This study aims to assess the new-onset depression and anxiety disorders in COVID-19 patients in Saudi Arabia during the pandemic. In this study, we sought the association between COVID-19 infection and new-onset mental health disorders such as depression and anxiety in COVID-19 patients, especially females. Though there is no significant difference in the prevalence of anxiety and depression among COVID-19-positive or negative-populations reported in this study, we found the females are more affected by COVID-19 than males in depression scores and to a moderate extent in the anxiety scores. While we cannot identify the underlying causal mechanisms, previous studies reported that COVID-19 infection, or coronaviruses infections, may increase the risk of anxiety and depression. For example, in a systematic search that included 3559 studies, it was found that depressed mood and anxiety were common symptoms among patients admitted to the hospital for SARS or MERS during the acute illness or the post-illness stage [7]. In another study that analyzed 69 million health records from over 62,000 people diagnosed with COVID-19, it showed that 6% of COVID-19 patients experienced mental health disorders such as depression and anxiety within 3 months of diagnosis compared to 3.4% of non-COVID-19 patients [16]. From a molecular biology perspective, different pathogenetic mechanisms have been described as central nervous system affection by SARS-CoV-2. However, the exact pathogenetic mechanism associated with neuropsychiatric symptoms in COVID-19 patients is currently unknown and needs to be elucidated. Some previous reports highlighted the ability of Coronavirus to penetrate the brain through the olfactory canal, retrograde neural pathway, or by induce a significant inflammatory response through activation of the inflammatory pathway and release cytokines into the body. The blood-brain barrier is likely to be damaged as a result of increased pro-inflammatory factors in the bloodstream making functional damage possible [4]. Moreover, different pathways of indirect infection of the CNS have been suggested, including host immune response against the virus, pre-existence of acute toxic encephalopathy, or as a side effect of COVID-19 medical treatment [4].
In the current study, we also found that females with COVID-19 are at high risk for mental disorders compared with males (Tables 4 and 5). This result is consistent with many other studies. For example, in one follow-up study, after 1 month of hospital treatment, which was done on 402 adult patients who were diagnosed with COVID-19 (66% male, mean age 58), it has been found that 42% of patients reported anxiety while 31% of patients reported depression (among many other mental conditions) and, furthermore, females have experienced more anxiety and depression than males [17]. Another study on 76 patients who were quarantined in fever-isolation wards with suspected COVID-19 to investigate anxiety and depression has found that female patients are more likely to experience depression and anxiety than male [18]. Another study investigated the gender differences in depression, anxiety, and the associated factors during the COVID-19 epidemic among Chinese social media users. The findings suggested that the increased prevalence of depression and anxiety during the COVID-19 epidemic among the Chinese population. Furthermore, females showed more severe anxiety symptoms than males [19]. Another study, conducted in Kuwait, aimed to assess the prevalence of anxiety and depression symptoms in Kuwaiti nationals and expats. The study’s secondary objective was to highlight the association between physical activity (PA) engagement and sociodemographic characteristics, with mental health disorders such as anxiety and depression during the COVID-19 pandemic. A web-based cross-sectional survey was used to examine the sociodemographic characteristics and PA engagement and generalized anxiety and depression symptoms. The results showed that anxiety was reported in more than 50% of the sample, and depressed mood reported in approximately 60% of the sample during COVID-19 outbreaks. Moreover, women and younger individuals with lower PA and education were more likely to develop anxiety symptoms while depressive symptoms were more prevalent among women, people with lower PA and education, elderly, and married people [20]. Overall, the patterns in this study are largely consistent with those reported in the literature. Notably, the prevalence of anxiety and depression in our study was relatively higher than the national rates [14]. The national rates were based on Saudi National Health and Stress Survey which has been conducted many years before the coronavirus outbreak while our survey has been conducted amid the outbreak, a likely factor that inflated anxiety and depression. While we do not know of any current estimates of the prevalence of anxiety and depression disorders, the prevalence in our sample is similar to other studies conducted in similar populations. For example, in a study conducted in Kuwait [20], anxiety prevalence was reported to be 50% while depression was reported to be 60% during the outbreak [18, 20].
This study has many limitations. As an online survey, there is potentially self-selection bias against those who did not have access to the Internet, and individuals who were more concerned about their mental health might have been more likely to participate in the study. Moreover, we used self-reported scales to assess anxiety and depression because it was convenient especially during the pandemic and social distancing measures, and that might lead to recall bias. Furthermore, the results of this study cannot be generalized to other populations because of possible sampling error. However, to the best of our knowledge, this is the first study that investigated the prevalence of new-onset mental health symptoms (i.e., symptoms of depression and anxiety) by standardized rating scales among the Saudi population during the COVID-19 pandemic. Our findings may provide more helpful recognition of high-risk populations and framework design for population-specific psychological crisis management. Furthermost, this study calls attention to the importance of early psychological therapeutic intervention because the prognosis of COVID-19 could be worsened by psychological distress and depression, which may negatively affect the patient’s immune system response.
