Evaluation of Perceived Depression, Anxiety, Stress Levels, Sleep Quality and Quality of Life among Adults During the COVID-19 Pandemic (original) (raw)

Evaluation of Perceived Depression, Anxiety, Stress Levels, Sleep Quality and Quality of Life among Adults During the COVID-19 Pandemic

Year 2025, Volume: 16 Issue: 2, 167 - 178, 18.08.2025

Gülşah Kaner , Buse Bakır , Gökçe Günsel Yıldırım , Elif Altıner

Abstract

Objective: This study aimed to determine sleep quality, depression, anxiety, stress, and quality of life scores among Turkish adults during the pandemic and to examine the correlations among these variables.

Material and Method: This online cross-sectional study was completed with 962 adults aged ≥18 years. The data collection form included questions about demographic and anthropometric characteristics, Pittsburgh Sleep Quality Index (PSQI), The World Health Organization Quality of Life Scale-Short Form (WHOQoL-BREF), and Depression Anxiety Stress Scales (DASS-42). The snowball sampling method was used.

Results: The median DASS and PSQI scores were higher in participants with poor sleep quality and sleep duration less than 7 hours (p<0.05). All subscales of the WHOQoL were significantly higher in individuals with good sleep quality and the general, physical, and psychological subscales were significantly higher in individuals with sleep duration of 7 hours or more (p<0.05). Age was found to have a weak correlation with the DASS subscales and a very weak correlation with the PSQI. There was a positive and moderately significant correlation between PSQI and the DASS subscales (p<0.001). Body weight and BMI had very weak correlation with DASS-D, DASS-A, and PSQI subscales (p<0.05). All subscales of WHOQoL were found to be negatively correlated with DASS subscales and PSQI (p<0.05).

Conclusion: Quality of life was significantly correlated with perceived depression, anxiety, and stress, and sleep quality. There was also a correlation between sleep quality and levels of depression, anxiety and stress.

Ethical Statement

This study was conducted according to the guidelines laid down in the Declaration of Helsinki, and all procedures involving research study participants were approved by Izmir Kâtip Celebi University Clinical Research Ethics Committee (Decision date/no: 21.10.2021/0443) and study permission from the T.R. Ministry of Health Scientific Research Platform. As the study is web-based, in order to obtain written consent, ‘I agree to participate in the study’ tab was added per online questionnaire.

Project Number

TÜBİTAK 2209-A (Approval number: 1919B012002239)

References

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• 4. Gupta R, Grover S, Basu A, Krishnan V, Tripathi A, Subramanyam A, et al. Changes in sleep pattern and sleep quality during COVID-19 lockdown. Indian J Psychiatry. 2020;62(4):370-378. doi: 10.4103/psychiatry.IndianJPsychiatry_523_20
• 5. Fidantek H, Yazıhan N, Tuna E. The mediator role of positive and negative affect in the relationship between sleep quality, depressive symptoms and anxiety in young adults. J Turk Sleep Med. 2022;9(2):120-129. doi: 10.4274/jtsm.galenos.2021.52244
• 6. Pak H, Süsen Y, Denizci Nazlıgül M, Griffiths M. The Mediating Effects of Fear of COVID-19 and Depression on the Association Between Intolerance of Uncertainty and Emotional Eating During the COVID-19 Pandemic in Turkey. Int J Ment Health Addict. 2022;20(3):1882-1896. doi: 10.1007/s11469-021-00489-z.
• 7. Aksoy A, Abiç A, Değirmenci F, Vefikuluçay Yılmaz D. The relationship between quality of life and fear of Turkish individuals during the COVID-19 pandemic: A cross-sectional study. Arch Psychiatr Nurs. 2021;35(5):472-478. doi: 10.1016/j.apnu.2021.06.003
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• 25. Varma P, Junge M, Meaklim H, Jackson ML. Younger people are more vulnerable to stress, anxiety and depression during COVID-19 pandemic: A global cross-sectional survey. Prog Neuropsychopharmacol Biol Psychiatry. 2021;109:110236. doi: 10.1016/j.pnpbp.2020.110236
• 26. Franceschini C, Musetti A, Zenesini C, Palagini L, Scarpelli S, Quattropani MC, et al. Poor sleep quality and its consequences on mental health during the COVID-19 lockdown in Italy. Front Psychol. 2020;11:574475. doi: 10.3389/fpsyg.2020.574475
• 27. Lin CY, Lai TF, Huang WC, Hung YC, Hsueh MC, Park JH, et al. Sleep duration and timing are nonlinearly associated with depressive symptoms among older adults. Sleep Med. 2021;81:93-97. doi: 10.1016/j.sleep.2021.02.012
• 28. Biddle DJ, Hermens DF, Lallukka T, Aji M, Glozier N. Insomnia symptoms and short sleep duration predict trajectory of mental health symptoms. Sleep Med. 2019;54:53-61. doi: 10.1016/j.sleep.2018.10.008
• 29. Pieh C, Budimir S, Probst T. The effect of age, gender, income, work, and physical activity on mental health during coronavirus disease (COVID-19) lockdown in Austria. J Psychosom Res. 2020;136:110186. doi: 10.1016/j.jpsychores.2020.110186
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COVID-19 Pandemi Sürecinde Yetişkinlerde Algılanan Depresyon, Anksiyete, Stres Düzeyi, Uyku Kalitesi ve Yaşam Kalitesinin Değerlendirilmesi

Year 2025, Volume: 16 Issue: 2, 167 - 178, 18.08.2025

Gülşah Kaner , Buse Bakır , Gökçe Günsel Yıldırım , Elif Altıner

Abstract

Amaç: Bu çalışmanın amacı, pandemi sürecinde Türk yetişkinlerin uyku kalitesi, depresyon, anksiyete, stres ve yaşam kalitesi puanlarını belirlemek ve bu değişkenler arasındaki ilişkiyi incelemektir.

Materyal ve Metot: Bu çevrimiçi kesitsel çalışma yaşları 18 ve üzerinde olan 962 yetişkin ile tamamlanmıştır. Veri toplama formunda demografik ve antropometrik özellikler, Pittsburgh Uyku Kalitesi İndeksi (PUKİ), Dünya Sağlık Örgütü Yaşam Kalitesi Ölçeği-Kısa Formu (WHOQoL-BREF) ve Depresyon Anksiyete Stres Ölçeği (DASÖ-42) yer almıştır. Kartopu örnekleme yöntemi kullanılmıştır.

Bulgular: Medyan DASÖ ve PUKİ skorları uyku kalitesi kötü olan ve uyku süresi 7 saatten az olan katılımcılarda daha yüksekti (p<0,05). WHOQoL-BREF’in tüm alt ölçekleri iyi uyku kalitesine sahip bireylerde ve genel, fiziksel ve psikolojik alt ölçekler 7 saat ve üzeri uyku süresine sahip bireylerde daha yüksekti (p<0,05). Yaş ile DASÖ alt ölçekleri arasında zayıf, PUKİ arasında ise çok zayıf bir korelasyon bulunmuştur. PUKİ ile DASÖ alt ölçekleri arasında pozitif ve orta derecede bir korelasyon belirlenmiştir (p<0,001). Vücut ağırlığı ve Beden Kütle İndeksi (BKİ) DASÖ-D, DASÖ-A alt ölçekleri ve PUKİ arasında çok zayıf bir korelasyon vardı (p<0,05). WHOQoL-BREF’in tüm alt ölçeklerinin DASÖ alt ölçekleri ve PUKİ ile negatif korelasyon gösterdiği saptanmıştır (p<0,05).

Sonuç: Yaşam kalitesi, algılanan depresyon, anksiyete, stres ve uyku kalitesi ile ilişkili bulunmuştur. Ayrıca, uyku kalitesi ile algılanan depresyon, anksiyete ve stres düzeyleri arasında da bir ilişki belirlenmiştir.

Ethical Statement

Bu çalışma Helsinki Bildirgesi'nde belirtilen ilkelere göre yürütülmüş olup, araştırma katılımcılarını içeren tüm prosedürler İzmir Kâtip Çelebi Üniversitesi Klinik Araştırmalar Etik Kurulu tarafından onaylanmış (Karar tarih/no: 21.10.2021/0443) ve T.C. Sağlık Bakanlığı Bilimsel Araştırma Platformu'ndan çalışma izni alınmıştır. Çalışma web tabanlı olduğundan, yazılı onam almak için çevrimiçi anket başına 'Çalışmaya katılmayı kabul ediyorum' sekmesi eklenmiştir.

Project Number

TÜBİTAK 2209-A (Approval number: 1919B012002239)

References

• 1. Holmes EA, O'Connor RC, Perry VH, Tracey I, Wessely S, Arseneault L, et al. Multidisciplinary research priorities for the COVID-19 pandemic: a call for action for mental health science. Lancet Psychiatry. 2020;7(6):547-560. doi: 10.1016/S2215-0366(20)30168-1.
• 2. World Health Organization (WHO). COVID-19 Dashboard 2023 [Internet]. Geneva: World Health Organization; 2023. [Access Date: 10 Oct 2023]. Access: https://data.who.int/dashboards/covid19/cases?n=c
• 3. Turna J, Zhang J, Lamberti N, Patterson B, Simpson W, Francisco AP, et al. Anxiety, depression and stress during the COVID-19 pandemic: Results from a cross-sectional survey. J Psychiatr Res. 2021;137:96-103. doi: 10.1016/j.jpsychires.2021.02.059.
• 4. Gupta R, Grover S, Basu A, Krishnan V, Tripathi A, Subramanyam A, et al. Changes in sleep pattern and sleep quality during COVID-19 lockdown. Indian J Psychiatry. 2020;62(4):370-378. doi: 10.4103/psychiatry.IndianJPsychiatry_523_20
• 5. Fidantek H, Yazıhan N, Tuna E. The mediator role of positive and negative affect in the relationship between sleep quality, depressive symptoms and anxiety in young adults. J Turk Sleep Med. 2022;9(2):120-129. doi: 10.4274/jtsm.galenos.2021.52244
• 6. Pak H, Süsen Y, Denizci Nazlıgül M, Griffiths M. The Mediating Effects of Fear of COVID-19 and Depression on the Association Between Intolerance of Uncertainty and Emotional Eating During the COVID-19 Pandemic in Turkey. Int J Ment Health Addict. 2022;20(3):1882-1896. doi: 10.1007/s11469-021-00489-z.
• 7. Aksoy A, Abiç A, Değirmenci F, Vefikuluçay Yılmaz D. The relationship between quality of life and fear of Turkish individuals during the COVID-19 pandemic: A cross-sectional study. Arch Psychiatr Nurs. 2021;35(5):472-478. doi: 10.1016/j.apnu.2021.06.003
• 8. Li W, Zhao N, Yan X, Zou S, Wang H, Li Y, et al. The prevalence of depressive and anxiety symptoms and their associations with quality of life among clinically stable older patients with psychiatric disorders during the COVID-19 pandemic. Transl Psychiatry. 2021;11(1):75. doi: 10.1038/s41398-021-01196-y
• 9. Liu N, Zhang F, Wei C, Jia Y, Shang Z, Sun L, et al. Prevalence and predictors of PTSS during COVID-19 outbreak in China hardest-hit areas: Gender differences matter. Psychiatry Res. 2020;287:112921. doi: 10.1016/j.psychres.2020.112921
• 10. Pacutova V, Madarasova Geckova A, Kizek P, F de Winter A, A Reijneveld S. The Impact of Pandemic Management on the Quality of Life of Slovak Dentists. Int J Environ Res Public Health. 2021;18(10):5484. doi: 10.3390/ijerph18105484
• 11. Lovibond SH, Lovibond PH. Manuel for the Depression Anxiety Stress Scales. 2nd edition. Sydney: Psychology Foundation; 1995.
• 12. Akin A, Çetin B. The Depression Anxiety and Stress Scale (DASS): The Study of Validity and Reliability. Educational Sciences: Theory and Practice. 2007;7:260-268.
• 13. Buysse DJ, Reynolds CF 3rd, Monk TH, Berman SR, Kupfer DJ. The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Res. 1989;28(2):193-213. doi: 10.1016/0165-1781(89)90047-4.
• 14. Ağargün MY, Kara H, Anlar Ö. The validity and reliability of the Pittsburgh Sleep Quality Index. Turkish Journal of Psychiatry. 1996;7(2):107-115.
• 15. Development of the World Health Organization WHOQOL-BREF quality of life assessment. The WHOQOL Group. Psychol Med. 1998;28(3):551-558. doi: 10.1017/s0033291798006667.
• 16. Fidaner H, Elbi H, Fidaner C, Eser SY, Eser E, Göker E. Measuring quality of life, WHOQOL-100 and WHOQOL-BREF. Psikiyatri Psikoloji Psikofarmakoloji (3P) Dergisi. 1999;7(Suppl 2):5-13.
• 17. Fitzpatrick KM, Harris C, Drawve G. Fear of COVID-19 and the mental health consequences in America. Psychol Trauma. 2020;12(S1):S17-S21. doi: 10.1037/tra0000924
• 18. Kowal M, Coll-Martín T, Ikizer G, Rasmussen J, Eichel K, Studzińska A, et al. Who is the Most Stressed During the COVID-19 Pandemic? Data From 26 Countries and Areas. Appl Psychol Health Well Being. 2020;12(4):946-966. doi: 10.1111/aphw.12234
• 19. Shah SMA, Mohammad D, Qureshi MFH, Abbas MZ, Aleem S. Prevalence, Psychological Responses and Associated Correlates of Depression, Anxiety and Stress in a Global Population, During the Coronavirus Disease (COVID-19) Pandemic. Community Ment Health J. 2021;57(1):101-110. doi: 10.1007/s10597-020-00728-y.
• 20. Lee H, Choi D, Lee JJ. Depression, anxiety, and stress in Korean general population during the COVID-19 pandemic. Epidemiol Health. 2022;44:e2022018. doi: 10.4178/epih.e2022018
• 21. El Sayed S, Gomaa S, Shokry D, Kabil A, Eissa A. Sleep in post-COVID-19 recovery period and its impact on different domains of quality of life. Egypt J Neurol Psychiatr Neurosurg. 2021;57(1):172. doi: 10.1186/s41983-021-00429-7.
• 22. Xiao J, Jiang Y, Zhang Y, Gu X, Ma W, Zhuang B, et al. The impact of psychology interventions on changing mental health status and sleep quality in university students during the COVID-19 pandemic. medRxiv (Preprint). 2020. doi:10.1101/2020.09.01.20186411.
• 23. Antwi CO, Belle MA, Ntim SY, Wu Y, Affum-Osei E, Aboagye MO, et al. COVID-19 Pandemic and International Students' Mental Health in China: Age, Gender, Chronic Health Condition and Having Infected Relative as Risk Factors. Int J Environ Res Public Health. 2022;19(13):7916. doi: 10.3390/ijerph19137916
• 24. Patra RC, Kanungo B, Bawa P. Mental health, sleep quality and quality of life in individuals with and without multiple health conditions during home quarantine in India due to the COVID-19 pandemic: a cross-sectional study. F1000Res. 2024;9:718. doi: 10.12688/f1000research.24321.3
• 25. Varma P, Junge M, Meaklim H, Jackson ML. Younger people are more vulnerable to stress, anxiety and depression during COVID-19 pandemic: A global cross-sectional survey. Prog Neuropsychopharmacol Biol Psychiatry. 2021;109:110236. doi: 10.1016/j.pnpbp.2020.110236
• 26. Franceschini C, Musetti A, Zenesini C, Palagini L, Scarpelli S, Quattropani MC, et al. Poor sleep quality and its consequences on mental health during the COVID-19 lockdown in Italy. Front Psychol. 2020;11:574475. doi: 10.3389/fpsyg.2020.574475
• 27. Lin CY, Lai TF, Huang WC, Hung YC, Hsueh MC, Park JH, et al. Sleep duration and timing are nonlinearly associated with depressive symptoms among older adults. Sleep Med. 2021;81:93-97. doi: 10.1016/j.sleep.2021.02.012
• 28. Biddle DJ, Hermens DF, Lallukka T, Aji M, Glozier N. Insomnia symptoms and short sleep duration predict trajectory of mental health symptoms. Sleep Med. 2019;54:53-61. doi: 10.1016/j.sleep.2018.10.008
• 29. Pieh C, Budimir S, Probst T. The effect of age, gender, income, work, and physical activity on mental health during coronavirus disease (COVID-19) lockdown in Austria. J Psychosom Res. 2020;136:110186. doi: 10.1016/j.jpsychores.2020.110186
• 30. Vitorino LM, Yoshinari Júnior GH, Gonzaga G, Dias IF, Pereira JPL, Ribeiro IMG, et al. Factors associated with mental health and quality of life during the COVID-19 pandemic in Brazil. BJPsych Open. 2021;7(3):e103. doi: 10.1192/bjo.2021.62
• 31. Kabeloğlu V, Gül G. Investigation of sleep Quality and associated social psychological factors during the COVID-19 outbreak. J Turk Sleep Med. 2021;8(2):97-104. doi: 10.4274/jtsm.galenos.2021.53244
• 32. Pellegrini M, Ponzo V, Rosato R, Scumaci E, Goitre I, Benso A, et al. Changes in weight and nutritional habits in adults with obesity during the "lockdown" period caused by the COVID-19 virus emergency. Nutrients. 2020;12(7):2016. doi: 10.3390/nu12072016
• 33. Akter T, Zeba Z, Hosen I, Al-Mamun F, Mamun MA. Impact of the COVID-19 pandemic on BMI: Its changes in relation to socio-demographic and physical activity patterns based on a short period. PLoS One. 2022;17(3):e0266024. doi: 10.1371/journal.pone.0266024
• 34. Lee GB, Kim Y, Park S, Kim HC, Oh K. Obesity, hypertension, diabetes mellitus, and hypercholesterolemia in Korean adults before and during the COVID-19 pandemic: a special report of the 2020 Korea National Health and Nutrition Examination Survey. Epidemiol Health. 2022;44:e2022041. doi: 10.4178/epih.e2022041.
• 35. Pop CL. Body mass index evolution before and during the COVID pandemic in a sample of university students. Marathon. 2021;13(1):11-17.
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