Prevalence of Mood Disorders and Associated Factors at the Time of the COVID-19 Pandemic: Potocol for a Community Survey in La Manouba Governorate, Tunisia

Uta Ouali1, 2, 3, *, Amina Aissa1, 2, 3, Salsabil Rjaibi4, 2, Nada Zoghlami4, Yosra Zgueb1, 2, 3, Amine Larnaout2, 5, Mejdi Zid4, Imen Kacem2, 3, 6, Fatma Charfi2, 7, Maria Francesca Moro8, Nadia Touihri9, Wahid Melki2, 5, 10, Hajer Aounallah-Skhiri2, 4, 11, Fethi Nacef, 1, 2, 3, Riadh Gouider2, 3, 6, Zouhaier El Hechmi12, Mauro Giovanni Carta13
1 Department Psychiatry A, Razi Hospital La Manouba, Tunis 1068, Tunisia
2 Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis 1068, Tunisia
3 Research Laboratory LR18SP03, Tunisia
4 National Institute of Health, Tunis, Tunisia
5 Department Psychiatry D, Razi Hospital La Manouba, Manouba 2010, Tunisia
6 Department of Neurology, Razi Hospital La Manouba, Manouba 2010, Tunisia
7 Department of Child Psychiatry, Mongi Slim Hospital La Marsa, Marsa, Tunisia
8 Mailman School of Public Health, Columbia University, NY, US
9 National Institute of Statistics, Tunis, Tunisia
10 Technical Committee for Mental Health Promotion at the Ministry of Health, Tunis, Tunisia
11 Laboratoire de Recherche en Epidémiologie Nutritionnelle (SURVEN), Tunis, Tunisia
12 Private Practice, Tunis, Tunisia
13 Center for Liaison Psychiatry and Psychosomatics, University Hospital, University of Cagliari, Cagliari, Italy

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Creative Commons License
© 2022 Ouali et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Psychiatry A, Razi Hospital La Manouba Cité des Orangers, La Manouba 2010, Tunisia; Tel: +216 23266078; E-mail:



The present survey aims to assess the overall mood disorder prevalence and identify associated socio-demographic and clinical factors in a Tunisian community sample, with special attention to the COVID-19 pandemic.


Mood disorders are one of the leading causes of all non-fatal burdens of disease, with depression being at the top of the list. The COVID-19 pandemic may have increased the prevalence of mood disorders, especially in Low and Middle-income countries (LMICs) and in vulnerable populations.


1/ Assess point and lifetime prevalence of depressive and bipolar disorders as well as subthreshold bipolarity in a representative population sample of La Manouba governorate and assess treatment patterns for these disorders; 2/Study socio-demographic and clinical correlates of mood disorders 3/ Assess the association between mood disorders and quality of life 4/ Study the impact of the COVID-pandemic on the prevalence of mood disorders 5/ Assess coping mechanisms to the COVID-pandemic and whether these mechanisms moderate the appearance of mood disorders or symptoms since the beginning of the pandemic


This is a household cross-sectional observational survey to be conducted in La Manouba Governorate in a sample of 4540 randomly selected individuals aged ≥ 15 years. Data collection will be carried out by trained interviewers with clinical experience, through face-to-face interviews and the use of the computer assisted personal interviewing approach (CAPI). The following assessment tools are administered:


Structured clinical Interview for DSM IV-TR (Mood disorder section and Screening questions on Anxiety), Mood Disorder Questionnaire (MDQ), Suicide Behaviors Questionnaire-Revised (SBQ), 12-item Short Form Survey (SF-12), the Brief-COPE, and a questionnaire about a headache. In addition, socio-demographic and clinical data will be collected.


This will be one of the very few household surveys in a general population sample to assess mental health problems and COVID-19-related variables since the beginning of the pandemic. Through this research, we aim to obtain an epidemiological profile of mood disorders in Tunisia and an estimation of the impact of the COVID-19 pandemic on their prevalence. Results should contribute to improving mental health care in Tunisia.

Keywords: Study protocol, Community survey, Prevalence, Mood disorder, Depression, Bipolar disorder, COVID-19.