Document Type : Original Article


1 Department of Psychology, College of Education,University of Garmin, Kalar, Kurdistan Regoin-Iraq

2 MPH, Directorate of Health, Garmian Administration, Kalar, Kurdistan Region, Iraq.

3 Ph.D. Independent Researcher, Tehran, Iran.

4 MSc in nursing, Shahid Aso Hospital, Slemani Directorate of Health, Slemani, Kurdistan Region, Iraq

5 Department of Maternal & Child Health, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA


This study was designed to evaluate the association of COVID-19 quarantine with the mental health outcomes in the Kurdistan region of Iraq according to key measures of this study. We conducted a matched case–control study within the cohort of all quarantined persons from February 22 through March 31, 2020 (n=300) in Kurdistan region of Iraq. Participants were matched on gender, age, marital status, and education level. Mental health outcomes measured by General Health Questioner (GHQ-28), Impact of event scale – revised (IES-R), and Fear of COVID-19(FC-19S) using an online form. Data analyzed with a t-test and Multiple Regression analysis (confidence intervals=99%). The final study sample included 102 cases and 106 controls, (69% participation rate). Cases showed significantly higher scores in general health questionnaire(t=4.57, p


  1. References

    1. Pan, A., Liu, L., Wang, C.,et al. Association of Public Health Interventions With the Epidemiology of the COVID-19 Outbreak in Wuhan, China. JAMA. 2020;323(19):1915-1923. doi:10.1001/jama.2020.6130
    2. World Health Organization. WHO statement on cases of COVID-19 surpassing 100 000. Accessed March 7, 2020.
    3. Han, Y., Liu, Y., Zhou, L., et al. Epidemiological Assessment of Imported Coronavirus Disease 2019 (COVID-19) Cases in the Most Affected City Outside of Hubei Province, Wenzhou, China. JAMA Netw Open. 2020;3(4):e206785. doi:10.1001/jamanetworkopen.2020.6785
    4. World Health Organization. Coronavirus disease 2019 (‎‎COVID-19)‎‎ situation report- 137. Accessed June 7, 2020.
    5. Kurdistan Regional Government. Coronavirus (COVID-19) situation update. Accessed June 7, 2020.
    6. Rudaw. Coronavirus: KRG bans non-emergency travel between provinces. March 11, 2020. Accessed April 28, 2020.
    7. Brooks, SK., Webster, RK., Smith, LE., et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020;395(10227):912-920. doi: 10.1016/S0140-6736(20)30460-8
    8. Barbisch, D., Koenig, KL., Shih, FY. Is There a Case for Quarantine? Perspectives from SARS to Ebola. Disaster Med Public Health Prep. 2015;9(5):547‐553. doi:10.1017/dmp.2015.38
    9. Reger, MA., Stanley, IH., Joiner, TE. Suicide Mortality and Coronavirus Disease 2019—A Perfect Storm? JAMA Psychiatry. Published online April 10, 2020. doi:10.1001/jamapsychiatry.2020.1060
    10. Hawryluck, L., Gold, WL., Robinson, S., Pogorski, S., Galea, S., Styra, R. SARS control and psychological effects of quarantine, Toronto, Canada. Emerg Infect Dis. 2004;10(7):1206‐1212. doi:10.3201/eid1007.030703
    11. Cava, MA., Fay, KE., Beanlands, HJ., McCay, EA., Wignall, R. The experience of quarantine for individuals affected by SARS in Toronto. Public Health Nurs. 2005;22(5):398-406.
    12. Taylor, MR., Agho, KE., Stevens, GJ., Raphael, B. Factors influencing psychological distress during a disease epidemic: data from Australia's first outbreak of equine influenza. BMC public health. 2008;8(1):347. doi:10.1186/1471-2458-8-347
    13. Charlson, F., van Ommeren, M., Flaxman, A., Cornett, J., Whiteford, H., Saxena, S. New WHOprevalence estimates of mental disorders in conflict settings: a systematic review and meta-analysis. Lancet. 2019;394(10194):240–248.
    14. Seidi, PA. Assessment of the Students’ Mental Health in the University of Garmian Using the Kurdish General Health Questionnaire. Passer Journal. 2020;2(1): 27-31.
    15. Seidi, P., Jaff, D. Mental health in conflict settings. Lancet. 2020;394(10216):2237–2238. DOI:
    16. Sadik, S., Bradley, M., Al-Hasoon, S., Jenkins, R. Public perception of mental health in Iraq. Int J Ment Health Syst.2010; 4(26).
    17. Hossain, MM., Sultana, A., Purohit, N. Mental health outcomes of quarantine and isolation for infection prevention: A systematic umbrella review of the global evidence. SSRN Electron J. 2020.
    18. Seidi, PA. Reliability and Validity of the Kurdish version of General Health Questionnaire (K-GHQ). Journal of Garmian University. 2019; 6: 955-961. DOI:10.24271/GARMIAN.5THC63
    19. Wang, Y., Xu, B., Zhao, G., Cao, R., He, X., Fu, S. Is quarantine related to immediate negative psychological consequences during the 2009 H1N1 epidemic? General hospital psychiatry. 2011;33(1):75-7. DOI: 10.1016/j.genhosppsych.2010.11.001
    20. Lai, J., Ma, S., Wang, Y., et al. Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Netw Open. 2020;3(3): e203976. doi:10.1001/jamanetworkopen.2020.3976
    21. Rometsch, C., Denkinger, J.K., Engelhardt, M., et al. Pain, somatic complaints, and subjective concepts of illness in traumatized female refugees who experienced extreme violence by the “Islamic State”(IS). J Psychosom Res. 2020:109931. DOI: 10.1016/j.jpsychores.2020.109931
    22. Ahorsu, D.K., 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;27:1-9.  doi:10.1007/s11469-020-00270-8
    23. Sperber, AD. Translation and validation of study instruments for cross-cultural research. Gastroenterology. 2004; 126: 124-128. DOI:10.1053/j.gastro.2003.10.016
    24. Seidi, P.A.M., Ardebil, MD., Jaff, D. COVID-19 pandemic: New challenge to securing mental well-being in conflict settings. Asian J Psychiatr. 2020; 51:102151. doi: 10.1016/j.ajp.2020.102151
    25. Steinman, M.A., Perry, L., Perissinotto, CM. Meeting the Care Needs of Older Adults Isolated at Home During the COVID-19 Pandemic. JAMA Intern Med. Published online April 16, 2020. doi:10.1001/jamainternmed.2020.1661
    26. Robertson, E., Hershenfield, K., Grace, SL., Stewart, DE. The psychosocial effects of being quarantined following exposure to SARS: a qualitative study of Toronto health care workers. The Canadian Journal of Psychiatry. 2004;49(6):403-7.
    27. Rothstein, M.A., Talbott, M.K. Encouraging compliance with quarantine: a proposal to provide job security and income replacement. Am J Public Health. 2007;97 Suppl 1(Suppl 1):S49‐S56. doi: 10.2105/AJPH.2006.097303
    28. DiGiovanni, C., Conley, J., Chiu, D., Zaborski, J. Factors influencing compliance with quarantine in Toronto during the 2003 SARS outbreak. Biosecur Bioterror. 2004;2(4):265‐272. doi:10.1089/bsp.2004.2.265
    29. Johal, S.S. Psychosocial impacts of quarantine during disease outbreaks and interventions that may help to relieve strain. N Z Med J. 2009; 122(1296):47‐52.  PMID: 19652680.
    30. Kim, H.C., Yoo, S.Y., Lee, B.H., Lee, S.H., Shin, H.S. Psychiatric Findings in Suspected and Confirmed Middle East Respiratory Syndrome Patients Quarantined in Hospital: A Retrospective Chart Analysis. Psychiatry Investig. 2018;15(4):355‐360. Doi:10.30773/pi.2017.10.25.1
    31. Liu, X., Kakade, M., Fuller, C.J., et al. Depression after exposure to stressful events: lessons learned from the severe acute respiratory syndrome epidemic. Compr Psychiatry. 2012;53(1):15‐23. doi: 10.1016/j.comppsych.2011.02.003
    32. Sweeney, A., Gillard, S., Wykes, T., Rose, D. The role of fear in mental health service users' experiences: a qualitative exploration. Soc Psychiatry Psychiatr Epidemiol. 2015;50(7):1079‐1087. doi: 10.1007/s00127-015-1028-z
    33. Barbera, J., Macintyre, A., Gostin, L., et al. Large-scale quarantine following biological terrorism in the United States: scientific examination, logistic and legal limits, and possible consequences. JAMA. 2001;286(21):2711‐2717. doi: 10.1001/jama.286.21.2711