ANXIETY-DEPRESSIVE DISORDERS IN THE GENERAL POPULATION DURING A PERIOD OF CONFINEMENT IN MOROCCO

Summary:Facedwith the spread of the coronavirus, the Moroccan population is in confinement, thisperiod of confinement isdifficult to live for all and especially for somevulnerable people, they are worried for theirhealth and that of theirfamilies, and theyriskhavingpsychologicalrepercussionsanxio- depressive, whichnegatively influences theirsocio-professional life. Objective: to measure the degree of depression and anxiety in the general population during a period of confinement Method: cross-sectional, descriptive and analyticalstudyconductedfrom 30 April to 10 August 2020, using a questionnaire, including the BECK scales for depression, the GAD (GeneralizedAnxietyDisorder) for anxiety Results: 632 responseswerecollected, of which 70.8% werewomen, 40.9% werebetween 18 and 30 yearsold, 47.8% were single, 76% hadhighereducation, 14.4% had a psychiatrichistory. 64.8% of the participants haddepression, of which 28.6% hadmilddepression, 24.3% hadmoderatedepression, 11.9% hadseveredepression and 8.3% hadanxiety. Age, presence of children, marital status, agreement to confinement, workduring confinement and type of occupation;presented a statisticallysignificantdifferencewith a P <0.005 between the 2 groups presenting or not a depression. Univariatelogisticregressionanalysisshowedthat the presence of anxiety (OR = 7.307; 95% CI: 2.4977 -21.379), and physicalpresence at the work site compared to the non-work group (OR = 0.5097; 95% CI: 0.2728 -0.950) wereindependentlyassociatedwith the occurrence of depression. Conclusion: Exploration of depression and anxietyconcludedthattherewas a definite impact of containment on the general population in Morocco. Research data are needed to developstrategies to reducepsychological impacts and psychiatricsymptomsduring the epidemic.

This pandemic has forced the implementation of a containment, whichseems to have seriouspsychologicalconsequences on somehumans.
In Lancet Psychiatry(5)experts have drawn attention to patient populations thatmayrequiretailored interventions (6) Thus patients withpsychiatricdisordersmayexperiencedistress (2) In addition, theymay not have access to care due to confinement restrictions and public transportation closures (7).Severalauthors (8) describe how confinement caused a sense of collective hysteria, leading staff to desperatemeasures. So fearseemsmostcertainly a consequence of these conditions. Duringepidemics, communityanxiety can increase for severalreasons, especiallywith the first deaths, the rapid and easyaccess to information (info-demic) and the increasingnumber of new cases and certainly the period of confinement (1). This is in favor (9) of an increase in psychologicalrepercussionincludinganxiety, depression and stress.
Cuiyan Wang and colleaguesin 2020 (10) assessed the psychological impact of confinement as moderate or severe, 16.5% reportedmoderate to severedepressivesymptoms, 28.8% reportedmoderate to severeanxietysymptoms. Jianyin Qui and collaboratorin 2020 (11) showed hatnearly 35% of respondentsexperiencedpsychologicaldistress The presentstudyaims to assess the psychological impact of confinement on the general population in Morocco, includingdepression and anxiety, and to investigate the factorsthatcontribute to the differentpsychiatricdisordersstudied. The results of thisstudywill help develop interventions and strategiesdesigned to reduce the psychological impacts of thisepidemic.

Type of study
Cross-sectional study, descriptive and analytical, wasconductedfrom30 April to 10 August 2020, using an anonymous questionnaire, which explores the three main areas of thiswork, firstly the socio-demographic conditions, whichfocused on age, gender, level of education, marital status, the presence of children, region, function and job position duringthispandemic, the agreement for the containment, secondly on the clinicalcharacteristics of the participants; the medical-surgical and psychiatricantecedents, and finally the evaluation of the psychologicalexperienceduring the confinement by psychologicalscales; the BECK for the depression, the GAD (GeneralizedAnxietyDisorder) for the anxiety 282 PsychologicalExperienceScales BECK scaleis a 13-item scalescoredfrom 0-3 with a maximum score of 39, this instrument can beuseful to assessdepressivesymptoms, or to screen for major depressivedisorders in target populations, itsinterpretation in favor of depression if it is higherthanthreewith an identification of 3 intensities of depression, mild for a score of 4 to 7, moderate for a score of 8 to 15 and severeif the score ishigherthan 16 GADscale:a 7 item scalescoredfrom 0-3 with a maximum score of 2, this instrument can beuseful to evaluateanxietysymptoms, itsinterpretation in favor of a significantanxietyrequiring a bio-psycho-social care if the score ishigherthan 15 If itislowerthan 15 itis in favor of a minimal anxietyrequiring a psychoeducation and a monitoring Inclusion criteria: -Subjectsolderthan 18 years.
-Foreign population residing in Morocco

Data management and statisticalanalysis
Qualitative variables werepresented as frequencies and percentages, quantitative variables werepresented as mean standard deviation (SD) or median (interquartile range, IQR). The Chi-square test (x2) or Fisher's exact test wereperformedaccording to theirparticular conditions of application, to identifydifferences in proportions of categorical variables betweentwo groups (group of participants withdepression versus thosewithoutdepression).
In addition, univariatelogisticregression analyses are used to identifyriskfactors for depression.
All independent variables with a statisticallysignificant value with P < 0.05 between the two groups wereincluded in the univariatelogisticregression.
Occupationalcharacteristicsduring confinement (table 2) 81.7% of the participants are under confinement, 90.6% are completely in agreement with the confinement, 32.4% travel to workdespite the confinement, 60.5% work in fieldsotherthanhealth 3.

Analyticalstatistics:
Considering the very important frequency of depression in the participants (64.8%), the analyticalstudywas made in comparisonbetween 2 groups: the group of the participants presenting a depression and the group of the participants who do not present a depressionaccording to the score of BECK 1.
Depression (Table 1 and 2): Comparing the 2 groups and using the Chi-square test (x2) or Fisher's exact test wefindthatthereis a statisticallysignificantdifferencewith a P <0.005 of age, presence of children, marital status, and agreement for confinement, workduring confinement and type of occupation for the presence of depression 2.
A publication by cuiyanwang and collaboratorin 2020 (10) used the Depression, Anxiety and Stress Scale (DASS-21), and included 1210 respondentsfrom 194 cities in China shows that 53.8% of respondentsrated the psychological impact of confinement as moderate or severe, 16.5% reportedmoderate to severedepressivesymptoms, 28.8% reportedmoderate to severeanxietysymptoms ; Along withourresults;femalegenderwascorrelatedwithhigherlevels of stress, anxiety and depression one adds to studentstatus, specificphysicalsymptoms (e.g., myalgia, dizziness, coryza) and poor selfratedhealthweresignificantlyassociatedwithgreaterpsychological impact of the epidemic and higherlevels of stress, anxiety and depression A publication by Jianyin Qui and collaboratorin 2020 (11)Thisstudyreceived a total of 52,730 validresponsesfrom 36 provinces, 34,131 werewomen (64.73%). Nearly 35% of respondentsexperiencedpsychologicaldistress Along withourresults;gender, age, educationlevel and occupation are related to the presences of psychologicaldistress Femalerespondentsshowedsignificantlyhigherpsychologicaldistressthantheir male counterparts, people aged 18-30 or over 60 had the highest scores on the CPGI, higher scores among the youngadult group (18-30) seem to confirmpreviousresearchfindings:young people tend to get a lot of information from social media which can easily trigger stress. Giventhat the highestdeath rate occurredamongolderadultsduring the epidemic, itis not surprisingthatolderadults are more likely to bepsychologicallyaffected. Similarly, people withhighereducationtended to be more distressed, probablybecause of high healthconsciousness.
A publication by limcaoco and collaboratorin2020,(13) a research team of doctorsfrom the hospital of Salamanca decided to make an assessment of the currentemotional state of the general population with an online survey in English and Spanish, considered a useful and rapidmethodthatcould help themdetermine how people perceived stress and anxiety due to COVID-19 The surveyincluded 22 items, gathering information in 3 sections:sociodemographic data, Cohen'sPerceived Stress Scale (PSS-10) and additionalqueriesassessingcurrentworry and behavior change due to thispandemic. Along withourresults;gender, age, and occupation wererelated to the presence of high levels of worry and stress, The averageage of the respondentswas 43.1 years, and more thantwothirdswerewomen. 21.1% werehealth care workers. The average PSS-10 score was 17.4 (6.4). Significantlyhigher scores wereobservedamongwomen, youth, students, and amongthosewhoexpressedconcern and thosewhoperceivedincreasedsensitivity to COVID-19 In contrast to ourresults, no significantdifferenceswereobservedbetweenhealthprofessionals and the general population. A weakcorrelationwasobservedbetween the mean relative RSV volume of the last 28 days and the number of reported cases (rho = 0.31, p <0.001) and deaths (rho = 0.28, p <0.001).
A longitudinal study (14) wasconductedamong the general population on two occasions (the first week of the epidemic and four weekslater), examiningdemographics, symptoms, knowledge, concerns, and precautionarymeasuresagainst COVID-19. There were 1738 respondentsin 190 Chinesecities (1210 respondents in the first survey, 861 in the second survey Psychological impact and mental healthwereassessed by the (IES-R) and (DASS-21) scales.

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During the initial assessment, moderate stress sore, severeanxiety and depressionwerefoundin 8.1%, 28.8% and 16.5 respectively and therewere no significant longitudinal changes in the levels of stress, anxiety and depression (p>0.05).

Limitations Of The Study :
Cross-sectional nature of the study, only one population assessment The geographical distribution of our population was not equitablebetween the differentregions of the kingdom (40.5% in the region of Rabat-Salé-Kenitra versus 0.2% in the region of Dakhla-Oued Eddahab).

Conclusion:-
In conclusion, weidentified a major psychological impact of confinement on the general population during the COVID-19 epidemic, youngwomenwithanxietywereparticularlyexposed to psychologicalproblemsincludingseveredepression Psychological first aid can beprovided by trainedindividuals to help the general population find effective and sustainable solutions to alleviate the stress of the general public during a crisis. Interventions shouldbebased on a comprehensiveassessment of riskfactorsleading to psychologicalrepercussions, includingpoor mental healthprior to a crisis, bereavement, emotionalshocks to self or familymembers, poor life circumstances, panic, familyseparation and lowhouseholdincome. (9) Lessonslearnedfrom the Pentagonterroristevents and the anthrax attacks in the United States have shown the importance of building community coalitions in advance to effectivelymobilizeresources and successfullyaddress the mental healthneeds of thoseaffected by the disaster.
The COVID-19 outbreakhighlightedmany of the issues related to the provision of psychologicalservices(3).
(3) Therefore, public health system strategies, based on soundscientificadvice, must be put in place to effectivelyaddress the mental healthproblemscaused by the public health emergenciesby public health emergencies and naturaldisasters.