The Symptom Checklist-90-R instrument was used to evaluate the range of psychological problems and symptoms of psychopathology. This test contains 90 items, which measures nine primary symptom dimensions, and it provides an overview of a patient’s symptoms and symptom intensity. Each of the 90 items is rated on a five-point Likert-type scale, ranging from ‘not at all’ (0 points) to ‘extremely’ (4 points); higher values indicate greater symptom severity during the past week. The Global Symptom Index score was used to assess the level of general psychological distress .