Qom University of Medical Sciences Journal

Introduction
The COVID-19 pandemic devastatingly affected all aspects of the lives of people, including psychological, social, and economic aspects. In addition to physical health problems, it caused serious psychological problems such as anxiety and stress. It also affected people’s living conditions, due to travel restrictions, fear of disease transmission or infection, fear of losing loved ones, the closure of schools, universities, and businesses, as well as devastating psychological effects such as social anxiety, depression, and post-traumatic stress disorder. College students were one of the groups that were affected by the pandemic. The closure of universities contributed to the increased levels of anxiety and stress among them. Many students participated in online classes for the first time and had no prior experience with distant education. Concern about the exams, financial problems, academic future, future career, and loss of social interactions all led to the development of anxiety in college students. Resilience is one of the contributing factors in facing and adapting to adverse conditions. Resilience causes a person to be less anxious in the face of difficulties and problems. The purpose of the study is to investigate the relationship between depression, anxiety, stress, and resilience in nursing and midwifery students of Qom University of Medical Sciences (QUMS) during the COVID-19 pandemic.
Methods 
This is a descriptive-correlational study. The study population consists of all nursing and midwifery students at QUMS in 2021. Samples were 320 eligible students who were selected using a simple random sampling method. The inclusion criteria were the willingness to participate in the study, age 18-30 years, Iranian nationality, no psychiatric disorders, and no use of psychoactive drugs in the past 6 months. Unwillingness to continue participation in the study was the exclusion criterion. The data collection tools included Alipour’s corona disease anxiety scale (CDAS), the Connor-Davidson resilience scale (CD-RISC), and the depression, anxiety, stress scale (DASS-21).
Results
The mean age of participants was 21.20±1.02 years. The majority of them were nursing students (74.5%) and females (58.9%). In terms of marital status, 67.2% were single and 32.8% were married. According to the CDAS scores, 58.9% of students had severe anxiety caused by COVID-19 and 41.1% had moderate anxiety. Linear regression analysis showed that anxiety caused by Covid-19 was significantly associated with depression, anxiety and stress scores; it predicted 31%, 39% and 11% of the changes in depression (β=0.56, R2=0.31, P<0.001), anxiety (β=0.62, R2=0.39, P<0.001) and stress (β=0.34, R2=0.11, P<0.001), respectively. dimensions of the CD-RISC were significantly and inversely related to DASS-21 and CDAS domains. The multiple linear regression analysis showed that positive acceptance of change (CD-RISC domain) predicted 26% of changes in COVID-19-related anxiety (β=-0.39, R2=0.26, P<0.001). It also significantly predicted 40% of changes in depression (β=-0.40, R2=0.40, P<0.001).
Conclusion 
There was a significant correlation between resilience and the level of stress, depression and anxiety in nursing and midwifery students of QUMS during the COVID-19 pandemic. Higher levels of stress, depression, and anxiety are associated with lower levels of resilience in these students. Thus, interventions are needed for improving the mental health of college students during pandemics.
Ethical Considerations
Compliance with ethical guidelines
The ethical approval was obtained from the Ethics Committee of Qom University of Medical Sciences (Code: IR.MUQ.REC.1400.154).
Funding
This study was funded by Qom University of Medical Sciences. 
Authors contributions
The authors contributed equally to preparing this research.
Conflicts of interest
The authors declared no conflict of interest.
Acknowledgements
The authors would like to thank the Qom University of Medical Sciences for the financial support and all the students participated in this study for their cooperation.