The novel coronavirus disease (COVID-19) was identified for the first time in Wuhan, China, in December 2019 (1), and the WHO affirmed it as a worldwide pandemic on March 11, 2020 (2). It is accompanied by respiratory conditions such as respiratory failure, respiratory distress syndrome, and septic shock. In most cases, patients with COVID-19 may improve without extraordinary management although those with advanced age and preexisting physical illnesses are highly prone to have severe symptoms and illness and may progress to death (1, 3).

Quarantine and isolation became increasingly applied around the world to contain the transmission of the virus (4). Besides practicing different COVID-19 control measures, such as hand washing or sanitizing, use of face masks, and physical distancing, most countries are demanding to provide economic assistance to several people who lost their jobs due to lockdown and closure of nonessential commercial activity (5, 6). Despite those control measures, in the framework of serious threats to everyone's health and livelihood with the irregularity of governance efforts, extensive mental health, substance use, and psychosocial problems seem estimated to occur, both directly from the pandemic and indirectly from the related economic recession. It is known that such a pandemic has a major impact on mental health, and this problem has been described as a “parallel epidemic” (7).

There are various reasons for the impact of the pandemic on mental health. People now are suddenly facing major changes in their daily life, working models, and social behaviors. It is not surprising that several individuals are showing acute fight-or-flight responses, such as increased anxiety levels, panic attacks, irrational fears up to paranoid-like convictions, and related behaviors (8, 9). Some are experiencing losses under traumatic circumstances, such as not being able to say goodbye to dying loved ones or the inability to offer proper burials (10, 11). The disease itself is multiplied as forced mass quarantine to battle COVID-19 can cause depression, anxiety, and distress (12) due to factors such as the sense of getting worried and loss of control (13). This can be severe if families need separation by the uncertainty of disease status, scarcity of essentials, economical constraints, and increased susceptibility to the disease, which usually get exaggerated by unclear information and inappropriate communications via media (5, 14, 15). “The potential benefits of mandatory mass quarantine need to be weighed carefully against the possible psychological costs as studies inform different mental health conditions that may appear when an individual is quarantined or isolated” (5).

Even though the WHO has strategically announced relevant policies and principles, the COVID-19 pandemic has caused a grave challenge on mental health services particularly among suspected and confirmed cases and frontline health care workers. They may develop a fear of contagion, which as a result, may lead to suicidal behaviors, sleep disturbances, and stress-related disorders. Further, firm quarantine and mandatory contact tracing policies by health authorities could cause societal rejection, discrimination, and stigmatization (5).

Previous studies conducted worldwide about the impact of COVID-19 on mental health show that symptoms of depression, anxiety, and unexplained somatic symptoms are common emotional and psychological responses to the pandemic (16, 17). The communities were concerned about social isolation accompanied by quarantine during the pandemic (18). According to a study done in China, which determines the impact of the COVID-19 pandemic, the majority of the study respondents reported a different level of symptoms of common mental disorders. In this study, about 16% of the participants reported different levels of depression, 35% reported different symptoms of anxiety, and 8% reported moderate-to-severe distress (19).

Developing countries traditionally have a higher prevalence of mental disorders (20, 21). Therefore, it is reasonable to assume that, in the pandemic, this situation worsened. Although the tremendous psychological impact of the pandemic is widely discussed, a burden of the psychological impact of this pandemic on the peoples in quarantine and isolation centers is not yet well studied in developing countries, including Ethiopia. It is very significant to study the mental health status of the people in quarantine to develop and implement effective interventions to mitigate the impact of psychological disorders in this grave pandemic era. Therefore, this study was intended to assess the psychological burden of COVID-19 on the people in quarantine and isolation centers and to identify associated factors for early and effective psychosocial intervention during the pandemic and beyond.

The present study utilizing a sample of 392 Ethiopian adults found that the common mental disorder was 13.5% in suspected cases of COVID-19 who were self-isolating and in a quarantine center due to the COVID-19 pandemic. The finding was comparable with studies done in China 11.9% (29), but it was lower as compared with the studies done in the United States 69% (30), China 36.05% (31), and Canada, which revealed the prevalence of depression and anxiety as 31.2 and 28.9%, respectively (14, 32). The possible explanation for this difference might be due to the government introducing the rapid response team to prevent and control the disease, which includes a psychological first aid team. Besides this, this study was conducted in December 2020 when the incidence of the cases decreased, indicating the quick transmission of the virus had been controlled, which alleviated psychological distress and symptoms of common mental disorder symptoms. On the other hand, the result was higher than the study conducted in another part of China at 9.0% (33). This discrepancy might be due to the variation in demographic characteristics, sampling size, and data collection instrument used to measure the dependent variable.

After adjusting for the potential confounder, being female, having known chronic medical illness, having inadequate accessibility of personal protective equipment, having poor knowledge about the COVID-19 pandemic, complaining of any symptoms of COVID-19, and currently using any type of substances were associated with a common mental disorder.

In this study, female sex was significantly associated with the common mental disorder. This result was consistent with studies conducted in Spain (34), the United Kingdom (35), and China (31). The possible explanation for this might be due to the affective nature of a female's response to stressful life events and hormonal changes. Second, during the virus pandemic, different studies reported the increments in domestic violence, and home quarantine may exacerbate gender-based violence (36).

Suspected cases of COVID-19 who had any type of chronic disease were seven times more likely to have a common mental disorder. This result agrees with a study done in the United Kingdom (37). In this situation, patients with chronic illnesses, cardiovascular diseases, cancer, diabetes, hypertension, stroke, cognitive disorders, and psychotic disorders experience emotional disturbance, nervousness, rage, perplexity, and stigma (5, 38) due to unexpected separation from loved ones, scarcity of essentials, the loss of freedom, and uncertainty over disease status. In addition, some patients have been confronted with difficulties in regular medical supplies due to delayed transportation and scarcity of medicines and human power in health facilities (39). Moreover, in this pandemic, the death rate in aged patients with chronic illness is the highest. Some older patients dared not go to the hospital. All these circumstances raise the possibility of relapse or even death.

According to this study, inadequate accessibility of personal protective equipment was significantly associated with the common mental disorder. This finding agreed with a study done in the United States (40). “Personal protective equipment is recommended in the care of anyone with suspected COVID-19 by multiple health organizations including the World Health Organization and the Centers for Disease Control and Prevention, forcing physicians to choose between protecting themselves and caring for their patients” (41). This causes specific sources of worry and panic among frontline health care worker that are combating the COVID-19 outbreak.

The other important predictor of a common mental disorder was having the common signs and symptoms of the COVID-19 disease. This result was in accordance with studies done in Spain (34) and Wuhan, China (42). In the current study, people with suspected cases of COVID-19 who had low awareness of the pandemic were 2.4 times more likely to have common mental disorders. The finding was consistent with the study done in Spain (34). The role of information seems to be fundamental and influences the mental health status of the individuals.

It is also worth noting that currently using any type of substance was significantly associated with the development of a common mental disorder (AOR = 2.7, 95% CI: 1.2, 6.1). This result was supported by studies conducted in the United Kingdom (43) and the United States (44). There are several possible explanations for this result. Existing literature shows that exposure to a traumatic event is particularly linked to starting substance use and that using the substance in response to stress has been specifically linked to an increased possibility of developing a substance use disorder and other common mental illness (45).

The finding of this study support the notion that public mental health interventions should be formally integrated into public health preparedness and emergency response plans. Mental health-care organizations and public health institutions are releasing practical guidelines on taking care of mental health and well-being (46, 47). The American Psychiatric Association (APA), the National Alliance on Mental Illness (NAMI), and the Substance Abuse and Mental Health Services Administration (SAMHSA) provide general tips for the community on how to organize their own time and manage their physical and mental health. The Centers for Disease Control and Prevention and the WHO supply further information specific for high-risk groups (48, 49).

The study has some limitations. Considering the limited availability of resources and the urgent or alarming effect of the COVID-19 pandemic outbreak, we implemented the convenience sampling technique. This sampling strategy was not based on a random selection of the sample, and the study population did not reveal the actual pattern of the general population.

The current study revealed that having a common mental disorder was relatively high among suspected cases of COVID-19 as compared with the general populations. Being female, having known chronic medical illness, inadequate accessibility of personal protective equipment, having poor knowledge about the COVID-19 pandemic, complaining of any symptoms of COVID-19, and currently using any type of substance was associated with a common mental disorder. Therefore, providing appropriate psychosocial intervention for the populations at risk is important to decrease the effect of common mental disorders among suspected cases of COVID-19.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

The studies involving human participants were reviewed and approved by Institutional Health Research Ethics Review Committee (IHRERC) of the College of Health and Medical Sciences, Haramaya University. The patients/participants provided their written informed consent to participate in this study.

All authors were contributed to the inception of the study, organized the data collection process, equally contributed to data analysis, drafting or revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

This study was financially supported by Haramaya University (Grant No. HUCF-2020-02-NA-06).

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.