Taking a lesson from the history of global pandemics over the past few decades, many social impacts seem inevitable. Several outbreaks, such as the bubonic plague (black death), Ebola, legionnaires, and SARS, have unveiled psychological conditions experienced by the affected people [1]. There are three types of disasters: natural, technological, and disasters caused by violence (war). Each type of disaster has a distinct impact; generally, the effect of war is more prominent than natural disasters (Norris, 2002 and Norris, 2006). However, a natural disaster caused by biological agents that are usually invisible and unfamiliar raises the anxiety about the uncertainty of the level of exposure that someone may suffer. The impact goes beyond individuals infected–social stigma and isolation, leading to broader economic disruption [2].

The transmission process of COVID-19 in Indonesia is relatively fast; the first two positive cases were detected on March 2^nd, 2020 [3], and were reported by the Gugus Tugas Percepatan Penanganan (COVID-19 Response Acceleration Task Force/GTPP) the next day in a press conference. In addition, through the GTTP official website on March 23^rd, 2020, 579 positive cases were reported, and 49 people died due to the COVID-19 [4]. Later, the COVID-19 cases spread rapidly in several provinces in Indonesia. Efforts to prevent the COVID-19 disease transmission to the community generate mobility restrictions (physical, psychological, and economic). Then rumors spread, some sanitation products were scarce on the market, schools and workplaces were closed, and activities that gathered people together were prohibited. The adoption of new habits and the uncertainty of conditions trigger social unrest. Psychologically, changes in the environment make someone feel insecure, restless, and anxious [5]. This extraordinary situation makes people worry about their health, family health, work, finances, and other daily activities. This condition can lead to social unrest, which has consequences for mental health problems.

Psychological conditions related to COVID-19 have been described in a study conducted in February 2020 in China involving 7.236 respondents using a website-based survey which showed that the prevalence of anxiety, depressive symptoms, and sleep quality were 35.1%, 20.1%, and 18.2%, respectively [6]. Another study in Iran in March found that 9.3% of the population experienced severe anxiety, while another 9.8% experienced very severe criteria [7]. Therefore, this study aims to determine the mental health consequences at the beginning of the COVID-19 pandemic in Indonesia.

This study provides an overview of the mental health condition of Indonesians at the beginning of the pandemic, precisely 1 (one) month after the large-scale social restriction policy was implemented in several provinces. We found that 6.92% of participants had moderate-severe anxiety symptoms, and 8.57% had moderate-severe depressive symptoms. This finding is almost similar to the overview of Japanese society, where the percentage of depression is higher than anxiety: 10.9% of the community had anxiety with an average GAD-7 score of 3.73 (SD = 4.61), while 17.3% had depression with an average PHQ-9 score of 5.25 (SD-5.62) [12]. This pattern is also similar to the conditions that occurred in Hong Kong during this COVID-19 pandemic using the same instrument and assessment: depression (19%) higher than anxiety (14%) [13], even though the numbers in our study are lower compared to those two studies.

Psychological problems history is closely related to anxiety and depression, which also happened in Cyprus and Turkey during the COVID-19 pandemic (Ioulia, 2020 dan Ozin, 2020). The high level of anxiety and depression in people with a history of mental illness may have been associated with the illness relapse. During the pandemic, people are advised not to leave their homes. People with psychiatric symptoms have difficulty accessing health services, such as attending their regular visits or accessing their medicines, because hospitals have limited face-to-face services to reduce the risk of getting exposed to the virus [14]. Indonesia has established online medical services, including psychiatric services.

Having a history of chronic illness is closely related to anxiety and depression. Chronic comorbidities (especially hypertension, diabetes, and heart disease) have been identified as significant risk factors for mortality from 2019-nCoV [15]. In addition, individuals with chronic diseases have an increased risk of contracting COVID-19 [16]. In addition, the results of a Danish study on people with diabetes reveal their concern about getting COVID-19 [17]. Studies in Brazil also show higher anxiety scores in respondents with heart disease and diabetes than healthy respondents [18]. From the reports of health facility providers, research conducted by 202 health professionals in 47 countries also mentions depression as one of the comorbidities experienced by patients with NCDs (diabetes, hypertension, and COPD). Another study also said that the mental state of some to most of the patients is deteriorating [19]. In line with all these findings, increased levels of anxiety and depression were also found in individuals with chronic illnesses.

Employment status is closely related to anxiety and depression. Economic factors are significantly affected during the pandemic, especially after the restrictions on various community activities, including economic activities. The financial status of many people to support their survival has been disrupted; they had lower or even no income due to termination of work by companies that can no longer operate. The results of our study show that anxiety and depression are closely related to employment status, where the unemployed are susceptible to anxiety and depression. Our findings are similar to Japan’s [10] and China’s [18] conditions. A study conducted on 5,974 respondents in Mexico also showed that during the pandemic period, the mean scores for depression (PHQ-9) and anxiety (GAD-7) were higher in students and those who were unemployed [20]. In addition, for job seekers, their chances of getting a job are now significantly reduced due to the decreasing vacancies [12]; this makes job seekers also experience anxiety and depression, as our study finds.

In this study, young age is associated with anxiety and depression. Some authors suggest more significant anxiety among more youthful age groups because they are more likely to get exposed to information circulated on social media, which may trigger stress [21–23]. This younger age group includes respondents still in school who were affected by mental health problems during the pandemic. Such issues may happen during the pandemic when parents are doing remote work from home, while at the same time, their children also have online learning from home. This fact was demonstrated in China, which showed an association between poorer mental health in those aged 12–21 years with educational difficulties arising from the restriction from attending the school and the uncertain examination period [24]. Another study also explains that older adults are more psychologically resilient than their younger counterparts which may be necessary when dealing with sources of stress associated with the COVID-19 pandemic [12].

The economic instability during the COVID-19 pandemic has impacted many community groups, including those who lived in rented houses/rooms. They usually have lower incomes and savings compared to the landlords. Although not all tenants have low income (poor), most of the poor are in the tenant group. This group is also vulnerable to losing their jobs or revenue during the pandemic, so they must fight even more challenging to fulfill their financial needs [25]. The difficulties experienced by tenants during the COVID-19 pandemic have been studied in the US. The most important manifestation is the inability to pay rent. About 16% of tenants could not pay their monthly rent in time. As for the tenants who could pay in time, they had to use their savings, owed some money, or ask for the help of friends and family. Threats of getting removed from their current rented house/room will always follow the tenants if they cannot pay, as 15% of tenants have experienced such a threat. This condition can trigger depression and anxiety [25].

Single participants are closely related to depression. This is in accordance with a study conducted in Canada on the population aged 18 years and over. They found that single/not married respondents have a higher risk of getting depression than respondents who got married [26]. A meta-analysis study also showed that single people had a worse prognosis for depression than married people [27]. This is because support from a partner is the most consistent social support that protects against depression in adults aged 18 years and over [28].

Women are closely related to anxiety and depression. This study adds to the evidence that women are more prone to experiencing anxiety and depression, as known in psychiatry [29]. Many previous studies are in line with these findings, such as in Cyprus from 3 to 9 April 2020 [29] and in April 2020 in Austria [30]. Women have been identified as the strongest predictors of post-traumatic stress disorder symptoms after the pandemic [31]. In a study from China, although during the pandemic, women were more aware of the COVID-19 disease than men and more adhered to the advice of health protocols, such as wearing masks and avoiding public spaces, women also felt that they were uncertain whether the pandemic could be controlled or not [32].

Education level is closely related to depression. Higher education had a greater risk for more significant anxiety and depression in this study. A study in Vietnam at the time of the implementation of the partial lockdown during the COVID-19 pandemic showed that the postgraduate education level had a higher stress level than the lower education level. This could be due to the high expectations of jobs in the future and financial pressures [33]. Higher education related to mental health problems occurred in China in early February 2020 and Iran in early March 2020 [7,34]. This may occur because of highly educated individuals’ high self-awareness of health conditions [35]. This fact is different from the result of another study which showed that people with lower education levels were associated with depression [36]. Although education can make one’s psychological well-being better because they may be able to encounter various economic pressures and difficulties, a higher education level can also be a risk factor for depression depending on multiple things such as gender, income level, occupation, marital status, and others [37].

Our research has a number of limitations. First, compared to face-to-face interviews, self-administered questionnaires have the potential for biased responses. Second, because this is an online poll, it is not representative, as it is confined to individuals with limited internet access. Thirdly, because the study is cross-sectional, it identifies only estimations and correlations of anxiety and depression with various factors, not their potential effects over time. This study does not investigate a number of crucial characteristics believed to influence anxiety and depressive disorders, such as stressful life events and patterns of social support. A prospective study with a larger sample size could provide light on the causes of anxiety and depression, regardless of the fact that performing such a study during the COVID-19 pandemic can be challenging.

In summary, our findings show that one third Indonesian had anxiety and depression during the period of activity restriction at the beginning of the pandemic. Anxiety and depression are strongly associated with a history of illnesses (psychological and chronic illnesses). In addition, they are also strongly related to community economic activities, where groups experiencing unfortunate financial events (affected by layoffs/job seekers, not working) are at risk of anxiety and depression. The young age group and students are also vulnerable to experiencing anxiety and depression. The importance of monitoring and continuity of treatment services for individuals with a history of psychological and chronic illnesses. Even though the government has implemented a social assistance program for these affected groups, other material or financial assistance can still be helpful for those experiencing financial difficulties.