Original Articles

Psychosocial Factors Associated with Depression and Anxiety During COVID-19 Pandemic Among Outpatients with Depression


Department of Psychological Medicine, University of Malaya School of Medicine, Kuala Lumpur, Malaysia


Department of Psychiatry, University Sciences Islam Malaysia (Islamic Science University of Malaysia (USIM)) Faculty of Medicine and Health Sciences, Kuala Lumpur, Malaysia

Alpha Psychiatry 2021; 22: 185-193
DOI: 10.5152/alphapsychiatry.2021.21107
Read: 2838 Downloads: 551 Published: 30 June 2021

Objective: Long-term social distancing, isolation, and economic fallout may be significant psychological triggers during pandemic, such as COVID-19, especially for those with underlying psychiatric illness. This study was conducted to address the psychological impact of COVID-19 pandemic among patients with depression based at a teaching hospital in Malaysia.

Methods: This is a cross-sectional online study among patients with depression from University Malaya Medical Centre, using Generalized Anxiety Disorder-7 (GAD-7), Montgomery-Åsberg Depression Rating Scale-Self Assessment (MADRS-S), Insomnia Severity Index (ISI), Multidimensional Scale of Perceived Social Support (MSPSS), Knowledge, Attitudes, and Practices (KAP), and Social Media Addiction during COVID-19 Pandemic (SMACOP).

Results: One hundred seventy-eight patients participated in this study. The mean total of the KAP score is 12.65 (SD = 2.65), with knowledge section (mean = 7.34 [SD = 2.13]), attitudes section (mean = 2.63 [SD = 0.58]), and practices section (mean = 2.69 [SD = 1.00]). They scored moderately on the MADRS-S (mean = 21.03 [SD = 4.62]) and ISI (mean = 20.25 [SD = 4.62]) but had high GAD-7 scores (mean = 16.8 (SD = 6.27]). From the multiple logistic regression analyses, depressive symptoms of greater severity (MADRS-S 18–34) are significantly associated with more severe insomnia (P < .001, adjusted OR = 9.101, 95% CI: 3.613-22.924). Furthermore, the high anxiety level is associated with the younger age group (P = .029, Adjusted OR = 2.274, 95% CI: 1.090-4.746), greater severity of insomnia (P < .001, Adjusted OR = 22.9, 95% CI: 6.145-85.343), and higher risk of COVID-19 related social media addiction (P = .011, adjusted OR = 2.637, 95% CI: 1.253-5.550).

Conclusion: This study demonstrates the high levels of sleep disturbances and anxiety symptoms experienced by outpatients with depression during the COVID-19 pandemic. These are closely linked to the younger age group and at-risk social media addiction related to COVID-19.

Cite this article as: Zulkifli NA, Chong Guan N, Zainal NZ, Ling TS. Psychosocial factors associated with depression and anxiety during COVID-19 pandemic among outpatients with depression. Alpha Psychiatry. 2021;22(4):185-193.

EISSN 2757-8038