Introduction
In December 2019, the COVID-19 outbreak started in Wuhan, China, inflicting widespread concern worldwide. In simply two and a half months, the World Health Organization declared it a worldwide pandemic as a result of speedy unfold and extreme influence of the virus (1). The uncertainty and unpredictability surrounding this illness, mixed with strict well being measures like quarantines and diminished providers, have led to vital stress and nervousness globally (2–4, 41, 42). One essential psychological consequence of such disturbing occasions, significantly life-threatening diseases like COVID-19, is loss of life nervousness (3).
Death nervousness is outlined by the British National Health Service as a sense of panic or excessive fear when considering loss of life, the method of dying, or what occurs afterward (5). This nervousness can disrupt a person’s regular functioning, leading to extreme psychological misery (6–8). The unfavorable results of loss of life nervousness might embrace elevated pessimism, hopelessness, diminished social assist, and bodily well being issues (9).
Furthermore, cultural values strongly affect how completely different populations expertise loss of life nervousness. Understanding these cultural variations is essential for addressing the psychological impacts of pandemics and informing well being interventions (10, 11). In Iran, the COVID-19 pandemic has had a big influence on psychological well being, with excessive ranges of stress and nervousness reported among the many common inhabitants (12–14). Those who had been extra ceaselessly uncovered to media and social media throughout the pandemic skilled even higher nervousness (4, 15, 16, 43, 44). Death nervousness, as a potent emotional response, has been famous to extend as individuals face the upcoming danger of shedding their lives throughout pandemics (17). For instance, a examine in Shahroud, Iran, reported average ranges of loss of life nervousness throughout the COVID-19 pandemic (18), and related findings had been noticed in Lebanon (10).
Research drawback and justification
Despite the appreciable consideration given to psychological well being points throughout the COVID-19 pandemic, there may be restricted analysis particularly addressing loss of life nervousness in jap Iran, a area with distinct socio-cultural and financial options (19). Eastern Iran is extra conventional and fewer urbanized than the western and central components of the nation, which can end in distinctive psychological responses to the pandemic (20). Furthermore, the area’s public well being infrastructure, which can be much less developed and fewer outfitted to deal with psychological well being crises, might exacerbate these challenges. Investigating loss of life nervousness on this area is crucial for tailoring psychological well being interventions and public well being insurance policies to the native inhabitants’s wants (21).
Given the dearth of analysis in jap Iran, this examine was performed to find out the prevalence of loss of life nervousness and its associated components inside this inhabitants. While the examine came about in 2019, the findings stay related as COVID-19 continues to influence psychological well being worldwide. This examine’s outcomes can present perception into how loss of life nervousness manifests throughout pandemics, providing precious classes for future well being crises and their psychological penalties.
Methods
Study design and examine setting
Participants
The inclusion standards for the examine had been:
• Providing knowledgeable consent,
• Being not less than 18 years outdated,
• Residing in Torbat Heydariyeh metropolis on the time of the examine.
Sample dimension and randomization
To decide the pattern dimension, we utilized a pattern dimension calculation system for estimating proportions, particularly the system:
n=(Z2 ∗ p ∗ (1- p))/d2
the place:
n = required pattern dimension
Z = Z-value (1.96 for a 95% confidence stage)
P = estimated proportion of the inhabitants (0.5 was used for optimum variability)
d = margin of error (set at 0.05).
Based on this system, the estimated pattern dimension was calculated to be 515 contributors. Randomly stratified and weighted sampling was then performed based mostly on the inhabitants distribution in every space of the town. The metropolis was divided into 5 components (North, South, East, West, and Center); the variety of samples required for every area was calculated in proportion to the general pattern dimension of the examine, guaranteeing sufficient illustration from every space.
Efforts to Reduce Selection Bias:To reduce choice bias, the sampling technique was meticulously designed to make sure that the pattern precisely mirrored the inhabitants of Torbat Heydariyeh. The random stratified sampling method took into consideration demographic and geographical variations throughout the 5 components of the town, thus offering a balanced illustration of all subgroups throughout the inhabitants.
Outcomes measures
The knowledge assortment instrument consisted of two components. The first half was demographic questions, together with age, gender, training, marital standing, occupation, medical historical past, well being standing, financial standing, and supply of revenue. In the second half, there have been questions associated to loss of life nervousness. Templer’s Death Anxiety Scale (DAS) was used to guage loss of life nervousness. This questionnaire included 15 Yes/No questions, the place a rating of 1 was given for “sure” and 0 for “no” (a rating of zero signifies the absence of loss of life nervousness and a rating of 1 signifies the presence of loss of life nervousness). The whole scores ranged from 0 (no loss of life nervousness) to fifteen (very excessive loss of life nervousness) (15 Death nervousness scores had been categorised into three ranges: gentle nervousness (0–6), average (7–9), and extreme (10–15). Templer’s loss of life nervousness scale is an ordinary questionnaire used worldwide and was translated and psychometrically evaluated in Iran by Rajabi et al. in (40). The reliability coefficient of classification was 0.6, and the interior consistency coefficient was 0.73 (16). Thomas et al. recorded its reliability as 0.76 and its inner consistency as 0.83 utilizing the test-retest technique (17). In the current examine, the reliability of the questionnaire was calculated with a Cronbach’s alpha coefficient of 0.75.
Data assortment
Due to the unfold of the COVID-19 illness and in compliance with well being tips, face-to-face interviews had been averted. With the cooperation of the Torbat Heydariyeh City Telecommunications Department, the landline cellphone numbers for every area had been randomly obtained. The researcher made a cellphone name to the analysis models, introducing themselves, explaining the aims of the analysis, guaranteeing the confidentiality of the knowledge, and acquiring knowledgeable consent. The researcher then learn and accomplished the questionnaire questions with none further rationalization.
Handling Missing Data: To tackle lacking knowledge, we employed an entire case evaluation method, guaranteeing that solely contributors with totally accomplished questionnaires had been included within the evaluation. Furthermore, a sensitivity evaluation was carried out to make sure that excluding lacking knowledge didn’t introduce vital bias into the outcomes. Any vital lacking knowledge patterns had been assessed and reported accordingly.
Statistical evaluation
Data evaluation was carried out utilizing the sixteenth model of SPSS software program. The frequency (share) was used to explain qualitative knowledge, and the imply ± customary deviation was used for quantitative knowledge. To make sure the validity of the evaluation, a number of statistical assumptions had been examined earlier than making use of the regression fashions. The Kolmogorov-Smirnov check was used to verify for the normality of the info distribution. Additionally, multicollinearity between unbiased variables was examined utilizing the Variance Inflation Factor (VIF), guaranteeing that no vital collinearity existed. The choice to make use of a number of linear regression was made based mostly on its appropriateness for investigating the connection between the dependent variable (loss of life nervousness) and a number of unbiased variables. This technique allowed for the adjustment of confounding variables to isolate the impact of every issue on loss of life nervousness.
Confounding Variables: The evaluation adjusted for a number of potential confounders, together with age, gender, training, marital standing, occupation, well being standing, and publicity to COVID-19 information. These variables had been included within the regression fashions to manage for his or her potential affect on loss of life nervousness.
Results
The common age of contributors was 32.88 ± 10.75 years, with a variety from 18 to 80 years. Most contributors, 357 (69%), had been married, and 339 individuals (66%) had been glad with their financial state of affairs. The common variety of youngsters was 1.20 ± 1.25, and the vast majority of contributors, 321 (62%), reported their well being standing pretty much as good, whereas the remaining contributors reported it as common. Further demographic info is offered in Table 1. Most contributors, 65%, had no historical past of sickness, with the frequency of diseases detailed in Table 2. Additionally, 448 contributors (87%) reported that they don’t smoke (Table 3).
Table 1. Demographic info of individuals collaborating within the examine.
Table 2. Frequency of illnesses of individuals collaborating within the examine.
Table 3. Prevalence of smoking among the many contributors.
The outcomes indicated that the common loss of life nervousness rating was 6.73 ± 3.11, with scores starting from 0 to 14. Most contributors, 244 (47%), had gentle loss of life nervousness, whereas 168 (33%) had average loss of life nervousness, and 103 individuals (20%) had extreme loss of life nervousness. The Kolmogorov-Smirnov check confirmed that the distribution of loss of life nervousness scores adopted a standard distribution (P = 0.11). Therefore, a number of linear regression was employed to research components associated to loss of life nervousness (Table 4).
Table 4. Factors associated to loss of life nervousness.
The regression evaluation revealed a number of key components related to loss of life nervousness:
Gender: Women had a mean loss of life nervousness rating 1.12 factors increased than males (P = 0.001).
Education Level: People with a highschool diploma or decrease had considerably increased loss of life nervousness scores in comparison with these with a college training. The distinction was 1.75 factors for highschool graduates and 0.34 factors for these with some increased training (P < 0.05).
Smoking Status: Smokers had a mean loss of life nervousness rating 0.76 factors increased than non-smokers (P = 0.049).
Economic Satisfaction: Participants who had been glad with their financial standing had a mean loss of life nervousness rating 0.82 factors decrease than those that weren’t glad (P = 0.006).
No statistically vital relationship was noticed between loss of life nervousness and variables corresponding to age, marital standing, occupation, historical past of sickness, treatment use, well being standing, supply of revenue, or variety of youngsters (P > 0.05).
Discussion
This examine aimed to evaluate the prevalence of loss of life nervousness and its related components within the inhabitants of jap Iran, discovering that loss of life nervousness associated to COVID-19 was average. Our findings revealed that age was not considerably related to loss of life nervousness, which is in line with the examine by Aghajani et al. (22), however contradicts the outcomes of Henrie et al. (23) and Soleimani et al. (24). Before the pandemic, youthful people might not have thought of loss of life as a lot as older adults. However, the common danger posed by COVID-19 might have influenced individuals of all ages equally, explaining the dearth of great correlation between age and loss of life nervousness on this examine.
A big relationship between gender and loss of life nervousness was noticed, with girls reporting increased ranges of tension than males. This discovering aligns with the outcomes of Thorson et al. (25), Pierce et al., and Mansurnezhad et al. (26). This distinction will be attributed to each emotional and cultural components, as girls could also be extra expressive about their anxieties and considerations concerning loss of life in comparison with males (27, 28). However, this consequence contrasts with the findings of Mousavi et al. (29), indicating that additional investigation into gender variations in loss of life nervousness is warranted.
Regarding financial standing, people with decrease financial standing skilled increased loss of life nervousness than these with higher financial circumstances, supporting the conclusions of Misler et al. (30). Those with higher entry to monetary assets and providers could also be higher outfitted to deal with nervousness, lowering their total stress ranges. These findings align with Soleimani et al. (24) and Chang et al. (31), although research corresponding to Postolica et al. (32) and Assari et al. (33), reported the other, with people of upper financial standing exhibiting extra loss of life nervousness. This discrepancy might stem from variations in how financial assets are perceived in varied cultural contexts.
Education additionally performed a vital function, with university-educated people reporting decrease loss of life nervousness than these with decrease ranges of training. This discovering is in line with the outcomes of Azaiza et al. (34), who famous that increased training ranges contribute to elevated consciousness and understanding of preventive measures towards COVID-19, thereby lowering nervousness.
Although marital standing didn’t considerably affect loss of life nervousness, married people exhibited barely increased nervousness scores than their single counterparts. This end result aligns with research by Rouhi et al. (35) and Massoudzadeh et al. (36), although Aghajani et al. (22) discovered that single individuals skilled extra loss of life nervousness.
Occupation was one other key issue influencing loss of life nervousness. Medical professionals exhibited the bottom ranges of tension, possible as a consequence of their familiarity with health-related dangers, whereas retirees reported the best ranges of tension. This might be attributed to age-related components, continual well being circumstances, and monetary insecurity amongst retirees (37, 38).
Finally, a big relationship between supply of revenue and loss of life nervousness was noticed. Participants reliant on charitable organizations or assist establishments reported increased ranges of tension, possible as a consequence of monetary dependence and considerations over healthcare bills throughout the pandemic. This discovering contrasts with the examine by Soleimani et al. (39), indicating a necessity for additional analysis on how revenue sources influence psychological wellbeing.
Additionally, the generalizability of the findings is proscribed by the examine’s regional focus. While the examine offers precious insights into the inhabitants of jap Iran, its applicability to different areas or populations should be approached with warning. Cultural, social, and public well being variations might considerably affect loss of life nervousness throughout completely different areas. Future research in various geographic and pandemic contexts are wanted to enhance exterior validity and guarantee broader applicability.
One vital limitation was the digital divide within the studied inhabitants, as unequal entry to on-line providers might have affected the representativeness of the pattern. Some people, significantly these in rural or underserved areas, might have been excluded as a consequence of restricted entry to web or phone providers, probably introducing bias into the outcomes. To adhere to well being tips throughout the pandemic, knowledge assortment was performed just about, which can have additional restricted participation for sure teams.
In future analysis, using various knowledge assortment strategies, corresponding to in-person interviews or a mixed-methods method, might enhance.
Conclusion
The outcomes of this examine point out that the extent of loss of life nervousness among the many inhabitants of Torbat Heydariyeh metropolis throughout the COVID-19 pandemic was average. Given that loss of life nervousness was current throughout varied demographic teams, together with people of various ages, marital statuses, and well being backgrounds, it’s essential to implement instructional packages geared toward instructing efficient coping methods. Additionally, it’s important to acknowledge the function of cultural and social components in shaping loss of life nervousness, as these might differ throughout completely different geographic areas. Therefore, conducting additional analysis in various populations is advisable to develop a extra complete understanding of loss of life nervousness and to assist the event of focused interventions.
Data availability assertion
Ethics assertion
The analysis was permitted by the Research Ethics Committees of Torbat Heydariyeh University of Medical Sciences (no. IR.THUMS.REC.1398.062). The research had been performed in accordance with the native laws and institutional necessities. The contributors offered their written knowledgeable consent to take part on this examine.
Author contributions
HB-D: Methodology, Resources, Supervision, Writing – unique draft. MAs: Resources, Software, Writing – overview & enhancing. MR: Conceptualization, Formal evaluation, Methodology, Visualization, Writing – overview & enhancing. MAb: Data curation, Software, Writing – overview & enhancing. MB: Project administration, Supervision, Writing – unique draft. AA: Project administration, Software, Visualization, Writing – unique draft. MN: Formal evaluation, Funding acquisition, Investigation, Writing – unique draft.
Funding
Acknowledgments
This article is extracted from the permitted analysis mission of Torbat Heydariyeh University of Medical Sciences in 2018 with the analysis code 9800064, which was supported by the Research and Technology Vice-Chancellor of Torbat Heydariyeh University of Medical Sciences. We are grateful to all those that have helped us in conducting this analysis.
Conflict of curiosity
Publisher’s notice
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