Data collection:
We designed an Arabic questionnaire composed of four sections to collect the data. Section I included a detailed explanation of the steps, aims, and eligibility criteria of the study. Section II included questions about the sociodemographic and educational features of students including age (in years), sex (man or woman), residence (urban or rural area), and discipline (faculty or institute name). Section III had questions related to the COVID-19 pandemic including having a friend or relative infected with COVID-19 (yes, no, or not sure), having a friend or relative died from COVID-19 (yes, no, or not sure), wearing masks (always, sometimes, or never), using detergents (always, sometimes, or never), applying social distancing (always, sometimes, or never), watching/reading COVID-19 news (<2, 2-4, or >4 hours/day), average daily sleeping hours per day (<6, 6-9, or >9 hours/day), and receiving enough emotional support from the family (yes or no), society (yes or no), and the university (yes or no). Section IV included the Arabic version of the Depression Anxiety Stress Scale-21 (DASS-21). The DASS-21 is a quantitative measure of depression, anxiety, and stress symptomatology (7 statements each) during the past week. The depression statements evaluated hopelessness, dysphoria, self-deprecation, devaluation of life, lack of interest and involvement, anhedonia, and inertia. The anxiety statements evaluated skeletal muscle effects, autonomic arousal, situational anxiety, and subjective experience of anxious affect. The stress scale evaluated nervous arousal, difficulties in relaxation, and being easily upset or over-reactive. Students had to decide how much the statements applied for them using a scale from zero to three where zero referred to “did not apply to me at all”, one referred to “applied to me to some degree or some of the time”, two referred to “applied to me to a considerable degree or a good part of the time” and three referred to “applied to me very much or most of the time”. The score of each axis was multiplied by two to lie within a zero to 42 scale where higher scores indicated worse outcomes. The cut-off values for the DASS-21 scales were the following: 1) Depression: normal (0-9), mild to moderate (10-20), and severe to extremely severe (≥21), 2) Anxiety: normal (0-7), mild to moderate (8-14), and severe to extremely severe (≥15), and 3) Stress: normal (0-14), mild to moderate (15-25), and severe to extremely severe (≥26) (14, 15). In this study, depression, anxiety, and stress were considered outcomes.