In December 2019, COVID-19 broke out as unexplained viral pneumonia in Wuhan Province, China [1] . WHO declared the novel coronavirus (COVID-19) a global pandemic on March 11, 2020 [2] . Iraq discovered the first case of SARS-CoV-2 in February 2020 [3] and since then, quarantine has taken place by closing the markets, taking long leaves from work, closing worship places, creating social distance, and even affecting education by closing schools and universities, and attending classes, online education was the fundamental way of studying until 2021, during which online courses were still partially included in the educational process.

All people were subjected to the infection with COVID-19, but the focus was on those who are more susceptible to complication from the infection (those with chronic diseases, immune-compromised people, mentally unstable people, advanced age people, etc.) [4] - [6] .

Closing educational institutes (schools, universities) has been proven to be effective in containing the infection with COVID-19 but it carried a lot of debate on mental health, social life [7] , and the educational process for students, families, and teachers [8] .

Quarantine, self-isolation, and sudden fear of death have an impact on the increased level of anxiety in general [9] , and on students in particular [10] .

Many students had to face personal financial issues due to the loss of student jobs and worries about their financial situation, future education, and career, resulting in emotional health issues, such as fears, frustrations, anxiety, anger, and boredom [11] - [14] .

Anxiety is a feeling of unease, such as worry or fear, that can be mild or severe. Their feelings of anxiety are more constant and can often affect their daily lives [15] .

(3.6%) globally live with anxiety [16] , in a WHO report that surveyed international college students at 19 colleges across eight countries (Australia, Belgium, Germany, Mexico, Northern Ireland, South Africa, Spain, USA), about 35% of first-year college students reported mental health disorders [17] . In a study in Iraq among healthcare medical students, more than one-half (52.1%) of the participants had scores that indicated anxiety symptoms, while 20.1% had scores that indicated anxiety borderline symptoms [18] . Anxiety may cause personal, health, societal, and occupational problems [19] .

A cause of concern globally is poor mental health among university students. A previous systematic review indicated that university students have higher rates of depression than the general population. Academic load, health concerns, heavy workloads, financial concerns, and student abuse and mistreatment are only a few factors that contribute to psychological morbidity among students [20] .

It’s important to understand whether the COVID-19 outbreak has had an impact on increasing the level of anxiety among students, affecting their performance and quality of life, or whether it increased the impact of different types of burdens added to students during the outbreak.

1) To find out the prevalence of anxiety among undergraduate students at Technical University during COVID-19.

2) To find out whether COVID-19 affected the students’ performance.

3) To find the association between anxiety and some demographic characteristic during the outbreak.

There were 703 responses received, with the highest percentage coming from Chemical Engineering 205 (29.2%), followed by Biotechnology Engineering 81 (11.5%), aged 20 - 29 years 468 (66.6%), male 397 (56.5%), never married 654 (93.0%), 257 (36.6%) thought they were infected by COVID-19, while only 161 (22.9%) had a nasal and/or oral swab, only 62 (8.8%) had a rapid blood test, and 177 (25.2%) were based only 62 (8.8%) had Rapid blood test, and 177 (25.2%) depending on the symptoms only which in Iraq not consider a diagnostic tool. Near half of the students who participated in the study mentioned the presence of chronic diseases 338 (48.1%), most of them had Osteoporosis &/or Vitamin D defiance 217 (30.9%), and psychological problems mentioned by 78 (11.1%) students, shown in Table 1 .

More than half of the participants had received psychological support 385 (54.76%), all received it from their family, relatives, & neighbors additionally; friends including friends on social media give psychological support to 158 (22.5%), Mosque, Husseinia, or Church had support to 24 (3.4%), the government gives psychological support to 7 (1%) the NGOs give psychologically to 8 (1.1%), and lastly 13 (1.8%) of the participants seeking Psychological support from Psychiatrist ( Figure 1 ).

The participants chose mostly “several days” in 1^st question 360 (51.2%), 2^nd question 286 (40.7%), 3^rd question 259 (36.8%), and 4^th question 313 (44.5%), while choosing “not at all” in 5^th question 340 (48.4%), 6^th question 314 (44.7%), 7^th question 351 (49.9%). That appeared in Table 2 .

The total GAD-7 screening tool was mild anxiety 140 (19.9%), moderate anxiety 317 (45.1%), moderate-severe anxiety 171 (24.3%), and only severe anxiety found in 75 (10.7%), as shown in Figure 2 .

Figure 3 shows that 397 (56.5%) of the Participants’ performance had not to impact by COVID-19, and nearly quartor 173 (24.6%) of them mention that their performance may be impacted by COVID-19, while 133 (18.9%) of their performance was impacted by COVID-19.

The study found a significant association between participants’ anxiety level with their sex, Job description COVID-19 infection, and presence of chronic disease as the p-value = 0.000, in all, but not significant with their age & marital status as the p-value (0.620, & 0.428 correspondingly).

Table 3 : association between participants feeling in their previous three months with some of their demographic variables.

PT Serif The highest percentage of participants’ life 347 (49.4%) had not been complicated by the COVID-19 pandemic, and 343 (48.8%) of them had no additional financial need, 415 (59.0%) not thinking about taking long leave. 323 (56.5%) not thinking about Isolated from other people and lastly, 397 (56.5%) of students had not-effect on their performance.

In conceding to benefits from COVID-19 to having more time with participant’s family 383 (54.5%), also to have more time to finish delayed work 256 (36.4%), and to be more time with God (praying, reading Quran or Engel) in 357 (50.8%).

Also, the study found a significant relationship between participants’ anxiety levels with complicated participants’ life, Increase Financial needs, taking long leave, isolation from people, and impact on their performance (p-values = 0.000, 0.000, 0.019, 0.000, and 0.000 respectively). But participants’ anxiety level has no significant relationship with spending more time with their family, spending more time finishing delayed work, spend more time with God, (p-value 0.112, 0.226, & 0.613 correspondingly). All that appeared in Table 4 .

In our study, about 80% of our sample had anxiety (about 24% had moderate-to-severe anxiety), which is a high rate of anxiety. According to Karim et al., being younger and being a student may have an impact on increasing the rate of anxiety in these categories [21] .

55% of our sample had psychological support from family members, neighbors, and relatives, which may be beneficial to decrease the effect of anxiety on the students (45% of our sample has moderate anxiety) [22] .

There’s significant association between effect on my performance and anxiety. COVID-19 has direct effect on academic performance and mental health [23] . Although 54.8% of the participants had COVID-19 infection with or without confirmatory test, more than half the sample stated that there was no effect on performance and 65% of them had minimal to moderate anxiety. The education in Iraqi universities returned near normal after the second wave of COVID-19 and attending lessons have been returned to fewer hours beside online lessons. This can give idea of returning of social life gradually with friends and increase social activities which might decrease level of anxiety on students [22] and improve their performance [24] .

The study results showed a strong association between anxiety and gender during COVID-19. Female students are more likely than male students to experience anxiety when under stress, which may be due to their jobs or household responsibilities [25] . Risk perception is different between sex; this may be due to entrenched sex roles that create dissimilarities in aspects of power relations and labor, in addition to different trusting of authority issues and institutions [26] .

A positive COVID-19 infection is also strongly associated with an elevated anxiety level. Several reports suggest that COVID-19 survivors are at increased risk of mood and anxiety disorders 3 months-post-infection [27] - [30] . This can be explained by the fear of another infection or the fear of infecting other family members or beloved ones with SARS-COV-2 and being subjected to the same severe, unusual symptoms of it.

Chronic diseases are also associated with the presence of anxiety. Our study stated that 30% of chronic diseases are caused by vitamin D deficiency. In certain studies, men and women with anxiety have lower levels of calcidiol [31] .

The only psychiatric disorder significantly associated with asthma is anxiety, asthma is present in 12% of students. The anxiety-asthma relationship is bidirectional; each can cause or result from the other [32] .

Because of the strong association between anxiety and whether COVID-19 complicated participant life, the governments have imposed measures of social isolation and quarantine, banned religious celebrations, closed specific types of establishments, and reduced the activity of others (e.g., restaurants and shops), with serious consequences for entire populations and economies. All these measures together can make life uneasy for people and affect their level of anxiety. This agrees with a study in Portugal, which stated that anxiety and other factors can decrease people’s quality of life in conjunction with the pandemic’s social and economic consequences [33] .

Another association was found between anxiety and an increase in financial needs. Students may be afraid of adverse outcomes due to decreased finances for them and their families, which could affect their life and study as well. This agrees with another study that concluded that GAD in adolescents is closely related to perceived decreased family finances due to COVID-19 [34] . Another study states that social support and government aid financially were associated with better mental health symptoms among women [35] .

Taking long leave and anxiety are also significantly associated. Even though Iraqi institutions have embraced online learning for the first and second COVID-19 waves, the prolonged lockdown has had an impact on all areas of education [36] . This may have happened because online education is not available to all, its resources are limited, and there are problems with access, networking, or even knowing how to use a platform. In addition, online education is not set up for practical lessons, which are important for the graduation of students. This agrees with a study in Bangladesh, which states that extended closure may lead to postponing graduation, increasing the chances of stress among students [37] .

Isolation from people and anxiety are associated. Social isolation and anxiety are a two-way street it is likely that both things are true. People who experience significant social anxiety commonly withdraw from social situations to reduce their stress. However, over time this can make their anxiety even worse, which only makes them more isolated. The same explanation has been given in a study that showed that loneliness impairs the process by which fears are diminished [38] .

Performance and anxiety are associated, students with high levels of anxiety may have low academic performance and, as a result, low graduation marks. This agrees with a study in Malaysia that confirms the relationship between anxiety and academic performance [39] .

The study relies on a convenient sample from an online survey from one university in Baghdad that is specialized in engineering, and may not represent the entire student population in Iraq, so we cannot measure the real effect of COVID-19 on mental health of Iraqi students. Also, the cross-sectional design cannot demonstrate the cause and effect between anxiety and other demographic variables or outcomes, so it’s hard to evaluate effect of these psychological aspects and students’ achievements in the future.

Although undergraduate students’ anxiety levels rose as a result of COVID-19, the outbreak had no negative effects on their academic performance. This study found a significant association between participants’ anxiety level and their sex, COVID-19 infection, presence of chronic disease, complicated participant life, increased financial needs, taking long leave, isolation from people, and impact on their performance.

Improve communication between the university administration and the Iraqi MOH in order to launch a program to handle anxiety among students. Mass media programs must be initiated to limit and decrease anxiety throughout the community. Increase the ability of university health workers to early diagnose cases of anxiety and early referral of complicated cases by developing training programs for GAD-7 screening tools.

Also, developing targeted training for university health services staff on using the GAD-7 for early screening in students.