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Current Psychiatry Research and Reviews, 2021, 17, 98-104

RESEARCH ARTICLE
ISSN: 2666-0822
eISSN: 2666-0830

Current
Psychiatry
Research and Reviews

Rates of Anxiety, Depression, and Stress Among High School

Students During the COVID-19 Pandemic
BENTHAM
SCIENCE

Ensiyeh Jenabi1, Saeid Bashirian2, Salman Khazaei3, Mohammad Poordavood4,

Rashid Heidarimoghadam5, Majid Barati2, Samane Shirahmadi6, Sepideh Zareian7,
Farshid Shamsaei8, Shahnaz Farzian4, Aliakbar Asgari4, Yaser Nankali4 and
Mohammad Haghighi9,*
1
Autism Spectrum Disorders Research Center, Hamadan University of Medical Sciences, Hamadan,
Iran; 2Social Determinants of Health Research Center, Hamadan University of Medical Sciences,
Hamadan, Iran; 3Research Center for Health Sciences, Hamadan University of Medical Sciences,
Current Psychiatry Research and Reviews

Hamadan, Iran; 4Department of Health Education, Office of Education in Hamadan, Hamadan,

Iran; 5Health Sciences Research Center and Department of Ergonomics, School of Public Health,
Hamadan University of Medical Sciences, Hamadan, Iran; 6Department of Community Oral Health,
Dental Research Center, Hamadan University of Medical Sciences, Hamadan, Iran; 7Department of
Health Education, Hamadan University of Medical Sciences, Hamadan, Iran; 8Mother and Child
Care Research Center, Hamadan University of Medical Sciences, Hamadan, Iran; 9Behavioral Dis-
orders and Substance Abuse Research Center, Hamadan University of Medical Sciences, Hamadan,
Iran
Abstract: Background: The novel coronavirus (COVID-19) was first reported in Wuhan,
China, and has since then spread worldwide, resulting in a large number of hospitalizations
and deaths. To the best of our knowledge, the study about the mental health status (depres-
sion, anxiety, and stress) among high school students during COVID-19 has not been per-
formed in Iran.
Objective: This study was performed to investigate rates of anxiety, depression, and stress
among high school students during the pandemic of COVID-19.
A R T I C L E H I S T O R Y

Methods: This cross-sectional study was performed among high school students (12-18
Received: March 13, 2021 years) from 30 April until 1 June 2020, in Hamadan City, west of Iran. In total, 2852 stu-
Revised: June 21, 2021
Accepted: July 06, 2021
dents contributed to the present study. Depression Anxiety and Stress Scale 21 (DASS-21)
was used in this study. Statistical analyses were conducted in STATA 14 with a significant
DOI:
10.2174/2666082217666210924143126 level of 0.05.
Results: The present study showed that although stress status was normal among most high
school students (70.3%), the status of anxiety and depression was high. The boys had re-
ported a higher proportion of normal status of depression (51.62% vs. 44.97%), anxiety
(31.71% vs. 26.91%), and stress (77.66% vs. 66.10%) compared to the girls. Also, students
in grades 7-9 had reported a higher percentage of normal status in all three dimensions of
stress, anxiety, and depression.
Conclusion: These findings suggest that as rates of depression and anxiety are high, school-
age children may benefit from policymakers and other authorities’ active role.

Keywords: Mental health, depression, anxiety, stress, COVID-19, pandemic.

*Address correspondence to this author at the Behavioral Disorders and Substance Abuse Research Center, Hamadan University of Medical Sciences,
Hamadan, Iran; E-mail: haghighi@umsha.ac.ir

2666-0830/21 $65.00+.00 © 2021 Bentham Science Publishers

Anxiety, Depression, and Stress During the Pandemic
1. INTRODUCTION
The novel Coronavirus was first reported in
Wuhan, China, and it has since then spread
worldwide, resulting in a large number of hospi-
talizations and deaths [1]. It causes a range of hu-
man respiratory tract infections varying from mild
cold to severe respiratory distress syndrome. The
present novel Coronavirus disease is a severe acute
respiratory syndrome (SARS)-CoV-2, and
coronavirus disease 2019 (COVID-19) is an
emerging global health threat [2]. Age, underlying
disease, population density, and obesity are af-
fected by higher mortality rates [3].
Efforts to reduce the spread of the COVID-19
virus among students have prompted the wide-
spread closure of schools, colleges, universities,
and other educational institutions in many coun-
tries. As of March 25, 150 countries have closed
schools and educational institutions, including
Iran, impacting over 80% of the world’s student
population. Several countries have implemented
localized school closures, and those closures are
expected to be nationwide [4]. Schools have
moved rapidly to transition various courses and
programs from face-to-face to online delivery
mode [5].
The use of public transports was found to be
one of the best predictors of disease lethality. On
average, people using public transports are
younger individuals (for instance, students and
workers). Since the infection tends to progress in
an asymptomatic manner or with few symptoms in
younger subjects, it has been hypothesized that the
use of public transports by younger individuals
may have favored the circulation of asymptomatic
cases, and consequently, the transmission of
coronavirus to the most vulnerable populations
including older adults and multimorbid patients
[6].
In Hamadan City (west of Iran), dramatic or
gradual changes were implemented during the
study period related to COVID-19, such as lock-
down of the entire city.
Mental health is considered an essential aspect
for a good quality of life. Stress can be described
as the feeling of emotional and physical distress
caused by any event that threatens our homeostasis
[7]. Stressful events are adverse environmental
factors that can predispose individuals to mental
disorders, in particular depression [8, 9]. In addi-
Current Psychiatry Research and Reviews, 2021, Vol. 17, No. 2 99
tion, studies have shown that during a pandemic,
people experience negative emotional responses,
such as anxiety and symptoms of depression [10].
Zhou et al., showed that the prevalence of depres-
sive symptoms, anxiety, and a combination of de-
pressive and anxiety symptoms among Chinese
high school students during the COVID-19 out-
break was 43.7%, 37.4%, and 31.3%, respectively.
This study showed that the female gender was the
higher risk factor for depressive and anxiety symp-
toms [11].
To the best of our knowledge, the study about
the mental health status (depression, anxiety, and
stress) among high school students during
COVID-19 has not been performed in Iran. There-
fore, the present study was performed to investi-
gate the rates of anxiety, depression, and stress
among high school students during the pandemic
of COVID-19.
2. MATERIALS AND METHODS
This cross-sectional study was performed from
30 April until 1 June 2020 in Hamadan City, the
west of Iran. The population of high school stu-
dents (12-18 years) was included in 7% of total
high school students (2852 from 40667 students).
First, the list of high school students in the edu-
cation districts of Hamadan city was received. The
number of selected schools was allocated accord-
ing to the population of high school students in
each district. Then, equal proportions of schools in
each district were allocated to boys 'and girls'
schools, and finally, the allocated schools were
randomly selected among the schools in the area.
According to the sample size, we calculated 2852
students for the present study. There was an almost
equal ratio of high school students in the two dis-
tricts and between the sexes. Eight high schools
from District 1 (4 high schools for girls and 4 high
schools for boys) and eight high schools from Dis-
trict 2 (4 high schools for girls and 4 high schools
for boys) were selected and 178 people were as-
signed to each high school. In each high school, 60
first graders (7th and 8th years), 60 second graders
(9th and 10th years), and 60 third graders (11th
and 12th years) were randomly selected through a
class attendance list. We received the mobile
number of students from the schools according to
the allocated sample size through random sam-
pling. The link to the online questionnaire was sent
100 Current Psychiatry Research and Reviews, 2021, Vol. 17, No. 2
via SMS for them to download the program via the
provided link for answering the questions. For
those who did not respond, a new person was ran-
domly selected (283 students, 9.92%).
The protocol of the study was confirmed by the
Hamadan University of Medical Science with
ethical code IR.UMSHA.REC.1399.251. The in-
clusion criteria were (a) high school students in
one of the schools in Hamadan City; (b) Consent
to contribute to this study.
Two questionnaires were used in this study: a)
Socio-demographic questionnaire including age,
gender, educational status, level of education of
parents and occupation of parents; b) Depression
Anxiety Stress Scale 21 (DASS-21). The DASS-
21 is a 21 item self-report scale that measures the
negative emotional states of depression, anxiety,
and stress. The main value of DASS in clarifying a
clinical situation is the locus of the emotional dis-
order as part of the broader task of clinical evalua-
tion. The basic function of DASS is to assess the
severity of the main symptoms of depression,
anxiety, and stress. Each of the three scales of
DASS consists of 7 items responded to using a 0-3
scale, where 0=did not apply to me at all, and
3=applied to me very much or most of the time
(the range of possible scores for each scale is 0–
42). The scores in the normal range are 0-9 for de-
pression, 0-7 for anxiety, and 0-14 for stress. The
scores above these ranges show the degree of dis-
order from mild to very severe. The severity levels
are not levels of the disease but rather levels away
from population means, and a true comparison
score would be to test it as a continuous measure.
The DASS was designed by Lovibond et al., in
1995 [12]. Asgharimoghaddam et al., in 2008
translated and validated the scale in Iran [13].
Descriptive statistics were reported as number
(%) for categorical variables and mean (SD) for
continuous variables across the participant’s back-
ground. The associations between respondents'
demographic characteristics and categories of
stress, anxiety, and depression severity were as-
sessed by Chi-square test. All statistical analyses
were conducted in STATA version 14. P<0.05 was
considered as a significant level.
3. RESULTS
In the present study, a total of 2852 students
were selected. The baseline characteristics of the
Jenabi et al.
study population are presented in Table 1. Among
the participants, 1988 (69.71%) were girls and
1508 (52.88%) were in grades 10-12. The educa-
tion of the father of 1076 (37.73%) and that of the
mother of 1033 (36.22%) participants was aca-
demic. Moreover, 1798 (63.04%) participants had
fathers that were self-employed and 2444
(86.69%) of the participants had mothers who
were housewives.
As shown in Fig. (1), regarding stress status,
70.3% were normal, 17.88% were mild, 10.62%
were moderate, 1.19% were in the stress category,
while regarding anxiety status, 28.37% of students
were normal, 29.42% had mild anxiety, 32.43% of
the students had moderate anxiety and 7.92% and
1.86% were in severe and very severe category of
anxiety, respectively. About 47% of students were
normal, i.e., they did not have depression. In con-
trast, 26.86% of the participants were in the mild
category, 18.97% were in the moderate category,
6.45% were severe, and 0.74% were in the very
severe category of depression.
The boys had reported a higher proportion of
normal status of depression (51.62% vs. 44.97%),
anxiety (31.71% vs. 26.91%), and stress (77.66%
vs. 66.10%) compared to the girls. Also, students
in grades 7-9 had reported a higher percentage of
normal status in all three dimensions of stress,
anxiety, and depression. Moreover, higher educa-
tion of students’ mother and father was associated
with a higher percentage of reporting normal status
in all three investigated dimensions. The relation
between the baseline characteristics of the study
population and levels of anxiety, stress, and de-
pression is shown in Table 2. There was a signifi-
cant relationship between gender, grade, and fa-
ther’s and mother’s education on their depression,
anxiety, and depression scores (P<0.05).
4. DISCUSSION
The present study showed that although stress
status was normal among most high school stu-
dents, the status of anxiety and depression was
high. The boys had reported a higher proportion of
normal status of depression, anxiety, and stress
compared to the girls. Also, students in grades 7-9
had reported a higher percentage of normal status
in all three dimensions of stress, anxiety, and de-
pression. Moreover, higher education of students’
mother and father was associated with a higher
Anxiety, Depression, and Stress During the Pandemic Current Psychiatry Research and Reviews, 2021, Vol. 17, No. 2 101

Table 1. Baseline characteristics of study population.

Variable Category Frequency (%)

Boy 864 (30.29)

Gender
Girl 1988 (69.71)

7-9 1344 (47.12)

Grade
10-12 1508 (52.88)

Primary 551 (19.32)

Guidance 558 (19.57)

Father education
High school 667 (23.39)

Academic 1076 (37.73)

Primary 594 (20.83)

Guidance 464 (16.27)

Mother education
High school 761 (26.68)

Academic 1033 (36.22)

Self-employee 1798 (63.04)

Job of father Worker 248 (8.70)

Employee 806 (28.26)

Housewife 2444 (86.69)

Job of mother Self-employee 78 (2.73)

Employee 330 (11.57)

80

70.3
70

60

50
46.98
Depression
Percentage

40 Anxiety

32.43 Stress
29.42
30 28.37
26.86

20 18.97
17.88

10.62
10 7.92
6.45

1.19 1.86
0.74 0
0
Normal Mild Moderate Severe Very severe

Fig. (1). The mental categorization of students according to scores of Depression, Anxiety, and Stress. (A higher resolution /
colour version of this figure is available in the electronic copy of the article).
102 Current Psychiatry Research and Reviews, 2021, Vol. 17, No. 2 Jenabi et al.

Table 2. Relation between baseline characteristics of the study population and levels of anxiety, stress, and depression.

Scale Variable Category Normal Mild Moderate Severe Very Severe Pearson chi2 df P.Value

Boy 446 (51.62) 223 (26.97) 146 (16.90) 30 (3.47) 9 (1.04)

Gender 27.37 4 <0.001
Girl 894 (44.97) 533 (26.81) 395 (19.87) 154 (7.75) 12 (0.6)

7-9 68 (50.82) 343 (25.52) 240 (17.86) 70 (5.21) 8 (0.6)

Grade 5.83 4 0.21
10-12 65 (43.57) 423 (28.05) 301 (19.96) 114 (7.56) 13 (0.86)

Primary 235 (42.65) 147 (26.68) 112 (20.33) 51 (9.26) 6 (1.09)

Depression

Father Guidance 241 (43.19) 154 (27.60) 116 (20.79) 44 (7.89) 3 (0.54)
237.99 12 0.001
education High school 31 (46.93) 176 (26.39) 137 (20.54) 39 (5.85) 2 (0.3)

Academic 551 (51.21) 289 (26.86) 176 (16.36) 50 (4.65) 10 (0.93)

Primary 260 (43.77) 161 (27.10) 119 (20.03) 50 (8.42) 4 (0.67)

Mother Guidance 199 (42.89) 132 (28.45) 99 (21.34) 34 (7.33) 0

33.97 12 0.001
education High school 354 (46.52) 186 (24.44) 167 (21.94) 47 (6.18) 7 (0.92)

Academic 527 (51.02) 287 (27.78) 156 (15.10) 53 (5.13) 10 (0.97)

Boy 274 (31.71) 283 (32.75) 238 (27.55) 55 (6.37) 14 (1.62)

Gender 22.89 4 <0.001
Girl 535 (26.91) 556 (27.97) 687 (34.56) 171 (8.60) 39 (1.96)

7-9 424 (31.55) 406 (30.21) 412 (30.65) 82 (6.10) 20 (1.49)

Grade 24.63 4 <0.001
10-12 385 (25.53) 433 (28.71) 513 (34.02) 144 (9.55) 33 (2.19)

Primary 128 (23.23) 165 (29.95) 198 (35.93) 45 (8.17) 15 (2.72)

Anxiety

Father Guidance 150 (26.88) 184 (32.97) 175 (31.36) 40 (7.17) 9 (1.61)
29.25 12 0.004
education High school 198 (29.69) 171 (25.64) 239 (35.83) 53 (7.95) 6 (0.9)

Academic 333 (30.95) 319 (29.65) 313 (29.09) 88 (8.18) 23 (2.14)

Primary 156 (26.26) 175 (29.46) 197 (33.16) 51 (8.59) 15 (2.53)

Mother Guidance 129 (27.8) 130 (28.02) 175 (37.72) 24 (5.17) 6 (1.29)
28.26 12 0.005
education High school 199 (26.15) 226 (29.70) 261 (34.30) 67 (8.80) 8 (1.05)

Academic 325 (31.46) 308 (29.82) 292 (28.27) 84 (8.13) 24 (2.32)

Boy 671 (77.66) 125 (14.47) 60 (6.94) 8 (0.93) 0

Gender 34.17 3 <0.001
Girl 1334(67.10) 385 (19.37) 243 (12.22) 26 (1.31) 0

7-9 1009(75.07) 209 (15.55) 114 (8.48) 12 (0.89) 0

Grade 28.85 3 <0.001
10-12 996 (66.05) 301 (19.96) 189 (12.53) 22 (1.46) 0

Primary 359 (65.15) 112 (20.33) 73 (13.25) 7 (1.27) 0

Guidance 382 (68.46) 112 (20.07) 57 (10.22) 7 (1.25) 0

Stress

Father
19.69 9 0.02
education High school 461 (69.12) 122 (18.29) 76 (11.39) 8 (1.20) 0

Academic 803 (74.63) 164 (15.24) 97 (9.01) 12 (1.12) 0

Primary 394 (66.33) 118 (19.87) 73 (12.29) 9 (1.52) 0

Mother Guidance 315 (67.89) 102 (21.98) 44 (9.48) 3 (0.65) 0

27.78 9 0.001
education High school 522 (68.59) 132 (17.35) 99 (13.01) 8 (1.05) 0

Academic 774 (74.93) 158 (15.30) 87 (8.42) 14 (1.36) 0

Anxiety, Depression, and Stress During the Pandemic
percentage of reporting normal status in all three
investigated dimensions.
Rehman et al., reported that among different
professions, students and healthcare professionals
were found to experience stress, anxiety, and de-
pression more than others in the time of COVID-19
lockdown [7]. The study was performed from the
3rd of April 2020 until the 6th of April 2020 and
with 403 participants. However, this study showed
that despite the current situation, stress, anxiety,
and depression were found to be in the normal
range. Our study reported that although stress
status was normal among most high school stu-
dents, depression and anxiety were high. The rea-
son for the increase of anxiety status can be related
to the fear of coronavirus.
Chang et al., reported that the overall incidence
of anxiety was 26.60%, and the incidences of mild,
moderate, and severe anxiety were 23.19%,
2.71%, and 0.70%, respectively, during the epi-
demic of COVID-19. Depressive emotions were
detected in 21.16% of the students, and the inci-
dences of mild, moderate, and moderate-to-severe
depression were 16.98%, 3.17%, and 1.01%, re-
spectively [14]. This study was performed among
3881 college students in Guangdong Province.
They showed that depression and anxiety are
closely related. However, the incidences of anxiety
and depression were higher in our study.
Zhou et al., reported that multivariable logistic
regression analysis showed that girls were at a
higher risk for depressive and anxiety symptoms
during the outbreak of COVID-19. Also, senior
high school was a risk factor for depressive and
anxiety symptoms; the higher the grade, the greater
the prevalence of depressive and anxiety symptoms
[11]. Our study confirmed the results of this study.
A cross-sectional study performed on 4,599 ado-
lescents in Tehran (Iran) showed the prevalence of
depression to be 19.5%, which was significantly
higher in girls compared with boys [15]. Another
study in Iran showed that the prevalence of depres-
sion, anxiety, and stress were reported in 43.3%,
43.3%, and 38.9% among high school students, re-
spectively [16]. In the study, data were collected us-
ing the validated Depression, Anxiety, and Stress
Scale (DASS-21). However, in our study, the preva-
lence of depression, anxiety, and stress was higher
after the COVID-19 pandemic. This may be due to
the extent of stay at home, school closings, increased
homework, and concerns about coronavirus.
Current Psychiatry Research and Reviews, 2021, Vol. 17, No. 2 103
This study had two limitations: (a) This study
was conducted in urban areas; therefore, it cannot
be generalized to rural areas. It is recommended
that this study be conducted in rural areas as well.
(b) We utilized the online questionnaires to collect
data, which prevents the participation of a large
segment of the population, such as people who do
not have access to the Internet, especially the un-
derprivileged. (c) We do not have a control group in
this study for comparison with the group infected
with COVID-19. Thus, the effect of COVID-19 on
depression, anxiety, and stress was without a com-
parison group. This was another limitation of our
study. According to our findings, we proposed that
proper counseling services should be available to
support the mental health and well-being of students
during the epidemic of COVID-19. In addition, we
suggest that future research should be focused on the
factors related to stress, depression, and anxiety
symptoms including adults and elderly individuals.
CONCLUSION
Our findings showed that although stress status
was normal among most high school students, the
status of anxiety and depression was high. The
boys had reported a higher proportion of normal
status of depression, anxiety, and stress compared
to the girls. Also, students in grades 7-9 had re-
ported a higher percentage of normal status in all
three dimensions of stress, anxiety, and depres-
sion. Therefore, the present study was performed
to investigate the rates of anxiety, depression, and
stress among high school students during the pan-
demic of COVID-19.
ETHICS APPROVAL AND CONSENT TO
PARTICIPATE
The protocol of the study was confirmed by the
Hamadan University of Medical Science, Iran with
ethical code IR.UMSHA.REC.1399.251.
HUMAN AND ANIMAL RIGHTS
No animals were used for studies that are the
basis of this research. All human procedures fol-
lowed were in accordance with the Helsinki Decla-
ration of 1975.
CONSENT FOR PUBLICATION
Consent was obtained prior to the study.
104 Current Psychiatry Research and Reviews, 2021, Vol. 17, No. 2
STANDARDS OF REPORTING
STROBE guidelines and methodology were
followed in this study.
AVAILABILITY OF DATA AND
MATERIALS

The data supporting the findings of the study is
available from corresponding author [M.H.] upon
reasonable request.
FUNDING

This work was supported by Hamadan Univer-
sity Medical Sciences with grant no: 9903271754.
CONFLICT OF INTEREST
The authors declare no conflict of interest, fi-
nancial or otherwise.
ACKNOWLEDGEMENTS
The authors thank the Hamadan University of
Medical Sciences for supporting this study.
REFERENCES
[1] Wang C, Pan R, Wan X, et al. Immediate psychologi-
cal responses and associated factors during the initial
stage of the 2019 coronavirus disease (COVID-19)
epidemic among the general population in China. Int J
Environ Res Public Health 2020; 17(5): 1729.
http://dx.doi.org/10.3390/ijerph17051729 PMID:
32155789
[2] Umakanthan S, Sahu P, Ranade AV, et al. Origin,
transmission, diagnosis and management of coronavi-
rus disease 2019 (COVID-19). Postgrad Med J 2020;
96(1142): 753-8.
PMID: 32563999
[3] Ilardi A, Chieffi S, Iavarone A, Ilardi CR. SARS-
CoV-2 in Italy: Population density correlates with
morbidity and mortality. Jpn J Infect Dis 2021; 74(1):
61-4.
http://dx.doi.org/10.7883/yoken.JJID.2020.200
PMID: 32611978
[4] Setiawan AR. Scientific literacy worksheets for dis-
tance learning in the topic of coronavirus 2019
(COVID-19). 2020.
[5] Lau J, Yang B, Dasgupta R. Will the coronavirus
make online education go viral. Times Higher Educa-
tion 2020; p. 12.
[6] Rehman U, Shahnawaz MG, Khan NH, et al. Depres-
sion, anxiety and stress among Indians in times of
Covid-19 lockdown. Community Ment Health J 2020;
1-7.
Jenabi et al.
PMID: 32577997
[7] Ilardi A, Chieffi S, Chieffi CR. Predictive role of
population density and use of public transport for ma-
jor outcomes of SARS-CoV-2 infection in the Italian
population: An ecological study. J Res Health Sci
2021; 21(2): e00518
[8] Uchida S, Hara K, Kobayashi A, et al. Epigenetic
status of Gdnf in the ventral striatum determines sus-
ceptibility and adaptation to daily stressful events.
Neuron 2011; 69(2): 359-72.
http://dx.doi.org/10.1016/j.neuron.2010.12.023
PMID: 21262472
[9] Yang L, Zhao Y, Wang Y, et al. The effects of psy-
chological stress on depression. Curr Neuropharmacol
2015; 13(4): 494-504.
http://dx.doi.org/10.2174/1570159X13041508311505
07 PMID: 26412069
[10] Van Bortel T, Basnayake A, Wurie F, et al. Psycho-
social effects of an Ebola outbreak at individual,
community and international levels. Bull World
Health Organ 2016; 94(3): 210-4.
http://dx.doi.org/10.2471/BLT.15.158543 PMID:
26966332
[11] Zhou SJ, Zhang LG, Wang LL, et al. Prevalence and
socio-demographic correlates of psychological health
problems in Chinese adolescents during the outbreak
of COVID-19. Eur Child Adolesc Psychiatry 2020;
29(6): 749-58.
http://dx.doi.org/10.1007/s00787-020-01541-4 PMID:
32363492
[12] Lovibond PF, Lovibond SH. The structure of negative
emotional states: Comparison of the Depression
Anxiety Stress Scales (DASS) with the Beck Depres-
sion and Anxiety Inventories. Behav Res Ther 1995;
33(3): 335-43.
http://dx.doi.org/10.1016/0005-7967(94)00075-U
PMID: 7726811
[13] Moghaddam A, Saed F, Dibajnia P, Zangeneh J. A
preliminary validation of the depression, anxiety and
stress scales (DASS) in non-clinical sample. Sci J
Clini Psychol Personal 2008; 1(31): 23-38.
[14] Chang J, Yuan Y, Wang D. Mental health status and
its influencing factors among college students during
the epidemic of COVID-19. Nan Fang Yi Ke Da Xue
Xue Bao 2020; 40(2): 171.
[15] Emami H, Ghazinour M, Rezaeishiraz H, Richter J.
Mental health of adolescents in Tehran, Iran. J Ado-
lesc Health 2007; 41(6): 571(1): 6.
http://dx.doi.org/10.1016/j.jadohealth.2007.06.005
PMID: 18023786
[16] Darchini-Maragheh E, Salehi M, Payandeh A,
Behdani F, Ghasemzadeh Kolagar H. Evaluation of
the correlations between depression, anxiety, and
stress as DASS-21 subscales and high-risk behaviors
in the adolescents in Torghabeh and Shandiz Towns,
Iran. J Patient Saf Quality Improv 2017; 5(3): 584-90.