Impacts of Covid-19 and Lockdown on Mental Health: Depression, Anxiety, Stress and Fear among Adult Population in Turkey

. Impacts of Covid-19 and Lockdown on Mental Health: Depression, Anxiety, Stress and Fear among Adult Population in Turkey. Archives of Clinical and Biomedical Research 6 (2022): 1010-1020


Introduction
The world is currently experiencing the biggest pandemic in 100 years. Unfortunately, the coronavirus disease 2019 (COVID- 19), first identified on December 31, 2019 in Wuhan, China, has since spread all over the world [1][2][3]. The COVID -19 pandemic has been associated with several mental health issues including depression, anxiety, and stress disorders [2,[4][5][6][7]. The COVID-19 pandemic has appeared to have caused a common concern globally, namely fear. Due to high levels of fear, individuals may not always think clearly and rationally in relation to COVID-19. Consequently, Ahorsu et al. developed a valid and reliable scale to assess the fear of COVID-19 [3]. The threat of COVID-19 can lead to a number of psychological symptoms in the general community [2,[8][9][10][11][12][13][14].
Fear can be triggered by many different things including the rise in infected cases, confinement at home, poor health facilities, lack of psychiatric services, and poor health information [8][9][10][11][12][13]. During country lockdowns, several studies have suggested that mental health problems have increased since the outbreak of the virus [2,7,12,15]. A recent study in India reported that anxiety, depression, stress, and other mental health diseases were commonly reported during lockdown [16]. Most of the documented literature to date has reported that the COVID-19 pandemic is associated with greater distress, anxiety, anger, stress, and agitation among the general public compared to before the onset of the pandemic [2,[11][12][13]15]. The aim of the present study was to examine the impacts of COVID-19 and lockdown, and fear of COVID-19 in relation to mental health outcomes of depression, anxiety, and stress among the general population in Turkey.

The Fear of COVID-19 scale:
The seven-item unidimensional FCV-19S was used to assess the fear of COVID-19 [3]. Each item is responded to a fivepoint Likert scale from 1 (strongly disagree) to 5 (strongly agree) with a scoring range of 7 to 35. It was developed by Ahorsu et al. [3], and adapted into Turkish language by Satıcı et al. [19]. The higher score indicates the greater the fear of COVID-19. In the present study the Cronbach's alpha for FCV-19S was good (α=0.74).

Statistical analysis
The Statistical Package for Social Sciences (SPSS, version 25) software was used to analyze data.
Significant differences between the means of continuous variables were calculated using student ttests. Chi-square tests were used to determine significant differences between categorical variables.
Multivariate stepwise linear regression analysis was used to determine the association between the FCV-19S and DASS-21. A level of p<0.05 was used as the cut-off value for statistical significance.

Discussion
Currently, the COVID-19 pandemic has become the biggest public health issue of the last 100 years. The management and prevention of COVID-19 has become a major public health concern. Research concerning knowledge and attitudes related to COVID-19 are important in developing public perceptions of the disease and drawing up preventive plans for health promotion programs [2,4,11]. Many of the participants (83%) in the present study had a good level of knowledge concerning COVID-19. This knowledge level was higher than a study conducted in China [2]. Hand washing with soap or using sanitizer, and using a mask to cover mouth and nose are essential for COVID-19 prevention [4,5]. The results of the present study demonstrated that most participants washed their hands with soap after being in crowded places. Many individuals reported avoiding crowded places and wearing a mask when going out. These results were consistent with the results of previous research conducted in China [7].
The findings of the present study also suggested that

Conclusion
The COVID-19 pandemic and the subsequent lockdown have had great impact on people's lives and presented highly significant challenges to public health in several areas, including psychosocial and mental health. The impact of the COVID-19 pandemic on depression, anxiety, and stress among the Turkish population appears to have been widespread. The findings of the study confirm that the fear of COVID-19 was significantly associated with depression, anxiety, and stress.