1. Introduction 
he outbreak of Coronavirus Disease 2019 (COVID-19) turned this disease into the world’s largest health threat in 2019. According to the World Health Organization (WHO), COVID-19 is a respiratory infectious disease caused by the newest known coronavirus, unrecognized before the initiation of the outbreak in Wuhan, China, in December 2019. Given coronavirus’s life-threatening nature, most training and services are focused on medical aspects, albeit with a reasonable justification. However, based on psychoneuroimmunology related theories, experience, and tolerance, maladaptive to stress can weaken the immune system and lead to an increased risk of disease development. It should also be noted that the virus survivors face serious psychological threats during and after the disease eradication. 
Most of the psychological studies available on this emerging disease are related to the adult population, such as students, the general public, and health care staff in hospitals involved with coronavirus patients. In contrast, a very small number of studies have been performed on children. Given the importance of psychological attention to children in the current psychological and health crisis, the present study intended to investigate the psychological effect of COVID-19-induced home quarantine on parental stress and its relationship with children’s anxiety and depression Guilan Province, Northern Iran.
2. Method
This research was conducted 7-16 March 2020, in the early stages of the public call to observe the quarantine in Guilan Province, Iran. The statistical population was all children in Guilan Province aged 5-12 years and their parents. The children were enrolled through the purposive sampling method. A total of 180 quarantined parents participated in the study. The inclusion criteria were living in Guilan Province, having a child aged 5-12 years, and completing an online questionnaire. The exclusion criterion was the history of anxiety and depression in the child diagnosed by a psychologist or a psychiatrist. The data were collected through a researcher-made demographic questionnaire, the items related to anxiety and depression on the Children Symptom Inventory (CSI-4), and the Weiss and Marmer Impact of Event Scale-Revised (IES-R). The data collection tools were shared on social media (Telegram and WhatsApp). The collected data were analyzed through the Pearson correlation coefficient, independent t-test, and hierarchical regression analyses after adjusting demographic confounders’ effect.
3. Results
This online survey’s findings showed that 96.7% and 3.3% of the parents who completed the questionnaires (n=181) were mothers and fathers with a mean age of 36.48 years and 40.43 years, respectively. The mean age of children whose parents participated in the study was 6.99 years. The analysis was performed on 5-12 years old children, 51.9% of whom were girls and 48.1% were boys. After eliminating the effect of demographic variables (number of children in family and age of the child), it was revealed that high scores of parents on subscales intrusion (β=0.568, P=0.004) and hyperarousal (β=0.772, P<0.0001) can significantly predict high scores of children’s anxiety. Besides, none of the IES-R components in parents could substantially predict children’s depression scores (P>0.05). After eliminating the effect of variables(number of children in the child’s family and age), higher IES-R scores of parents significantly predicted higher anxiety scores of children (β=0.258, P=0.011). Finally, the results showed that higher IES-R scores could substantially predict children’s higher depression scores (β=0.325, P<0.0001) (Table 1 & 2). 





4. Discussion and Conclusion
It seems that Fear of illness, home quarantine-induced financial problems, temporary or permanent unemployment, limited social connections, unknown end of the pandemic, concern for family and relatives, and Fear of the future are among the factors that, as COVID-19 pandemic-induced adverse psychological effects, may cause stress in parents. This stress can predict anxiety and depression in children. Home quarantine increases interactions between parents and children, although this increase in the quantity can be associated with a decline in communication quality. 
Parents who experience stress caused by quarantine or the disease outbreak are more likely to have individual and responsible concerns about their children or the withheld mandatory supports for their parents or others. They are also faced with hyperarousal and disturbing thoughts, which hinder a good quality relationship with children and possibly cause significant signs of anxiety and depression. This problem requires further investigations through quasi-experimental projects. 
Given the importance of the issue, specific strategies have been developed by the countries’ health agencies to provide psychological assistance to children. For example, the Iranian Academy of Child and Adolescent Psychiatry has provided guidelines on issues such as management of stress and excitement in crisis (stress and crisis management in the family, talking to the child about coronavirus disease, etc.), resuming academic activities and virtual education, psychological support for the sufferers (psychological support for the loss of loved ones, helping children mourn, the affected child: what parents should do to support themselves and their families, etc.), and long-term measures in crisis(timely recognition of risk signs and prevention, visiting specialists and counseling in cyberspace: tips for parents, etc.). 
The results of this study confirmed the effects of unwanted thoughts and hyperarousal of parents on children; accordingly, psychotherapists should intervene with families to separately manage and treat stress and anxiety of parents and depression of children and to modify their possible maladaptive interactive styles through interactive and aggressive treatments, all of which can help mental and financial saving for the government and health care providers.
Ethical Considerations
Compliance with ethical guidelines
All ethical principles are considered in this article. The participants were informed of the purpose of the research and its implementation stages. They were also assured about the confidentiality of their information and were free to leave the study whenever they wished, and if desired, the research results would be available to them.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Authors' contributions
Conceptualization and methodology: Sajjad Rezaei; Investigation and critical review: Azra Zebardast; Data collection and data analysis: Azadeh Sameni Toosarvandani 
Conflicts of interest
The authors declare no conflict of interest.


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