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.