Psychological responses of Tunisian general population during COVID-19 pandemic

Introduction: this is the first study assessing the psychological impact on Tunisian general population during the first peak of the COVID-19 pandemic. We aimed to assess the prevalence of anxiety, depressive symptoms and insomnia, as well as associated factors. Methods: a cross-sectional study was conducted through an online survey of 1615 people during March 23rd to May 5th, 2020. We used the hospital anxiety and depression scale for anxiety and depression screening, and the insomnia severity index to assess sleep disturbances. Results: our study revealed a high prevalence of anxiety and depressive symptoms, and insomnia (70.9%, 71.1% and 60.6% respectively). Multivariable statistics showed that anxiety symptoms were correlated to female gender (adjusted odds ratio [aOR] 1.784, 95% confidence interval (CI 1.252-2.542; p=10(-3)), history of mental illness (aOR: 1.680, 95% CI: 1.329-2.125; p<10(-3)), frequently social media exposure (aOR: 1.578, 95%CI: 1.250-1.992; p<10(-3)), times to focus on COVID-19 >= 3hours (aOR: 1.840, 95% CI: 1.433-2.362; p<10(-3)), consultation with doctor in the clinic in the past 14 days (aOR: 1.821, 95%CI : 1.220-2.718; p=0.003) and recent traumatic event in the past 14 days (aOR: 1.641,95% CI: 1.331-2.024; p<10(-3)). Principal factors associated with depressive symptoms included female gender (aOR: 1.637, 95% CI: 1.150-2.331; p=0.006), history of mental illness (aOR: 1.498, 95% CI: 1.189-1.888; p=10-3), times to focus on COVID-19 >= 3hours (aOR: 1.956, 95% CI: 1.555-2.461; p<10(-3)), and recent traumatic event in the past 14 days (aOR: 1.558, 95% CI: 1.265-1.919; p<10(-3)). The main factors correlated to insomnia were younger (age <35years) (aOR: 1.592, 95% CI: 1.17-2.152; p=0.003), female gender (aOR: 1.864, 95% CI: 1.252-2.775; p=0.002), having organic diseases (aOR: 1.527, 95% CI: 1.131-2.061; p=0.006), history of mental illness (aOR: 1.777, 95% CI: 1.396-2.263; p<10(-3)), students (aOR: 1.931, 95% CI: 1.495-2.495; p<10(-3)), times to focus on COVID-19 >= 3hours (aOR: 1.877, 95% CI: 1.467-2.400; p<10(-3)) and recent traumatic event (aOR: 1.431, 95% CI: 1.144-1.789; p=0.002). Conclusion: our study revealed a major mental health burden in Tunisia during COVID-19 pandemic. Many factors were correlated to anxiety, depressive symptoms and insomnia, suggesting the need for greater psychological support in general and in certain vulnerable groups.