Received: 16 March 2022 | Revised: 1 July 2022 | Accepted: 1 August 2022

DOI: 10.1002/hsr2.792

ORIGINAL RESEARCH

Demographic characteristics and anxiety in the educational

setting during the COVID‐19 pandemic in Indonesia:
A cross‐sectional study

N. Juni Triastuti1 | Erna Herawati2

1
Department of Medical Education,
Universitas Muhammadiyah Surakarta, Abstract
Indonesia
Background and Aims: This study aims to analyze the relationship between gender,
2
Department of Psychiatry, Universitas
Muhammadiyah Surakarta, Indonesia
age, occupation, residence, and anxiety in the education environment during the
coronavirus disease 2019 (COVID‐19) pandemic.
Correspondence
Methods: This study used a descriptive‐analytic cross‐sectional design to determine
N. Juni Triastuti, Department of Medical
Education, Faculty of Medicine, Universitas anxiety using the DASS 42 questionnaire given to 181 respondents. The sampling
Muhammadiyah Surakarta, Indonesia. technique used was purposive sampling, and the data analysis used was the Chi‐
Email: [email protected]
square test and multivariate analysis.
Results: It was found that 66.7% of teenagers experienced anxiety, while 33.3% of
adults experienced anxiety. In addition, the school‐age community (86.2%)
experienced higher anxiety compared with the working‐age community (13.8%)
who experienced anxiety. Women experienced more significant anxiety (66.7%)
compared with men (33.3%). People living on the island of Java (74.7%) have a
greater incidence of anxiety compared with people living outside Java (25.3%).
Conclusion: There is a significant relationship between the type of occupation and
the incidence of anxiety with p < 0.05 (OR = 0.341). A significant correlation was
found between age with the incidence of anxiety with p < 0.05 (OR = 0.489). The
demographic factors altogether had significant relationships with the anxiety in the
educational environment during the COVID‐19 pandemic with a p value < 0.05 and R
Square of 0.069. There is a strong relationship between the demographic factors and
the incidence of anxiety in the community's educational environment during the
COVID‐19 pandemic with p < 0.05. It is suggested that women, school‐age
communities, or the un‐employment community need to be supported to alleviate
the impact of COVID‐19 on anxiety through several programs.

KEYWORDS
age, anxiety, COVID‐19, demographic, educational

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium,
provided the original work is properly cited.
© 2022 The Authors. Health Science Reports published by Wiley Periodicals LLC.

Health Sci. Rep. 2022;5:e792. wileyonlinelibrary.com/journal/hsr2 | 1 of 9

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2 of 9 | TRIASTUTI AND HERAWATI

1 | INTRODUCTION to live that is not conducive to certain traumas, disorders of self‐

concept such as divorce from parents, loss of someone, loss of work,
Society around the globe is currently facing a coronavirus disease changes in social culture and education, anxiety among parents.14
2019 (COVID‐19) pandemic. This pandemic has occurred from the Meanwhile, internal factors can also affect anxiety such as a lack of
end of 2019 until now.1 The various impacts that have arisen due to functioning of the immune system, cardiovascular disease disorders,
this pandemic include public anxiety regarding the relatively high interpersonal conflict disorders, and changes in relationships and
2
incidence of COVID‐19. Meanwhile, little is known about the roles.14
prevalence of anxiety in the educational setting during the COVID‐19 Norepinephrine plays an important role in the mechanism of
pandemic. anxiety disorders, caused by anxiety disorders, poor noradrenergic
Anxiety or usually recognized as Generalized Anxiety Disorder limbic regulation, or excessive activity.15 Serotonin is a monoamine
(GAD) is defined as a feeling of insecurity, fearfulness, tension, and neurotransmitter that acts at the synapses of nerve cells. Many
fear that arises as a result of an unpleasant event and persists for at serotonin receptors have an important role in the pathogenesis of
least 6 months or more.3 According to Henriksson et al.,4 anxiety is anxiety, namely the 5‐HT1A receptor which has the widest
an emotional condition that is an unpleasant feeling, involving distribution of other receptors. The presence of serotonergic is the
psychophysiological responses that occur as a result of anticipating cause of anxiety.16
the risk that threatens, and exercise is suggested to provide healing Gamma‐aminobutyric acid or GABA is the most widespread
to the anxiety and depression. inhibitory neurotransmitter in the central nervous system. The
The estimated prevalence of anxiety disorders in the United States is presence of increased GABA activity and dysregulation or poor
more than 23 million people each year, which is about 19.1% of GABA‐anergic regulatory centers causes anxiety. The role of GABA in
individuals who experience an anxiety disorder.5 Anxiety is a mental the mechanism of anxiety is supported by the benefits of
disorder whose age and lifetime prevalence increased from August to benzodiazepines that increase GABA activity against GABA‐A in
December 2020 during the COVID‐19 pandemic.6 It is reported that the treatment of several anxiety disorders.17
1,7,8
women are more prone to anxiety disorders than men. Anxiety Symptoms that are usually complained of by people with
disorders occur in about 29.7% compared with 19.3% of mood anxiety disorders include Anxious, bad feelings, worry, anxiety,
disorders.7 Meanwhile, during the COVID‐19 pandemic the prevalence afraid of his mind, easily offended, and hopelessness. The other
of anxiety increased by around 25%.9,10 During the pandemic, the symptoms encompass feeling unsettled, tense, restless, easily
number of populations who took the prescription and counseling startled, afraid of crowds, and afraid of being alone. Sleep
treatment for the mental health increased to around 25% from previously disturbances, nightmares, impaired concentration, and memory
22.4% during late August until early December 2020.11 can also be experienced by the patients. Somatic symptoms such
The research reported in the first month of the COVID pandemic as muscle and bone pain, palpitations, shortness of breath,
indicated that the anxiety cases in Indonesia were reported at headache, etc., gastrointestinal disorders, ringing in hearing
around 20%.8 (tinnitus), and urogenital disorders.11,18
Several factors contribute to the incidence of the anxiety during This study needs to be done to assess the incidence of anxiety
COVID‐19 pandemic which encompasses gender; COVID‐19 pa- that occurs in the primary educational environment therefore factors
tients; lack of social assistance.8 Providing sufficient information on can be identified that can be a risk for anxiety events during the
the COVID‐19, accessible healthcare system (supportive relation- COVID‐19 pandemic. The research data regarding the incidence of
ship), and social assistance are believed to mitigate the impact of anxiety during the COVID‐19 pandemic that discusses events in the
COVID‐19 on the anxiety.8 educational environment are still absent, particularly in Indonesia.
The mechanism of the anxiety in the COVID‐19 pandemic is The study related the anxiety to the COVID‐19 pandemic is limited in
related to the inflammation marker, following the oxygen saturation Bangladesh that conveyed data on the number of people experien-
level exacerbated in the patient with COVID‐19.12 cing anxiety and only focused on undergraduate students (Islam M.A,
Several theories explain the factors for the occurrence of anxiety 2020) and data that expressed the incidence of anxiety in the
5,13
disorders, namely: (1) Psychoanalytic theory which this theory states educational environment in Indonesia is still very limited. One study
that anxiety occurs due to emotional conflict between two psychological explored the anxiety in the initial phase of COVID‐19 with the
structures, specifically the id and the super‐ego. (2) Behavioral theory respondents who were not focusing on the educational setting.8
explains that anxiety occurs as a result of an excessive response to a Hence, this study extends the knowledge using different respondents
specific or learned stimulus from an individual experience. (3) Existential both from the educational staff or teachers and the students from
theory, where there is no specific stimulus for chronic anxiety disorders. different levels of education from high school to undergraduate
(4) Biological theory, this theory shows the three main neurotransmitters students, and from different ages of 17‐64 years.
associated with anxiety disorders including norepinephrine, serotonin, and The research question of this study is whether there are
gamma‐aminobutyric acid (GABA).14 relationships between the factors of age, gender, place of residence,
Some of the triggering factors are sourced from the external and type of work on the incidence of anxiety in the Indonesian
environment such as the entry of bacterial infections, viruses, a place education community.
TRIASTUTI AND HERAWATI | 3 of 9

minimum number of samples required (154 samples).19 Respondents

were then asked to fill out an online questionnaire.

2.2 | Data collection

The location of data collection in this study was carried out in the
environment and community in the territory of Indonesia. The data
collection was from March–May 2021.
The questionnaire in the online form (Google Form) was sent to the
prospective respondents through online platforms such as WhatsApp and
Instagram and to be circulated to friends or colleagues. Upon filling out
the questionnaire, the respondents have agreed to consent to participate
in the study by filling out the questionnaire.
All the prospective respondents which have occupations either
F I G U R E 1 The research method flow chart. DASS, Depression as teachers/lecturers/educational staff, or students (high school or
Anxiety and Stress Scale undergraduate) can fill the questionnaire if they wish.

2 | MATERIALS AND METHODS 2.3 | Measures

To answer the research questions, the researcher used an analytical The survey in this study used Depression Anxiety and Stress Scale
observational method using the Chi‐Square test and multivariate (DASS) Questionnaire which was first developed by Lovibond and
analysis to analyze the data. The method of data collection is Lovibond22 and then adapted in Indonesia by Damanik and Rusli.23
illustrated in Figure 1. The DASS questionnaire consists of 42 items that measure general
psychological distress. The anxiety scales consist of 14 statement items.
The value obtained from the respondent's response is categorized
2.1 | Study design and participants according to the level of the respondent's psychological disorder. Anxiety
level responses were categorized into 2, namely scores with a score of
This study used an observational analytic research design with a not being anxious ≤ 7 and experiencing anxiety with a score of >7.24,25
cross‐sectional study approach, in which the independent and The demographics information which was presented in this study
dependent variables are assessed at the same time. included age, gender, employment, and place of residence.
Samples were taken with the following inclusion criteria: People The reliability test used Cronbach's alpha, it was found that
who live in the environment in Indonesia and or Indonesian citizens Cronbach's alpha value was 0.963, which indicates that all questions
14–75 years old, who were willing to become research respondents, on the DASS questionnaire have very high (perfect) reliability
and who are involved in the educational environment, both as because the value >0.9.
students, staff and teachers/lecturers. Exclusion Criteria included
residents who cancel to take part in the study, and who did not fill out
the questionnaire. This study used a purposive sampling technique, 2.4 | Statistical/data analysis
that selected samples based on certain criteria.19–21 The minimum
sample size in this study was determined using the rule of thumb The research data was analyzed using SPSS Ver 26. computer software.
formula based on the number of independent variables. One of the Data analysis comprised descriptive univariate, bivariate, and multivariate
guidelines in the rule of thumb is that the number of samples required analysis. To explain the relationship between the dependent variable and
is between 5 and 50 times the number of independent variables the independent variable, the statistical test used is the Chi‐Square test
studied. To narrow the confidence interval of the research results, in (χ2). The chi‐square test is used in this study because the chi‐square test is
this study a multiplication factor of 35 times the number of a data analysis technique that can be used to test hypotheses if there are
19–21
independent variables was determined. In this study, there were two or more classes in the population where the independent variable
four independent variables studied thus a sample size of 35X the data is nominal and the sample is large.(16) In this study, the analyzed data
number of independent variables was determined and was obtained in has met the requirements of using Chi‐square, which indicated there
140 samples. To avoid samples that drop out, the number of samples is were no cells with a value of zero and the number of cells with an
added by 10% thus the required number of samples was 154 samples. expected count of less than 5 was not more than 20%.21,26 The analysis
The number of respondents who met the inclusion criteria was 181 employed a 95% confidence Interval (CI) for the level of significance using
samples, therefore the number of samples of 181 had exceeded the two‐side The analysis was then continued to multivariate analysis. The
4 of 9 | TRIASTUTI AND HERAWATI

regression logistic was applied to test whether all independent variables

R square
as predicting factors are associated with anxiety.27,28 In reporting the

0.069
analysis, this study followed the SAMPL guidelines and STROBE
guidelines for cross‐sectional studies reports (https://www.equator-
network.org). This study has been granted the Ethics Approval from the

Logistic regression
Faculty of Medicine Universitas Muhammadiyah Surakarta. (Reference
number. 3390/B.2/KEPK‐FKUMS/III/2021).

(p value)

<0.001
3 | RESULT

0.619 (0.339–1.132)

0.489 (0.262–0.875)

1.336 (0.665–2.685)

0.341 (0.162–0.721)
Odd Ratio (95% CI)
Based on the research data obtained from the DASS Questionnaire
through the online platform (Google form), revealed that 181
respondents agreed to fill out the questionnaire. The outliers of the
data were minimal as indicated in the mean and median values which
were quite close (Table 1). In this study, the characteristics of the
respondents were divided by age, gender, place of residence, and the
respondent's level of anxiety (Table 1).

Chi‐Square)
Respondents are categorized as not having anxiety if the anxiety

p value

<0.05

<0.05
<0.5

<0.5
level value is 7, while the total anxiety value is >7 then categorized as
experiencing anxiety.24,25

Median (range)
Based on Table 1 above, it was found that as many as 60.8%

1.00 (1.00)

1.00 (1.00)

1.00 (1.00)

1.00 (1.00)
(n = 110) were female while the male respondents were 39.2% (n = 71).
Women experienced more anxiety as much as 58 66.7% (n = 58)
compared with men who suffered from anxiety as much as 33.3%
(n = 29). However, the significance value which shows the relationship
1.39 (±0.49)

2.58 (±0.72)

1.387 (±0.81)

1,23 (±0.42)
Mean (SDs)

between gender and the incidence of anxiety is less significant, which is

indicated by a p‐value <0.5 with an OR value of 0.619.
In this study, the age category grouped into 17–23 years was 57.8%
Experiencing anxiety

(n = 104) more than the 24–64 years age group, which was 42.2%
(n = 76). In this age group, it was found that adolescents aged 17–23
years were found to experience more anxiety, namely 66.7% (n = 58)
29 (33.3%)

58 (66.7%)

58 (66.7%)

29 (33.3%)

65 (74.7%)

19.7 (25.3%)

12 (13.8%)

75 (86.2%)
when compared to adults aged 24–64 years, which were 33.3% (n = 29).
Data analysis shows that the age factor has a strong relationship with the
incidence of anxiety as evidenced by a strong significance value with a
Subject characteristics and bivariate analysis (n = 181)

p‐value of <0.005 with an OR value of 0.489. This shows that the factor
of adolescent age or school age is more prone to experiencing anxiety

Abbreviations: CI, confidence interval; SDs, standart deviations.

Not experiencing

events than adults or not in school‐age where adolescents tend to

42 (44.7%)

52 (55.3%)

46 (49.5%)

47 (50.5%)

75 (79.8%)

19 (20.2%)

30 (31.9%)

64 (68.1%)

experience anxiety which is 0.489 times higher than adults.

anxiety

Based on data related to the residential of the respondents

categorized into regions on Java island and outside Java island, it was
found that the number of respondents in Java was more than 77.3%
Percentage

(n = 140) experiencing anxiety when compared to outside Java, which

39.2

60.8

57.8

42.2

77.3

22.7

23.2

76.8

was 22.7% (n = 41). Respondents living on the island of Java were

found to experience more anxiety with a total of 74.7% (n = 65) when
Total

71

76

41

42
110

104

140

139

compared with anxiety in residents living outside Java, which was

25.3% (n = 19.7). The residential factor in this study did not show a
Not working (School)
Outside Java Island

very strong relationship, which was obtained for a p‐value <0.5 with
17‐23 years old

24‐64 years old

an OR value of 1.336. Figures 2–5 depict the characteristics of the

Characteristics

Java Island

respondents based on their ethnicity. Figure 2 indicates that the

Employment

Working
Residential
TABLE 1

Female

respondents comprise students, teachers/lecturers, and educational

Male
Gender

staff, and the majority of the students' residential is widely spread in

Age

six out of seven major islands such as Sumatera, Java, Kalimantan,

TRIASTUTI AND HERAWATI | 5 of 9

FIGURE 2 Employment status based on the ethnicity (primary source).

FIGURE 3 The anxiety status is based on the ethnicity (primary source).

FIGURE 4 The gender status is based on the ethnicity (primary source).

6 of 9 | TRIASTUTI AND HERAWATI

FIGURE 5 The age status is based on the ethnicity (primary source).

Sulawesi, Maluku, and Bali. Meanwhile, the respondents who health.11,29 This study analyzes the impact of the pandemic on public
experience anxiety occurred in five out of seven major islands such anxiety in the education environment.
as Sumatera, Java, Kalimantan, Sulawesi, and Maluku. Only a small To control the confounding variables, this study applied a
part of south Sumatera, East Kalimantan, and Bali that less likely to limitation of respondents based on inclusion criteria and exclusion
experience anxiety (Figure 3). The female respondents lived in five criteria. In addition, this study also used multivariate logistic
out of seven major islands and the male respondents in four out of regression analysis to control confounding factors.20,30 In this study,
seven major islands (Figure 4). Teenagers' age respondents were the confounding factor can be controlled properly as evidenced by
spread widely in five out of seven major islands and adults the obtaining of a strong R‐Square value in logistic regression
respondents in four out of seven major islands (Figure 5). analysis, which is 0.069.20,30
The type of work factor for the respondent group who are not In this study, data showed a significant relationship with a p‐value
working or studying at school/university showed a higher number of <0.00 on the type of work factor showing a strong relationship with the
experiencing anxiety with 76.8% (n = 139) compared to the working incidence of anxiety. Based on this study, it is stated that the population
group, namely 23.2% (n = 42). Respondents studied in the school/ group who does not have a job is more likely to experience anxiety during
university group were found to experience more anxiety, 86.2% the pandemic. This is understandable since during the pandemic the
(n = 75) compared with the working group, 13.8% (n = 12). The type population can experience anxiety caused by uncertain conditions and
of work factor seems to have a strong relationship with the incidence many layoffs throughout the pandemic. The results of this study are in
of anxiety where the group is still studying in the school/university or line with the research conducted by another researcher34 which states
not working tends to experience more anxiety with a p‐value of that 87.7% of students experience severe anxiety.
<0.05 with an OR value of 0.341. This shows that the group who has On the other hand, the community population and students are also
not worked or still studying is more at risk of experiencing anxiety by affected by the pandemic, these students also experience uncertainty in
0.341 times compared to the group that is already worked. their education period where almost all learning processes are carried out
In the multivariate analysis by using logistic regression was found online, and this form of online learning is not accessible to all the students.
that the variables of gender, age, residential, and employment The difficulties that arise due to the online learning process coupled with
altogether have a substantial relationship with the incidence of their study load during the pandemic are very burdensome for this type
anxiety in the education environment with a p‐value <0.05 and an R of educational community group or the students, where the students had
Square value of 0.069. the potential to experience anxiety 0.341 times higher than the working
group.
On the other hand, the age factor also affects the incidence of
4 | DISC US SION anxiety where the age group between 17 and 23 years is more prone to
experience anxiety as much as 0.486 times compared to the age group
The COVID‐19 pandemic has caused various impacts, especially in between 24 and 64 years. This is comprehensible for the reason that
terms of mental health caused by different factors such as economic teenagers have shortcomings in dealing with various problems in life and
problems, lack of knowledge about infectious diseases, sleep health. However, the other results of research31 which examined the
disorders, the influence of social media, quarantine or isolation of incidence of anxiety in the elderly stated that those aged 40–60 years
patients during the pandemic, and fear of personal and family tend to experience anxiety more often than those aged 25–40 years.
TRIASTUTI AND HERAWATI | 7 of 9

In this study, the gender factor did not show significant results relatively new. This study also complements previous research where
but there was a tendency that the female group experienced anxiety most of the studies only examined the impact of the COVID‐19
as much as 66.7% compared with the male (33.3%). This study is in pandemic on university students.
line with other research14,32,33 which also stated that female The drawbacks of this study are due to the time constraints of
residents are more prone to anxiety. However, the results of this the research and the relatively small number of samples which could
study are different from other studies(7) said that their research in be improved in future studies. Thus, conducting research with larger
Bangladesh stated that the female group had a lower level of anxiety samples and different instruments is recommended in the forthcom-
(33.67%) when compared to the male (66.33%). ing studies. In addition, the mental status of the participants did not
Another factor is the residential factor, where in this study, seek in this study, hence, further studies are expected to complement
residence between the island of Java and outside Java did not appear the survey with the mental status.
to have a significant relationship with the incidence of anxiety.
Although this study mentioned that the incidence of anxiety was
higher in residents living on the island of Java by 74.7% compared 5 | CONCLUSION
with the incidence of anxiety in residents living outside Java (25.3%).
This is undoubtedly true due to the population density on the island The impact of the COVID‐19 pandemic has had a lot of influence on
of Java which causes the risk of being exposed to COVID‐19, causing all aspects of life, including the impact on the education environment.
the community to experience high levels of anxiety than outside Java This study has added important data to determine the impact of
with a lower population density. The results of this study are COVID‐19 in the aspect of education where this study is different
following research conducted by Islam et al.34 which states that from previous research. Previous research only examined a small
residents who live in urban areas are more likely to experience number of students.34 This study complements previous research by
anxiety (64.9%) than those who live in rural areas (35.1%). A review adding other samples besides students, namely all lecturers, teachers,
of the study also said that the incidence of anxiety in Asia was staff and students, and students.
29
32.9%. In this study, by using multivariate analysis, it was found that
Several alternative approaches that can be implemented by the demographic factors (age, gender, residential, and employment)
community in dealing with anxiety during the pandemic are by altogether have a very strong relationship with the incidence of
performing a coping mechanism for the anxiety that arises with the anxiety in the community in the education environment with a
29
intention of it does not continue to become severe anxiety. The p‐value <0.05 and R square 0.069. From these various demographic
need to reduce reading various obnoxious news about COVID‐19 on factors, it was found that the age and occupation factors had a
social media that can increase anxiety can also be administered. This significant relationship with the incidence of anxiety and supported
is because someone who always follows news developments on previous research examining the incidence of anxiety in older people
social media tends to experience high levels of anxiety.29 In addition, during the COVID‐19 pandemic.31
problem‐solving in the form of providing counseling and involving It can be concluded in this study that although the factor of
psychiatrists or psychologists to educate the community can help gender and demographic factors have a less significant relationship to
minimize anxiety in the community.31 In addition, universities can the occurrence of the anxiety with a p‐value >0.05, the age and
also provide special programs for their students to stipulate financial employment factors were found significantly associated with the
and psychological assistance for the students.34 The use of telehealth prevalence of anxiety (p‐value <0.05) in the educational sector during
is also found to help provide counseling to overcome the the COVID‐19 pandemic. The demographic factors altogether had a
psychological impact of the pandemic.11 substantial correlation (p < 0.05) with the occurrence of anxiety in the
Lifestyle approaches can be taken to mitigate the impact of the educational environment during the COVID‐19 pandemic.
anxiety. Several measures can also be taken such as physical The impact of the COVID‐19 pandemic on the populations varies
exercises, a nutritious diet, mood balancing, and proper stress widely. The evidence of the population suffering from mental health
treatments, controlling and or preventing diabetes and heart disruption persists for the duration of the pandemic. This predomi-
1,35–37
failure, psychological condition, maintaining a relationship, nantly occurred due to several factors such as fear of the suffering
and sleep quality,36,37 and avoiding the use of tobacco and alcohol.37 COVID‐19 leading to the severity, un‐pleasant extended quarantine,
The use of a healthy diet such as consuming more fruits and COVID‐19 stigma, and worrying the jobs losing due to the lockdown
vegetables is also a good example to alleviate anxiety and stress.1 situation. Health and education sector may also experience the
impact of the pandemic on the un‐secure feelings and un‐certainty
conditions of the pandemic. Several programs, however, can be
4.1 | Research strengths and weaknesses developed to diminish the impact of the pandemic on mental health.
The results of this study can be a part of recommendations for
This study has advantages including analyzing data on the impact of the management of anxiety during the COVID‐19 pandemic. The
the community due to the COVID‐19 pandemic on the incidence of implications for the educational setting would be that such measures
anxiety comprehended from various factors where this study is can be taken from the fact that several factors may contribute to the
8 of 9 | TRIASTUTI AND HERAWATI

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