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Citation: Ghader N, AlMheiri N, Fikri A,
AbdulRazzak H, Saleheen H, Saddik B, et al. (2024)
Prevalence and factors associated with mental
illness symptoms among school students post
lockdown of the COVID-19 pandemic in the United
Arab Emirates: A cross-sectional national study.
PLoS ONE 19(2): e0296479. https://doi.org/
10.1371/journal.pone.0296479
Editor: Humayun Kabir, McMaster University,
CANADA
Received: July 12, 2022
Accepted: December 12, 2023
Published: February 1, 2024
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https://doi.org/10.1371/journal.pone.0296479
Copyright: © 2024 Ghader et al. This is an open
access article distributed under the terms of the
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permits unrestricted use, distribution, and
reproduction in any medium, provided the original
author and source are credited.
PLOS ONE | https://doi.org/10.1371/journal.pone.0296479 February 1, 2024
Prevalence and factors associated with
mental illness symptoms among school
students post lockdown of the COVID-19
pandemic in the United Arab Emirates: A
cross-sectional national study
Nariman Ghader ID1*, Noor AlMheiri1, Asma Fikri2, Hira AbdulRazzak ID3,
Hassan Saleheen4, Basema Saddik5, Yousef Aljawarneh6, Heyam Dalky6, Ammar Al
Banna7, Shammah Al Memari3, Budoor Al Shehhi3, Shereena Al Mazrouei3, Omniyat Al
Hajeri3
1 Mental Health Department, Emirates Health Services, Dubai, United Arab Emirates, 2 National Center for
Health Research, Ministry of Health and Prevention, Dubai, United Arab Emirates, 3 Statistics and Research
Center, Ministry of Health and Prevention, Dubai, United Arab Emirates, 4 Abu Dhabi Public Health Center,
Department of Health, Abu Dhabi, United Arab Emirates, 5 Department of Family and Community Medicine,
University of Sharjah, Sharjah, United Arab Emirates, 6 Faculty of Health Sciences, Higher Colleges of
Technology, Dubai, United Arab Emirates, 7 Child and Adolescent Mental Health Center of Excellence, Al
Jalila Children’s Specialty Hospital, Dubai, United Arab Emirates
* nariman.ghader@ehs.gov.ae
Abstract
Limited data exists on the mental health of children in the United Arab Emirates (UAE). This
study aimed to fill this gap by examining the prevalence of anxiety, depression, and risk for
Post-Traumatic Stress Disorder (PTSD) among school students in post-lockdown of the
COVID-19 pandemic. A sample of 3,745 school students participated, responding to standard-
ized tests (Mood and Feeling Questionnaire-Child Self-Report, Screen for Child Anxiety
Related Disorders-Child Version, and Children’s Revised Impact of Event Scale-8). Findings
showed that the risk for PTSD was the most prevalent (40.6%), followed by symptoms of anxi-
ety (23.3%), and depression (17.1%). For gender differences, symptoms of the three condi-
tions (depression, anxiety, and PTSD) were higher in female students (9.2%) compared to
male peers (7.7%) (p = 0.09). Moreover, symptoms of depression and anxiety were found to
be higher among late adolescents (p<0.05). Further analysis revealed that having medical
problems was a positive predictor for anxiety (OR = 2.0, p<0.01) and risk for PTSD (OR = 1.3,
p = 0.002); similarly, witnessing the death of a close family member due to COVID-19 (OR for
depression, anxiety, and PTSD = 1.7, p<0.01) were positive predictors associated with PTDS,
depression, and anxiety. The study concluded that post COVID-19 lockdown, symptoms of
anxiety, depression, and risk for PTSD were found to be prevalent among school students in
the UAE. Researchers put forward recommendations on the initiation of a national school men-
tal health screening program, the provision of follow-up services for vulnerable students, and
the integration of a mental health support system in the disaster preparedness plans.
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PLOS ONE
Data Availability Statement: Anonymous data
sets are available on public data repository https://
doi.org/10.6084/m9.figshare.22231585, 2023.
Funding: The author(s) received no specific
funding for this work.
Competing interests: The authors have declared
that no competing interests exist.
PLOS ONE | https://doi.org/10.1371/journal.pone.0296479 February 1, 2024
School students mental health in COVID 19 in the United Arab Emirates
Introduction
The outbreak of the COVID-19 pandemic in early 2020 triggered an unprecedented global
health crisis, resulting in substantial morbidity, mortality, and pervasive disruptions to daily
life. As a response to mitigate the spread of the virus, stringent public health measures, includ-
ing nationwide lockdowns were implemented across many countries, including the United
Arab Emirates (UAE). These measures aimed to curb the transmission of the virus; however,
they inadvertently imposed significant psychological and social challenges, particularly among
school students. Over the course of this period, mental health has emerged as a critical focal
point, garnering significant attention. The World Health Organization (WHO) confirmed that
a substantial proportion of nations, approximately 90%, encountered substantial disruptions
in the basic healthcare services, coinciding with a marked surge in the requisition for mental
health services [1].
Additionally, the Policy Brief on the need for action on mental health released by the
United Nations (UN) in 2020 affirmed that the COVID-19 crisis has affected the mental health
and overall well-being of entire communities, necessitating immediate attention and prioriti-
zation [2]. While, focusing on mitigating the distinct impacts of COVID-19 on children, the
UN Policy Brief concerning the influence of COVID-19 on children emphasized the detrimen-
tal effects of measures such as physical distancing and movement restrictions on children’s
mental well-being. It also underscored the increased vulnerability of anxiety within this demo-
graphic [3]. Globally, the prevalence of depression, stress, and anxiety among the general pop-
ulation during the COVID-19 pandemic is estimated to be 33.7%, 29.6%, and 31.9%
respectively [4]. The escalating risk of contracting the infection, harrowing narratives of pain
and mortality, enforced measures and regulations (including social isolation, lockdowns, and
vaccinations), the pervasive information frenzy in the media, and the ensuing economic rami-
fications have collectively engendered a global atmosphere of heightened depression and anxi-
ety [5]. Studies have revealed an increased risk of post-traumatic stress disorder (PTSD), sleep
disorders, and cognitive underperformance in comparison to the pre-pandemic period [6].
Conventionally, children and young people are at the heart of global development. How-
ever, in a press release by UNICEF in October 2021, it was affirmed that the younger genera-
tion has been carrying the burden of mental health conditions even prior to COVID-19 [7].
According to the State of the World’s Children 2021 report, one in seven adolescents aged 10–
19 years is estimated to suffer from a mental disorder; additionally, the report warned that chil-
dren and young people may experience the impact of COVID-19 on their mental health and
well-being for many years to come [8]. In a systematic review on the mental health of children
and young people before and during COVID-19 pandemic, data from 21 studies across 11
countries showed that since the pandemic has started there was a longitudinal decline in the
overall mental health status of adolescents and young people with preponderance of depres-
sion, anxiety and psychological distress [9]. Further evidence showed that uncertainties associ-
ated with the pandemic itself, such as prolonged and widespread parental stressors, school
closures, and loss of loved ones have been detrimental to the well-being of adolescents and
children [10].
In the pre-pandemic era, a comprehensive review of relevant global and national initiatives
addressing mental health challenges reveals a dynamic landscape shaped by concerted efforts
to promote mental well-being, alleviate stigma, and enhance access to mental health services.
On a global scale, initiatives such as the World Health Organization’s Mental Health Action
Plan emphasize the integration of mental health into overall health policies and the develop-
ment of community-based mental health services [11]. Additionally, international collabora-
tions, such as the Global Mental Health Movement, underscore the need for a collective
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PLOS ONE School students mental health in COVID 19 in the United Arab Emirates

response to address the multifaceted nature of mental health issues [12]. In the United Arab
Emirates (UAE), mental health was recognized as a national priority which resulted in the
release of the 2017 National Policy for Mental Health Promotion by the Ministry of Health
and Prevention [13]. Despite this focus, a national report by Janssen indicated that mental dis-
orders, particularly depression and anxiety, accounted for a substantial portion (19.9%) of the
UAE’s disease burden [14]. In response to this issue, the UAE strategically initiated mental
health initiatives, including the launch of the National Campaign for Mental Support, led by
the National Program for Happiness and Wellbeing, during the pandemic [15].
Nevertheless, consistent with the global trend, local studies demonstrated a noticeable men-
tal health impact within the population. For instance, a study focusing on the psychological
well-being of university students in the UAE during the pandemic revealed that over 50% of
students reported anxiety levels ranging from mild to severe, with higher levels reported by
females [16]. Additionally, a separate study conducted in the UAE showcased increased levels
of anxiety and depression in the adult community compared to pre-pandemic figures. Further-
more, this study highlighted significant associations between mental symptoms (depression
and anxiety) and factors such as youth, gender (female), prior history of mental health issues,
and personal or loved ones’ positive COVID-19 test results [17].
Indisputably, studies on the mental health of the UAE’s younger population are essential,
given that 17–22% of the nation’s youth suffer from depressive symptoms [18]. These findings
underscore the critical need to address mental health issues among the youth, emphasizing the
urgency for targeted interventions and support measures to alleviate mental distress in this
demographic. Expectedly, the emergence of COVID-19 has exacerbated this state of distur-
bance. It has been acknowledged that during the pandemic, children in the UAE were facing
increased mental health issues associated with stories of calamities, home confinement, and
fear of contracting the virus [19]. In a UAE study that explored the anxiety levels among adults
and children during the COVID-19 pandemic, findings showed that the overall prevalence of
Generalized Anxiety Disorder was 71% in the total population and 59.8%) in the younger gen-
eration [20]. Moreover, a study focusing on policy development for children’s mental health
during the COVID-19 pandemic anticipated a rise in the volume of individuals seeking mental
health assistance [21].
Understanding the mental health impact of the pandemic and the subsequent lockdown
measures on school students is of paramount importance. Identifying the prevalence of mental
illness symptoms and associated factors in this population post-lockdown is crucial for devel-
oping targeted interventions, providing appropriate mental health support, and informing
future public health strategies. Given the limited specialized research on children mental health
before and during the COVID-19 pandemic in the UAE, this study aimed to establish a com-
prehensive data reference regarding the prevalence of mental illness symptoms (depression,
anxiety, and PTSD) and to determine the associations of these symptoms with bio-demo-
graphic and other pandemic-related factors among UAE school students. The study’s out-
comes will serve as valuable scientific evidence, shedding light on the scale and characteristics
of required efforts in children’s mental health.

Methodology
Study design
A descriptive cross-sectional study was conducted between February 2021 and July 2021 to
establish a comprehensive data reference regarding the prevalence of mental illness symptoms
(depression, anxiety, and PTSD) and to determine the associations of these symptoms with
bio-demographic and other pandemic-related factors among UAE school students. This

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PLOS ONE School students mental health in COVID 19 in the United Arab Emirates

design was selected as lit has been affirmed by literature as the best way to describe the distri-
bution of one or more variables, devoid of causal links. Furthermore, this type of studies has
been considered instrumental in measuring the prevalence of a disease or of a risk factor in a
population [22].

Sampling and data collection procedure

In this cross-sectional study, data was gathered through online means between February 2021
and July 2021 in the UAE. This timeframe followed a period of lockdown, during which a
majority (83.3%) of students were still engaged in complete online school learning. A total of
3,745 respondents from all seven emirates of the United Arab Emirates participated in the
study. Participation was open to students from both private and government schools in the
UAE, encompassing grades 2 to 12 and spanning ages 8 to 18. The study targeted individuals
with the ability to competently comprehend written Arabic and/or English texts. Those
enrolled in vocational, continuing education, or special education programs/schools were
excluded. Furthermore, parents of surveyed students responded to a series of biodata inquiries
through the same instrument.
Our study utilized convenience and snowball sampling techniques, which have been widely
used in similar research conducted amidst the COVID-19 pandemic [23–25]. This approach
was chosen due to the logistical challenges and restrictions posed by the pandemic, making it a
practical method for data collection under the circumstances. Initially, potential participants
were reached electronically through school and parental communication channels. Addition-
ally, the study harnessed electronic communication platforms associated with the authors’ cor-
porate affiliations. This approach involved disseminating the study invitation and link to the
public through official websites, press releases, and various social media outlets such as Face-
book, Instagram, and Twitter. Moreover, to ensure comprehensive outreach, the study utilized
the established networks of corporate facilities, including hospitals and clinics, to circulate the
invitation via SMS to the employees’ families who met the inclusion criteria. This innovative
dissemination technique facilitated wider access to the study’s invitation.

The instrument
The data collection instrument used in this study was composed of three sections. Firstly, a
detailed participant information sheet and an informed consent form were mandatory fields
to be completed before participants had access to the anonymous questionnaire. Secondly,
parents were asked to respond to 26 questions which included family sociodemographic data
as well as information on the student’s general health status; the estimated time to complete
this part was 15 minutes. Thirdly, students, just after they consented to their participation,
were requested to answer blocks of questions that included three standardized scales tested for
validity and reliability in both languages (English and Arabic).
The Mood and Feelings Questionnaire (Short Version)–MFQ is a self-reported 13-item
measure that assesses the current depressive symptomatology among children. Psychometric
data at an early stage have revealed a high internal consistency along with a Cronbach’s alpha
of 0.90. Test-retest reliability across the clinical samples for a 1-week period is wide-ranging
between 0.73 and 0.75 (intraclass correlation) [26]. The “Screen for Child Anxiety Related
Emotional Disorders (SCARED)” is a youth- and parent-report measure that was established
to screen children for anxiety related disorders. SCARED comprises of 41 items. In prior
investigations involving outpatient psychiatric samples, the SCARED demonstrated favorable
convergent and divergent validity when compared to other psychiatric assessment tools, indi-
cating robust sensitivity (0.71) / specificity (0.67) [27, 28]. The “Children’s Revised Impact of

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PLOS ONE School students mental health in COVID 19 in the United Arab Emirates

Events Scale” (CRIES-8) realizes the principles for good screening instruments and has been
utilized across a large number of cultures and countries. CRIES has exhibited strong reliability,
a consistent factor structure, satisfactory face and construct validity, and has been employed to
screen extensive cohorts of vulnerable children following various traumatic events [29]. The
cutoff values for these scales were established based on previous research) [26–32].

Data quality assurance

To ensure the accuracy and reliability of the data collected for this study, stringent measures
were implemented throughout the research process. These procedures were designed to tackle
potential issues related to completeness, accuracy, and the handling of unanswered responses.
A standardized data collection protocol was developed, clearly outlining the procedures for
obtaining responses from participants. Although the questionnaire utilized standardized scales
to ensure reliability and validity, a pilot test was conducted as an additional measure. This pre-
liminary trial involved a select group of individuals mirroring the study’s target participants.
Its purpose was to detect any potential shortcomings, enhance clarity, and optimize user expe-
rience, ultimately refining the questionnaire’s effectiveness for the larger study. Feedback from
the pilot test guided adjustments to ensure the questionnaire was user-friendly and the instruc-
tions provided proper guidance. After the completion of data collection, thorough data clean-
ing procedures were applied. The percentage of unanswered responses for each variable was
also reported for transparency purposes. These data quality assurance measures collectively
aimed to enhance the reliability and inclusiveness of the dataset, ensuring the robustness of the
study findings [33].

Privacy and confidentiality

Data were collected anonymously and were confidentially stored in the Emirates Health Ser-
vices database system. Investigators and statisticians who helped in data analysis were the only
individuals authorized to access the data and only after signing a non-disclosure agreement
form. Moreover, to facilitate transparency and replication of the study’s findings, an anon-
ymized dataset essential for reproducing the study’s results has been made accessible to fellow
researchers. This dataset is publicly available on a designated repository [34], promoting col-
laboration and the advancement of knowledge in the field while upholding the confidentiality
of participant information.

Ethical considerations
Ethical approvals were acquired from the Emirates Institutional Review Board for COVID-19
Research (Reference No. DOH/CVDC/2020/2471) and the Research Ethics Committee at the
Ministry of Health and Prevention, Dubai (reference No. MOHAP/DXB-REC/ DDD/No.163
/2020). Moreover, anonymity, confidentiality, and voluntariness were preserved throughout
the study. As is conventional in anonymous surveys, consent was in place before starting the
survey. Parents confirmed their consent in the electronic questionnaire by answering two writ-
ten mandatory questions placed just at the end of the Participant Information Sheet. Students
were also requested to confirm their consent by responding to one mandatory written question
just before they answered the electronic survey questions. Participants were informed they
could stop completing the questionnaire or refrain from submitting their responses if they felt
uncomfortable at any stage during completion. Participation in the study was voluntary. Par-
ticipants had the full right to withdraw at any time without the need to justify their actions.
There were no apparent risks that could result from participating in this study. However, due
to the fact that some students could feel uncomfortable expressing their feelings, a mental

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PLOS ONE School students mental health in COVID 19 in the United Arab Emirates

health support hotline was made accessible to participants in case they needed relevant profes-
sional consultations.

Data analysis
Data were analyzed using IBM SPSS Statistics for Windows version 26. The number of submit-
ted questionnaires was 3,762. However, post-data cleaning, the number was reduced to 3,745.
A combination of descriptive and inferential statistical techniques were implemented to
achieve the study goal. Descriptive statistics were used to present the distribution of students
across different age groups, gender, and various conditions related to the current coronavirus
pandemic. The inferential statistics included chi-squared tests (χ2) and p-values to assess the
association between categorical variables (age groups, gender, and the presence of symptoms)
and to analyze the relationship between various factors (student medical problems, method of
school learning, coronavirus-related experiences of the student and their family members) and
the presence of symptoms (Depression, Anxiety, PTSD). Moreover, logistic regression analysis
with Odds Ratios (OR) along with 95% confidence intervals (CIs) and p-values were used to
assess the association between different categorical variables and the presence of symptoms
(Depression, Anxiety, PTSD). A P-value < 0.05 was considered statistically significant in all
analyses. In constructing our multivariable logistic regression model, we meticulously navi-
gated the variable selection process by considering a range of factors to ensure both statistical
robustness and theoretical relevance to our research question. The prioritization of variables
was grounded in a theoretical assessment of their relevance to the research objectives, with a
focus on those directly linked to the investigated phenomenon. Our approach was further
informed by a comprehensive literature review, incorporating insights from prior studies and
established theoretical frameworks. To bolster the clinical validity of our model, we sought
input from domain experts, including clinicians, to align selected variables with relevant clini-
cal knowledge. Additionally, we employed statistical tests, such as chi-square tests or others
depending on variable nature, to evaluate the significance of variables.
This comprehensive statistical approach allowed for a nuanced exploration of the factors
influencing mental health symptoms among students in the UAE, providing valuable insights
into the interplay between various variables and mental well-being.

Findings
The socio-demographic characteristics of participants shown in Table 1 were derived from the
section answered by the parents. The majority of parents were married (94.2%), employed
(81.4%), and expats (67.8%). Likewise, most respondents (93.5%) had none of their family
members been previously diagnosed with a mental health-related problem or behavioral disor-
der. As for students, over one-third (34.3%) were pre-adolescents (<10 years), 37.5% belonged
to the early adolescence age group (10–13 years), 23.7% to middle adolescence (14–17 years),
and 1.8% to late adolescence (22 years). It is to be noted that these age groups were defined
based on the UAE stages of school education [35] and a published article on stages of adoles-
cence [36]. For gender, a little over half (50.6%) of the participants were male. Most of the stu-
dents (81.6%) studied in private schools and attended school completely online (82.3%).
In Table 2, data were also collected from parents’ questions. It showed that 14% had a close
family member at the time tested positive for coronavirus, followed by 14% who indicated that
a close family member was before or at the time sick/hospitalized because of the current coro-
navirus infection. However, only 5.8% reported that a close family member had died because
of the coronavirus. A smaller percentage of students (3%) tested positive for coronavirus at the
time while 5.4% were either unwell or hospitalized.

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PLOS ONE School students mental health in COVID 19 in the United Arab Emirates

Table 1. Socio-demographic characteristics of the sample (N = 3745).

Variables Number (%)*
Person responding to this questionnaire
Father 1227 (32.8)
Mother 2120 (56.6)
Both parents/ Legally Authorized Representative/Guardian 398 (10.6)
Total 3745 (100)
Parents Marital status
Married 3528 (94.2)
Divorced 125 (3.3)
Separated 53 (1.4)
Widowed 39 (1.0)
Total 3745 (100)
Total number of people living in house at present
2–4 1442 (38.5)
5–7 1719 (45.9)
8–10 358 (9.6)
More than 10 219 (5.8)
Not answered or not applicable (N/A) 7 (0.2)
Total 3738 (100)
Nationality
Emirati 1201 (32.1)
Non-Emirati 2540 (67.8)
N/A 4 (0.1)
Total 3741 (100)
Employment status (parents/guardian/legally authorized representatives)
Employed 3051 (81.4)
Unemployed 694 (18.5)
Total 3745 (100)
Family member diagnosed with a mental health-related problem or behavioral disorder
Yes 231 (6.2)
No 3503 (93.5)
N/A 11 (0.3)
Total 3734 (100)
Age of student (years)
Pre-adolescence (<10 years) 1285 (34.3)
Early adolescence (10–13 years) 1403 (37.5)
Middle adolescence (14–17 years) 888 (23.7)
Late adolescence (18 years) 67(1.8)
N/A 102 (2.8)
Total 3643 (100)
Gender of student
Male 1895 (50.6)
Female 1800 (48.1)
N/A 50 (1.33)
Total 3695 (100)
Student has any medical problems
Yes 259 (6.9)
No 3486 (93.1)
(Continued )

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PLOS ONE School students mental health in COVID 19 in the United Arab Emirates

Table 1. (Continued)

Variables Number (%)*

Total 3745 (100)
Student being diagnosed with a mental health-related problem or behavioral disorder
Yes 114 (3.0)
No 3631 (97.0)
Total 3745 (100)
Student school category
Private 3057 (81.6)
Governmental 517 (13.8)
Semi-governmental 137 (3.7)
N/A 34 (0.9)
Total 3711 (100)
Student current method of school learning
Completely online 3083 (82.3)
Hybrid (partly online) 520 (13.9)
Completely live at school 109 (2.9)
N/A 33 (0.9)
Total 3712 (100)
https://doi.org/10.1371/journal.pone.0296479.t001

Table 2. COVID-19 information pertaining to the sample (N = 3,745).

Variables Number (%)
A close family member has currently tested positive for coronavirus
True 532 (14.2)
False 2998 (80.1)
Not sure 215 (5.7)
A close family member is/got sick or is/was hospitalized because of the current coronavirus
infection
True 525 (14.0)
False 3072 (82.0)
Not sure 148 (4.0)
You work around people who might have the current coronavirus
True 798 (21.3)
False 2291 (61.2)
Not sure 656 (17.5)
A close family member died because of the current coronavirus
True 216 (5.8)
False 3367 (89.9)
Not sure 162 (4.3)
Student is currently tested positive for coronavirus
True 113 (3.0)
False 3516 (93.9)
Not sure 116 (3.1)
Student is/got sick or is/was hospitalized because of the current coronavirus pandemic
True 203 (5.4)
False 3419 (91.3)
Not sure 123 (3.3)
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PLOS ONE School students mental health in COVID 19 in the United Arab Emirates

Fig 1. Prevalence of common mental health disorders.

https://doi.org/10.1371/journal.pone.0296479.g001

A comprehensive examination of the outcome variables, which encompassed mental health

symptoms as self-reported by the students, revealed substantial variability. Among the 3,745
students, 642 (17.1%) reported depression symptoms on the MFQ-Child Self-report scale,
which utilized a total score range of 0–26 with a suggested cutoff of �12. On SCARED-Child
version scale, among the 3,745 students, 871 (23.3%) exceeded the scale’s cutoff (>30), signify-
ing the potential presence of an anxiety disorder. Similarly, symptoms indicative of a risk for
PTSD were observed in 1519 (40.6%) students who met or surpassed the defined cutoff score
of � 17 on CRIES-8 scale (Fig 1.).
Further inferential analysis looked into trends and associations among the outcome vari-
ables and predictive variables, age and gender. The data in Table 3 underscores intriguing pat-
terns and disparities. Significant age and gender differences were found to be associated with
mental health symptoms. A significantly higher proportion of participants who were late ado-
lescents reported symptoms of two conditions (depression and anxiety) compared to partici-
pants in the younger age group (p<0.05). Additionally, a significantly higher proportion of
female students reported symptoms of one condition-depression (p<0.05), anxiety (p<0.01),
or risk for PTSD only (p<0.05) or two conditions (p<0.05).

Table 3. Distribution of symptoms of depression, anxiety, and risk for PTSD by age and gender.
Age of student (years) Gender of student
Pre-adolescence (<10 Early adolescence (10– Middle adolescence Late adolescence (18 p- Male Female p-value
years) [n = 1285] 13 years) [n = 1403] (14–17 years) [n = 888] years) [n = 67] value [n = 1895] [n = 1800]
Symptoms of one condition
Depression only 218 (17.0) 246 (17.5) 153 (17.2) 18 (26.9) 0.22 301 (15.9) 333 (18.5) 0.035
Anxiety only 288 (22.4) 328 (23.4) 219 (24.7) 16 (23.9) 0.68 377 (19.9) 482 (26.8) <0.001
PTSD only 499 (38.8) 593 (42.3) 371 (41.8) 27 (40.3) 0.30 730 (38.5) 765 (42.5) 0.014
Symptoms of two conditions
Depression and 125 (9.7) 153 (10.9) 114 (12.8) 12 (17.9) 0.016 177 (9.3) 224 (12.4) <0.01
anxiety
Depression and 146 (11.4) 184 (13.1) 104 (11.7) 11 (16.4) 0.35 207 (10.9) 237 (13.2) 0.014
PTSD
Anxiety and PTSD 198 (15.4) 254 (18.1) 151 (17.0) 12 (17.9) 0.31 279 (14.7) 340 (18.9) <0.01
Symptoms of three conditions
Depression, 96 (7.5) 130 (9.3) 81 (9.1) 8 (11.9) 0.24 146 (7.7) 166 (9.2) 0.09
anxiety, and PTSD
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PLOS ONE School students mental health in COVID 19 in the United Arab Emirates

Table 4. Prevalence of symptoms of depression, anxiety, and PTSD stratified by pandemic-related factors.
Number (%) Depression Anxiety PTSD
Present Absent p-value Present Absent p-value Present Absent p-value
Student has any medical problems
Yes 259 (6.9) 68 (26.3) 191 (73.7) <0.01 107 (41.3) 152 (58.7) <0.01 131 (50.6) 128 (49.4) <0.01
No 3486 (93.1) 574 (16.5) 2912 (83.5) 764 (21.9) 2722 (78.1) 1388 (39.8) 2098 (60.2)
Student current method of school learning
Completely online 3083 (83.1) 511 (16.6) 2572 (83.4) 0.025 734 (23.8) 2349 (76.2) 0.10 1242 (40.3) 1841 (59.7) 0.63
Hybrid (partly online) 520 (14.0) 98 (18.8) 422 (81.2) 102 (19.6) 418 (80.4) 221 (42.5) 299 (57.5)
Completely live at school 109 (2.9) 28 (25.7) 81 (74.3) 27 (24.8) 82 (75.2) 44 (40.4) 65 (59.6)
Student currently tested positive for coronavirus
True 113 (3.0) 21 (18.6) 92 (81.4) 0.66 33 (29.2) 80 (70.8) 0.08 53 (46.9) 60 (53.1) 0.38
False 3516 (93.9) 598 (17.0) 2918 (83.0) 804 (22.9) 2712 (77.1) 1419 (40.4) 2097 (59.6)
Not sure 116 (3.1) 23 (19.8) 93 (80.2) 34 (29.3) 82 (70.7) 47 (40.5) 69 (59.5)
Student is/got sick or is/was hospitalized because of the current coronavirus pandemic
True 203 (5.4) 46 (22.7) 157 (77.3) 0.09 60 (29.6) 143 (70.4) 0.007 99 (48.8) 104 (51.2) 0.007
False 3419 (91.3) 574 (16.8) 2845 (83.2) 775 (22.7) 2644 (77.3) 1373 (40.2) 2046 (59.8)
Not sure 123 (3.3) 22 (17.9) 101 (82.1) 36 (29.3) 87 (70.7) 47 (38.2) 76 (61.8)
A close family member is currently tested positive for coronavirus
True 532 (14.2) 106 (19.9) 426 (80.1) 0.15 139 (26.1) 393 (73.9) 0.002 229 (43.0) 303 (57.0) 0.45
False 2998 (80.1) 503 (16.8) 2495 (83.2) 668 (22.3) 2330 (77.7) 1204 (40.2) 1794 (59.8)
Not sure 215 (5.7) 33 (15.3) 182 (84.7) 64 (29.8) 151 (70.2) 86 (40.0) 129 (60.0)
A close family member is/got sick or is/was hospitalized because of the current coronavirus infection
True 525 (14.0) 109 (20.8) 416 (79.2) 0.04 165 (31.4) 360 (68.6) <0.01 238 (45.3) 287 (54.7) 0.028
False 3072 (82.0) 512 (16.7) 2560 (83.3) 674 (21.9) 2398 (78.1) 1219 (39.7) 1853 (60.3)
Not sure 148 (4.0) 21 (14.2) 127 (85.8) 32 (21.6) 116 (78.4) 62 (41.9) 86 (58.1)
A close family member died because of the current coronavirus
True 216 (5.8) 57 (26.4) 159 (73.6) <0.01 78 (36.1) 138 (63.9) <0.01 119 (55.1) 97 (44.9) <0.01
False 3367 (89.9) 553 (16.4) 2814 (83.6) 740 (22.0) 2627 (78.0) 1326 (39.4) 2041 (60.6)
Not sure 162 (4.3) 32 (19.8) 130 (80.2) 53 (33.7) 109 (67.3) 74 (45.7) 88 (54.3)
https://doi.org/10.1371/journal.pone.0296479.t004

A more detailed examination of the relationship between pandemic-related factors and

mental health symptoms is shown in Table 4. Students who were reported to have medical
problems were more likely to have mental health symptoms as compared to those with nil his-
tory (p<0.01). Those who reported a close family member was sick or hospitalized because of
the coronavirus infection were more likely to report mental health symptoms as compared to
those who reported the statement was false (p<0.05). In terms of the death of a close family
member due to coronavirus infection, respondents who reported a close family member had
died because of the coronavirus infection were more likely to show mental health symptoms as
compared to those who did not (p<0.01).
Following a thorough regression analysis, the study substantiates the factors associated with
depression, anxiety, and risk for PTSD as shown in Table 5. Notably, students who had any medi-
cal problems demonstrated a 2.0-fold increased likelihood (95% CI 1.5–2.6) of manifesting anxi-
ety symptoms and a 1.3-fold increased likelihood (95% CI 1.0–1.8) of being at risk for PTSD.
Likewise, participants who had experienced the death of a close family member due to coronavi-
rus infection exhibited a 1.7-fold increased likelihood (95% CI 1.2–2.4) of reporting depression
symptoms. Moreover, they were 1.7 times more likely (95% CI 1.2–2.4) to experience elevated
anxiety levels and 1.7 times more likely (95% CI 1.2–2.3) to be at risk for PTSD, even after adjust-
ing for variables such as age, gender, and pre-existing mental health-related problems.

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PLOS ONE School students mental health in COVID 19 in the United Arab Emirates

Table 5. Predictive factors of common mental health symptoms using regression analysis.
Number Depression Anxiety PTSD
(%) Odds Ratio 95% p- Odds Ratio 95% p-value Odds Ratio 95% p-
(OR)¥ CI value (OR)¥ CI (OR)¥ CI value
Student has any medical problems No 3486 1.0 Ref 1.0 Ref 1.0 Ref
(93.1)
Yes 259 (6.9) 1.2 0.8– 0.19 2.0 1.5– <0.01 1.3 1.0– 0.002
1.7 2.6 1.8
Student is/got sick or is/was hospitalized because False 3419 1.0 Ref 1.0 Ref 1.0 Ref
of the current coronavirus pandemic (91.3)
True 203 (5.4) 1.3 0.8– 0.16 1.1 0.7– 0.54 1.1 0.8– 0.25
1.8 1.5 1.6
Not 123 (3.3) 1.3 0.7– 0.24 1.3 0.8– 0.21 0.8 0.5– 0.35
sure 2.4 2.2 1.2
A close family member is/got sick or is/was False 3072 1.0 Ref 1.0 Ref 1.0 Ref
hospitalized because of the current coronavirus (82.0)
infection True 525 (14.0) 1.0 0.8– 0.63 1.3 1.0– <0.001 1.0 0.8– 0.38
1.3 1.6 1.3
Not 148 (4.0) 0.6 0.3– 0.11 0.6 0.4– 0.10 1.0 0.6– 0.99
sure 1.1 1.0 1.4
A close family member died because of the current False 3367 1.0 Ref 1.0 Ref 1.0 Ref
coronavirus (89.9)
True 216 (5.8) 1.7 1.2– <0.01 1.7 1.2– <0.01 1.7 1.2– <0.01
2.4 2.3 2.3
Not 162 (4.3) 1.2 0.7– 0.37 1.6 1.0– <0.001 1.2 0.8– 0.23
sure 2.0 2.4 1.8
https://doi.org/10.1371/journal.pone.0296479.t005

Discussion
This cross-sectional web-based study investigated the prevalence of mental health symptoms
(depression, anxiety, and risk for PTSD) among 3,745 school students in the UAE post lock-
down of the COVID-19 pandemic. This study also identified the potential factors that pre-
dicted school students’ depression, anxiety, and risk for PTSD.

Prevalence of anxiety, depression, and risk for PTSD

This study has adequate evidence that students in the UAE are exhibiting symptoms of mental
health disorders in the post COVID-19 pandemic period and this is consistent with that of
recent studies across the globe. In a comprehensive review of evidence, the WHO concluded
that the world has experienced a 25% increase in the prevalence of anxiety and depression in
the first year of the COVID-19 crisis. More precisely, the report revealed that the pandemic
has particularly affected the mental health of young people who, more seriously, were found
disproportionally at risk of suicidal and self-harming behaviors [37]. Accordingly, the organi-
zation considered the COVID-19 pandemic a wake-up call to the world to set up mental health
services [38]. Another study examined the mental health challenges among Bangladeshi
healthcare professionals during COVID-19, urging comprehensive mental health support.
This study may offer valuable context and a comparative viewpoint to better comprehend the
mental health symptoms observed in school students in the UAE following the lockdown. It
highlighted the significance of comprehensive mental health support and interventions,
emphasizing the need for such measures not only during but also after the pandemic [39].
More support can be derived from a study that explored workplace stressors for nurses during
the COVID-19 pandemic, emphasizing the need for comprehensive mental health

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PLOS ONE School students mental health in COVID 19 in the United Arab Emirates

interventions. Understanding these dynamics is critical for contextualizing and comparing the
mental health experiences of school student’s post-lockdown in the UAE, emphasizing the
need for planned interventions across various affected populations [40]. Several other studies
indicated that adolescents experienced more adverse mental health effects during the pan-
demic in comparison to adults. These comparative findings underscored that adolescents were
more prone to reporting symptoms of depression, anxiety, and post-traumatic stress disorder
(PTSD) [41, 42].

Gender and age differences

The results from this study highlight that female and older adolescents showed a significantly
higher proportion of anxiety, depression, and risk for PTSD symptoms. These differences are
supported by a number of recent studies that showed female high school students at an
increased risk of psychological stress [43] and at higher levels of anxiety and depressive symp-
toms during the pandemic [44]. Interestingly, a number of researchers have argued that a pos-
sible explanation for female high school students’ higher levels of anxiety, depression, and
stress symptoms during the COVID-19 pandemic could be due to physiologic hormonal and
bodily changes or a lack of coping mechanisms [45, 46].

Past medical history and family/social support

This study explored more associations between mental symptoms and existing medical condi-
tions. Findings showed that students who had any medical problem were 2.0 (95% CI 1.5–2.6)
times more likely to have anxiety, 1.3 (95% CI 1.0–1.8) times more likely to have PTSD. These
results are supported by a recent post-lockdown study conducted in Germany which showed
that children with complex chronic diseases were more likely to have mental health problems
[47]. In another supportive study, researchers concluded that COVID-19-associated mental
health risks were more likely to appear in children and adolescents with special needs [48].
Conventionally, social ties and family relationships are understood to have a significant impact
on the maintenance of psychological well-being and reduce the risk for depression among ado-
lescents [49–53]. The relevant findings from our study are supportive of this conviction; partic-
ipants who had experienced the death of a close family member due to coronavirus infection
were 1.7 (95% CI 1.2–2.4) times more likely to have depression, 1.7 (95% CI 1.2–2.3) times
more likely to have anxiety, and 1.7 (95% CI 1.2–2.3) times more likely to have PTSD.
In a nutshell, symptoms of anxiety, depression, and risk for PTSD were found in the UAE
school students. Mental health services are needed to help those children cope and recover as
the Covid-19 pandemic is receding. Special attention must be regarded to disadvantaged chil-
dren and proactive plans should be put in place for potentially forthcoming threats.

Strengths and limitations

The study holds several strengths that underscore its significance and contribution to the field of
children mental health research in the UAE. Interestingly, healthcare entities in the country have
proactively prioritized mental health even before the pandemic, and the study takes advantage of
this groundwork. The collaboration of a multi-disciplinary team consisting of government health
regulators, disaster management experts, healthcare providers, and academia further enhances the
robustness of the research. Notably, the involvement of parents and students from across the
seven emirates strengthens the representativeness of the findings. The generation of robust data-
sets serves as a valuable resource for multiple disciplines, including physical and mental health,
education, social studies, and economics, amplifying the study’s utility. An additional strength lies
in the novelty of the study, as the literature review highlights its pioneering nature in the UAE

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PLOS ONE School students mental health in COVID 19 in the United Arab Emirates

context. However, the study is not without limitations. The wealth of data variables presents a
challenge in comprehensive incorporation within a single study. This constraint, while inevitable,
offers an avenue for subsequent research to extract relevant studies from the data bank, thus serv-
ing the broader community of mental health professionals and policymakers. Like many similar
research efforts conducted during the ongoing pandemic, the challenge of relying on convenience
and snowball sampling methods was inevitable [54]. Chosen for their practicality given the cir-
cumstances, it is important to acknowledge that this approach can have implications for the gen-
eralizability of our findings to the broader population.

Conclusion
The global COVID-19 pandemic, characterized by widespread lockdowns and pervasive uncer-
tainty, has inflicted significant mental health challenges upon children worldwide. Our study dili-
gently examined the prevalent mental health symptoms experienced by UAE school students after
the pandemic’s lockdown phase. It delved into anxiety, depression, and PTSD symptoms among
students, uncovering crucial associations with demographic and health factors. Notably, late ado-
lescents and females exhibited heightened vulnerability to various forms of mental distress. Addi-
tionally, students with pre-existing medical issues and those with family members affected by the
virus faced significantly increased odds of mental symptoms. These results highlight the urgent
necessity for tailored mental health support initiatives designed for students, with a specific focus
on those at an elevated risk. Furthermore, this work underscores the critical importance of con-
ducting subsequent studies to evaluate the pandemic’s enduring effects. Additionally, there is a
vital need to incorporate a mental health support system into disaster preparedness plans, recog-
nizing the significance of mental well-being in crisis management.

Implications
The implications of our findings are substantial in shaping psychological support strategies for
children. Specific attention must be given to vulnerable groups, such as late adolescents, female
students, and those grappling with complex chronic illnesses or challenging family dynamics.
Individuals who underwent pandemic-related traumas, like severe illness or bereavement,
require targeted interventions. Continuous mental wellness evaluations, tailored coping mech-
anisms for evolving learning contexts, prompt identification of individual psychological needs,
and accessible interventions for distressed students are essential. Educators need training to
discern school students’ verbal and non-verbal cues indicating potential mental distress, foster-
ing effective school-family communication. These insights underscore the importance of
developing a comprehensive school mental health program that promotes the well-being of
youth and enhances their resilience against future uncertainties.

Acknowledgments
We thank the Emirates Health Services Establishment for assisting in publishing this research.
Likewise, we acknowledge Ms. Ahlam Al Maskari for assisting in data collection at Abu Dhabi
Public Health Center and the research team at the Statistics and Research Center-Ministry of
Health and Prevention.

Author Contributions
Conceptualization: Nariman Ghader, Asma Fikri, Basema Saddik, Heyam Dalky, Ammar Al
Banna, Shammah Al Memari, Budoor Al Shehhi, Shereena Al Mazrouei, Omniyat Al
Hajeri.

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PLOS ONE School students mental health in COVID 19 in the United Arab Emirates

Data curation: Nariman Ghader, Hira AbdulRazzak, Hassan Saleheen.

Formal analysis: Nariman Ghader, Hira AbdulRazzak, Hassan Saleheen, Basema Saddik, You-
sef Aljawarneh.
Funding acquisition: Noor AlMheiri.
Investigation: Nariman Ghader, Asma Fikri, Hira AbdulRazzak, Ammar Al Banna.
Methodology: Nariman Ghader, Basema Saddik, Ammar Al Banna.
Project administration: Nariman Ghader, Noor AlMheiri, Asma Fikri, Hira AbdulRazzak.
Resources: Nariman Ghader, Noor AlMheiri.
Software: Nariman Ghader, Hassan Saleheen.
Supervision: Nariman Ghader, Noor AlMheiri.
Validation: Nariman Ghader, Yousef Aljawarneh, Heyam Dalky, Ammar Al Banna.
Visualization: Nariman Ghader.
Writing – original draft: Nariman Ghader, Asma Fikri, Hira AbdulRazzak.
Writing – review & editing: Nariman Ghader, Noor AlMheiri, Hassan Saleheen, Basema Sad-
dik, Yousef Aljawarneh, Heyam Dalky, Shammah Al Memari, Budoor Al Shehhi, Shereena
Al Mazrouei, Omniyat Al Hajeri.

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