1 Introduction

On December 31, 2019, the Wuhan Municipal Health Commission in the Hubei province of China reported the first cases of a pneumonia with unascertained etiology. Eventually, a novel coronavirus was identified, and later, the World Health Organization (WHO) characterized COVID-19 as a pandemic due to its increasing rate of spread and severity [56]. The disease soon spread through Europe; and in the Middle East, the first case was identified in the United Arab Emirates, while Iran was one of the worst-hit countries in the region [12]. The first cases of the disease in Iraq, which consisted of four family members returning from Iran, were confirmed in February [8]. As for the Kurdistan Region of Iraq (KRI), the Ministry of Health confirmed the first cases of COVID-19 on March 1, and 14 days later, the regional government started implementing a lockdown and banned all non-emergency travels between its governorates (i.e., Erbil, Sulaymaniyah, Duhok, Halabja). The lockdown was extended multiple times and was, in effect, fully inside the governorates until late May. As of July 15, 2020, the region has recorded 10,114 confirmed cases with 370 deaths [30]. It has been documented that outbreaks of infectious diseases and pandemics could have psychosocial impacts on the general population and may lead to psychological distress [5, 41]. Individuals may fear contracting the disease, which can lead to experiences of stigma and threaten their lives [17]. In a cross-sectional study conducted in Europe to assess psychological reactions to swine flu, in which 186 participants completed an online questionnaire, 25% of the respondents reported being worried about having the disease. Additionally, 45% of the respondents were worried that their family members could contract the virus [15]. Another study also reported that anxiety was common in a sample of college students during the swine flu outbreak [53].

As for COVID-19, data from 1210 respondents were collected in a cross-sectional study in China using an online survey. The results of this study showed that more than half of the participants (52.8%) reported psychological impact. Concerning depression, anxiety, and stress, 4.3% of the sample had high to extreme levels of depression, 8.4% had high to severe levels of anxiety, and 5.5% had high to severe levels of stress. Male participants showed higher scores of depression, anxiety, and stress [52]. A similar study, also in China, was conducted on 7236 participants to assess the mental health effects of the outbreak on the public. The study reported that the prevalence of Generalized Anxiety Disorder (GAD) and depressive symptoms were 35.1% and 18.2%, respectively, with no significant gender differences. However, among individuals aged 35 or older, GAD and symptoms of depression were higher compared to individuals below 35 years of age [20]. Another study in China, with 263 participants, reported mild levels of stress during the COVID-19 pandemic, with no significant differences based on gender [58]. An online cross-sectional study of 976 participants in Spain investigated the psychological aspects of the pandemic. Low symptoms of depression, anxiety, and stress were reported during the initial stages of the COVID-19 outbreak, but the symptoms increased after a lockdown was implemented [40]. Another inquiry in Egypt, in which 1629 individuals participated by filling out an online survey, found that 22.5%, 22.9%, and 15% of the participants reported experiencing severe to very severe depression, anxiety, and stress symptoms, respectively [3].

To prevent the spread of COVID-19, the WHO advised people to maintain social distancing. Thus, in most countries, lockdowns were implemented, and it was shown to effectively lower the number of infected and deaths [13, 55]. However, the lockdown measures also had psychological impacts, as shown in a study conducted on 2530 participants during the first three weeks of lockdown that belonged to the University of Valladolid in Spain. The prevalence rate of depression, anxiety, and stress was 34.19%, 21.34%, and 28.14%, respectively, and the rates for all three were lower among graduate students compared to undergraduate students [39]. The psychological impacts of confinement have previously been shown during the Severe Acute Respiratory Syndrome (SARS) outbreak by Hawryluck et al. [18]. Of 129 confined Canadian individuals, 31.2% reported symptoms of depression. In addition, during the outbreak of COVID-19 and lockdown measures, in an online survey by Statista [50], 44% of the respondents reported spending longer hours on Facebook, Instagram, Twitter, and other social media platforms. Various studies have previously shown a link between excessive use of social media and mental health problems [6, 22, 27, 31, 47].

One of the challenges WHO faced during the COVID-19 pandemic was the spread of misinformation; thus, “Stop the Spread” campaign was announced by the organization to counter and combat the spread of misinformation, which can circulate on the internet, especially on social media domains. In this regard, a study was conducted in the KRI by Ahmad & Murad [1] that aimed to address the influence of social media on mental health and inducing panic during the outbreak of COVID-19 in the region. A descriptive content analysis of their data showed that the relationship between social media use and the spread of panic about COVID-19 was positive. Moreover, the participants reported the significant impact of social media on spreading panic and fear, which negatively influenced the participant’s mental health. The authors concluded that social media was instrumental in inducing anxiety about COVID-19 spreading in the region. Ni et al. [37] examined social media use as a risk factor for mental health problems in an online cross-sectional study in the Wuhan province of China. Their results, based on responses from 1577 participants, revealed that 19.21% of adults reported probable depression, while for probable anxiety, the rate was 23.84%. They also reported that the use of social media for more than two hours a day to access news about COVID-19 was associated with increased depression and anxiety, consequently declaring social media use as a risk factor for elevated mental health problems. In their conclusion, the authors warned against using social media excessively to find news about the COVID-19 pandemic since an online infodemic also exists. Another cross-sectional study in China also reported that elevated levels of mental health problems were positively associated with social media use. The sample of this study was collected from 32 provinces, and the number of participants was 4872. Of this total number, 82.0% reported using social media frequently, with higher usage rates among females. Anxiety prevalence was 22.6%, and married participants had higher odds of having anxiety. As for depression, individuals aged below 20 had lower odds of having depression compared to individuals aged 21 to 40, and the overall prevalence rate of depression was 48.3%. Frequently using social media had a positive association with mental health problems during the COVID-19 outbreak [14]. A study in Indonesia, using a sample of university students majoring in health, found that social networking usage was associated with increased depression and anxiety. The authors concluded that using social networking increased the risk of experiencing depression and anxiety among university students [54].

Overall, the scientific literature shows that the COVID-19 pandemic negatively influenced the mental health of the public and that social networking usage was associated with worsened mental health outcomes. The influence of the COVID-19 outbreak and lockdown on mental health and social networking usage remains largely unexplored in the KRI. Furthermore, there is a dearth of investigations into the relationship between social networking usage and mental health problems in the region. Additionally, the previous epidemics that broke in the KRI (e.g., swine flu and the bird flu) were, for the most part, not subject to scientific inquiries in terms of their psychological influence, and this has led to a situation in which the relevant governmental agencies in the KRI do not consider the psychological aspect of the epidemics. Thus, it is crucial to explore the associated impact of social networking usage and the COVID-19 pandemic on the psychology of community individuals of the KRI. The present study was one of the first to be conducted on the psychological influence of the COVID-19 pandemic, the resulting lockdown, and its association with social networking usage. Therefore, it is the aim of the current study to adopt a quantitative cross-sectional method to find the level and prevalence of social networking usage and mental health problems; that is, depression, anxiety, and stress, and to explore group differences in these variables based on sociodemographic variables (i.e., gender, economic status, intimate relationship status, religious orientation, and employment status). Moreover, this study aims to address the relationship between social networking usage and mental health problems during the COVID-19 outbreak and lockdown. The association between social networking usage and mental health problems is also explored.

2 Method

2.1 Participants and design

The current study adopted a cross-sectional design, and we used an online questionnaire to assess social networking usage and mental health problems during the COVID-19 outbreak and lockdown. The data were collected through a snowball sampling method as participants were asked to distribute the survey further and send it to other individuals so they may participate. Only adult (age > 18) respondents who were residing in one of the four governorates of KRI (i.e., Erbil, Sulaymaniyah, Duhok, and Halabja) were eligible to participate in this study. Thus, individuals residing in the other cities of Iraq and Kurds who were residing outside of the KRI were not eligible to participate in our study. A total of 355 individuals participated in this study. The Institutional Review Board of Charmo University, KRI, approved the current study’s protocol.

2.2 Procedure

The questionnaires were posted on and shared through social media platforms, including Facebook and Snapchat, by the authors and then through the respondents. The data was collected in a week, during which the governorates of KRI were on lockdown, from March 20, 2020, to March 27, 2020. The purpose of the study was explained in a written informed consent, which was put in the first section of the form. Two different versions of the forms were sent out; one in Kurdish and the other in English, and the participants were asked to fill out the one they felt comfortable with. The purpose of having the form and questionnaires available in English was to reach participants residing in the KRI but not speaking Kurdish, particularly the Christian participants. The KRI is a multi-ethnic region, and the authors perceived English as one of the common languages.

2.3 Instruments

2.3.1 Social networking usage

The usage of social networking was measured by using the Social Networking Usage Questionnaire (SNUQ) developed by Gupta & Bashir [16]. The scale is composed of 19 items with the following options: Never (1), Rarely (2), Sometimes (3), Often (4), and Always (5). All the items are positively worded. The scale measures the social networking usage of individuals, and it contains four dimensions (i.e., academic, socialization, entertainment, and informativeness),higher scores indicate higher usage of social networks. The original English version and a back-translated Kurdish version of the questionnaire were used in this study. Based on the sample of this study, the scale's Kurdish and English versions showed good internal consistency with a Cronbach's alpha score of 0.83 and 0.78, respectively.

2.3.2 Depression and anxiety

Symptoms of depression and anxiety were assessed by Hopkins Symptom Checklist-25 (HSCL-25) [19]. The scale is composed of 25 items, and each item has four-point response categories, which are not at all (1), a little bit (2), quite a bit (3), and extremely (4). HSCL-25 also contains two subscales; the first includes 10 items that measure the severity of anxiety symptoms, while the second consists of 15 items that measure the severity of depression symptoms. A value of 1.75 or higher is considered a scientifically valid cut-off point, calculated by dividing the total score by the number of items. The English and Kurdish versions of the scale were used in the current study. There is evidence for the cross-cultural validity of the scale [42], and the depression subscale of the Kurdish version has previously been shown to have high internal consistency with an alpha score of 0.85 [33]. Similar results were found based on the sample of the current study as the Kurdish version of the scale had Cronbach’s alpha score of 0.91. As for the anxiety subscale, with a Cronbach's alpha score of 0.89, it also showed high internal consistency. Regarding the English version of the scale, the items of depression and anxiety sub-scales demonstrated high internal consistency based on Cronbach's alpha with a score of 0.90 and 0.94, respectively.

2.3.3 Perceived stress

For measuring stress, the Perceived Stress Scale (PSS) was used in this study [10]. The PSS consists of 10 questions, and each item has five options: “Never” = 0, "Almost never" = 1, “Sometimes” = 2, "Fairly often" = 3, and “Very often” = 4. The scores on questions 4, 5, 7, and 8 are reversed, and a total score is obtained by summing the scores from each question. The score ranges 0–13, 14–36, and 27–40 are considered low, moderate, and high perceived stress, respectively. In this study, the English version and the Kurdish version, which was back-translated, were used. Based on the data from the present study, the PSS had good internal consistency, assessed using Cronbach's alpha with a score of 0.80. Similar results were found for the English version of the questionnaire as it also had a Cronbach's alpha score of 0.80.

2.4 Data analysis

The statistical analysis of the data was carried out using the Statistical Package for Social Science (SPSS) version 23. Sample Characteristics, mental health problems, and social media usage were found using descriptive statistical analysis. To assess the distribution of the scores, an exploratory data analysis was executed. Visual inspection of histograms and normal Q-Q plots, as well as the skewness and kurtosis score [28], showed that the scores of continuous variables, social media usage, and perceived stress were approximately normally distributed. The scores of social networking usage had a skewness of − 0.011 (SE = 0.129) and kurtosis of 0.226 (SE = 0.258), whereas the scores of perceived stress had a skewness of -0.056 (SE = 0.129) and kurtosis of -0.293 (SE = 0.258). Similar results were found for the scores of anxiety and depression. Depression scores showed a skewness of 0.619 (SE = 0.129) and a kurtosis of − 0.319 (SE = 0.258), whereas anxiety scores showed a skewness of 0.916 (SE = 0.129) and a kurtosis of 0.174 (SE = 0.257). Therefore, Pearson correlation was used to find the relationship between the variables. One-way Analysis of variance (ANOVA) and t-test were used in assessing group differences.

3 Results

3.1 Characteristics of the participants

Of the total participants, 172 were female, and 183 were male. The mean age was 26.05 with a standard deviation of 6.18, and the age range of the participants was from 18 to 49. As for the provinces, the majority of the respondents were from Erbil and Duhok governorates (54.9%), and the rest were from the Sulaymaniyah and Halabja governorates (45.1%); the governorates were grouped based on geographical proximity. Most individuals in this study reported Islam as their religion (89.3%), 3.7% were Christians, and only 5.6% of the sample comprised atheists and agnostics; the rest reported other religious affiliations. In terms of educational status, only 3.7% reported that they had not received a formal education, and 3.9% had an elementary school education. College graduates (5.4%), high school graduates (22.3%), and individuals with graduate degrees (4.8%) were the most reported educational statuses, respectively. Most participants were employed (69.9%), while only 19.7% reported being unemployed. 10.4% reported their occupation status as a student. With regards to intimate relationship status, more than half of the participants (57.7%) were currently single; 42.3% were either married or in a relationship. Most respondents had a middle economic level (69.9%), followed by the upper middle and high (15.5%) and low and lower moderate (14.6%) economic levels (Table 1).

Table 1 Group differences in social networking usage, depression, anxiety, and stress based on sociodemographic characteristics
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3.2 Social networking usage

The results showed that the overall mean of the participants in social networking usage was 53.92 (SD = 10.28); this reflects a moderate level of social networking usage (Table 2). The participants had a mean score of 17.6 (SD = 5.45) in the academic dimension of social networking. The socialization, entertainment, and information dimensions showed a mean score of 14.4 (SD = 3.34), 11.93 (SD = 2.95), and 9.99 (SD = 2.32), respectively.

Table 2 Mean and standard deviation scores of dependent variables
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To investigate the group difference in social networking usage, independent sample t-test and one-way ANOVA were used. The results from the independent sample t-test did not reveal significant differences in social networking usage based on gender and residence. Using one-way ANOVA, Similar results were found based on education level, employment, and economic status; however, significant differences were found based on age groups, religion, and marital status (see Table 1). A significant effect of age groups on social networking usage was found F (2,352) = 5.79, p < 0.01. Since the assumption of homogeneity was not violated as revealed by Levene's test of homogeneity of variance (P > 0.05), the post hoc analysis was performed through Tukey's HSD. The post hoc results showed that individuals aged 18–27 (M = 55.22, SD = 9.94) scored higher on social networking usage than individuals aged 28–37 (M = 51.21, SD = 10.72). Whereas significant differences were not found between the other age groups. Similar results were found on the effect of religion on social networking usage F (3, 351) = 2.78, p < 0.05. As investigated through Levene's test of homogeneity of variance, the assumption of homogeneity was not violated (P > 0.05). The post hoc analysis of Tukey's HSD showed that compared to the non-religious participants (M = 48.2, SD = 8.08) Muslim participants (M = 54.04, SD = 10.39) scored higher on social networking usage.

The results also showed a significant effect of marital status on social networking usage F (2, 352) = 6.39, p < 0.01. Levane's' test of homogeneity of variance was not statistically significant (P > 0.05). Therefore, post hoc analysis was conducted by using Tukey's HSD, and it was shown that single participants (M = 55.52, SD = 10.18) and married participants (M = 51.41, SD = 9.81) were significantly different (i.e., single participants scored higher on social media usage as compared to married participants). However, similar significant differences were not found between the other groups (i.e., single and in-relationship participants, married and in-relationship participants).

3.3 Depression

Depression symptoms had a mean severity of 29.45 and a standard deviation of 9.33 (Table 2). Using the cut-off score of 1.75, it was found that 56.3% of the participants were experiencing probable depression. As it was revealed through conducting an independent sample t-test, females (M = 30.87, SD = 9.68) scored higher on depression as compared to males (M = 28.13, SD = 8.81), t (353) = 2.79, p < 0.01, two-tailed. Levene's test of homogeneity of variance indicated equal variances assumed (P > 0.05); therefore, no adjustments were made in the degrees of freedom. In addition, the results of a one-way ANOVA showed a significant effect of employment status on depression F (2, 352) = 9.16, p ≤ 0.001. Based on the results of Levene's test of homogeneity of variance (P > 0.05), equal variances were assumed. A post hoc test using Tukey's HSD demonstrated that unemployed participants (M = 33.24, SD = 9.67) had higher depression scores than employed participants (M = 28.15, SD = 9.01). Significant differences between the other groups were not found (see Table 1).

3.4 Anxiety

As depicted in Table 2, the mean severity of anxiety symptoms was 17.02 (SD = 5.70), and 37.7% of participants scored above the 1.75 cut-off point. Group differences were explored through independent sample t-tests and one-way ANOVA. The results of an independent sample t-test showed a statistically significant difference between females and males in their anxiety score t (328.5) = 3.62, p ≤ 0.001, two-tailed. The female participants (M = 18.14, SD = 6.20) scored higher in anxiety compared to male participants (M = 15.97, SD = 4.99). Levene's test of homogeneity of variance (F = 11.35, P > 0.05) indicated unequal variances assumed; consequently, the degrees of freedom were adjusted from 353 to 328. 51.

Moreover, the results of a one-way ANOVA showed a significant effect of employment status on anxiety F (2, 352) = 4.66, p < 0.01. Based on the results of Levene's test of homogeneity of variance (P > 0.05), equal variances were assumed. A post hoc test using Tukey's HSD showed that unemployed participants (M = 18.66, SD = 5.92) experienced higher anxiety scores than employed participants (M = 16.44, SD = 6.16). The other group pair did not reveal significant differences. Additionally, significant differences in anxiety were not found based on residency, religion, marital status, education, age groups, and economic status.

3.5 Perceived stress

The perceived stress level among the participants was at a moderate level (M = 18.24, SD = 6.02) (Table 2). The results also revealed that 9.6% of the participants reported a high level of perceived stress, 67% reported a moderate level of perceived stress, and 23.4% reported low perceived stress levels. Females (M = 19.01, SD = 6.44) reported higher experiences of perceived stress compared to males (M = 17.51, SD = 5.52), and this difference, which was assessed through using independent sample t-test, was statistically significant t (337.4) = 2.35, p < 0.01, two-tailed. Levene's test of homogeneity of variance showed equal variances not assumed (F = 4.45, P > 0.05); therefore, an adjustment was performed on the degrees of freedom from 353 to 337.4.

Using a one-way ANOVA, as depicted in Table 2, it was revealed that there exists a significant difference in perceived stress based on religious orientation (i.e., Islam, Christianity, non-religious, and others) F (3, 351) = 4.35, p < 0.01. Levene's test of homogeneity of variance (P > 0.05) showed that the assumption of homogeneity was not violated. Using Tukey's HSD test, post hoc comparisons showed that the mean score of Muslim participants (M = 17.87, SD = 5.95) was significantly lower than the mean score of Christian participants (M = 22.62, SD = 5.80) in perceived stress; non-religious and followers of other religions did not differ significantly from Muslim and Christian participants.

Moreover, it was also revealed that there was a significant effect of education level on stress F (4, 350) = 2.63, p < 0.05. The assumption of homogeneity was not violated based on Levene's test of homogeneity of variance (P > 0.05). Post hoc comparisons through Tukey's HSD demonstrated that participants with no formal education (M = 22.69, SD = 6.50) scored higher in stress compared to participants with graduate education (M = 15.82, SD = 5.68). There were no significant differences between the other pairs. Similar results were found regarding group differences in employment status in stress F (2, 352) = 4.71, p < 0.05. Unemployed participants (M = 19.89, SD = 6.03) had higher scores of perceived stress than employed participants (M = 17.61, SD = 5.08). The assumption of homogeneity was not violated (Levene’s test of homogeneity of variance; P > 0.05).

3.6 Correlation between Social networking usage and mental health problems

The relationship between social networking usage and its dimensions with depression, anxiety, and perceived stress was explored through Pearson's product-moment correlation coefficient. The results revealed that there was a significant positive relationship between social networking usage and depression r (355) = 0.150, p < 0.01. Similar results were found regarding the relationship between social networking usage and anxiety as they were positively correlated r (355) = 0.131, p < 0.05. However, social networking usage and stress were not significantly correlated. As for the correlation between the dimensions of social networking usage and mental health problems, it was revealed that the socialization dimension of social networking usage was positively correlated with depression r (355) = 0.161, p < 0.01, anxiety r (355) = 0.156, p < 0.01, and stress r (355) = 0.149, p < 0.01. Furthermore, the entertainment dimension demonstrated similar results as it had a significant positive correlation with depression r (355) = 0.204, p ≤ 0.001, anxiety r (355) = 0.132, p < 0.01, and stress r (355) = 0.222, p ≤ 0.001. However, social networking usage's academic and information dimensions were not significantly correlated with depression, anxiety, or stress (see Table 3).

Table 3 The correlation between social media usage and mental health problems
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3.7 Association of social networking usage with mental health problems

To investigate the association between mental health problems (i.e., depression, anxiety, and stress) and social networking usage, a simple linear regression was conducted (see Table 4). In the first model, social networking usage was entered as a predictor variable, and depression was entered as the independent variable. The model successfully explained significant variance in depression, F (1, 353) = 8.09, p < 0.01. Social networking usage was a significant predictor of depression, β = 0.165, t (353) = 2.85, p < 0.01. On average, an increase in one score of social networking usage corresponded to a 0.165 increase in depression, B = 0.136, 95% CI [0.05, 0.28]. Cohen's f2 was calculated to determine the effect size; the result was 0.02. According to Cohen's [9] guidelines, this indicates a small effect size.

Table 4 Simple linear regression models with social media suage as the predictor variable
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In the second model, social networking usage was entered as the predictor variable, and anxiety was entered as the independent variable. The results showed that the model was successful in predicting significance variance in anxiety, F (1, 353) = 6.18, p < 0.05. Social networking usage was found to be a significant predictor of anxiety β = 0.236, t (353) = 2.49, p < 0.05. On average, each increase in one score of social networking usage was associated with a 0.236 increase in anxiety B = 0.236, 95% CI 0.05, 0.42. In order to determine the effect size, Cohen’s f2 was calculated, and the result was 0.02, which indicates a small effect size based on Cohen’s [9] guidelines.

In the final model, social networking usage was entered as the predictor variable, and stress was added as the independent variable. However, the results showed that the model did not successfully explain significant variance.

4 Discussion

The present study aimed to explore the prevalence of and the association between social networking usage and mental health problems during the COVID-19 pandemic in the KRI. A cross-sectional inquiry was performed in which 355 individuals from the four governorates of the KRI participated. The results demonstrated that social networking usage was at a moderate level during the COVID-19 pandemic in the KRI, including 17.6% for academic, 14.4% for socialization, 11.93% for entertainment, and 9.99% for information purposes. This may be in line with previous findings suggesting significantly increased social networking use during the COVID-19 pandemic across cultures in China [32], Indonesia [54], Ukraine [21] and in the UK [26]. Due to the extreme social restriction as a preventative measure of the pandemic, people have a higher need to tackle their psychological obstacles [36], and social networking usage may compensate for daily routines [54]. This may fulfill the psychological needs for social interaction. People may spend too much time searching for news and information about COVID-19 on social media. Our findings revealed that social networking usage was more common among single and younger participants aged 18–27 than those who were married and aged 28–37. Such findings are consistent with Jones et al. [25], who found that young adults are more likely to use social networking sources to attend to disaster-related coverage. Such people may use social networking to connect with others and share distress caused by the pandemic.

Further, the results showed that social networking was more used for academic and entertainment purposes. It has been documented that they may use social networking for academic and job-related purposes [49]. In line with our findings, Shahghasemi & Emamzadeh [46] reported that married individuals use social networking less than other marital groups. One possible explanation could be that since social networking use negatively influences the married couple's relationship, they use it at a lower rate. Social networking usage is negatively correlated with marital well-being [51].

The results show that as the initial responses to the global COVID-19 pandemic, within the first weeks of the national lockdown, the prevalence rates of depression, anxiety, and stress were 56.3%, 37.7%, and 9.6%, respectively. This rate is significantly higher than the findings of Wang et al. [52] conducted during the first two weeks of the country lockdown in China. They reported that moderate to severe symptoms of depression, anxiety, and stress were as low as 16.5%, 28.8%, and 8.1%, respectively. Furthermore, other findings later during COVID-19 in China reported significantly lower levels of such disorders [32]. However, in line with our findings, similar prevalence rates of depression and anxiety were found by Gao et al. [14] in China. This finding shows significantly elevated rates of depression and anxiety among the residents during the outbreak. It was reported that pandemics cause elevated rates of mental health issues [41], such as the 2014 Ebola Outbreak [24, 48] and SARS [34]. An explanation for this finding could be the implementation of lockdown measures during which the data for the present study was collected, which may have caused uncertainty despite being the early stage. A study in Spain reported that during the initial stages of the breakout of COVID-19, the level of depression and anxiety was low; however, after implementing lockdown measures, the levels increased [40]. Overall, to meet the psychological needs of the general population during this global crisis, the government needs to take the opportunity to provide psychological interventions for those with any psychological distress, including depression, anxiety, and stress. The first step in this regard is for the government to provide comprehensive trainings to social workers and psychologists in the region in psychological first aid as an initial response to emergencies and in internet-based Brief Cognitive Behavioral Therapy (BCBT), especially for depression, anxiety, and stress as it has been shown to be effective [2]. Considering the fact that the COVID-19 pandemic led to lockdown and social distancing measures, it is essential to have these services available online. Therefore, the government of the KRI can work on developing an online platform to have trained professionals deliver these services. In terms of reducing distress, online therapy and counseling have been shown to be effective in previous studies (e.g., [23]). In line with the fact that a significant portion of individuals still have not received formal education, it is imperative for the platform to be easily accessible, and awareness-raising campaigns should be started to inform individuals regarding the use of the platform.

The results also indicated that depression, anxiety, and stress symptoms were more prevalent in females compared to males. This finding corresponds to previous studies conducted during the COVID-19 outbreak, in which females suffered higher levels of stress, anxiety, and depression [4, 52]. Additionally, we found in this study that unemployed participants experience more depression, anxiety, and stress than employed participants. This is consistent with several studies that reported higher rates of depression and anxiety among unemployed individuals [7, 11, 35, 43]. Jones et al. [26] explained that socioeconomic uncertainty regarding current and future employment could be a risk factor for mental health. We also found that stress level was higher among individuals with no educational background than among graduates. Previous literature suggests local agencies provide information in diagrams, audio format, or simple language to support this group of people [52]. It was also found that Muslim participants scored lower in perceived stress compared to Christian participants. One possible explanation for this, as described by Sabry & Vohra [45], is that in the face of stressful life events, Muslims can draw out coping strategies from their religion as it provides them with strict behavioral and moral codes. Another possible explanation could be the amount of social networking consumption, which was less among Muslim participants and thus decreased levels of depression, anxiety, and stress. Evidence suggests that social networking usage, which has increased during the pandemic, presents a risk to mental health and psychological well-being [26]. This was also the focus of the present study.

Depression and anxiety were found to be positively correlated with social networking usage. This is consistent with other findings conducted across cultures during the COVID-19 outbreak [4, 14, 37, 54, 59]. The results also showed that social networking usage's socialization and entrainment dimensions were positively correlated with depression, anxiety, and stress. One study showed that during the global COVID-19 pandemic, young web users preferred passive social media use over communication, leading to depression, anxiety, and detachment over time [21]. Another reason may be that many citizens expressed their negative feelings, such as fear, worry, nervousness, and anxiety, on social media, which are contagious social networks [29, 38]. As for the positive correlation between negative mental health outcomes and entertainment uses of social networking, it could be argued that individuals with mental health problems may engage in entertainment-related content to cope with their negative emotions. This highlights the need to raise awareness to reduce social media use and filter information.

The regression analysis indicated that social networking usage is associated with worsened mental health outcomes (i.e., increased depression and anxiety). The Previous literature has highlighted various explanations for this; one explanation could be due to the large quantity of information about the pandemic that spread throughout social networks, including information about the number of deaths and the danger of the disease, which may cause fear among the public [57]. Another possible explanation may be an infodemic online. Literature suggests that infodemic transmission has a negative emotional impact [44, 54], although WHO announced a campaign to reduce false information on social networking platforms. Those who are isolated due to being quarantined may engage in social networking usage more than usual. There is a need to take advantage of this platform to help the public; psychologists, healthcare professionals, and social media influencers should caution people against social media rumors and death news. In the KRI, people used to announce COVID-19-related deaths on social networks, such as the death of beloved people, acquaintances, friends, and relatives. There were few warnings from mental health practitioners to stop such actions. Hence, the authorities may encourage psychologists to publish short videos and interviews to give wise public counsel about the appropriate use of social networking during the pandemic. Considering the fact that individuals of this region have undergone many traumatic events, such as the war against the Islamic State of Iraq and Syria (ISIS) and ethnic cleansing, genocide, torture, and death at the hands of the fascist government of Saddam Hussain. Psychologists can advise people to use social media to seek support from authorized institutions, participate in online trainings, and learn new skills.

The present study had a number of limitations. Firstly, the data was collected close to the initiation of the lockdown measures, limiting the implications of the results on the psychological impacts of the lockdown measures. Secondly, the sample was collected through an online survey, and the snowball sampling technique was used; this limits the generalizability of the results. Thirdly, the social networking usage and perceived stress scales were merely translated into the Kurdish language through the back-translation technique; although the scales showed high internal consistency, there is still a need for them to be culturally validated. Finally, the number of participants was not adequate. Although the study was not intended to be a nationally representative survey, a larger sample would have yielded more conclusive results.

5 Conclusion

The findings of this study suggest that the COVID-19 outbreak and the lockdown measures have negatively influenced the mental health of the residents of the KRI. For mental health problems, females were impacted more compared to males, as is the case generally with depression, anxiety, and stress. The findings also support that social networking usage is associated with a worsened mental health state, as the regression analysis found this to be the case for depression and anxiety; for all that, the effect sizes of these associations were small. The results of the current study have practical implications in that the KRI government should work on training social workers and psychologists on psychological interventions and create an online platform for these services to be delivered during social distancing. Furthermore, the results have theoretical implications in providing evidence for the association between social networking usage and a worsened mental health outcome; future studies can strive to develop a conceptual framework of how this association occurs. Especially considering the cultural, social, political, geographical, and historical context of the KRI—people in a region with a history of complex and nationwide traumas. Overall, more research into this matter is necessary to find the adverse psychological effects of the COVID-19 outbreak and reveal how social networking usage leads to mental health problems.