Journal of Preventive Medicine

Extended Abstract
Introduction
Since December 2019, cases of infection with COVID-19 have been reported in China, and due to its high transmission rate, the virus quickly spread in many countries and became an epidemic. The increase of critically ill patients has faced a great challenge to global health. In such conditions, in addition to physical disorders and death, people have experienced various symptoms of mental health disorders, including psychosis, anxiety, and panic. Most lifelong mental disorders occur for the first time during student years, and anxiety, depression, and stress are the most common mental disorders. In this epidemic, the mental health of students has been affected due to virtual learning, the lack of sufficient knowledge and equipment for virtual teaching, and the need to observe social distancing. Due to the presence of clinical training and the employment of some students in hospitals and the lack of adequate personal protective equipment, nursing students are afraid of contracting the disease or transmitting it to other family members, and these factors can create tension in a person’s mental health. Considering the importance of anxiety and depression in nursing students and the emerging nature of the disease, the main goal of this study was to determine the prevalence of depression and anxiety in Abadan nursing students during the COVID-19 pandemic.
Methods
This study was a descriptive-analytical cross-sectional study. The research population was all undergraduate nursing students of Abadan University of Medical Sciences in 2019. The sample size was determined to be 253. Sampling was done within a month through an online questionnaire that was uploaded to the Digisurvey system. Data were collected through the “Basic Information” questionnaire, “Patient Health Questionnaire-9” and “Corona Disease Anxiety Scale”. Sampling was done by the available sample method and students were asked to send the link of the questionnaire to their classmates on WhatsApp. 
The basic information form included the variables of age, gender, marital status, academic semester of the student, income level, tuition payment, probation history, place of residence, history of COVID-19, employment status, regular exercise program, birth rank, history of chronic mental illnesses, and history of using neuropsychiatric drugs. The inclusion we being a nursing student and being in the second semester or higher. The significance level in all statistical tests was considered less than 0.05. Data analysis was done using SPSS 21. A frequency table was used to show the basic information and logistic regression was used to determine the factors affecting students’ anxiety and depression. Thirty questionnaires were incomplete and they were excluded from the study, and 13 students were excluded from the study due to exclusion criteria, and finally, the sample size was reduced to 210 people.
Results
Out of a total of 210 participants, 129 cases (61.43%) showed mild to severe symptoms of depression and 45 cases (21.43%) showed moderate and severe symptoms of anxiety. Among all students with depression, female students (61.23 %), single students (85.02 %), students who did not have a regular sports program (70.55 %), and those who lived in the city with their families (85 (86.0%) showed symptoms of depression more than their peers. Also, out of all students who showed symptoms of anxiety, male students (29.79%) experienced less anxiety than female students (70.21%). Of all the students who reported moderate and severe anxiety, single students (88.93 %), students who did not have a regular sports program (71.14 %), and those who lived in the city with their families (93.42% %) showed anxiety symptoms more than their counterparts. 
Females showed 1.9 times more symptoms of COVID-19-related anxiety than males, which can be considered significant (P=0.055). Students who had a history of COVID-19 showed 2.04 times more symptoms of anxiety than people who did not have a history of COVID-19 (OR=2.049), and this difference was significant (P=0.049). Also, students who had a probation history showed 0.16 times more depression symptoms than students who did not have a probation history, and this difference was statistically significant (P=0.028).
Discussion 
This study showed that 61.43% of nursing students of Abadan University of Medical Sciences reported mild to severe depression and 21.43% reported moderate to severe anxiety symptoms. Miri et al. indicated that during the COVID-19 pandemic, students in Hamedan University of Medical Sciences had some degree of anxiety and depression, but the prevalence of depression symptoms in medical students was significantly less than that in our study.
The current study showed that not having a regular exercise can increase the symptoms of depression and anxiety in students. Bagheri et al. in a study showed that the anxiety caused by the COVID-19 was lower and the use of problem-oriented coping style was higher in athletes than in non-athletes [25].
In the current study, students who had a history of infection with COVID-19 had symptoms of anxiety and depression more than those with no history of infection. This study is consistent with the study conducted in China, which showed that people who had a suspected or infected person among their relatives showed more symptoms of anxiety and depression [27]. This is because experiencing the stressful conditions of the disease by the patients or their families can lead to psychological disorders in them.
The symptoms of depression in students who had a history of probation were more than in students with no history of probation. In other studies, students who had a history of probation also reported more mental disorders such as anxiety and depression than others. In general, after being placed on probation, students feel inefficient in their studies, which can develop psychological disorders such as anxiety and depression [29].
The prevalence of anxiety and depression in nursing students of Abadan University of Medical Sciences during the COVID-19 pandemic is considerable. The continuation of the pandemic can endanger their mental health. Since nursing students are the future nursing manpower, this can be considered a threat to the public health.
Ethical Considerations
Compliance with ethical guidelines
This study has ethical approval code IR.ABADANUMS.REC.1399.191 from Abadan University of Medical Sciences.
Funding
All authors contributed equally in preparing all parts of the research.
Authors' contributions
Sampling and writing the article: Tara Berzo; Research design, final summary, article writing and conclusion: Mehsa Tafzali; Statistical analysis: Fatemeh Maqsoudi; Review of texts: Shahla Asadi Hawizian.
Conflicts of interest
The authors declared no conflict of interest.
Acknowledgements
Appreciation and thanks to the esteemed officials of the Research Vice-Chancellor of Abadan University of Medical Sciences.
 

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