The relationship between COVID-19 fear and anxiety with the quality of life of students in Sulaymaniyah, Iraq

Document Type : Original Article


1 Faculty of Nursing and Midwifery, Kurdistan University of Medical Sciences, Sanandaj, Iran

2 Faculty of Nursing and Midwifery, Islamic Azad University of Sanandaj, Sanandaj, Iran

3 Lab Assistant Researcher, Sulaymaniyah, Kurdistan Region, Iraq

4 Student research committee, Kurdistan University of Medical Sciences, Sanandaj, Iran

5 Department of Mathematics, Shahrood University of Technology, Shahrood, Iran

6 Kurdistan University of Medical Sciences, Sanandaj, Iran


Background: The outbreak of the COVID-19 pandemic led to mental disorders and a negative impact on people's quality of life. Due to the closure of universities and the shift to virtual classes, students experienced significant fear and anxiety.
Objective: The aim of this study was to investigate the relationship between fear and anxiety and students' quality of life during the COVID-19 pandemic.
Methods: This descriptive correlational study included 304 students in Sulaymaniyah, Iraq, in February and March 2021. Participants were selected using convenience sampling, and data were collected using a sociodemographic form, the Fear of COVID-19 Scale (FCV-19), the Corona Disease Anxiety Scale (CDAS), and the COVID-19-Impact on Quality of Life (COV19-QOL) scale.
Results: The mean age of the participants was 20.61 ± 3.53 years. Students had high levels of fear and moderate anxiety towards COVID-19, and this pandemic had a moderate impact on their quality of life. The mean score of all variables was significantly higher in girls than in boys. There was a significant relationship between quality of life and fear and anxiety, such that an increase of 1 point in quality of life was associated with a 0.27- and 0.35-point decrease in fear and anxiety, respectively.
Conclusion: There is a significant relationship between fear and anxiety and students' quality of life. Providing training classes on anxiety and fear control can improve their quality of life.


  1. Ma Y-F, Li W, Deng H-B, Wang L, Wang Y, Wang P-H, et al. Prevalence of depression and its association with quality of life in clinically stable patients with COVID-19. J Affect Disord. 2020;275:145-8. doi:10.1016/j.jad.2020.06.033 PMid:32658818 PMCid:PMC7329672
  2. Erbil KR, Iraq (GOV.KRD). Kurdistan Regional Government Committee on Coronavirus Issues 2020 [Available from:
  3. Cao W, Fang Z, Hou G, Han M, Xu X, Dong J, et al. The psychological impact of the COVID-19 epidemic on college students in China. Psychiat Res. 2020:112934. doi:10.1016/j.psychres.2020.112934 PMid:32229390 PMCid:PMC7102633
  4. Rehman U, Shahnawaz MG, Khan NH, Kharshiing KD, Khursheed M, Gupta K, et al. Depression, anxiety and stress among Indians in times of Covid-19 lockdown. Commun Ment Health J. 2020:1-7.doi:10.1007/s10597-020-00664-x PMid:32577997 PMCid:PMC7309680
  5. Wang Y, Di Y, Ye J, Wei W. Study on the public psychological states and its related factors during the outbreak of coronavirus disease 2019 (COVID-19) in some regions of China. Psychol Health Med. 2020:1-10. doi:10.1080/13548506.2020.1746817 PMid:32223317
  6. Kwasi Ahorsu D, Ying Lin C, Saffari M, Griffiths D, Pakpour A. The Fear of COVID-19 Scale: Development and Initial Validation. Int J Ment Health Addict. 2020. doi:10.1037/t78404-000
  7. Islam SD-U, Bodrud-Doza M, Khan RM, Haque MA, Mamun MA. Exploring COVID-19 stress and its factors in Bangladesh: a perception-based study. Heliyon. 2020;6(7):e04399. doi:10.1016/j.heliyon.2020.e04399 PMid:32685726 PMCid:PMC7350787
  8. Syed NK, Griffiths MD. Nationwide suicides owing to alcohol withdrawal symptoms during COVID-19 pandemic: a review of cases from media reports. J Psychiatr Res. 2020. doi:10.1016/j.jpsychires.2020.08.021 PMid:32866677 PMCid:PMC7438040
  9. Cheng SK, Wong C, Tsang J, Wong K. Psychological distress and negative appraisals in survivors of severe acute respiratory syndrome (SARS). Psychol Med. 2004; 34(7):1187. doi:10.1017/S0033291704002272 PMid:15697045
  10. Hamer M, Kivimaki M, Stamatakis E, Batty GD. Psychological distress and infectious disease mortality in the general population. Brain Behav Immun. 2019;76:280-3. doi:10.1016/j.bbi.2018.12.011 PMid:30579940
  11. Wu P, Fang Y, Guan Z, Fan B, Kong J, Yao Z, et al. The psychological impact of the SARS epidemic on hospital employees in China: exposure, risk perception, and altruistic acceptance of risk. Can J Psychiatr. 2009; 54(5):302-11. doi:10.1177/070674370905400504 PMid:19497162 PMCid:PMC3780353
  12. Dymecka J, Gerymski R, Machnik-Czerwik A. How does stress affect life satisfaction during the COVID-19 pandemic? Moderated mediation analysis of sense of coherence and fear of coronavirus. Psychol Health Med. 2022;27(1):280-8. doi:10.31234/ PMid:31578088
  13. Deacon B, Maack DJ. The effects of safety behaviors on the fear of contamination: An experimental investigation. Behav Res Ther. 2008;46(4):537-47. doi:10.1016/j.brat.2008.01.010 PMid:18313031
  14. Dong L, Hu S, Gao J. Discovering drugs to treat coronavirus disease 2019 (COVID-19). Drug Discov Ther. 2020;14(1):58-60. doi:10.5582/ddt.2020.01012 PMid:32147628
  15. Bai Y, Yao L, Wei T, Tian F, Jin D-Y, Chen L, et al. Presumed asymptomatic carrier transmission of COVID-19. JAMA. 2020; 323(14):1406-7. doi:10.1001/jama.2020.2565 PMid:32083643 PMCid:PMC7042844
  16. Abdullah MF, Murad NS, Teoh SH, Mohamad MA. Quality of life of university students during the COVID-19 pandemic: age, history of medical illness, religious coping, COVID-19 related stressors, psychological factors and social support were predictive of quality of life. Res Sq. 2020:1-33. doi:10.21203/
  17. Nejati V, Shirinbayan P, Akbari Kamrani A, Foroughan M, Taheri P, Sheikhvatan M. Quality of life in elderly people in Kashan, Iran. Middle East J Age Ageing. 2008; 5 (2):21-5. 
  18. Rogowska AM, Kuśnierz C, Bokszczanin A. Examining anxiety, life satisfaction, general health, stress and coping styles during COVID-19 pandemic in Polish sample of university students. Psychol Res Behav Manag. 2020;13:797. doi:10.2147/PRBM.S266511 PMid:33061695 PMCid:PMC7532061
  19. Ahorsu DK, Lin C-Y, Imani V, Saffari M, Griffiths MD, Pakpour AH. The fear of COVID-19 scale: development and initial validation. Int J Ment Health Addict. 2020. doi:10.1037/t78404-000
  20. Alipour A, Ghadami A, Alipour Z, Abdollahzadeh H. Preliminary validation of the Corona Disease Anxiety Scale (CDAS) in the Iranian sample. Health Psychol. 2020;8(32):163-75.
  21. Repišti S, Jovanović N, Kuzman MR, Medved S, Jerotić S, Ribić E, et al. How to measure the impact of the COVID-19 pandemic on quality of life: COV19-QoL–the development, reliability and validity of a new scale. Glob Psychiat. 2020. doi:10.2478/gp-2020-0016
  22. Parisod H, Holopainen A, Kielo‐Viljamaa E, Puukka P, Beeckman D, Haavisto E. Attitudes of nursing staff towards pressure ulcer prevention in primary and specialised health care: A correlational cross‐sectional study. Int Wound J. 2021:1-12. doi:10.1111/iwj.13641 PMid:34121328 PMCid:PMC8762573
  23. Alyami M, de Albuquerque JV, Krägeloh CU, Alyami H, Henning MA. Effects of fear of COVID-19 on mental well-being and quality of life among Saudi adults: a path analysis. Saudi J Med Med Sci. 2021;9(1):24. doi:10.4103/sjmms.sjmms_630_20 PMid:33519340 PMCid:PMC7839565
  24. Broche-Pérez Y, Fernández-Fleites Z, Jiménez-Puig E, Fernández-Castillo E, Rodríguez-Martin BC. Gender and fear of COVID-19 in a Cuban population sample. Int J Ment Health Addict. 2020:1-9. doi:10.1007/s11469-020-00377-y
  25. Limcaoco RSG, Mateos EM, Fernandez JM, Roncero C. Anxiety, worry and perceived stress in the world due to the COVID-19 pandemic, March 2020. Preliminary results. MedRxiv. 2020.
  26. Qiu J, Shen B, Zhao M, Wang Z, Xie B, Xu Y. A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: implications and policy recommendations. Gen Psychiatr. 2020;33(2). doi:10.1136/gpsych-2020-100213 PMid:32215365 PMCid:PMC7061893
  27. Sakib N, Bhuiyan AI, Hossain S, Al Mamun F, Hosen I, Abdullah AH, et al. Psychometric validation of the Bangla Fear of COVID-19 Scale: Confirmatory factor analysis and Rasch analysis. International J Ment Health Addict. 2020:1-12. doi:10.1007/s11469-020-00289-x
  28. Bitan DT, Grossman-Giron A, Bloch Y, Mayer Y, Shiffman N, Mendlovic S. Fear of COVID-19 scale: Psychometric characteristics, reliability and validity in the Israeli population. Psychiatr Res. 2020;289:113100. doi:10.1016/j.psychres.2020.113100 PMCid:PMC7227556
  29. Bakioğlu F, Korkmaz O, Ercan H. Fear of COVID-19 and positivity: mediating role of intolerance of uncertainty, depression, anxiety, and stress. Int J Ment Health Addict. 2020:1-14. doi:10.1007/s11469-020-00331-y PMid:32837421 PMCid:PMC7255700
  30. AlAteeq DA, Aljhani S, AlEesa D. Perceived stress among students in virtual classrooms during the COVID-19 outbreak in KSA. J Taibah Univ Med Sci. 2020;15(5):398-403. doi:10.1016/j.jtumed.2020.07.004 PMid:32837508 PMCid:PMC7395822
  31. Demirbas N, Kutlu RJIJoMH, Addiction. Effects of COVID-19 Fear on Society's Quality of Life. Int J Ment Health Addict. 2021;15:1-10. doi:10.1007/s11469-021-00550-x PMid:34539282 PMCid:PMC8443113
  32. Overfield T. Biologic variation in health and illness: race, age, and sex differences: CRC Press; 2017. doi:10.1201/9781315150307 PMid:29340321 PMCid:PMC5762951