, which is a nominal
question, allowing respondents to choose multiple options, the answers are summarized in table
2 below.
Table 2
Responses Percent of
Yes Percent Cases
Knowledge and It is caused by a virus 150 15.1% 44.2%
awareness a previously not known
Anyone who contacts 91 9.2% 26.8%
will always get
complications
Taking 87 8.8% 25.7%
medicines/vaccines
which are currently
available can be helpful
Yes, it is a disease, but 54 5.4% 15.9%
seems to be more of a
scam
People have been 66 6.6% 19.5%
unnecessarily alarmed
by the media
Remaining at home is 281 28.3% 82.9%
the best solution
It spreads through 265 26.7% 78.2%
human to human contact
Total 994 100.0% 293.2%
a. Dichotomy group tabulated at value 1(yes)
According to table 1.1, 150(15.1%) respondents think it is caused by a virus previously
unknown, 265 (26.7%) people agreed that it spreads through human contact and 91(9.2%)
respondents were of the idea that the virus causes complication in anyone who contracts it and
about 54(5.4%) respondents think of it as a scam. Nevertheless, a vast majority of the
respondents, 281(28.3%), agrees that social distancing is the best solution to avoid contracting
this virus.
ROLE OF MEDIA IN THE CURRENT SITUATION

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According to table 1.1, 66 (6.6%) participants support the idea that media is falsely alarming the
public. This is further elaborated by table 1a which concludes the response to questions
regarding media’s role in the current situation. Shown in Figure 1 below
figure1

This indicates that majority of the respondents were neutral on the subject but negative still
predominates the positive as 31.8% respondents think the role media is playing is negative and
only 15.1% participants think they are playing a positive role.
Anxiety and Depression levels using GAD7 and PHQ9 Scale:
To evaluate the level of anxiety in individuals due to covid19, we used GAD7 scale
according to which, after facing the pandemic only 58.3% respondents had no anxiety
while 41.7% respondents had either mild (27.6%), moderate (9.9%), or severe anxiety
(4.2%). While 18.2% respondents had GAD score ≥10..see figure 2
Figure 2

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Multiple logistics regression models controlling for gender , age , socioeconomic status,
education , occupation, province, marital status and social media influence revealed
that Females were more likely to have anxiety than males(p value for gender =0.019 )
and Young adults were more likely to have anxiety than adults and old ( p value for age
= 0.04 ). Rest of the variables showed no significant P-values. Shown in table 3

Table 3 Anxiety levels Total

no moderate severe
anxiety mild anxiety anxiety anxiety P-value
Gender Male 90 28 9 5 132
female 134 78 29 11 252
Total 224 106 38 16 384 0.019
Age groups Young adults (25 165 84 29 14 292
and under)
Adults (26-45) 40 18 9 2 69
Old (45 and 19 4 0 0 23
above)
Total 224 106 38 16 384 0.043
Socioeconomic upper class 84 47 11 7 149
status middle class 132 56 26 7 221
lower class 8 3 1 2 14
Total 224 106 38 16 384 0.835
Education college and below 33 13 8 1 55

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 undergraduate 131 72 22 14 239
postgraduate and 60 21 8 1 90
above
Total 224 106 38 16 384 0.190
Occupation Un-Employed 154 76 29 11 270
Employed 70 30 9 5 114
Total 224 106 38 16 384 0.478
Marital status Single 55 23 10 1 89
Married 168 82 28 15 293
Total 223 105 38 16 382 0.289
Have you ever Yes 89 52 16 7 164
had anxiety or No 135 54 22 9 220
depression
Total 224 106 38 16 384 0.401
kind of role of negative 69 34 15 4 122
digital and social neutral 123 53 17 11 204
media is playing Positive 32 19 6 1 58
in this situation?
Total 224 106 38 16 384 0.735

To evaluate the level of depression in individuals due to covid19, we used PHQ9 scale
according to which, after facing the pandemic only 41.4% respondents had no
depression rest 58.6% had either mild (29.4%), moderate (14.6%), moderately severe
(10.2%) or severe depression (4.4%). while 29.2% respondents had PHQ9 score ≥ 10.
See figure 3.
figure 3

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 Multiple logistics regression models controlling for gender , age , socioeconomic status,
education , occupation, province, marital status , social media influence and previously
diagnosed cases revealed that Females were more likely to have depression than
males(p value= 0.003), Young adults were more likely to have depression than adults
and old ( p value =0.00) , Married people were more likely to have depression than
single( p value = 0.029). Rest of the variables showed no significant P-values. Shown in
table 4.

Table 4 Depression levels Total

moderately

no mild moderate severe severe

depression depression depression depression depression P-Value

Gender Male 68 33 20 8 3 132

female 91 80 36 31 14 252

Total 159 113 56 39 17 384 0.003

Age groups Young adults 108 90 46 31 17 292

(25 and under)

Adults (26 -45) 33 20 8 8 0 69

Old (45 and 18 3 2 0 0 23

above)

Total 159 113 56 39 17 384 0.00001

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Socioeconomic status upper class 54 51 17 18 9 149

middle class 100 59 37 19 6 221

lower class 5 3 2 2 2 14

Total 159 113 56 39 17 384 0.433

Education college and 27 14 9 4 1 55

below

undergraduate 83 73 42 27 14 239

postgraduate 49 26 5 8 2 90

and above

Total 159 113 56 39 17 384 0.212

Occupation Un-Employed 104 82 44 25 15 270

Employed 55 31 12 14 2 114
Total 159 113 56 39 17 384 0.110
Marital status Single 48 20 9 12 0 89
Married 110 93 46 27 17 293
Total 158 113 55 39 17 382 0.029
kind of role of digital negative 52 36 18 13 3 122

and social media is neutral 82 62 28 21 11 204

playing in this Positive 25 15 10 5 3 58
situation?

Total 159 113 56 39 17 384 0.630

Have you ever had Yes 58 60 19 18 9 164

anxiety or depression No 101 53 37 21 8 220

Total 159 113 56 39 17 384 0.037

ABLE TO COPE ANXIETY:

Our third objective was to find out the coping mechanism being practiced and how many people
were able to cope up anxiety. According to our ACQ scale we generated we found out among
384 people 332 (86.4%) were able to cope anxiety and the 52 (13.4%) left were not able to
cope. Hence it showed most of the people were able to cope up anxiety. According to our
research we found out gender affected the ability to cope up anxiety as it showed a p-value of
0.001 and showed out of 252 women 207 (82.1%) were able to cope their anxiety and the rest
of 45 (18%) were not able to cope anxiety.
For males out of 132 responses 125 (95%) were able to cope anxiety and the rest of 7 (5%)
were not able to cope. This showed male were more able to cope anxiety than females.
On the basis of education, we also found a link as chi square test indicated a P-value of 0.03
and showed out of 384 participants 55 were college and below 46 were able to cope anxiety
and rest of 9 were not able to cope anxiety, 239 were undergraduates out of which 201 were
able to cope rest of 38 were unable to cope anxiety and 90 people were postgraduates and
above out of 90 people 85 were able to cope but 5 were not able to cope.
On the basis of occupation, we also found a link as chi square test indicated a P-value of 0.006
and showed out of 270 un-employed people 225 (83.3%) were able to cope rest of 45 (17.6%)

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were not able to cope anxiety. For employed-ones out of 114 people 107 (94%) were able to
cope anxiety rest of 7 (6%) were not able to cope. This showed that unemployed people had
more likelihood of not being able to cope anxiety.
The rest of variables like age group, marital status, socioeconomic status, province they are
living in showed no significant p value i.e less than 0,05 hence not showed no association to the
ability to cope anxiety

COPING METHODS USED:

Furthermore we also found out coping mechanism acquired by the people to cope their anxiety,
we also analyzed if they have faced anxiety /depression related problems in the past and how
they deal with that, below are the activities in which they got engaged for coping their anxiety.
Summarized in table 5
Table 5
Anxiety levels Total
no mild moderate severe
anxiety anxiety anxiety anxiety
how are Spend time with Count 138 74 25 11 248
people coping immediate family % within 55.6% 29.8% 10.1% 4.4%
anxiety at home
Spend time by Count 21 22 4 3 50
meeting the % within 42.0% 44.0% 8.0% 6.0%
friends
Listen to music Count 67 40 11 7 125
% within 53.6% 32.0% 8.8% 5.6%
Pray to God Count 149 70 27 9 255
% within 58.4% 27.5% 10.6% 3.5%
Playing games Count 67 42 13 6 128
% within 52.3% 32.8% 10.2% 4.7%
Watch TV/ movies Count 96 52 21 10 179
% within 53.6% 29.1% 11.7% 5.6%
Use of socail Count 117 68 25 8 218
media % within 53.7% 31.2% 11.5% 3.7%
Total Count 174 94 33 13 314
Percentages and totals are based on respondents.

The table showed that majority of the people who used 1or more these methods were unlikely to
develop anxiety and were able to cope well.

6-DISCUSSIONS & CONCLUSION:

To the best of our knowledge, this is the first population study to evaluate the depression and
anxiety of people in Pakistan during the COVID-19 pandemic. The study provides important and

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timely data about the impact of COVID-19 on individuals’ mental health. In the present study,
29.2% of the respondents had depression (PHQ-9 score ≥10) and 18.2% had anxiety (GAD
score ≥10). The prevalence of depression was much higher than that reported in previous
studies [7]. For example, a meta-analysis that evaluated the aggregate prevalence of
depression in communities from multiple countries between 1994 and 2014 reported that the
lifetime prevalence of depression was 10.8%. [7].Besides, our findings are also consistent with
previous studies which found that exposing public health emergency [8] such as Ebola outbreak
[9], earthquakes [10], and SARS [11]can cause mental health issues.
Our study investigated anxiety levels in relation to Age, Gender, Marital status , socioeconomic
status and in different provinces. Overall, among the 384 respondents ,78.6% had significant
(mild / moderate /severe) psychological impact regarding COVID-19.Similar to studies in one
paper which revealed lower psychological well-being (WHO-5) compared to before COVID-19.
[12]
When assessed at different Age groups categorized as young adults ( <25 ), adults (26-40),
old(>45) it was found that high frequency of anxiety was present in age group between 25 and
below , while lowest frequency of anxiety was found among older (45 and above) and all the
levels of anxiety was found among young age group who were more prone to mild anxiety, it
was also found that people of all age groups were able to cope up with their anxiety.
According to gender 63.8% females had anxiety while only 48.4% males had anxiety signifying
a higher probability of females being impacted by the current pandemic. Furthermore Severe
anxiety was also most common in females than in males. is also corresponds to previously
available extensive epidemiological literature which shows that women are at a higher risk. The
impact on females was found to be statistically significant. These findings were similar in the
Chinese community where females suffered a greater psychological impact of due to the
coronavirus outbreak. [13]
For evaluation of anxiety levels amongst different socioeconomic groups, participants were
divided into three groups upper class, middle class and lower class.it was found that the most
effected group was middle class who experienced mild anxiety at a greater frequency . Lower
class was least affected,
Anxiety levels and frequency were also assessed between employed and unemployed
participant, high frequency of anxiety was found among un-employed group of mild level and
most of the people were able to cope up with anxiety both from employed and un-employed
group.
Different levels of anxiety and frequency were evaluated among married and un-married, and it
was concluded that married people were the most affected ones i.e 64% with mild anxiety
levels while only 62.4,% singles faced anxiety ,nevertheless both groups were able to cope up
with their anxiety.
For the assessment of anxiety according literacy level, we made three groups college and
below, undergraduate and postgraduate. It was found that high percentage of anxiety was
present among undergraduate students. This can be aligned with this study which suggested
College students' anxiety about COVID-19 might have been related to the effect of the virus on
their studies and future employment (C. Wang et al., 2020)[14] . On the other hand, the
students' anxiety may have been caused by the gradually increasing distances between people

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resulting from the quarantine. It is known if anxiety disorders are more likely to occur and
worsen in the absence of interpersonal communication.
These findings were different from the study conducted in china by Wang et al which reported
53.8% of respondents suffered a psychological impact from the outbreak, ranging from
moderate to severe among 1210 respondents. [13]Since these findings were during the early
phase of COVID-19 outbreak in the country, chances are they could have changed over time
and hence, should be interpreted accordingly. In the past, during outbreaks such as ‘Ebola
Virus’, individual and community at national and international had a major and wide spectrum of
psychosocial impacts due to the sudden outbreak of the disease. It is likely that people are
relating contracting the virus with a fear of falling sick, helplessness, hopelessness, stigma and
even death.[17]
Another important aspect of our study looked at individuals experiencing anxiety, whether they
were able to cope up with their psychological state or not, and which coping mechanisms they
resorted to. According to our research 86.4% of population was able to overcome their anxiety,
out of which we found out that men were more resilient than women and it included 95% men
while only 82.1% women. This also corresponds to previously available extensive
epidemiological literature which shows that women are at a higher risk. [16]
This study revealed that majority of the people (66.4%) turned to prayer to God . In the absence
of a vaccine and no known cure for COVID19, it is expected that people will easily turn to
a higher power than themselves as a way of finding hope in a seemingly hopeless situation
as coping mechanism during the lockdown. these findings are confirmed by results from
Italy, which is also predominantly Catholic, where Piana and Bordoni (2020) [19] observed
that a lot of people had started online prayer groups that came together at a particular time to
pray for the country and the world at large and that Catholic nuns prayed for the sick at the
hospitals, shared inspirational bible verses and prayed the rosary for people.
Another finding was that 64.5% people coped up with their anxiety by spending time with their
family giving them a rare opportunity to bond together which they could not previously do due to
their hectic work and school schedules. Which can be supported by another study done in
England by Shepka P., and England R, (2020)[18].
It was also found that 56.8% population resorted to social media such as WhatsApp groups to
maintain contact with family and friends and enhance social relationships in the absence of
physical contact , Huang (2020)[20] also observed the same result in Wuhan where a lot of
expatriates were constantly worried about their loved ones as they could not be with them. With
the assistance of the Social Work Service Center in Nanning, Guangxi together with
volunteers they started an online support group which helped disseminate information on
COVID 19 as well as to provide emotional support to those that needed it. 45.3% spent time
playing games giving them an opportunity to connect with friends and get their minds off of the
frightful situation. Others 47.7% indulged in watching movies/tv and catching up on their favorite
shows. While others listened to music. This is supported by Nasim (2015)[21] who also asserts
that the psychological benefits of music can be powerful and wide ranging and include but
not limited to, relieving stress and anxiety that could be caused by the lockdown. This was
supported by Liao (2020[22] Yau (2020) [23]who found out that in China people used the down
time to bond through playing a lot of online games, watching television, listening to music as
well as self-reflection. Results of the study showed that, 11 (27.5%), of the respondents used

18 | P a g e
social media platforms such as WhatsApp, twitter, zoom to stay connected to their family and
friends during the lockdown.
Providing psychological first-aid & counselling are quintessential during an epidemic. It helps in
reducing the psychological distress and promoting adaptive coping strategies to deal with the
situation[24] .Despite the efforts of WHO and other public health authorities to contain the
COVID-19 outbreak, this time of crisis is generating stress throughout the country , much alike
its impact on the global counterparts. Constant support for mental and psychosocial well-being
in different groups during the outbreak should be of highest priority.[32]
It concluded that before the pandemic, 57.3% respondents had never faced any form of anxiety
or depression as opposed to the rest of 42.7% participants who previously had one of the two.
To evaluate the level of depression in individuals due to covid19, we used PHQ9 scale
according to which, after facing the pandemic only 41.4% respondents were free of depression
while 29.2% respondents had PHQ9 score ≥ 10 and had either mild (29.4%), moderate (14.6%),
moderately severe (10.2%) or severe depression (4.4%). The rise in depression amongst
individuals after covid19 clearly indicates its role in influencing mental health. It is worth noting
that the prevalence of depression in Pakistan is far more than that reported in studies from other
countries, for example a study evaluating depression and anxiety of the people of Hong Kong
during covid19 reported that only 19% of their respondents had depressions (PHQ score ≥ 10)
which is far less than this study[25] Moreover, the incidence of depression in the present case is
more than that reported in the healthcare workers of Wuhan, China which is the city of origin of
the pandemic in question. According to a study the aimed at assessing the immediate
psychological effects of covid19 in health workers at Tongi Hospital in Wuhan China, 24.1%
respondents reported symptoms of stress, anxiety or depression. [26] which is far less than that
reported in this study suggesting that the pandemic has substantially affected the mental health
of the people of Pakistan which is alarmingly deteriorating.
The role of media is also biased as the spread of knowledge and awareness amongst people by
social and digital media is accompanied by the constant updates of reported cases and people
that are critical or passed away due to covid19 which can play a vitally negative role in inducing
depression in people, but according to our study, 122 of the 384 respondents who had
depression said that media was playing a negative role however, the p value was calculated to
be 0.630 (i.e. > 0.050) which means its insignificant and does not play a mentionable role in our
respondents, this finding is consistent with another study that was conducted to assess the role
of social media and networking in mental health issues which concluded that no evidence of a
negative link was found between the two. [27]
According to the present study, 252 out 384 respondents were female, out of which, 161 had
some form of depression i.e. 68.3% females and 48.4% males had depression which signifies
female predominance which could be due to a number of factors, according to a study
conducted in Canada that questions why depression is more prevalent in females than males
and states females had 1.6 folds greater incidence of depression than males in 2012 [28],
hormonal changes in females, particularly during puberty, prior to menstruation, following
pregnancy and at perimenopause, suggests that female hormonal fluctuations may be a trigger
for depression. [29] however there is no conclusive evidence hence no women specific
medication. Age and marital status also showed a chi-square value of 0.00 and 0.29
respectively thus being significant, according to our study, depression was more than thrice as

19 | P a g e
prevalent in young males and females (25 years and less) than older respondents also, a
decline in the rate of depression is seen in older respondents, according to a study that sheds
light on recent increase in depressive symptoms among US adolescents from 1991 to 2018 [30]
Depressive symptoms were increasing among teens, especially among girls, consistent with
increases in depression and suicide. Similarly, incidence of depression was greater in married
people (62.4%) this relation was also reported by Choi and Marks [31] who suggested that
marital conflict is direct factor that increases depression among married individuals.

Limitations
There are some limitations that need to be addressed while analyzing the study results. Firstly,
heterogeneity of the studies as well as the methodological appraisal and the probably reduced
no of studies (due to recent covid-19 breakout) which may influence the external validity.
Secondly, the inherent design selected involved the usage of smartphones, having access to
internet, having email IDS, and the ability to speak English and Urdu; indirectly created a bias in
automatically selecting the educated population of the country, therefore it should not be
generalized to the entire population. Moreover, the respondents were mainly from Sindh and
this made a bias as rest of the provinces were not included in the study affecting the study
credibility. The awareness, attitude, anxiety and perceived mental healthcare need in
uneducated people might differ from our study results. Moreover, our study exclusively
assessed population beyond 18 years of age hence it lacks the emotional impact of covid-19 on
children and adolescents as well as on those already affected by covid-19. Third are the major
concerns of social desirability while responding to questions on mental health issues. Lastly, the
study was conducted during a period of lockdown, which can have its own psychological impact
and this confounder could not be addressed through the questionnaire used in the study. These
issues could have caused under or over reporting in the rate of psychological impact found in
the study.

Conclusion:
Twenty-nine per cent of the respondents had depression and eighteen per cent had anxiety
during the COVID-19 pandemic. Our findings suggested that COVID-19 has substantially
affected individuals’ mental health. Women, young adults, unemployed and married people had
a higher rate of mental health deuteriation. One key policy implication of the present study is
that governments should provide psychological support to citizens during this pandemic. For
example, brief, home-based psychological interventions should be developed to diminish the
adverse impacts of COVID-19 on mental health in Pakistan.

7-RECOMMENDATIONS:
The aim of this study was to collect data from general population but as this is conducted online
due to pandemic so it can only include educated people, so for future household survey should
be conducted so that it can justify its title of including general population in a true sense. Along
with it, if household survey would be conducted in future, then it can include population of
underprivileged areas. There were many rumors regarding the COVID-19 in the initial period of
pandemic that it is "scam" , and many other like that also created a sort of panic and fear in
people which not only create but also exacerbates mental health of the individual . So, proper
webinar should be delivered by the government for students telling about the facts through

20 | P a g e
which Corona can transfer. Likewise, government should also play role in creating awareness
about this virus to every single individual which will eventually minimize the panic situation
spreading through rumors. We did not mention about whether they are already taking
medications regarding anxiety or depression. Moreover, our study lacks about consulting help
from mental health care professionals after noticing the change in their behavior and effect on
the their daily activities. Amount of time spent on internet usage should also be assessed which
our study lacks, as different pictures and videos circulated via different social media platform
regarding this COVID-19 pandemic greatly influences the mind of people contributing to mental
health issues. These rumors especially affect younger age group which will eventually intensify
their feelings of anxiety and depression Similarly, the duration of watching television should also
be enquired as media constantly reports about the rapidly increasing number of new cases and
mortality rate that also affects mind of individuals especially old age population. Our study report
does not have any findings regarding whether any of the family member or the close one was
infected by this virus because having someone in family or relative suffering from COVID will
also have an impact on the mental health of other family members. Therefore, questions
regarding this assessment should be mentioned in the study.

Conflicts of Interest
There was no conflict of interest.

21 | P a g e
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24 | P a g e
APPENDIX

1. Research questionnaire

2. Consent form

3. Sample size calculation

4. Ethical clearance

1-QUESTIONNAIRE (ENGLISH):
1-What is your Gender?
O Female
O Male
O Shemale

2-What is your Age?

Please specify

3-How will you classify as regards to socio-economic status?

O Upper class
O Upper Middle class
O Middle class
O Lower Middle class
O Lower class
4-What is your current Education?
O Less than high school
O Matriculation/O'Levels
O Intermediate/A'Levels
O Undergraduate
O Postgraduate
O Doctorate
O Post Doctorate

5-What is your current Occupation?

O Unemployed
O Professional/Technical/Managerial
O Clerical
O Sales and services
O Skilled manual
O Unskilled manual
O Domestic service
O Agricultural
Other: Please specify

6-Relationship status *
O Single

25 | P a g e
O Engaged/ in relationship
O Married
O Separated
O Divorced
O Widow/widower

7-What province do you live in

O Punjab
O Sindh
O KPK
O Balochistan
O Gilgit/ Baltistan
O Azad Jammu Kashmir
O FATA

8-Are you aware of the coronavirus pandemic?

O Yes
O No
O Not sure
8-A. If yes, what do you know? You can tick as many you wish
O Not applicable
O It is caused by a virus previously not known
O Anyone who contracts will always get complications
O Taking medicines/vaccines which are currently available can be helpful
O Yes, it is a disease, but seems to be more of a scam
O People have been unnecessarily alarmed by the media
O Remaining at home is the best solution
O It spreads through human to human contact
Other:

Over the last 2 weeks, how often have you been bothered by any of the following
problems?
10-Feeling nervous, anxious, or on edge
O Not at all
O Several days
O More than half the days
O Nearly every day

11- Not being able to stop or control worrying

O Not at all
O Several days
O More than half the days
O Nearly every day

12- Worrying too much about different things

O Not at all
O Several days
O More than half the days
O Nearly every day

13- Trouble relaxing

O Not at all
O Several days

26 | P a g e
O More than half the days
O Nearly every day

14- Being so restless that it's hard to sit still

O Not at all
O Several days
O More than half the days
O Nearly every day

15- Becoming easily annoyed or irritable

O Not at all
O Several days
O More than half the days
O Nearly every day

16- Feeling afraid as if something awful might happen

O Not at all
O Several days
O More than half the days
O Nearly every day

17-Little interest or pleasure in doing things

O Not at all
O Several days
O More than half the days
O Nearly every day

18-Feeling down, depressed, or hopeless

O Not at all
O Several days
O More than half the days
O Nearly every day

19-Trouble falling or staying asleep, or sleeping too much

O Not at all
O Several days
O More than half the days
O Nearly every day

20-Feeling tired or having little energy

O Not at all
O Several days
O More than half the days
O Nearly every day

21-Poor appetite or overeating

O Not at all
O Several days
O More than half the days
O Nearly every day

22-Feeling bad about yourself, or that you are a failure, or have let yourself or your family
down
O Not at all
O Several days

27 | P a g e
O More than half the days
O Nearly every day

23-Trouble concentrating on things, such as reading the newspaper or watching television

O Not at all
O Several days
O More than half the days
O Nearly every day

24-Moving or speaking so slowly that other people could have noticed. Or the opposite—
being so fidgety or restless that you have been moving around a lot more than usual
O Not at all
O Several days
O More than half the days
O Nearly every day

25-Thoughts that you would be better off dead, or of hurting yourself in some way
O Not at all
O Several days
O More than half the days
O Nearly every day

26-How do you cope up during such situations to make you feel better and relaxed?
(Instructions :You can choose multiple options in this question)
O Spend time with immediate family at home
O Spend time by meeting the friends (in neighborhood, nearby places)
O Listen to music
O Pray to God
O Play games
O Watch TV/ movies
O Use social media
Other (please specify) _______

27- What kind of role do you think digital and social media played in this situation?
O Negative
O Neutral
O Positive

28- Have you ever had anxiety or depression or some related problems?
O Yes
O No

29- Are you taking any medications for it?

O Not applicable
O Yes please specify

O No

Instructions: Listed below are a number of statements describing a set of beliefs.

Please read each statement carefully and, indicate how much you think each
statement is typical of you:
30-I am usually able to avoid threat quite easily
O Strongly disagree

28 | P a g e
O Moderately disagree
O Slightly disagree
O Slightly agree
O Moderately agree
O Strongly agree

31-How well I cope with difficult situations depends on whether I have outside help
O Strongly disagree
O Moderately disagree
O Slightly disagree
O Slightly agree
O Moderately agree
O Strongly agree

32-Whether I can successfully escape a frightening situation is always a matter of chance

with me
O Strongly disagree
O Moderately disagree
O Slightly disagree
O Slightly agree
O Moderately agree
O Strongly agree

33-I can usually influence the degree to which a situation is potentially threatening to me
O Strongly disagree
O Moderately disagree
O Slightly disagree
O Slightly agree
O Moderately agree
O Strongly agree

34-If something is going to hurt me, it will happen no matter what I do

O Strongly disagree
O Moderately disagree
O Slightly disagree
O Slightly agree
O Moderately agree
O Strongly agree

35-When I am under stress, I am not always sure how I will react

O Strongly disagree
O Moderately disagree
O Slightly disagree
O Slightly agree
O Moderately agree
O Strongly agree

36-I am unconcerned if I become anxious in a difficult situation, because I am confident in

my ability to cope with my symptoms
O Strongly disagree
O Moderately disagree
O Slightly disagree
O Slightly agree
O Moderately agree
O Strongly agree

29 | P a g e
37-I sometimes think, "Why even bother to try to cope with my anxiety when nothing I do
seems to affect how frequently or intensely, I experience it?"
O Strongly disagree
O Moderately disagree
O Slightly disagree
O Slightly agree
O Moderately agree
O Strongly agree

38-I can usually relax when I want

O Strongly disagree
O Moderately disagree
O Slightly disagree
O Slightly agree
O Moderately agree
O Strongly agree

39-I am able to control my level of anxiety

O Strongly disagree
O Moderately disagree
O Slightly disagree
O Slightly agree
O Moderately agree
O Strongly agree

40-I always know exactly how I will react to difficult situations

O Strongly disagree
O Moderately disagree
O Slightly disagree
O Slightly agree
O Moderately agree
O Strongly agree

Thank you once again for taking out your precious time.

QUESTIONNAIRE (URDU)
‫ن‬
‫آپ کی ج س ک ی ا ہ‬
‫ے؟‬ ‫۔خ ت‬1
‫ وا ی ن‬O
30 | P a g e
 ‫‪ O‬خ‬
‫مرد‬
‫‪ O ‬واج ہ سرا‬

‫ے؟‬
‫خ‪2‬ت۔آپ کی عمر ک ی ا ہ‬
‫ا صاص کری ں‬

‫قت‬ ‫‪ ‬‬
‫ے کری ں گے ؟‬ ‫ک‬ ‫ن‬ ‫ی‬ ‫ح‬
‫۔آپ سما ی و ا صادی ث ی ت کے حوالے سے درج ہ ب دی ی س‬ ‫ج‬ ‫‪3‬‬
‫ق‬
‫ے ق‬ ‫‪O‬ا ر‬
‫پ طبت‬
‫ے‬ ‫‪ O‬اپتر م ق‬
‫وسط طب‬
‫ے ق‬ ‫وسط طب‬ ‫‪O‬‬
‫مئ ت‬
‫ے‬ ‫‪ O‬لوئ ر م قوسط طب‬
‫ے‬‫‪ O‬لو ر طب‬
‫ت‬
‫ع‬
‫ے؟‬ ‫۔آپ کی موج ودہ لی م ک ی ا ہ‬ ‫‪ 4‬ئ‬
‫‪ O‬ہ ا ی ا کول سے کم‬ ‫س‬
‫‪ O‬نمی ٹ رک‪/O'Levels‬‬
‫‪ O‬ا ٹ رم ی ڈی ٹ ‪/A'Levels‬‬
‫ن‬
‫‪ O‬ا ڈر گری ج وی ٹ‬
‫‪ O‬پوسٹ گری ج وی ٹ‬
‫ٹ‬
‫‪ O‬ڈاک ری ٹ‬
‫ٹ‬
‫‪ O‬پوسٹ ڈاک ری ٹ‬
‫ض‬ ‫ق‬
‫ے؟‬ ‫‪5‬۔آپ کا موج ودہ ب ک ی ہ‬
‫ا‬ ‫ہ‬
‫نت‬ ‫ے روزگار ت ن‬ ‫ب‬ ‫‪O‬‬
‫ی‬ ‫ک‬
‫‪ O‬پ ی ہ ورا ہ‪ /‬کی‪/‬ا ظ امی‬ ‫ن‬ ‫ش‬
‫‪ O‬کلرک‬
‫خ‬
‫‪ O‬س ی لز اور دمات‬
‫ت‬
‫‪ O‬ہغ ن رم ن د دس ی‬
‫ت‬
‫‪ O‬ی ر ہ ن ر م ن د دس ی‬
‫‪ O‬ڈومی س ٹ ک سروس‬
‫ض‬
‫ن‬ ‫‪ O‬زرعیئ‬
‫م‬
‫دی گر‪ :‬ب راے ہرب ا ی و احت کری ں‬

‫ت ق‬
‫۔ازدواج ین( عل ات) کی ح ی ث ی ت‬‫‪ 6‬ن‬
‫‪ O‬کش غوارہ‪/‬ک تواری‬
‫ق‬
‫‪ O‬م ول‪ /‬عل ات می ں‬
‫‪ O‬ش ادی‬

‫‪31 | P a g e‬‬
 ‫‪ O‬ج دا‬
‫ش‬
‫‪ O‬طالق دہ‬
‫ن‬
‫‪ O‬ب یوہ‪/‬ر ڈوا‬
‫ہت‬ ‫‪ ‬‬
‫‪7‬۔ نآپ کس صوب ہ می ں رے ہ ی ں‬
‫‪ O‬پ ج اب‬
‫ن‬
‫دھت خن‬‫‪O‬خس خ‬
‫‪ O‬ی بر پ و واہ‬
‫‪ O‬ب لوچ ست ان ت‬
‫‪ O‬گلگت ب ل ستش ان‬
‫آزاد ج موں ک می ر‬ ‫‪O‬ف ٹ‬
‫‪ O‬اا‬
‫ق‬ ‫ن ئ‬
‫ل‬
‫‪8‬۔ک ی ا آپ کورو اوا رس عا مگی ر وب ا سے وا ف ہ ی ں ؟‬
‫‪ O‬جن ی ہ اں‬
‫‪ O‬ق ہی ںن‬
‫ئ‬ ‫ق ن‬ ‫‪ O‬نی ی ن ہی ں‬
‫اگر ہی ں ‪ ،‬ی ا اس ب ات کا ی ی ن ہی ں ‪ ،‬سوال‪ 9‬پر ج ا ی ں‬
‫ت‬ ‫‪ ‬‬
‫ت‬ ‫ٹ‬ ‫جن‬ ‫نت‬
‫ے ہ ی ں(‬ ‫ے ہ ی ں ؟ )آپ ت ی زی ادہ چ اہ ی ں ک کر سک‬ ‫‪8A‬۔ناگر ہ اں ت‪ ،‬و آپ ک ی ا ج ا‬
‫ن تت‬ ‫ن‬ ‫‪ O‬الگو ہی ں ہ و ا۔‬
‫ئ‬
‫ے ہی ں ج ا ا ج ا ا ھا۔‬ ‫‪ O‬ک ئسی وا رس کی وج ہ سےج و کے اس سے پہل‬
‫ش‬
‫‪ O‬کو ی ب ھی ج و اس ب ی ماری کا کارہ وگا اس کوہث می ش ہ دیچیپگ ی اں حاصل ہ وں گی۔‬
‫ٹ‬
‫ے ‪/‬وی کسی ن اس می ں مددگار اب ت ہ و س تک ے ہ ی ں۔‬ ‫‪ O‬ادوی ات‪ /‬ی ک‬
‫‪ O‬ج ی ہ اں ‪ ،‬ہ ا ک ب ماری ے ‪ ،‬ل ی کن ا ک اسک ن‬
‫ے۔‬‫ئی ڈل لگت ا ہ‬ ‫ی‬ ‫ہ‬ ‫غ ضی ی ی‬
‫ےہی ں۔‬ ‫‪O‬لوگ ی ر روری طور پر م ی ڈی ا کی طرف سےڈراے ج ارہ‬
‫ے۔‬ ‫ح‬
‫سے اچ ھا ل ہ‬ ‫سب ن‬ ‫ن‬ ‫‪ O‬نگھر می ں رہ ن ا‬
‫ے سےپ ھ ی لت ا۔‬‫ے ان سا ی راب ط‬ ‫کے ذری ع‬ ‫‪O‬ا سان ئ‬
‫ض‬
‫‪O‬دی گر‪ :‬ب راے مہرب ا ی و احت کری ں۔‬

‫ئ‬
‫ن‬ ‫کن‬ ‫‪  ‬ش ت ہ فت‬
‫گز ہ ‪2‬ش نوں کے دوران ‪ ،‬ت ی ب ار آپ کو م درج ہ ذی ل مسا ل می ں سے کسی کی طرف‬
‫ن‬ ‫ےن؟‬ ‫ہ‬
‫سے پری ا ی وئ ہش‬
‫ن‬
‫ساس اعصابی ‪ ،‬پری ا ی ‪ ،‬ی ا ک ارے پرمحسوس کر ا‬
‫‪10‬۔احک ن‬
‫‪ O‬ب ال ل ہی ں‬
‫ئ‬
‫‪ O‬نک ی دن‬
‫صف دن سے زی ادہ‬ ‫‪O‬تق ً‬
‫‪ O‬ری ب اہ ر دن‬
‫‪32 | P a g e‬‬
 ‫ن‬ ‫‪ ‬‬
‫ے کے ق اب ل ن ہ ں لگ ان‬ ‫ن‬ ‫ٹ‬ ‫ن ن‬
‫ے ی ا ک رول کر‬
‫ش‬
‫ی‬ ‫‪ 11‬۔پکری انی کو روک‬
‫‪ O‬ب ال ل ہی ں‬
‫ئ‬
‫‪ O‬نک ی دن‬
‫‪ O‬ت قصف دن سے زی ادہ‬
‫‪ O‬ری ب ا ًہ ر دن‬
‫ن‬ ‫‪  ‬خ‬
‫ہ‬ ‫ش‬ ‫ب‬ ‫ت‬
‫لف چ یزوں کے ب ارے می ں ہت پری ان و ا‬ ‫‪ 12‬۔ کم ن‬
‫‪ O‬ب ال ل ہی ں‬
‫ئ‬
‫‪ O‬نک ی دن‬
‫صف دن سے زی ادہ‬ ‫‪O‬تق ً‬
‫‪ O‬ری ب ا ہ ر دن‬
‫شک پ ن‬ ‫ت ق‬ ‫‪ ‬‬
‫‪13‬۔آرامنکرے و ت م ل یش آ ا‬
‫‪ O‬ب الکل ہی ں‬
‫ئ‬
‫‪ O‬نک ی دن‬
‫صف دن سے زی ادہ‬ ‫‪O‬تق ً‬
‫‪ O‬ری ب ا ہ ر دن‬
‫ن ٹ ن‬ ‫ن‬ ‫‪ ‬‬
‫ٹ‬
‫ےنچ ی ن ہ وے کی وج ہ سے ای ک ج گہ پر ک کر ہ ب ی ھ پ ا ا‬ ‫‪ 14‬۔ کب‬
‫‪ O‬ب ال ل ہی ں‬
‫ئ‬
‫‪ O‬نک ی دن‬
‫‪ O‬ت قصف دن سے زی ادہ‬
‫‪ O‬ری ب ا ًہ ر دن‬
‫ن‬ ‫ن‬ ‫ن‬ ‫‪ ‬‬
‫ہ‬ ‫چ‬ ‫چ‬
‫‪ 15‬۔آسا نی سے اراض ی ا ڑ ڑا وج ا ا‬
‫‪ O‬ب الکل ہی ں‬
‫ئ‬
‫‪ O‬نک ی دن‬
‫‪ O‬ت قصف دن سے زی ادہ‬
‫‪ O‬ری ب ا ًہ ر دن‬
‫ن‬ ‫خ‬ ‫ت‬ ‫خف‬ ‫‪ ‬‬
‫ن‬
‫‪16‬۔اگر چک نھ و اک ہ و وآرام سے وف زدہ ہ وج ا ا‬
‫‪ O‬ب الکل ہی ں‬
‫ئ‬
‫‪ O‬نک ی دن‬
‫صف دن سے زی ادہ‬ ‫‪O‬تق ً‬
‫‪ O‬ری ب ا ہ ر دن‬
‫خش ص ن‬ ‫ت‬ ‫ن‬ ‫‪ ‬‬
‫چ‬
‫ل‬
‫زوں کو کرے می ں ھوڑی د سپ ی ی ا و ی حا ل کر ا‬ ‫‪17‬۔چکی ن‬
‫‪ O‬ب ال ل ہی ں‬

‫‪33 | P a g e‬‬
 ‫ئ‬
‫‪ O‬نک ی دن‬
‫‪ O‬ت قصف دن سے زی ادہ‬
‫‪ O‬ری ب ا ًہ ر دن‬
‫ن‬ ‫‪ ‬‬
‫ساس ‪ ،‬اداس ‪ ،‬ی ا مایوس کن محسوس کر ا‬ ‫‪18‬۔حک ن‬
‫‪ O‬ب ال ل ہی ں‬
‫ئ‬
‫‪ O‬نک ی دن‬
‫صف دن سے زی ادہ‬ ‫‪O‬تق ً‬
‫‪ O‬ری ب ا ہ ر دن‬
‫ن‬ ‫شک پ ن‬ ‫ت ہن‬ ‫ن‬ ‫‪ ‬‬
‫ب‬
‫ےی ا سوے رے می ں ل یش آ ا ‪ ،‬ی ا ہت زی ادہ سو ا‬ ‫م‬ ‫‪19‬۔ کسو ن‬
‫‪ O‬ب ال ل ہی ں‬
‫ئ‬
‫‪ O‬نک ی دن‬
‫صف دن سے زی ادہ‬ ‫‪O‬تق ً‬
‫‪ O‬ری ب ا ہ ر دن‬
‫ن‬ ‫ن ت نئ‬ ‫‪  ‬ت‬
‫کن کااحساس ہ و ا ی ا وا ا ی کم محسوس کر ا‬ ‫ھ‬
‫‪20‬۔ک ن‬
‫‪ O‬ب ال ل ہی ں‬
‫ئ‬
‫‪ O‬نک ی دن‬
‫صف دن سے زی ادہ‬ ‫‪O‬تق ً‬
‫‪ O‬ری ب ا ہ ر دن‬
‫ھوک کم ا ز ادہ لگ ان‬
‫‪21‬۔بک ن ی ی‬
‫‪ O‬ب ال ل ہی ں‬
‫ئ‬
‫‪ O‬نک ی دن‬
‫صف دن سے زی ادہ‬ ‫‪O‬تق ً‬
‫‪ O‬ری ب ا ہ ر دن‬
‫شخ‬ ‫ن‬ ‫ن‬ ‫‪ ‬‬
‫نخن‬ ‫ن‬ ‫ن‬ ‫ج‬
‫م‬ ‫س‬ ‫ن‬ ‫ُ‬ ‫ُ‬ ‫ن‬
‫ے ا دان‬ ‫ے آپ کی ی ا اپ‬ ‫ے آپ کو ای ک اکام ص ھ ا ‪ ،‬ی ا اپ‬ ‫ے ب ارے می نں ب تُرامحنسوس کر ا ‪،‬ی ا آپ‬ ‫‪22‬۔اپ‬
‫والون کی انم ی دپر پورا ہ ا رپ ا ا‬
‫‪ O‬ب الکل ہی ں‬
‫ئ‬
‫‪ O‬نک ی دن‬
‫صف دن سے زی ادہ‬ ‫‪O‬تق ً‬
‫‪ O‬ری ب ا ہ ر دن‬
‫ق‬ ‫یک ن‬ ‫ن ٹ‬ ‫ج خ‬ ‫ن‬ ‫ت‬ ‫‪ ‬‬
‫ے می ں ِد ّت‬ ‫ی‬ ‫زوں پر وج ہ مرکوز کرے می ں مصی ب ت ‪ ،‬ی س‬
‫ے ی ا لی ویژن کو د ھ‬ ‫ے ا ب ار پڑھ‬ ‫‪23‬۔چک ی ن‬
‫‪ O‬ب ال ل ہی ں‬
‫ئ‬
‫‪ O‬نک ی دن‬
‫صف دن سے زی ادہ‬ ‫‪O‬تق ً‬
‫‪ O‬ری ب ا ہ ر دن‬

‫‪34 | P a g e‬‬
 ‫ع تن خ‬ ‫ست‬ ‫ت‬ ‫تن‬ ‫‪ ‬‬
‫ت‬ ‫ب‬ ‫ن‬ ‫ت‬
‫‪24‬۔ ا ی آہ نس ہ حرکت ی ا ب ول ا کہ دوسرے لوگوں کو ھی وج ہ ہ و ک ی ہ و ی ا اس کے بر کس‪،‬ا ا پ ہ ی ا‬
‫م‬
‫ے ہ وں۔‬ ‫ے چک ی ننہ و ا کہ آپ عمول سے کہی ں زی ادہ گھوم رہ‬ ‫ب‬
‫‪ O‬ب ال ل ہی ں‬
‫ئ‬
‫‪ O‬نک ی دن‬
‫صف دن سے زی ادہ‬ ‫‪O‬تق ً‬
‫‪ O‬ری ب ا ہ ر دن‬
‫پ ن ن خ‬ ‫نق‬ ‫ن‬ ‫ن‬ ‫ن‬ ‫خ‬ ‫‪ ‬‬
‫ت‬
‫ے آپ کو صان ہ چ اے کا ی ال‬ ‫ن‪25‬۔ ی ال آ ا کے آپ کا مرج ا ا ہ ی ب ہ ر ہ و گا ‪ ،‬ی ا کسی طرح سے اپ‬
‫آ ا۔ ک ن‬
‫‪ O‬ب ال ل ہی ں‬
‫ئ‬
‫‪ O‬نک ی دن‬
‫صف دن سے زی ادہ‬ ‫‪O‬تق ً‬
‫‪ O‬ری ب ا ہ ر دن‬
‫‪ ‬‬
‫‪26‬۔ اپنے آپ کو بہتر اور راحت محسوس کرانےکے لیےآپ موجودہ صورتحال میں‬
‫کیاکر رہے ہیں؟ (ہدایات‪ :‬آپ اس سوال میں ایک سے زیادہ اختیارات منتخب کرسکتے‬
‫ہیں)‬
‫‪ O‬گھر پر خاندان کے ساتھ وقت گزارکے‬
‫‪ O‬دوستوں کی طرف وقت گزارکے (پڑوس میں‪ ,‬قریبی مقامات)‬
‫‪ O‬موسیقی سن کے‬
‫‪ O‬خدا سے دعا کرکے‬
‫‪ O‬کھیل کھیل کے‬
‫‪ O‬ٹی وی‪/‬فلم دیکھ کے‬
‫‪ O‬سوشل میڈیا کا استعمال کرکے‬
‫‪ O‬دیگر (برائے مہربانی وضاحت کریں) _______‬

‫‪27‬۔آپ کو کس قسم کا قردارلگتا ہے ڈیجیٹل اور سوشل میڈیا کااس صورت حال میں ؟‬
‫‪ O‬منفی‬
‫‪ O‬غیر جانبدار‬
‫‪ O‬مثبت‬

‫‪28‬۔کیا آپ کو کبھی پریشانی یا ڈپریشن یا کچھ متعلقہ مسائل تھے ؟‬

‫‪ O‬جی ہاں‬
‫‪ O‬نہیں‬

‫‪29‬۔کیا آپ اس کے لئے کوئی ادویات لے رہے ہیں ؟‬

‫‪ O‬قابل اطالق نہیں‬

‫‪35 | P a g e‬‬
 ‫‪ O‬ہاں )اختصاص کریں__________________(‬
‫‪ O‬نہیں‬

‫ہدایات‪:‬عقائد کے ایک سیٹ کو بیان کرنے کے لئے ذیل میں چند بیانات دیئے‬
‫گئے ہیں۔ براہ کرم ہر ایک بیان کو بغور مطالعہ کریں اور ‪ ،‬اس بات کی‬
‫نشاندہی کریں کہ آپ کے خیال میں ہر بیان کتنا آپ کے لیے عام ہے‪:‬‬

‫‪30‬۔میں عام طور پر خطرے سے بچنے کے قابل ہوں‬

‫‪ O‬سختی سے اختالف‬
‫‪ O‬اعتدال اختالف‬
‫‪ O‬تھوڑا اختالف‬
‫‪ O‬تھوڑا اتفاق‬
‫‪ O‬اعتدال اتفاق‬
‫‪ O‬سختی سے اتفاق‬

‫‪31‬۔میں مشکل حاالت سے کس طرح نمٹ رہا ہوں اس پر منحصر ہے کہ آیا مجھے مدد‬
‫سے باہر ہے‬
‫‪ O‬سختی سے اختالف‬
‫‪ O‬اعتدال اختالف‬
‫‪ O‬تھوڑا اختالف‬
‫‪ O‬تھوڑا اتفاق‬
‫‪ O‬اعتدال اتفاق‬
‫‪ O‬سختی سے اتفاق‬

‫‪32‬۔ میں خوفناک صورتحال سے کامیابی سے بچ سکتا ہوں میرے لئے ہمیشہ صرف‬
‫موقع کی بات ہوتی ہے‬
‫‪ O‬سختی سے اختالف‬
‫‪ O‬اعتدال اختالف‬
‫‪ O‬تھوڑا اختالف‬
‫‪ O‬تھوڑا اتفاق‬
‫‪ O‬اعتدال اتفاق‬
‫‪ O‬سختی سے اتفاق‬

‫‪33‬۔میں عام طور پر اُتنا اثر انداز ہوسکتا ہوں یہ دیکھ کر کے صورتحال میرے لئے‬
‫کتنا بڑاخطرہ ہے‬
‫‪ O‬سختی سے اختالف‬
‫‪ O‬اعتدال اختالف‬

‫‪36 | P a g e‬‬
 ‫‪ O‬تھوڑا اختالف‬
‫‪ O‬تھوڑا اتفاق‬
‫‪ O‬اعتدال اتفاق‬
‫‪ O‬سختی سے اتفاق‬

‫‪34‬۔اگر کوئی چیزنے مجھے تکلیف پہنچا نی ہے ‪ ،‬تو وہ پہنچائےگی چاہےمیں کچ بھی‬
‫کروں‬
‫‪ O‬سختی سے اختالف‬
‫‪ O‬اعتدال اختالف‬
‫‪ O‬تھوڑا اختالف‬
‫‪ O‬تھوڑا اتفاق‬
‫‪ O‬اعتدال اتفاق‬
‫‪ O‬سختی سے اتفاق‬

‫‪35‬۔ جب میں دباؤ کا شکار ہوں تو مجھے نہیں پتا ہوتا کے میں کس طرح کا رد عمل‬
‫کروں گا‬
‫‪ O‬سختی سے اختالف‬
‫‪ O‬اعتدال اختالف‬
‫‪ O‬تھوڑا اختالف‬
‫‪ O‬تھوڑا اتفاق‬
‫‪ O‬اعتدال اتفاق‬
‫‪ O‬سختی سے اتفاق‬

‫‪36‬۔میں بےفکر ہوں کےمیں مشکل حاالت میں پریشان ہونگا ‪ ،‬کیونکہ میں اپنی عالمات‬
‫سے نمٹنے کی صالحیت میں اعتماد رکھتا ہوں‬
‫‪ O‬سختی سے اختالف‬
‫‪ O‬اعتدال اختالف‬
‫‪ O‬تھوڑا اختالف‬
‫‪ O‬تھوڑا اتفاق‬
‫‪ O‬اعتدال اتفاق‬
‫‪ O‬سختی سے اتفاق‬

‫‪37‬۔ میں بعض اوقات سوچتا ہوں ‪" ،‬جب میرے کچھ کرنے سے میری پریشانی کتنی‬
‫بار یاکتنی شدت اختیار کرنے پر کوئ فرق نہیں پڑنا ہوتا تو میں پریشانی سے‬
‫نمٹنے کی کوشش کرنے کی زحمت بھی کیوں کرتا ہوں؟"‬
‫‪ O‬سختی سے اختالف‬
‫‪ O‬اعتدال اختالف‬

‫‪37 | P a g e‬‬
 ‫‪ O‬تھوڑا اختالف‬
‫‪ O‬تھوڑا اتفاق‬
‫‪ O‬اعتدال اتفاق‬
‫‪ O‬سختی سے اتفاق‬

‫‪38‬۔ عام طور پر جب میں چاہوں آرام کر سکتا ہوں‬

‫‪ O‬سختی سے اختالف‬
‫‪ O‬اعتدال اختالف‬
‫‪ O‬تھوڑا اختالف‬
‫‪ O‬تھوڑا اتفاق‬
‫‪ O‬اعتدال اتفاق‬
‫‪ O‬سختی سے اتفاق‬

‫‪39‬۔میں اپنی پریشانی کی سطح کو کنٹرول کرنے کے قابل ہوں‬

‫‪ O‬سختی سے اختالف‬
‫‪ O‬اعتدال اختالف‬
‫‪ O‬تھوڑا اختالف‬
‫‪ O‬تھوڑا اتفاق‬
‫‪ O‬اعتدال اتفاق‬
‫‪ O‬سختی سے اتفاق‬

‫‪40‬۔میں ہمیشہ یہ جانتا ہوں کہ میں مشکل حاالت می ں ک ی ا رد عمل کروں گا‬
‫‪ O‬سختی سے اختالف‬
‫‪ O‬اعتدال اختالف‬
‫‪ O‬تھوڑا اختالف‬
‫‪ O‬تھوڑا اتفاق‬
‫‪ O‬اعتدال اتفاق‬
‫‪ O‬سختی سے اتفاق‬

‫آپ کےقیمتی وقت کو لینے کے لئے ایک بار پھر آپ کا شکریہ‪.‬‬

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2-CONSENT FORM(ENGLISH)

Dear Sir/Madam/colleagues,
We, the students of Bahria Medical & Dental College are conducting a
study to assess the awareness in people as regards to the disease and
how to protect oneself from this ongoing pandemic and to determine the
anxiety levels/Psychological stress in the Pakistani population during the
“stay-home” approach for this  COVID-19 pandemic. 
The general emphasis through social media is how to avoid physical
disease and keep oneself protected.  However, the definition of health
also includes the social, mental, and spiritual well being. This study will
explore some of these dimensions so that newer and correct messages
may be produced to ensure the complete well-being of the population
during this endemic. The mandatory required ethical clearance from the
competent body has been sought. We also request you to be part of the
study by filling this survey form, which requires your honest and true
answers; it will take about 10 minutes to fill it; in most answers, you just
have to click. However, if you do not wish to continue, you can opt-out
of this survey.

So please reply:

Do you wish to be part of this survey?

O Yes
O No

For those who wish to continue, accept our gratitude for your support. By
clicking the start button, you are agreeing to be a part of this study. 

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‫)‪CONSENT FORM(URDU‬‬

‫ت‬ ‫ت‬ ‫ت‬

‫ع‬ ‫ن ئ‬ ‫رمہ‪/‬سا ییھ ن ٹوں‬
‫ن ٹ‬‫م‬‫ح‬ ‫‪/‬‬ ‫رم‬ ‫مب‬‫ہ‪ ،‬ح‬
‫طالب علم ہ ی ں۔ ج و کےحالی ہ کرو انوا رس کی ف ل ظمگی روب اکی‬ ‫ئ‬
‫ک‬
‫م‪ ,‬حری ہ یو ی ورس ی م ی ڈی ل ڈ ل کالج کے‬
‫کی ح اش ت کے‬ ‫آپ ت‬ ‫ن‬
‫ے ف‬ ‫ے ‪ ،‬ناس ج اری عالمگی ر وشب انسے اپ‬ ‫لوگوں نمی ں آگاہ ی کے ل‬ ‫لے سے ن ق‬ ‫کے حوا ق‬ ‫ب یئماری‬
‫س‬ ‫گ‬
‫کے دوران پ اکست ا ی آب ادی می ں پری ا ی کی طح‪ /‬س ی ا ی ک ی دگی کا‬ ‫ام" کےن طہ ظ ر ن ق‬ ‫نکے ی ئ‬ ‫ے اور " ھر‬ ‫تل‬
‫ن‬ ‫محف ک ن‬ ‫خ‬ ‫ں۔‬ ‫ے‬
‫ہ ہی‬ ‫ر‬ ‫کر‬ ‫د‬ ‫عہ‬
‫ل ی م ل مع‬ ‫طا‬ ‫ک‬ ‫ا‬ ‫ے‬ ‫کے‬ ‫ے‬ ‫کر‬ ‫ن‬‫یش‬‫ع‬
‫ے۔حاال کہ‬ ‫ھ پہ‬ ‫ر‬ ‫ے‬ ‫ر‬ ‫وظ‬ ‫ے‬‫س‬ ‫ک‬ ‫سے‬ ‫ش‬ ‫خ‬ ‫ن‬
‫اس‬ ‫کو‬ ‫ود‬ ‫اور‬ ‫ں‬ ‫م‬ ‫ارے‬
‫ب ج ی ہن‬ ‫کے‬ ‫اری‬ ‫ن‬ ‫م‬ ‫ی‬ ‫ب‬ ‫ن‬
‫ی‬ ‫سما‬ ‫ج‬ ‫زور‬ ‫ام‬‫ع‬ ‫کا‬ ‫ا‬ ‫ڈ‬
‫یی‬ ‫م‬ ‫ل‬ ‫سو‬
‫ے میئ ں‬
‫اس م طال ع‬ ‫ے ۔ن ن‬ ‫ق‬ ‫ب‬ ‫ل‬ ‫ج‬ ‫ط‬
‫حالی ھی یہن‬ ‫ب‬
‫صحت کا م لب تصرف سما ی ہی ں بئکہ س تما ی ‪ ،‬ذ ی اور روحا فی و‬
‫ے‬ ‫کے‬
‫ئ ل‬ ‫ے‬ ‫ا‬ ‫ب‬ ‫ی‬ ‫ی‬ ‫کو‬ ‫ود‬‫ن ئان می ں سے چک ھغج ہ وں پکی کھوج کی ج اےگی اکہ آب ادی کی پوری خ ہ ن‬
‫ب‬ ‫و‬ ‫ق‬
‫الح‬
‫ے ج اسکی ں۔ مج از ادارے سے الزمی ا ال ی م ظ وری طلب کر لی گ ی‬ ‫ے اور درست پ ی امات یش یک‬
‫بن‬ ‫ف‬ ‫ت‬ ‫خ‬ ‫ے۔‬ ‫ہہ‬
‫کے م طالعہ کا نحصہ ی ں ‪،‬‬ ‫ً‬ ‫نپُر کر قت‬ ‫واست کرے ہ ی ں کہ اس سروے کے ارم کو‬ ‫در‬ ‫ھی‬ ‫ب‬ ‫سے‬ ‫آپ‬ ‫م‬
‫ن‬
‫سے پُر کرے می ں ری ب ا ن‪10‬ن م ٹ لگتی ں‬ ‫ے ج واب ات درکار ہ ین ں۔ا ت‬ ‫ےآپ کے دی ا ت دار اور چس‬ ‫جس کے لی‬
‫ےہی ں‬ ‫تگے۔ زی ادہ ت ر ج واب ات می ں ‪ ،‬آپ کو صرف کلک کر ا ہ وگا۔ اہ م ‪ ،‬اگر آپ ج اری رکھ ا ہی ں چ اہ‬
‫ت‬
‫ے ہ ی ں۔‬ ‫اس سروے کو چ ھوڑسک‬ ‫‪ ‬تو ‪ ،‬آپ ن‬
‫‪ :‬و ب راہ ہرب ا ی واب دی ں ن ن ہ ت‬
‫ج‬ ‫م‬
‫ک ی ا آپ اس سروے کا حصہ ب ا چ اے ہ ی ں ؟‬
‫‪O‬ج نی ہ اں‬
‫ن‬ ‫ٹ‬ ‫ش‬ ‫ُ‪ O‬ہی ں‬
‫ت‬ ‫ن‬ ‫ک‬
‫ے ج و ج اری ر ھ ا چ اہ‬ ‫ئ‬
‫ے ہ ی ں ‪ ،‬نآپ کیضحمای ت کا ‪ ،‬کری ہ۔ اس ٹ ارٹ ب ن پر کلک کرے‪ ‬‬ ‫ان لوگوں کے ل‬
‫ن‬
‫ے پر را ی م د ہ ی ں۔‬ ‫ے کا حصہ ب ن‬ ‫ے کہ آپ اس م طال ع‬ ‫کا م طلب ہ‬

‫‪3- Sample size calculation:‬‬

‫‪sample size was 384 and was calculated based on Epi-info calculations, having an assumed‬‬
‫‪prevalence of 50%, confidence interval as 95% and precision of 5%.‬‬

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4- Ethical clearence:
It has been made by ERC of BUMDC and the letters are with HoD

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