Physician's Burnout during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis

The burnout rate among physicians is expected to be higher during COVID-19 period due to the additional sources of physical and emotional stressors. Throughout the current COVID-19 pandemic, numerous studies have evaluated the impacts of COVID-19 on physicians' burnout, but the reported results have been inconsistent. This current systematic review and meta-analysis aims to assess and estimate the epidemiology of burnout and the associated risk factors during the COVID-19 pandemic among physicians. A systematic search for studies targeting physicians' burnout was conducted using PubMed, Scopus, ProQuest, Cochrane COVID-19 registry, and pre-print services (PsyArXiv and medRχiv) for English language studies published within the time period of 1 January 2020 to 1 September 2021. Search strategies resulted in 446 possible eligible studies. The titles and s of these studies were screened, which resulted in 34 probable studies for inclusion, while 412 studies were excluded based on the predetermined inclusion criteria. These 34 studies went through a full-text screening for eligibility, which resulted in 30 studies being included in the final reviews and subsequent analyses. Among them, the prevalence of physicians' burnout rate ranged from 6.0–99.8%. This wide variation could be due to the heterogeneity among burnout definitions, different applied assessment tools, and even cultural factors. Further studies may consider other factors when assessing burnout (e.g., the presence of a psychiatric disorders, other work-related and cultural factors). In conclusion, a consistent diagnostic indices for the assessment of burnout is required to enable consistent methods of scoring and interpretation.

Physician's Burnout during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis.

The burnout rate among physicians is expected to be higher during COVID-19 period due to the additional sources of physical and emotional stressors. Throughout the current COVID-19 pandemic, numerous studies have evaluated the impacts of COVID-19 on physicians' burnout, but the reported results have been inconsistent. This current systematic review and meta-analysis aims to assess and estimate the epidemiology of burnout and the associated risk factors during the COVID-19 pandemic among physicians. A systematic search for studies targeting physicians' burnout was conducted using PubMed, Scopus, ProQuest, Cochrane COVID-19 registry, and pre-print services (PsyArXiv and medRχiv) for English language studies published within the time period of 1 January 2020 to 1 September 2021. Search strategies resulted in 446 possible eligible studies. The titles and abstracts of these studies were screened, which resulted in 34 probable studies for inclusion, while 412 studies were excluded based on the predetermined inclusion criteria. These 34 studies went through a full-text screening for eligibility, which resulted in 30 studies being included in the final reviews and subsequent analyses. Among them, the prevalence of physicians' burnout rate ranged from 6.0-99.8%. This wide variation could be due to the heterogeneity among burnout definitions, different applied assessment tools, and even cultural factors. Further studies may consider other factors when assessing burnout (e.g., the presence of a psychiatric disorders, other work-related and cultural factors). In conclusion, a consistent diagnostic indices for the assessment of burnout is required to enable consistent methods of scoring and interpretation.

The Impact of Event Scale-Revised: Examining Its Cutoff Scores among Arab Psychiatric Patients and Healthy Adults within the Context of COVID-19 as a Collective Traumatic Event.

The Impact of Event Scale-Revised (IES-R) is the most popular measure of post-traumatic stress disorder (PTSD). It has been recently validated in Arabic. This instrumental study aimed to determine optimal cutoff scores of the IES-R and its determined six subscales in Arab samples of psychiatric patients (N = 168, 70.8% females) and healthy adults (N = 992, 62.7% females) from Saudi Arabia during the COVID-19 pandemic as a probable ongoing collective traumatic event. Based on a cutoff score of 14 of the Depression Anxiety Stress Scale 8-items (DASS-8), receiver operator curve (ROC) analysis revealed two optimal points of 39.5 and 30.5 for the IES-R in the samples (area under the curve (AUC) = 0.86 & 0.91, p values = 0.001, 95% CI: 0.80-0.92 & 0.87-0.94, sensitivity = 0.85 & 0.87, specificity = 0.73 & 0.83, Youden index = 0.58 & 0.70, respectively). Different cutoffs were detected for the six subscales of the IES-R, with numbing and avoidance expressing the lowest predictivity for distress. Meanwhile, hyperarousal followed by pandemic-related irritability expressed a stronger predictive capacity for distress than all subscales in both samples. In path analysis, pandemic-related irritability/dysphoric mood evolved as a direct and indirect effect of key PTSD symptoms (intrusion, hyperarousal, and numbing). The irritability dimension of the IES-R directly predicted the traumatic symptoms of sleep disturbance in both samples while sleep disturbance did not predict irritability. The findings suggest the usefulness of the IES-R at a score of 30.5 for detecting adults prone to trauma related distress, with higher scores needed for screening in psychiatric patients. Various PTSD symptoms may induce dysphoric mood, which represents a considerable burden that may induce circadian misalignment and more noxious psychiatric problems/co-morbidities (e.g., sleep disturbance) in both healthy and diseased groups.

Emotional Reaction to the First Dose of COVID-19 Vaccine: Postvaccination Decline in Anxiety and Stress among Anxious Individuals and Increase among Individuals with Normal Prevaccination Anxiety Levels.

Although vaccination has been adopted by the WHO to limit worldwide transmission of COVID-19, people's worries about COVID-19 vaccines may suppress their desire for vaccination despite vaccine availability. This study aimed to investigate anxiety and stress symptoms among 250 Jordanians (mean age = 43.18 ± 6.34 years, 72% females) who received their first vaccine dose. The respondents completed the anxiety and stress subscales of the Depression Anxiety and Stress scale 21 (DASS-21) before and after vaccination. The respondents expressed more moderate-severe levels of stress before than after vaccination (20.8% and 13.2%, respectively). Meanwhile, 37.2% and 45.2% of the respondents expressed moderate-severe anxiety before and after vaccination, respectively. Wilcoxon signed-rank test revealed that the drop in the level of stress from before- (median (IQR) = 5 (1-8)) to after vaccination (median (IQR) = 3 (1-7)) was statistically significant (z = -3.81, p = 0.001, r = 0.17) while the increase in anxiety was not. Anxiety significantly dropped postvaccination among individuals experiencing mild to severe anxiety before vaccination. Similarly, stress and anxiety significantly increased among individuals expressing normal anxiety before vaccination (z = -3.57 and -8.24, p values = 0.001, r = 0.16 and 0.37, respectively). Age positively correlated with postvaccination anxiety among respondents with mild prevaccination anxiety, and it negatively correlated with the prevaccination level of stress in the normal-anxiety group. Gender, marital status, respondents' level of education, and history of COVID-19 infection had no significant correlation with anxiety or stress at either point of measurement. Overcoming their hesitancy to receive COVID-19 vaccines, individuals with normal levels of anxiety experienced a rise in their distress symptoms following immunization. On the contrary, vaccination seemed to desensitize anxious individuals. Policymakers need to formulate a population-specific plan to increase vaccine preparedness and promote psychological well-being over all during the pandemic.

Burnout and the Psychological Impact among Physiatrists in Saudi Arabia during COVID-19.

BACKGROUND: Burnout is an emerging critical issue facing specialists and trainees in all disciplines and not particularly studied among physiatry specialists and trainees in Saudi Arabia during the COVID-19 pandemic. OBJECTIVE: To assess physiatrist burnout, depression, anxiety, and stress during the current COVID-19 pandemic crisis in Saudi Arabia. DESIGN: Cross-sectional study. SETTING: By distributing an electronic survey, the researcher assessed burnout using the Maslach Burnout Inventory (MBI) Human Services Survey (HSS) in the midst of the curfew that Saudi authorities imposed. PARTICIPANTS: One hundred one participating trainees, specialists, and consultants. RESULTS: Of the 101 study participants, the majority (73.3%) were between the ages of 24 and 34 years old, with the rest distributed within the age group ranging from 35 to 65 years old. Junior residents represented 34.7%, senior residents 22.8%, physiatrist specialists 26.7%, and consultants 15.8%. The sample included 55.4% males and 44.6% females; 64.4% of the participants were married, 29.7% were still single, and 5.9% were divorced. Among the total group participating, 25.7% were handling COVID-19 patients. In the total participant sample, 80.2% reported experiencing burnout, 10.9% experienced stress, and 22.8% and 6.9% experienced anxiety and depression, respectively. CONCLUSION: Burnout in Saudi Arabia exists among more than two-thirds of practicing physiatrists in Physical Medicine & Rehabilitation (PM&R), and that did not appear to have a statistically significant influence on stress, anxiety, or depression (p > 0.05). The current COVID-19 global pandemic might escalate burnout and influence mental health outcomes. The healthcare authority and administration should take the lead in identifying the challenges, overcoming the obstacles, and optimizing clinician well-being, delivering up-to-date solutions, and promptly checking their effectiveness.

The Arabic Version of the Impact of Event Scale-Revised: Psychometric Evaluation among Psychiatric Patients and the General Public within the Context of COVID-19 Outbreak and Quarantine as Collective Traumatic Events.

The Coronavirus Disease-19 (COVID-19) pandemic has provoked the development of negative emotions in almost all societies since it first broke out in late 2019. The Impact of Event Scale-Revised (IES-R) is widely used to capture emotions, thoughts, and behaviors evoked by traumatic events, including COVID-19 as a collective and persistent traumatic event. However, there is less agreement on the structure of the IES-R, signifying a need for further investigation. This study aimed to evaluate the psychometric properties of the Arabic version of the IES-R among individuals in Saudi quarantine settings, psychiatric patients, and the general public during the COVID-19 outbreak. Exploratory factor analysis revealed that the items of the IES-R present five factors with eigenvalues > 1. Examination of several competing models through confirmatory factor analysis resulted in a best fit for a six-factor structure, which comprises avoidance, intrusion, numbing, hyperarousal, sleep problems, and irritability/dysphoria. Multigroup analysis supported the configural, metric, and scalar invariance of this model across groups of gender, age, and marital status. The IES-R significantly correlated with the Depression Anxiety Stress Scale-8, perceived health status, and perceived vulnerability to COVID-19, denoting good criterion validity. HTMT ratios of all the subscales were below 0.85, denoting good discriminant validity. The values of coefficient alpha in the three samples ranged between 0.90 and 0.93. In path analysis, correlated intrusion and hyperarousal had direct positive effects on avoidance, numbing, sleep, and irritability. Numbing and irritability mediated the indirect effects of intrusion and hyperarousal on sleep and avoidance. This result signifies that cognitive activation is the main factor driving the dynamics underlying the behavioral, emotional, and sleep symptoms of collective COVID-19 trauma. The findings support the robust validity of the Arabic IES-R, indicating it as a sound measure that can be applied to a wide range of traumatic experiences.

The Nine-Item Internet Gaming Disorder Scale (IGDS9-SF): Its Psychometric Properties among Sri Lankan Students and Measurement Invariance across Sri Lanka, Turkey, Australia, and the USA.

The prevalence of internet gaming disorders (IGD) is considerably high among youth, especially with the social isolation imposed by the ongoing COVID-19 pandemic. IGD adversely affects mental health, quality of life, and academic performance. The Internet Gaming Disorder Scale (IGDS9-SF) is designed to detect IGD according to DSM-IV diagnostic criteria. However, inconsistent results are reported on its capacity to diagnose IGD evenly across different cultures. To ensure the suitability of the IGDS9-SF as a global measure of IGD, this study examined the psychometric properties of the IGDS9-SF in a sample of Sri Lankan university students (N = 322, mean age = 17.2 ± 0.6, range = 16-18 years, 56.5% males) and evaluated its measurement invariance across samples from Sri Lanka, Turkey, Australia, and the USA. Among Sri Lankan students, a unidimensional structure expressed good fit, invariance across different groups (e.g., gender, ethnicity, and income), adequate criterion validity (strong correlation with motives of internet gaming, daily gaming duration, and sleep quality), and good reliability (alpha = 0.81). Males and online multiplayers expressed higher IGD levels, greater time spent gaming, and more endorsement of gaming motives (e.g., Social and Coping) than females and offline players. Across countries, the IGDS9-SF was invariant at the configural, metric, and scalar levels, although strict invariance was not maintained. The lowest and highest IGD levels were reported among Turkish and American respondents, respectively. In conclusion, the IGDS9-SF can be reliably used to measure IGD among Sri Lankan youth. Because the scale holds scalar invariance across countries, its scores can be used to compare IGD levels in the studied countries.

COVID-19-Related Psychological Trauma and Psychological Distress Among Community-Dwelling Psychiatric Patients: People Struck by Depression and Sleep Disorders Endure the Greatest Burden.

COVID-19 has created a general state of worry and distress, especially among vulnerable groups such as those with psychiatric diagnoses. Worldwide, psychiatric care provision has drastically suffered during the pandemic, with many patients unable to access proper care, which may have implications for increased mental health consequences in patients with psychiatric disorders (e.g., relapse and suicide). This cross-sectional study used structural equation modeling to investigate COVID-19-related trauma and distress among Arab psychiatric population during COVID-19 quarantine. Patients with pre-existing psychiatric disorders (N = 168) completed an online survey that comprised the Depression Anxiety Stress Scale 21 (DASS-21), the Impact of Event Scale-Revised (IES-R), and a questionnaire on COVID-19-related attitudes/perceptions, sources of information, used protective measures, and socio-demographic information. Respondents commonly reported feeling down-hearted/blue, trouble concentrating, along with symptoms of avoidance and rumination related to the pandemic. Patients with depression and sleep disorders expressed higher COVID-19-related trauma than patients with other disorders. Perceived physical health mediated the effect of co-morbid chronic physical disorders on COVID-19 trauma, psychological distress, perceived vulnerability to COVID-19, and perceived likelihood of recovery in case of contracting COVID-19. Perceived physical health and perceived vulnerability to COVID-19 were strong direct predictors of COVID-19-related trauma and psychological distress. Staying at home negatively predicted COVID-19 trauma and exerted an indirect negative effect on psychological distress via COVID-19 trauma. COVID-19 trauma, age, and marital status directly predicted psychological distress, with COVID-19 trauma being the strongest predictor. Educational level, income, having family members working in the medical field, keeping up to date with the news on deaths/infected cases or the development of COVID-19 drugs or vaccines, satisfaction with available information on COVID-19, and using different protective measures were not associated with significant differences in COVID-19 trauma and psychological distress scores. Immuno-psychiatric interventions should be designed to target COVID-19-trauma and distress among younger single patients with perceived poor physical health, especially those diagnosed with depression and sleep disorders.

The Six-Item Version of the Internet Addiction Test: Its Development, Psychometric Properties, and Measurement Invariance among Women with Eating Disorders and Healthy School and University Students.

Internet addiction (IA) is widespread, comorbid with other conditions, and commonly undetected, which may impede recovery. The Internet Addiction Test (IAT) is widely used to evaluate IA among healthy respondents, with less agreement on its dimensional structure. This study investigated the factor structure, invariance, predictive validity, criterion validity, and reliability of the IAT among Spanish women with eating disorders (EDs, N = 123), Chinese school children (N = 1072), and Malay/Chinese university students (N = 1119). In school children, four factors with eigen values > 1 explained 50.2% of the variance, with several items cross-loading on more than two factors and three items failing to load on any factor. Among 19 tested models, CFA revealed excellent fit of a unidimensional six-item IAT among ED women and university students (χ2(7) = 8.695, 35.038; p = 0.275, 0.001; CFI = 0.998, 981; TLI = 0.996, 0.960; RMSEA = 0.045, 0.060; SRMR = 0.0096, 0.0241). It was perfectly invariant across genders, academic grades, majors, internet use activities, nationalities (Malay vs. Chinese), and Malay/Chinese female university students vs. Spanish women with anorexia nervosa, albeit it was variant at the scalar level in tests involving other EDs, signifying increased tendency for IA in pathological overeating. The six-item IAT correlated with the effects of internet use on academic performance at a greater level than the original IAT (r = -0.106, p < 0.01 vs. r = -0.78, p < 0.05), indicating superior criterion validity. The six-item IAT is a robust and brief measure of IA in healthy and diseased individuals from different cultures.

Obsessive-compulsive disorder post-COVID-19: a case presentation.

BACKGROUND: Since the emergence of the COVID-19 pandemic and the significant changes that impacted because of it, people around the world have been left dealing with its consequences-fear of becoming ill and dying, fear of losing loved ones, uncertainty about the future, and imposed social isolation-several elements which could lead to psychological consequences. Moreover, as suggested by recent evidence, the virus acts as a factor in causing psychological symptoms, including depression, anxiety, fatigue, and post-traumatic stress disorder. CASE PRESENTATION: Here, we report a case of a patient with new-onset OCD after his recovery from the coronavirus disease, which presented in the form of recurrent and persistent intrusive thoughts and doubts which responded to medication. CONCLUSIONS: This case shows the potential of COVID-19-associated inflammatory triggers to precipitate or induce obsessive-compulsive symptoms. Although this case cannot support causation, it does stress the bidirectional effects that physical and mental illness share.

The Depression Anxiety Stress Scale 21: Development and Validation of the Depression Anxiety Stress Scale 8-Item in Psychiatric Patients and the General Public for Easier Mental Health Measurement in a Post COVID-19 World.

Despite extensive investigations of the Depression Anxiety Stress Scales-21 (DASS-21) since its development in 1995, its factor structure and other psychometric properties still need to be firmly established, with several calls for revising its item structure. Employing confirmatory factor analysis (CFA), this study examined the factor structure of the DASS-21 and five shortened versions of the DASS-21 among psychiatric patients (N = 168) and the general public (N = 992) during the COVID-19 confinement period in Saudi Arabia. Multigroup CFA, Mann Whitney W test, Spearman's correlation, and coefficient alpha were used to examine the shortened versions of the DASS-21 (DASS-13, DASS-12, DASS-9 (two versions), and DASS-8) for invariance across age and gender groups, discriminant validity, predictive validity, item coverage, and internal consistency, respectively. Compared with the DASS-21, all three-factor structures of the shortened versions expressed good fit, with the DASS-8 demonstrating the best fit and highest item loadings on the corresponding factors in both samples (χ2(16, 15) = 16.5, 67.0; p = 0.420, 0.001; CFI = 1.000, 0.998; TLI = 0.999, 0.997; RMSEA = 0.013, 0.059, SRMR = 0.0186, 0.0203). The DASS-8 expressed configural, metric, and scalar invariance across age and gender groups. Its internal consistency was comparable to other versions (α = 0.94). Strong positive correlations of the DASS-8 and its subscales with the DASS-21 and its subscales (r = 0.97 to 0.81) suggest adequate item coverage and good predictive validity of this version. The DASS-8 and its subscales distinguished the clinical sample from the general public at the same level of significance expressed by the DASS-21 and other shortened versions, supporting its discriminant validity. Neither the DASS-21 nor the shortened versions distinguished patients diagnosed with depression and anxiety from each other or from other psychiatric conditions. The DASS-8 represents a valid short version of the DASS-21, which may be useful in research and clinical practice for quick identification of individuals with potential psychopathologies. Diagnosing depression/anxiety disorders may be further confirmed in a next step by clinician-facilitated examinations. Brevity of the DASS-21 would save time and effort used for filling the questionnaire and support comprehensive assessments by allowing the inclusion of more measures on test batteries.

COVID-19 Pandemic and Mental Health Status of Saudi Citizens Living Abroad.

BACKGROUND: The COVID-19 pandemic is a global health crisis associated with unprecedented levels of morbidity and mortality worldwide. The COVID-19 pandemic has been suggested to contribute to a great burden on global mental health. We assumed that individuals in quarantine outside their home country would be more vulnerable to developing mental health disorders during the current pandemic and might face difficulties in accessing mental health services. AIM: To explore the degree of association between the COVID-19 pandemic and mental health status of Saudi citizens living abroad. OBJECTIVES: (1) To measure the prevalence and risk factors of mental health problems among Saudi citizens studying and living abroad during the COVID-19 pandemic; (2) to assess the correlation between the COVID-19 pandemic and mental health status of Saudi citizens living abroad; and (3) to explore the level of anxiety/depression during the COVID-19 pandemic. METHODS: A cross-sectional survey was conducted from August 2020 to September 2020 using a self-administrated questionnaire composed of sociodemographic, (GAD-7) and (PHQ-9) scales. RESULTS: A total of 64% of participants experienced psychiatric symptoms during the pandemic, and 34% and 30% met the diagnostic criteria for symptoms of depression and anxiety, respectively. The risk of psychological symptoms was more likely experienced by females, young, single, or divorced, or those who were living alone. In addition, those who lived in the UK and Ireland were more likely to develop depressive and anxiety symptoms. More than 80% appreciated the response of the Saudi government and embassy to meet the MH needs of students undergoing quarantine abroad and in Saudi Arabia. CONCLUSIONS: The COVID-19 pandemic represents an unprecedented threat to global mental health. Two-thirds of study participants who were in foreign countries during the COVID-19 pandemic reported anxiety or depressive symptoms. Living away from family and friends was significantly associated with increased loneliness and psychological distress. These and other findings highlight the need to remove barriers preventing easily accessible online mental health services, social and family support, and timely provision of resources.

Burnout and depression among psychiatry residents during COVID-19 pandemic.

Very few studies have been concerned with assessing the prevalence of burnout and depressive symptoms, especially during an infectious outbreak on non-frontline health care workers, such as a psychiatrist. In such instances, the role of psychiatrists and other mental health providers as a source of psychological support to the public and frontline workers is indispensable and valuable. This study aims to assess the prevalence of burnout and depressive symptoms, and their correlation, during the COVID-19 pandemic among psychiatry residents in Saudi Arabia. A total of 121 out of 150 psychiatry residents in Saudi Arabia completed the Maslach Burnout Inventory and Patient's Health Questionnaire for the assessment of burnout and depressive symptoms. Burnout symptoms were found in 27.3%, and another 27.3% reported having depression symptoms. In addition, 16.5% reported having both burnout and depressive symptoms, with a significant relationship between them. Participants in the first 2 years of training and having a history of receiving mental health treatment in the past 2 years were at higher risk. The need is urgent to increase investment in mental health services and to construct a plan to reduce this risk of burnout and depression among psychiatrists by developing preventative strategies to prevent burnout and promote wellness is more important than ever.

Psychological Distress in Quarantine Designated Facility During COVID-19 Pandemic in Saudi Arabia.

BACKGROUND: Quarantine is a useful measure for preventing and controlling pandemics; however, it might be stressful for quarantined individuals. Fear and anxiety about a disease can be overwhelming. These emotions were reported for individuals in involuntary quarantine facilities dedicated to quarantine purposes. METHODS: This cross-sectional study surveyed the individuals in involuntary quarantine institutions (for a planned period of 14 days of quarantine) in two regions of Saudi Arabia. The mental health status of individuals was assessed using the Revised Impact of Event Scale (IES-R) and Depression, Anxiety, and Stress Scale (DASS-21). RESULTS: The study surveyed 214 quarantined/isolated individuals. The stress, anxiety, and depression rates were 25.7%, 21.5%, and 32.7%, respectively. On the IES-R, 28.0% of the participants met the criteria for psychological distress. Female gender, self-reported history of psychiatric disorder, and average health status were significantly associated with negative psychological impact and depression, anxiety, and stress symptoms (p<0.05). Watching television was found to be a factor in reducing rates on the IES-R and DASS-21 scale while working out lowered rates on the IES-R alone (p<0.05). CONCLUSION: During an institutional involuntary quarantine, additional attention should be paid to vulnerable groups like females and individuals with a history of psychiatric illness. More than one-fourth of our sample experienced a negative psychological impact; therefore, coping practices like working out should be encouraged. This study contributes to the ongoing discussion about the psychological aspects of being quarantined. Much work remains to be done to identify strategies that prevent and mitigate psychological distress throughout the quarantine experience and to determine whether these impacts will last for an extended period of time.

The psychological impact of COVID-19 pandemic on the general population of Saudi Arabia.

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an emerging infection causing a widely spread pandemic of Coronavirus disease 2019 (COVID-19). The current COVID-2019 pandemic is prompting fear of falling sick, dying, helplessness and stigma, urgent and timely understanding of mental health status is needed to help the community. Our investigation designed to survey the general population in Saudi Arabia to assess the degree of psychological impact during the pandemic. METHODS: During the early stage of the outbreak, we conducted an online-based survey using a snowballing sample technique. The surveys collected data about several aspects of participant sociodemographic, knowledge, concerns, psychological impact, and mental health status. We assessed the psychological impact and mental health status using the Impact of Event Scale-Revised (IES-R), and the Depression, Anxiety, and Stress Scale (DASS-21). RESULTS: Our survey recruited 1160 respondents of the general public of Saudi Arabia. Of them, 23.6% reported moderate or severe psychological impact of the outbreak, 28.3%,24%, and 22.3% reported moderate to severe depressive, anxiety, and stress symptoms, respectively. Females reported IES-R (B: 5.46, 95% CI: 3.61 to 7.31) and DASS subscales B coefficient ranged from 1.65 to 2.63, along with high-school students, working in the medical field, and poor self-reported health status was significantly associated with a high level of IES-R and DASS scales (p < .05). Experiencing breathing difficulty and dizziness showed a stronger association with higher IES-R and DASS subscales than other somatic symptoms (e.g., headache and fever);(p < .001). Respondents who practiced specific preventative measures (e.g., hand washing, social distancing) demonstrated a protective effect against stress, anxiety, and depression symptoms. Social distancing appeared to be protective on stress and anxiety subscales (B: -1.49, 95% CI: -2.79 to -0.19),(B: -1.53, 95% CI: -2.50 to -0.57),respectively; and hand hygiene on depression subscale (B: -2.43, 95% CI: -4.44 to -0.42). CONCLUSION: Throughout the early stage of the COVID-19 outbreak in Saudi Arabia, the results showed that nearly one-fourth of the sampled general population experienced moderate to severe psychological impact. Following specific precautionary measures appeared to have a protective effect on the individual's mental health. Our findings can be used to construct psychological interventions directed toward vulnerable populations and to implement public mental health strategies in the early stages of the outbreak.