Qom University of Medical Sciences Journal

Introduction
Anxiety was one of the most important psychological disorders during the COVID-19 pandemic. Children were among the high-risk groups for psychological disorders during the pandemic. While several studies assessed the pandemic on the mental health of adults, there is little evidence of the impact of this disease on the mental health of children. The outbreak of COVID-19 led to school closures, fear of contracting the disease, unpleasant thoughts and low interaction with classmates, friends, and teachers and low recreation and play outside the house. The need for affection in children is of great importance; showing affection and love to them can reduce their stress, which was limited during the pandemic due to social distancing. The observation of personal hygiene measures may exacerbate certain types of anxiety, such as phobias, obsessive-compulsive disorder, and general anxiety in children. In addition, children’s concern about the health of their parents increased during the pandemic. Paying attention to the psychological effects of COVID-19 in children is important for planning to control its psychological consequences. Therefore, the present study aims to determine the anxiety level of children during the COVID-19 pandemic in Qom, Iran, and find the related factors.
Methods
This descriptive cross-sectional study was conducted on 364 primary school students in Qom City in 2022 who were selected using multi-stage random and convenience sampling methods. The inclusion criteria were having a mobile phone and consent to participate in the study. Children with mental illnesses and taking psychiatric drugs were excluded from the study. To collect data, the Spence children’s anxiety scale (SCAS) was used, which has 45 items and six subscales of separation anxiety, social phobia, panic/agoraphobia, generalized anxiety, physical injury fears, and obsessive-compulsive disorder. The items are rated as 0 (not true), 1 (somewhat or sometimes true), and 2 (very true). The questionnaire was sent online to the parents of the children and they were asked to complete it. The data were described using descriptive statistics, including frequency, Mean±SD. The data were analyzed using the Spearman correlation test, Kruskal-Wallis test, and Mann-Whitney U test. The significance level was set at 0.05.
Results
In the present study, 235 boys (64.6%) and 129 girls (35.4%) participated. They had a mean age of 9.64±1.94 years (9.48±1.93 years for boys and 9.73±1.94 years for girls). The majority of students (45.3%) were the firstborn children and had a high educational status (53.6%), and moderate economic status (53.5%). The mean score of SCAS in children was 16.51±2.28. For its dimensions, the mean score was 1.53±2.04 for panic/agoraphobia, 3.36±4.45 for separation anxiety, 1.66±1.77 for physical injury fears, 2.71±3.43 for social phobia, 2.54±2.73 for obsessive-compulsive disorder and 2.28±2.59 for generalized anxiety.
The results of the Mann-Whitney U test showed a significant difference in children’s anxiety based on sex (P=0.031). Girls experienced more anxiety during the pandemic (17.39±11.48) than boys (14.9±11.38). Based on the Spearman correlation test, children’s anxiety level had no significant relationship with their age (P=0.084), number of siblings (P=0.390), or birth rank (P=0.961). The findings of the Kruskal-Wallis test showed a significant difference in anxiety level of children based on educational status (P<0.001). Children with high educational status experienced less anxiety (14.31±10.7) than children with poor educational status (25.5±12.04). There was no significant difference in children’s anxiety level based on economic (P=0.126).
Conclusion
The results of this study showed that the COVID-19 pandemic caused anxiety in Iranian children, which was higher in girls and those with low educational status. Therefore, the implementation of appropriate interventions and the use of practical solutions to maintain the mental health of children during the pandemic are recommended.
Ethical Considerations
Compliance with ethical guidelines
This study was taken from a project that was approved by the Ethics Committee of Qom University of Medical Sciences, Qom, Iran (Code: IR.MUQ.RES.1401.008).
Funding
The present study is a project approved by the Student Research Committee of Qom University of Medical sciences, and was funded by Qom University of Medical sciences, Qom, Iran.
Authors contributions
The authors contributed equally to preparing this article.
Conflicts of interest
The authors declared no conflict of interest.
Acknowledgements
The authors are grateful to the Vice Chandler of Research and research experts of Qom University of Medical sciences, Qom, Iran who helped in conducting the research.