1. Dear Editor
he outbreak of Covid-19 has caused concern among the general population around the world. Many people may be anxious and scared, and those who are directly affected by the virus in different ways may experience more panic, fear, and anxiety [1].
Everyone who is exposed to a traumatic crisis is affected to varying degrees [2]. The effects of an accident crisis on some people go away quickly, and they regain resilience. However, typically at least one-third of these people develop a condition called Calamity Syndrome; that is, the patient may be physically relieved of the disease over time, but its psychological effects may remain in him/her for a long time [3]. But the question is, which groups are most at risk for Calamity Syndrome, which includes severe anxiety, stress, and thought disorders?
In our initial research -- which was related to another study [4]-- and in our initial psychological interventions in coronavirus patients who were in the first ten days of their disease [4], we came across results that might be useful to future researchers. We might help answer the question: which group of patients with Covid-19 needs more psychological interventions?
2. Main Subject
In this study, individuals were selected by available random sampling method from among patients with Covid-19(whose disease was diagnosed by an infectious disease specialist and they were spending the second week of their illness and were among those referred to Ziaeian Hospital). In this study, assessment and evaluation tools were the initial mental status assessment form based on the DSM-5 model and the DASS21 questionnaire, which was done by the patients themselves. This questionnaire measures the level of anxiety, stress, and depression, and its validity and reliability have been proven in various studies [5, 6, 7]. 
The study population consisted of 61 patients with Covid-19 disease, 23 were in the hospital, and 38 were in-home quarantine according to the specialists’ order. Evidence showed that patients in quarantine had acute and morbid stress at a rate of 7.7%, while no acute stress was observed in hospitalized patients. Severe anxiety scores were reported to be 8.2% among home quarantine patients, but the rate of anxiety in hospitalized patients was 0%. It should be noted that hospitalized patients were nervous to b oth the anxiety and stress scales, but both factors were reported at a mild level. In the depression factor, 1 quarantine patient was reported to have severe depression, while none of the hospitalized patients had severe depression.
It is worth mentioning that based on the diagnostic interview of the psychologist of the hospital mentioned above, two quarantine patients had decided to commit suicide, stating that the main reason for their action was fear of disease and prevention of infecting their family members and others. However, the hospitalized patients were in a better mental condition since they were constantly under medical staff’s care and received various pharmacological and non-pharmacological interventions.
3. Results
The present study results showed that the quarantined patients reported more stress, acute anxiety, and severe depression than hospitalized patients due to lack of access to treatment staff and lack of continuous treatment interventions. These factors can lead to panic attacks in patients and have unpleasant results [8].
Since in this study, 2 patients in quarantine had decided to commit suicide, the follow-up treatment by telephone or social networks for patients who have received a positive coronavirus test and are referred to home quarantine [9] becomes very important. By this, the disease’s transmission becomes slower, and the importance of psychological interventions for this group of people becomes more apparent.
Ethical Considerations
Compliance with ethical guidelines
The Iranian Registry of Clinical Trials (IRCT) approved the study guideline (IRCT20200509047360N1).
Funding
This project was approved by Tehran University of Medical Sciences (Grant Number: IR.TUMS.VCR.REC.1399.335).
Authors' contributions
Methodology: All author; Writing – original draft, Hossein Gharaati Sotoudeh; Writing – review & editing: Seyyed Salman Alavi. 
Conflicts of interest
The authors declared no conflict of interest.
Acknowledgements
Both author would like to thank to all colleagues at Ziaeian Hospital.

Reference

1. Shahyad S, Mohammadi MT. [Psychological impacts of covid-19 outbreak on mental health status of society individuals: A narrative review (Persian)]. Journal of Military Medicine. 2020; 22(2):184-92. http://militarymedj.ir/article-1-2479-en.html
2. Berg T, Roonieh D. Crisis Management. Tehran: Hadis; 2015.
3. Ahmadi Kh. [Strategy of psychological intervention in disaster crisis (Persian)]. Journal of Military Medicine. 2004; 6(1):45-51. http://militarymedj.ir/article-1-150-en.html
4. Gharaati Sotoudeh H,  Alavi SS, Akbari Z, Jannatifard F, Artounian V. The effect of brief crisis intervention package on improving quality of life and mental health in patients with COVID-19. Iranian Journal of Psychiatry. 2020; 15(3):205-12. [DOI: https://doi.org/10.18502/ijps.v15i3.3812]
5. Ho CSH, Tan ELY, Ho RCM, Chiu MYL. Relationship of anxiety and depression with respiratory symptoms: comparison between depressed and non-depressed smokers in Singapore. International Journal of Environmental Research and Public Health. 2019; 16(1):163. [DOI:10.3390/ijerph16010163] [PMID] [PMCID]
6. Le MTH, Tran TD, Holton S, Nguyen HT, Wolfe R, Fisher J. Reliability, convergent validity and factor structure of the DASS-21 in a sample of Vietnamese adolescents. PLoS One. 2017; 12(7):e0180557. [DOI:10.1371/journal.pone.0180557] [PMID] [PMCID]
7. Samani S, Jokar B. [Investigating the validity and validity of the short form of the scale of depression, anxiety and stress (Persian)]. Journal of Social Sciences and Humanities, Shiraz University. 2007; 26(3):65-76. https://www.sid.ir/fa/journal/ViewPaper.aspx?id=82319
8. Ho CS, Chee CY, Ho RC. Mental health strategies to combat the psychological impact of covid-19 beyond paranoia and panic. Annals of the Academy of Medicine, Singapore. 2020; 49(3):155-60. [DOI:10.47102/annas-acadmedsg.202043]
9. Pinto da Costa M. Can social isolation caused by physical distance in people with psychosis be overcome through a Phone Pal?. European Psychiatry. 2020; 63(1):e61. [DOI:10.1192/j.eurpsy.2020.53] [PMID] [PMCID]