Pandemics exert intense impacts on the mental health of a given population. Several studies reported that the general population adversely develops the psychological consequences of pandemics, such as SARS, Ebola, and H1N1 [13,14,15,16]. The common themes of psychological responses to outbreaks include guilt, grief from loss, stigmatization, anxiety, and depression. Fear and anxiety related to epidemics or pandemics also influence the behavior of communities. During the H1N1 epidemic, a significant proportion of the population was unaware of the severity and preventive measures of the epidemic [17].
To the best of our knowledge, the current study is the first to address the psychological association between COVID-19 and anxiety, depression, and OCD in Egyptian subjects from different governorates. More than half of the participants were female, middle-aged, married, and belong to the middle-class socioeconomic level. Majority of the participants were educated, urban residents, and employed. In a similar study on Egypt that assessed the knowledge and attitude of the general public toward COVID-19, two-third of the participants were female, most of them were from urban areas, and more than half were university graduates [18]. These characteristics are expected to be dominant because these population groups have more access to the Internet and thus complete the questionnaire.
Previous studies have found that the incubation period of SARS-CoV-2 could range between 0 and 24 days [19], and approximately 44% of the virus transmission can occur before symptoms emerge [20, 21]. Transmission occurs when the mouth, nose, or conjunctiva is exposed to infective droplets with certain evidence that COVID-19 could be present in fecal matter [22, 23]. The WHO (2020) has emphasized the importance of frequent hand washing, respiratory precaution, and environmental disinfection. Subsequently, the participants in the current study displayed an adequate level of knowledge regarding the mode of transmission of COVID-19, incubation period, and preventive measures. However, the HCWs utilized hand wash, masks, gloves, and alcohol more frequently than non-HCWs. Strict infection control measures in health services could increase the HCWs’ use of protective measures. Conversely, a shortage of such protective measures or high cost could be the reason for the low utilization of non-HCWs. Similarly, a study on the Egyptian population found that participants demonstrated sufficient general knowledge about COVID-19, its routes of transmission, and positive attitude toward preventive measures [18].
In the current study, the participants regularly followed health information mainly through official records and the Internet with a high level of interest in news about new positive and death cases related to COVID-19. The low level of interest in following recovered cases indicates concern regarding the spread and fatality of the disease particularly with the participants’ expectation of a low chance of recovery.
Attitude toward the management of suspected family members showed the tendency of the participants to avoid informing health authorities or seeking medical care in hospitals and preferring home isolation or waiting for symptoms to emerge. This tendency could be explained by the stigmatization of COVID-19-infected patients. The stigma can force people to hide their illnesses and avoid immediate healthcare (WHO, 2020). In a study on Egypt, approximately 22.7% of the participants believed that COVID-19 infection is associated with stigma and that 75% of the participants were willing to undergo home isolation, whereas a low proportion was willing to stay in hospitals in the case of contact with an infected case [18].
In the current study, the attitude of the non-HCWs toward positive or recovered cases nearby indicates a fear of transmission after recovery. However, a significant proportion of HCWs felt comfortable to contact the recovered cases safely. Nevertheless, Lo et al. [24] recently reported that the RNA of SARS-CoV-2 persists for approximately 18 days in the nasopharyngeal cavity or 19 days in the feces after the improvement of symptoms.
In the current study, the participants exhibited a moderate level of fear of the disease. More HCWs than non-HCWs expected worse outcomes from the epidemic. Moreover, COVID-19 exerted a negative impact on the different aspects of life of the participants, which added to the fear regarding the pandemic. This effect was more prominent in HCWs. This finding is similar to that of a study in Egypt that reported increased stress from work and home during the COVID-19 pandemic with increased financial stress [25]. In the current study, the non-HCWs reported more improvement in their social or daily life than HCWs, which could be attributed to the decrease in the working hours, thus leading to longer periods of staying at home due to the curfew and having more time for vacations. Meanwhile, the urgent increase in the demand for HCWs increased their working hours, thus putting more workload for them.
HCWs displayed increased frequencies in clinically significant symptoms of anxiety and OCD than non-HCWs. In addition, HCWS suffered from severe levels of depression and OCD than non-HCWs. Several studies provided evidence that COVID-19 is severely affecting the wellbeing of healthcare professionals [26]. This result could be related to the regular following of health information, increasing concern regarding news about infection and death rates, expectation of worse outcomes from the pandemic, negative impact on social and daily lives, decreased income, decreased vacation from work due to increased work shifts, and increased risk at work. In a systematic review, Vindegaard [27] demonstrated that symptoms of depression and anxiety increased among HCWs compared to the general public. Similarly, higher levels of symptoms of OCD were reported among health professionals compared with non-medical staff.
The current study illustrated that being female, young, students, smokers, and urban residents and a history of chronic diseases and low socioeconomic class were significant factors associated with high risks of anxiety, depression, and OCD. Similarly, a study in China reported that women and students suffered from high levels of anxiety and depression during the COVID-19 outbreak [1]. Similarly, previous study reported that those with chronic illnesses are susceptible to psychological impact as they consider themselves to be of poor health and thus more susceptible to contract COVID-19 [28].
In addition, urban residence increases the occurrence of these mental health outcomes because sources of health information, such as the Internet, are more readily available in urban areas. The mean score of knowledge could be significantly lower among those living in rural areas [18]. In Egypt, the diagnosis of COVID-19 cases occurs mainly in urban areas, where isolation facilities are present. Thus, residents in cities are more aware of such cases. Meanwhile, those belonging to the low socioeconomic class tend to suffer more from the impact of COVID-19 in the economic aspect. The COVID-19 pandemic led to several implications for closure of schools, companies, and public places, and changes in work routines that led to isolation and increased physical and social distance, and feelings of helplessness [29]. The dramatic economic impact [30] and lack of interpersonal attachments could lead to poor physical and mental health [31].
In another study in Egypt, Arafa et al. [32] demonstrated that being female, working in non-health sectors, watching or reading COVID-19 news for longer than 2 h daily, and lack of emotional support were associated with a high prevalence of severe to very severe depression and anxiety among the general population. However, the said study was conducted only in four Egyptian governorates.
Therefore, the present study recommends decreasing mental health consequences by encouraging daily exercise activities at home and maintaining safe modes of social communication, such as through smartphones, during the COVID-19 pandemic [33]. Early detection and effective treatment of mild clinical mood symptoms are necessary to prevent their evolution to more complex psychological responses [26]. Adequate psychiatric treatments should be provided for those presenting with severe mental health problems. Psychotherapy techniques based on the stress-adaptation model may be helpful because emotional and behavioral responses form part of an adaptive response to extreme stress [34, 35].
The present study has several limitations because it was limited to the individuals with access to smartphones, e-mail addresses, and the Internet. This group largely represents the educated population. Therefore, the findings should not be generalized across the population, particularly those with less educational attainment. Moreover, people with concerns regarding their mental health wellbeing were expected to participate as an online questionnaire was used to collect data.
