The 2019 novel coronavirus (COVID-19) has made to a quick and serious outbreak of threatening respiratory disease, which originated first in China and has expanded as a worldwide pandemic, with far-reaching effects [17]. The emergence of this virus is regarded as a particular stressor for people’s physiological, psychological, and behavioral reactions [18]. Moreover, anxiety is one of the self-regulation subjective capabilities as a response to COVID-19 that will have a psychological impact on the well-being of the general population [19]. The limited knowledge of the COVID-19 and the upsetting news may lead to anxiety and fear in society [5]. It is notable that our study is the first one holding in Iraq to examine the health anxiety related to COVID-19 by an online survey method of data collection.
In our study, among the 1591 respondents to the online survey, 788 (49.5%) accounted for having health anxiety. The former history of the Iraqi population going through decades of internal and external conflicts making it easy to believe that mental disorders are common among the Iraqi population. In turn, this is forcing them to be more vulnerable to anxiety disorders and may explain the higher prevalence encountered in our study [20]. Another reasonable explanation may be that the Iraqi people believe that inadequate public health care services and weak health systems being unable to manage the probable upcoming pandemics. Moreover, the current world-wide home restriction situation, including the measures taken in Iraq, obligated people to be more exposed to an unheard-of stressful position of unknown duration [21]. Iraqi measures included (a) awareness of the seriousness of the situation started at the beginning of March 2020 and (b) prevention and control measures of movement suspension were announced in some cities of Iraq that have positive COVID-19 cases. Following the mid-term of March 2020, more restrictions imposed on traffics and strong isolation measures began after March 20, 2020, especially after the detection of further COVID-19 cases.
Many other studies proved the psychosocial reactions of the general population toward the severe acute respiratory syndrome outbreak [22]. The mutual topics in these psychological reactions included anxiety, depression, posttraumatic stress, and stigmatization. Comparing to other studies, an online survey on the psychological impact of COVID-19 in China estimated the rate of anxiety being 36.4% with different severities, including 28.8% having moderate to severe anxiety [23].
Our survey identified that younger ages experienced more COVID-19-related health anxiety compared to older ages. Analogous data were proven by a study in China in which the anxiety risk of people above 40 years old was 0.40 odds ratio (CI 0.16–0.99) times compared with those below 40 years old [24].
In this work, females reported higher health anxiety compared to males (57.7% vs 42.3%). An analysis in China on anxiety and depression rates among the general population revealed that females’ anxiety risk was 3.01 times equated to males [24]. Similarly, the anxiety scores of female medical staff also were higher compared to males [25]. Studies proved that the fear and rousing responses are more active among females, and this can explain the observed gender differences [26].
Respondent Iraqi students expressed a notifiable fraction (43%) of possible anxiety, especially college students, during the span of extending outbreak. To some degree, parallel results were shown in a survey from Changzhi Medical College, which indicated that 24.9% of the students were impaired with received anxiety over the COVID-19 outbreak era [27]. Of these students, 0.9% experienced severe anxiety, and 21.3% experienced mild anxiety. Accordingly, college students who experienced anxiety undoubtedly will have a negative impact on the educational process and possible delays in education. Likewise, our study showed that health care professionals have a higher percentage of health anxiety next to the student group. This is consistent with previous studies which showed that health professionals are suffering from mental health problems during outbreaks.
The health care professionals reported 20.9% health anxiety, which seems to be near some other studies’ rates. A previous survey showed that the incidence of anxiety among medical staff was 23.04% during the COVID-19 epidemic [25]. In contrast, some other studies evidenced much higher percentages of anxiety reaching up to 44.7% [5]. Reasonable elucidation is that they have the responsibility of attention to the patients, obligatory handling of patients, and to a lesser extent contact with patients’ families or relatives [5]. Additionally, frontline health workers usually have close contact with infected patients, excessive workload, and isolation, making them highly vulnerable to experience physical exhaustion, worry, mood problems, and sleep disturbances. The proportionally low level of our figure compared to the last-mentioned study could be attributed to the low toll of confirmed COVID-19 cases at the time of initiation of the survey, which was less than 300 patients.
Although our findings were not statistically significant regarding anxiety linkage with household size, the more households were accompanying to more health anxiety percentages. However, as much as the family size or the household size increase, the thoughts of the danger of exposure to COVID-19 are rising not only for themselves alone but extends to their colleagues and their families. Furthermore, people must beguile to the demands of elderly parents who are in the huge need to support, in addition to the needs of children who are abruptly out of school and exposed to movement bans [28].
Unexpectedly, the rate of health anxiety in those having a history of chronic respiratory disease was low. The smaller sample size and lower proportion of those having chronic respiratory illnesses might affect the results. However, at the time of the sample collection, there was an uncertainty of population knowledge about the definite magnitude of the risks of unfavorable outcomes attributable to COVID-19 in patients with chronic respiratory diseases.
In this survey, based on the regional distribution of our sample, the southern Iraqi population displayed more health anxiety compared to the northern and middle portions. The respondent from southern provinces demonstrated significantly higher health-related anxiety (59.1%) than the middle or northern provinces. Furthermore, the difference in distribution between these regions was not only in the means of diagnosis of health anxiety but also broaden to the four defining factors or subclasses outlined as health worry and preoccupation, fear of illness and death, reassurance-seeking behavior, and interference with life. Unlikely, an equivalent survey done in China deduced that there are no differences between the midwestern and eastern regions [24]. This might be explained by that the southern cities exhibit more social conflicts and border insecurity, which may subsequently submit a significant awareness attitude about this accused outbreak. It is worthy to mention that the rise of infection-related reaction has been a common response when people are threatened with an infection that originates from outside of their community [18].
The current study poses an impression of how COVID-19-related anxiety affects the Iraqi general population as they practiced a specific comprehensive precautionary measure against COVID-19 infection. Among them, about half of the respondents were spending more than 60 min focusing on news of COVID-19. This impact has got to be compatible with the results from a Chinese web-based cross-sectional study, in which 36.3% of participants consumed 1–2 h to follow COVID-19 news [29].
Also, this survey expressed that 80 to 90% carrying out preventive measures and home quarantine against COVID-19 infection which is similar to other studies performed during the COVID-19 outbreak in China [30]. Hence, this success in self-practiced prevention hypothetically may concern about changing the epidemiological curve of COVID-19 cases in Iraq compared with that in China, Italy, and the UK [31]. This perceived threat could act as a motivational influence to perform a behavior that facilitates COVID-19 prevention [32].
Iraq has high prevalence rates of mental health crises as a result of previous wars, violence, and oppression [33]. Noticeably, the data from this work disclosed that the participants’ experienced fear from the risk of COVID-19 infection was either more or equal to the level of war scare, in 70.1% of the sample, while data from Germany demonstrated that 62% of answered people had general worry about COVID-19 [34].
As aforementioned, it is argued to put a specific scale of fear from COVID-19 [32]. Our study evidenced that specific COVID-19 anxiety item means are positively correlated with the total health anxiety scales and its four subscales. Additionally, these positive correlations and high anxiety levels are manifested between the used subscales.
Limitations
Illness-related anxiety was not among the exclusion criteria; therefore, cases diagnosed as having health anxiety might include patients who previously had illness-related anxiety. However, previous surveys on the Iraqi population demonstrated only 13.8% to have anxiety disorders [20]. Response bias may be considered as one of these limitations since the response rate from the capital Baghdad was only 9% which may be attributed to either too stressed to respond or not interested in this survey. The sample was convenient, and the online participation has a possibility of selection bias. The response of the people took longer than expected which could interfere with the study being cross-sectional which was due to the fact that the authors did not have access to people from all over Iraq, to begin with. This problem was later solved by involving co-authors from the governorates that had low responses.
