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American Journal of  Medical 
Science and Innovation (AJMSI) 

Impact of  COVID-19 on Mental Health of  the Health Care Workers: A Cross sectional 
Study at Sher- E- Bangla Medical College Hospital, Barishal

Layla Azmin Akter1*, Md. Nazrul Islam2, Arif-uz-zaman Khan3

Volume 2 Issue 2, Year 2023
ISSN: 2836-8509 (Online)

DOI: https://doi.org/10.54536/ajmsi.v2i2.1447
https://journals.e-palli.com/home/index.php/ajmsi

Article Information ABSTRACT

Received: March 15, 2023

Accepted: April 10, 2023

Published: April 16, 2023

The world is passing through and is being challenged by the emergence of  a novel Severe 
Acute Respiratory Syndrome Corona virus (SARS-Cov-2). The World Health Organization 
(WHO) proclaimed the 2019 Corona Virus Disease (COVID-19) an international public 
health emergency on January 30, 2020. (WHO). A structured questionnaire was used to 
conduct a cross-sectional study. The Patient Health Questionnaire (PHQ9) and Generalized 
Anxiety Disorder-7 (GAD-7) were used as the two instruments to assess the symptoms of  
anxiety and depression in HCWs. Inferential statistics like the independent t-test, one-way 
ANOVA, and Pearson Product Moment Correlation Coefficient were used to examine the 
relationship between general psychological impact and socio-demographic factors. Descriptive 
statistics like frequency, percentage, mean, and standard deviation were used to describe the 
socio-demographic characteristics. The age varied from 30-55 years, with a mean of  34.92 
(SD=6.65). More than half  (53.3%) of  the respondents were Muslims, and the majority 
(84.8%) of  them were female. The average GAD7 score was 2.65 (SD:.76). The findings 
showed that only 18.5 respondents had been diagnosed with severe depression, whereas 
50% of  respondents scored as having moderate levels of  anxiety. The average GAD7 score 
was 2.65 (SD:.76). As mental health issues were strongly related to all the mental health 
outcomes, more than half  of  the health workers experienced depression and only a few 
reported generalized anxieties at work. More anxious than other healthcare professionals 
were nurses. By emphasizing these things, it is advised that health workers can improve their 
mental health.

Keywords
Covid 19, Health Care Workers, 
Pandemic, Mental Health

1 Nursing Institute, Munshiganj, Bangladesh
2 South Appolo Medical College Hospital, Barishal, Bangladesh
3 Department of  Public Health, ADUST, Dhaka, Bangladesh
* Corresponding author’s e-mail: laylaazmin@gmail.com

INTRODUCTION
The COVID-19 pandemic might trigger mental health 
problems among the general population as well as HCPs. 
(Repon, 2021). Loneliness is associated with poor physical 
and mental health and higher mortality risk (Henriksen, 
2019). Till to date, the effective ways to limit the viral 
spread are frequent hand washing, use of  face masks, 
lockdown, quarantine, and social distancing.30 But 
adopting social distance in daily life contradicts the deep-
rooted human nature to relate to others and therefore 
brings about the feeling of  loneliness (Odusanya, 
2020). As the HCPs are always in close contact with the 
COVID-19 patients, this may make them a super spreader 
of  corona virus. Therefore, self-isolation and quarantine 
from family members are frequent for them. These 
factors due to the HCP’s nature of  profession may create 
additional psychological pressure on them, (Khan,2020). 
Besides other health problems, several cross-sectional 
studies reported poor sleep quality among lonely people 
(Repon,2021).  Both loneliness and poor sleep quality 
impacted the mental health of  HCPs.38 compared to 
non-clinical staff, frontline medical staff  are 1.4 times 
more likely to feel fear of  infection and twice as likely 
to suffer from anxiety and depression. Therefore, the 
frontline fighters of  the COVID-19 pandemic are more 
susceptible to developing mental health problems than 
others.  In developing countries, the healthcare system is 
already overburdened (Buenaventura, 2020).

The sudden reversal of  role from HCW to a patient 
might lead to frustration, helplessness, adjustment 
issues, stigma, fear of  discrimination in the medical staff  
(Rana, 2020). Despite the low mortality rate of  2 %, 
the COVID-19 virus has a high transmission rate, and 
the mortality is higher than that caused by severe acute 
respiratory syndrome (SARS) and Middle East respiratory 
syndrome (MERS) combined (Lombardi, 2020). Studies 
from previous infectious outbreaks suggest that this 
group may be at risk of  experiencing worsening MH 
during an outbreak. Current evidence examining the 
psychological impact on similar groups suggests that 
this group may be at risk of  experiencing poor MH as a 
direct result of  the COVID-19 pandemic. Compounding 
the concerns about these data is that HSCWs will be 
likely to not only be at a higher risk for experiencing MH 
problems during the pandemic, but also in its aftermath 
(De Kock, 2021). There are some specific features of  the 
COVID-19 pandemic that may specifically heighten its 
potential to impact on the MH of  HSCWs. Firstly, the 
scale of  the pandemic in terms of  cases and the number 
of  countries affected has left all with an impression 
that ‘no-one is safe’. Media reporting of  the pandemic 
has repeatedly focused on the number of  deaths in 
HSCWs and the spread of  the disease within health and 
social care facilities which is likely to have amplified the 
negative effects on the MH of  HSCWs. In the face of  
this global crisis, healthcare workers are directly involved 

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Am. J. Med. Sci. Innov. 2(2) 1-7, 2023

in the process of  diagnosing, treating, and caring patients 
with COVID-19 and  are at  risk  for mental distress 
and adverse health effects. Psychiatric disorders such as 
stress, depression, and anxiety are on the rise, with an 
increasing number of  confirmed and suspected cases of  
the disease,  high  work  pressure,  lack  of   protective  
equipment,  widespread  media coverage, lack of  Page 
7 of  9 promising therapeutic agents and feelings of  
inadequacy (Lai, 2020). In 2005, study conducted during 
the severe acute respiratory syndrome (SARS) outbreak, 
health workers feared that they would become infected 
or infect their family, friends, or colleagues (Ho, 2005). 
Before the outbreak of  COVID-19, nearly 50 percent of  
healthcare workers suffered from job stress and burnout. 
Mental health problems of  healthcare staff  were 
widespread, though hidden issues, before the outbreak 
of  COVID-19. These problems have now become more 
evident due to the massive outbreak. In a recent study 
on medical and nursing staff  working in many hospitals 
around the world, 36.9% had mental health disorders 
below the threshold, 34.4% had mild disorders, 22.4% 
had moderate disorders, and 6.2% had severe mental 
disorders (Rad, 2020). Patient care in hospital wards 
with less than adequate beds, as well as environmental 
stress factors such as increased number of  patients, long 
work shifts, and increased number of  infected medical 
staff  and their deaths pose as a major risk for the mental 
health of  the healthcare personnel. Therefore, it is 
essential to decrease the levels of  anxiety in the present 
circumstances.  It is also important to protect the mental 
health of  healthcare workers in the inpatient wards of  
COVID-19 patients (Mosheva, 2021). Adequate rest, 
adequate fluid intake, and proper nutrition can improve 
the physical and mental health of  the health care workers. 
Some studies have shown   that   multidisciplinary   mental   
health   support   by   psychiatrists, clinical psychologists, 
psychiatric nurses, and   another   mental   health   
professionals, clear communication, providing accessible 
and reliable psychological services such as e-books and 
mobile applications, and reduction in work shifts of  the 
health workers to less than 16 hours a day can be effective 
in improving the mental health of  health care workers. 
Implementing these measures is recommended for the 
improvement of  the mental health status in healthcare 
personnel during the COVID-19 outbreak (Tahara, 2021).
Mental health is defined as a person’s emotional, 
psychological, and social well-being (Agha, 2021). 
From the beginning of  the COVID-19 pandemic, news 
broadcasts have addressed the novel virus and how 
details are developing each day. As a result, healthcare 
6 workers’ mentality is drastically affected. For 
instance, many healthcare workers are left to deal with 
personal protective equipment (PPE) shortage, high 
transmissibility of  COVID-19 to friends and loved ones, 
uncertainty due to lack of  treatment guidelines, increased 
work responsibilities, and physical isolation Due to the 
pandemic, many healthcare workers fear bringing home 
the virus to their loved ones, resulting in mental stress 

from work. Healthcare workers are expected to face the 
virus daily due to them being in constant close contact 
with sick patients. Even with the PPE, it is not guaranteed 
that one will not contract the virus and spread it to others. 
Some healthcare workers are brave enough to speak on 
behalf  of  most workers about the mental burden they 
experience from work. Some have verbalized the feelings 
of  helplessness, worthlessness, and guiltiness related to 
poor patient outcomes. Today, there is only so much one 
can do to lessen the spread of  COVID19, such as the 
importance of  practicing hand hygiene, social distancing, 
staying at home when one is sick, and getting vaccinated.
The objectives of  this study are to describe the socio 
demographic characteristics of  the respondents and to 
assess the psychological disorder of  the respondents 
during pandemic situation. In addition to examine the 
relationship between socio-demographic characteristics 
and mental health related disorders among the 
respondents.

LITERATURE REVIEW
This section reviewed existing literature on the impact of  
COVID-19 on mental health among the HCWs related 
to COVID-19, generalized anxiety disorder, patients’ 
loneliness, sleep disorder and demographic characteristics.  
The main purpose of  the literature review articles is to 
explore and improve healthcare workers’ mental health in 
Sher-E-Bangla Medical College Hospital, Barishal, along 
with discovering interventions to cope with difficult 
stressors throughout the COVID-19 pandemic. The 
research questions will be thoroughly answered based 
on the literature reviews that are separated into three 
categories, such as the relevancy of  depression and 
anxiety in healthcare workers, comparison of  healthcare 
workers ’mental health in the emergency department 
(ED) and intensive care unit (ICU), and interventions to 
improve healthcare workers’ mental well- being.
The world Health Organization (WHO) confirmed 
the COVID-19 as a global pandemic on March 11, 
2020. Since then, the Since then, the world struggles 
this pandemic, and nobody knows when it will stop 
The Bangladesh government declared a country-wide 
lockdown on March 26,2020, to hold the spreading of  
this virus among its citizens. The COVID-19 responses 
have impacted the personal, social, and work life of  many 
people world-wide. Therefore, the COVID-19 pandemic 
fearfully affected the mental health of  general population 
as frontline fighters; the impact of  COVID-19 pandemic 
on mental Health of  HCWs was high due to relatively 
unknown and fatal virus. The ongoing pandemic has 
situated HCWs in a situation of  intense psychological 
pressure and moral responsibilities.
A study concerning the mental health of  healthcare 
professional during COVID-19 pandemic in Bangladesh. 
According to their findings, the composition   of    
physicians, pharmacist, nurses, and   medical   technologist   
were 30%,23%,26%and 26% respectively. Among all 
HCPs, male was 57 % and 43%. Only 36% respondents 

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belong to the age group of  40 years (Hossain, 2020). 
Another cross- sectional study conducted which aim was 
to assess the mental health outcomes of  Bangladeshi 
HCPs and associated risk factors, in 2020. A total of  355 
HCPs aged between 20 and 60 years. All the participants   
completed   a   self-administered   questionnaire   through   
Google   Forms consisting of  socio-demographic 
characteristics and mental health outcomes, measure 
loneliness, depression, anxiety, and sleep disturbance 
using the UCLA loneliness scale-8, patient health 
questionnaire-9, 7-item generalized anxiety disorder scale, 
Pittsburgh sleep quality index. The present study observed 
the prevalence of  loneliness, depression, anxiety, and 
sleep disturbance among HCPs were 89%, 44%, 78%, 
and 87%, respectively. The factors significantly associated 
with the development of  mental health problems among 
HCPs were working environment, economic condition, 
and education level, area of  residence, marital status, 
gender differences, professional category, body mass 
index, and smoking habit. (Yang, 2018). Another study 
on Fear of  COVID-19 and Depression and his colleague 
result found that of  the total sample (N = 3388), just 
over half  were females (n = 1754, 51.8%). The majority 
were married (60.8%), had no children (57.8%), had 
elderly people who were at high-risk of  COVID-19 
living at home (66.1%), and had no chronic physical 
disease (57.5%). Three quarters of  the total sample were 
the general population (75.4%), and the remainder was 
healthcare professionals (24.6%). Over half  the HCPs 
were medical officers (53.2%), 10% were nurses, 6.8% 
were interns, 10% had affiliations with medical colleges 
(e.g., lecturer, assistant or associate professor, registrar), 
and the remainder held other positions. The prevalence 
of  depression among HCPs in relation to personal 
protective equipment they were using in their patient care. 
Approximately two-thirds of  HCPs purchased their own 
safety equipment at least once (63.2%) and 49% had got 
PPE from their employer. Only 15.9% were satisfied with 
the quality of  the PPE provided, and the prevalence of  
depression was higher among HCPs who were dissatisfied 
with their PPE (30.2%) (Sakib, 2021). According to Chen 
et al. (2021), it was found that 543 (60.20%) doctors, 311 
(34.48%) nurses, and 48 (5.32%) other occupations like 
administration staff  of  the hospital were included in the 
study. The percentage of  male and female participants 
was 283 (31.37%) and 619 (68.63%) respectively. 
Healthcare workers who demonstrated no or mild anxiety 
and depression 9 resulted in 681 (75.50%) and those who 
had moderate or severe anxiety and depression resulted in 
221 (24.50%). Based on the GAD-7 scores, 274 (30.38%) 
healthcare workers experienced mild anxiety, whereas 
150 (16.63%) experienced moderate or severe anxiety. In 
comparison, the PHQ-9 scale showed that 274 (30.38%) 
healthcare workers felt mild depression and 165 (18.29%) 
felt moderate or severe depression. Healthcare workers 
who had depression and anxiety together resulted in 
291 (32.26%).  The remaining 330 (36.59%) healthcare 
workers did not experience any symptoms of  depression 

and anxiety. This study shows that depression and anxiety 
were relevant in healthcare workers’ mental status. 
The independent risk factors for both depression and 
anxiety were respiratory symptoms, digestive symptoms, 
negative coping style, and job burnout, (Chen et al., 2021). 
Regarding the article’s published in 2021, the findings, 
before the peak of  COVID-19, 40% experienced 
depression and 38% experienced anxiety among 
healthcare workers, whereas 33% experienced depression 
and 24% experienced anxiety among the public. During 
COVID19, the prevalence of  depression was 31% 
and anxiety was 40% among healthcare workers, 26% 
suffered from depression and 22% suffered from anxiety 
among the public. After the peak of  COVID-19, 22% 
experienced depression and 22% experienced anxiety 
among healthcare workers. In contrast, 62% experienced 
depression and 44% experienced anxiety among the 
public (Deng, 2021).

MATERIALS AND METHODS
A cross-sectional survey was undertaken by administering 
structured questionnaire. Two tools, including the Patient 
Health Questionnaire (PHQ9) and Generalized Anxiety 
Disorder-7 (GAD-7), were employed to measure anxiety 
and depression symptoms among HCWs. The data 
analyses were carried out using descriptive statistics and 
inferential statistics. 

Study Area
This research was conducted in Sher-E-Bangla Medical 
College Hospital, Barishal among healthcare workers.  
There are 1000 health-care workers inSher-E-Bangla 
Medical College Hospital, Barishal.

Population and Unit of  Analysis
The population in this study was the frontline health care 
workers (Doctor, Nurse, and Medical Technologist) who 
work in the COVID19 dedicated unit at Sher-E-Bangla 
Medical College Hospital, Barishal during the time of  
study. The individual was the unit of  analysis.

Selection Criteria
• Respondents whose age was 25 years.
• Respondents who had been working more than six 

months in COVID-19 unit.
• Frontline healthcare workers who were willing to 

participate.

Exclusion Criteria
• Unwilling to participate in the study.
• Working experience less than six month had been 

excluded from the study. 
 
Sampling
The total population of  this hospital is 1000. Sample 
size was estimated by using G power analysis in which 
accepted minimum significant level (α) 0.05, power 0.80 
(1-β) and the effect size of  0.30 and actual sample size 

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is 84. To reduce the attrition rate by 10% more samples 
were added. Therefore, the total sample size was 92.

Techniques of  Data Collection
Data collection was carried out using the convenience 
technique. After getting the approval from the authority, 
respondents were being explained about the study 
purpose, data collection procedure and benefit of  the study 
by the author. After getting consent from the respondent, 
the data were collected by face-to-face interview with 
structured questionnaire. Approximately 30 minutes were 
needed to complete the interview session. The collected 
information from the participants kept in confidential. The 
participation of  the respondent in this study was completely 
voluntary. Respondent had the right to withdraw the data 
from the study at any time without any reason or penalty. 
Their anonymity and identity were strictly maintained 
using code numbers. Raw/ primary data were kept in my 
file cabinet for 3 years, and it would be destroyed after 
publication of  research in a scientific journal.
The study’s aims were listed on the first page. Besides, 
confidentiality information, the right of  withdrawal, 
consent, and voluntary participation was also presented. 
Informed consent was taken by all participants prior to 
participation. The eligibility criteria of  this study include 
both frontline and non-frontline HCWs. Participants 
were not receiving any incentives. Relevant data was 
extracted into structured tables including country, setting, 
population, study design, number of  participants, mental 
health conditions and their measurement tools and main 
study results. Where available, we extracted risk factors 
and protective factors; data was checked for accuracy and 
completeness.
 
Data Analysis and Processing
Current best practice guided the tabulated and narrative 
synthesis of  the results. The studies’ outcomes were 
categorized according to the psychological impact of  
COVID-19 on HSCWs of. The data was analyzed by 

using SPSS version 23. Descriptive statistics such as 
frequency, percentage, mean, and standard deviation was 
used to describe the socio-demographic characteristics, 
inferential statistics such as independent t-test, one- way 
ANOVA and Pearson Product Moment Correlation 
Coefficient was used to examine the relationship general 
psychological impact and socio-demographic factors.

Ethical Consideration of  the Study
The ethical clearance was obtained from the hospital. 
Written informed consent was taken from study 
participants and privacy was maintained with the exclusion 
of  personal identifiers. This part should contain adequate 
detail to reproduce reported data. It can be divided into 
subsections to demonstrate data type and collection, 
and if  several methods are described. Methods already 
published should be indicated by a reference; only relevant 
modifications should be described. The methodology 
should be written concisely in detail by maintaining the 
continuity of  the texts. 

RESULTS AND DISCUSSION
Socio-Demographic Characteristics of  the 
Respondents.
Table 1 shows the Socio-demographic characteristics of  
the respondents among 92 respondents the mean age was 
34.92 (SD= 6.65) years, which was ranged from 30-55 
years. Majority of  the respondents (84.8%) were female 
and more than half  (53.3%) of  them was Muslim.  Most 
of  the respondents (90.8%) were married. Many of  the 
participants (95.6%) were nurses. More than half  (72.8%) 
have working experience in COVID-19 ward. Most of  
them (69.6%) family members were tested positive of  
COVID-19 and 59.8% has ever been quarantine due 
to due COVId-19 during the last 12 month. 73.9% of  
respondents were tested positive. Regarding Training on 
IPC only 30.3% of  respondents got training. The majority 
of  the (75%) respondents were healthy, and 84.8% of  
participants did not suffer any chronic diseases.

Table 1: Demographic Characteristics of  Respondents
Variables Categories N %
Age 25-34 54 58.7

35-45 32 34.8
46-55 6 6.5

Gender Male 14 15.2
Female 78 84.8

Profession Doctor 4 4.3
Nurse 85 92.4
Medical Technologist 3 3.3
Medical Graduate 4 4.3

Education Diploma in Nursing 53 57.6
Diploma in Medical Technology 3 3.3
BSc in Nursing 24 26.1
Master’s in public health 8 8.7

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Religion Islam 49 53.3
Hindu 39 42.4
Christian 4 4.3

Work Experience in COVID-19 Hospital during last 
12 month

Yes 76 82.7
No 25 27.2

Family members tested positive for COVID-19 Yes 64 69.6
No 28 30.4

Have you Ever been quarantine last 12 month? Yes 55 59.8
No 37 40.2

Have you ever been tested positive for COVID-19? Yes 68 73.9
No 28 26.1

Have you got COVID-19 Vaccine? Yes 88 95.7
No 4 4.3

Received Training on IPC Yes 28 30.4
No 64 69.6

Perceived health status Healthy 69 75
Moderately healthy 22 23.9
Poor 1 1.1

History of  Diseases Hypertension 7 7.6
Heart disease 1 1.1
Diabetes 4 4.3
Asthma 2 2.2
None 78 84.8

Patients Health Questionnaire (PHQ-9) Depression 
Measure Scale (N=92)
Table 2  S hows  that  the  distribution  of   frequency,  
percentage,  means  and  SD  of  depression  among  the  
respondents  during  COVID-19  pandemic.  According to 
the findings the mean score of  depression was calculated 

30.51 (SD±3.80) out of  maximum 36 points which 
indicate higher level of  depression. According to most 
of  the respondents had moderate to severe depression. 
Findings was consistent previous studies was conducted 
in Bangladesh by R. Islam and associates & China by Hu, 
et al, 2020. 

Table 2: Total score of  Patient Health Questionnaire (PHQ9)
Valid 92
Missing 0

N Mean 30.51
Median 30.51
Range 15-36
Std. Deviation 3.80 

The results from the survey in India & Malaysia showed 
that 835 (41.5%) frontline nurses reported high levels 
of  emotional exhaustion while 556 (27.6%) nurses 
marked high depersonalization while working caring 
for COVID-19 patients (Hu, et al, 2020). In India the 
population-based study, female gender, being a student, 
having symptoms suggestive of  COVID-19, and poor 
perceived health were associated with higher rates of  
anxiety and depression; on the other hand, the availability 
of  accurate information and the use of  specific preventive 
measures, such as handwashing, seemed to mitigate these 
effects (Wang et al., 2020). Figure 1: PHQ (Category (Level of  Depression).

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Generalized Anxiety Disorder (GAD7) on COVID 19 
(N=92)
The following figure illustrates the results of  generalized 
anxiety disorder (GAD7) among the respondents during 
the COVID19 pandemic situation. The mean score on 
GAD7 was 2.65 (SD±.76). The results reveled that half  
(50%) of  the respondents had score of  moderate level of  

anxiety while only 18.5 respondents diagnosed at severe 
anxiety. Similar finding was found in study conducted in 
China, Malaysia, and Yemen. A possible reason for similar 
findings is because when the pandemic situation across 
the region and worldwide health care workers suffered 
high levels of  depression & anxiety due to devastating 
unknown threat. 

Figure 2: Distribution if  generalized anxiety disorder (GAD7) on COVID 19

CONCLUSION
This study reported a high prevalence of  symptoms 
of  depression and moderate level of  anxiety among 
health workers Sher E Bangla Medical College Hospital, 
Barishal, during the initial phase of  the pandemic. More 
than half  of  the health workers faced depression and only 
a few health workers reported generalized anxiety in their 
workplace as mental health problems were significantly 
associated with all the mental health outcomes. Nurses 
had higher anxiety than other health workers. Improving 
the mental wellbeing of  health workers is recommended 
by focusing on stigma reduction, equipping health 
workers with protective measures, as well as ensuring 
personal and family support for those with a history of  
mental health issues.

Limitations
The study has some limitations which need to be 
acknowledged. Firstly, the study was conducted during 
the early phase of  pandemic and thus the mental health 
outcomes might still reflect conditions existing before 
the pandemic. The relative contribution of  the pandemic 
to the increase in mental health disorders needs to be 
evaluated using a longitudinal study design. Secondly, 
there might be respondent bias as the findings were self-
reported by health workers and based on a subjective 
scale. Importantly, the tool used in the study should be 
taken into consideration while reporting mental health 
outcomes. Although the history of  mental illness and 
medications taken for any kind of  mental illness was 
included in the questionnaire, specific type of  mental 
illness was not identified, which may or may not have 
affected the current symptoms of  anxiety, depression. 
Despite limitations, this study provides early evidence 

on the mental health status among health workers during 
the COVID-19 pandemic in Bangladesh, which should 
be of  interest to policymakers, health facility managers 
and those involved in the response to COVID-19 or any 
future epidemic.

RECOMMENDATIONS
Based on the limitations of  this study, the following 
recommendations are presented for further research. 
Future descriptive study may be conducted in large scale 
to increase the generalizability of  the findings to other 
same settings. Followed by intervention study may   be   
recommended   to   investigate   the   relationship   between   
Depression   and demographic characteristics. Findings 
act as base line data for higher authority to mitigate 
mental health problems. Government organizations and 
non-government agencies should launch their programs 
on a substantial educational campaign to improve 
understanding and preventive measures of  depression 
and anxiety.

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