**1. Introduction**

The coronavirus disease (COVID-19) first emerged in December 2019 in China and caused a global health pandemic [1,2]. The total number of COVID-19-infected people has been accelerating, and the death count is exceeding previous Middle East respiratory syndrome coronavirus (SARS-CoV) epidemics [3]. In Saudi Arabia, the first coronavirus infection was reported in March 2020 [4]. More than 470,000 people have been infected in Saudi Arabia as of June 2021.

To prevent the transmission of COVID-19 infection, significant intervention such as physical distancing and the use of face masks is widely recommended [5–7]. Saudi Arabia was one of the first countries that imposed strict measures including the limiting of outdoor activities, closing schools, minimizing social contacts, and banning mosque prayers [8]. The entire country was quarantined, and curfew was legislated in big cities.

The restrictions may have caused serious impacts on the mental health of the public. The sudden change in people's routine can predispose one to depression. COVID-19 as a new emerging virus with unique features and high infectious rates predispose people to high levels of stress. COVID-19 news in all media, the numerous hypotheses of its mode of transition and consequences, and the fear of getting the infection personally for family members can all be predisposing factors for depression. A recent study in Saudi Arabia indicated that about one-third of individuals studied had moderate to severe depression

**Citation:** Sonbol, H.; Alahdal, H.M.; Alanazi, R.A.; Alsamhary, K.; Ameen, F. COVID-19 Pandemic Causing Depression in Different Sociodemographic Groups in Saudi Arabia. *Int. J. Environ. Res. Public Health* **2021**, *18*, 6955. https:// doi.org/10.3390/ijerph18136955

Academic Editors: Paolo Roma, Merylin Monaro and Cristina Mazza

Received: 28 May 2021 Accepted: 23 June 2021 Published: 29 June 2021

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during the COVID-19 pandemic [9]. Younger people, people spending too much time thinking about the outbreak, and healthcare workers were at high risk of mental illness in China [10]. In Saudi Arabia, it is not known how and to what extent the epidemic is affecting different sociodemographic groups of people. Such studies are crucial to help determine general mental health status and anticipate possible mental disorders.

Our aim was to assess the level of depression during the COVID-19 pandemic in different sociodemographic groups and how following the precautionary measures affected depression symptoms. We measured the depression burden in adults living in Saudi Arabia during the period of curfew using a questionnaire and examined the relationship between participants' depression level and protecting factors such as commitment to follow the precautionary measures, education level, and family circumstances. Preparedness to face the virus-related mental health outcomes will help to treat the issue at an early stage.

#### **2. Research Methodology**

#### *2.1. Study Design*

A snowball sampling recruitment method was used to recruit adults living in Saudi Arabia (18–55 years old) between 18th of May and 11th of June 2020. The participants were recruited through WhatsApp chains starting from the researchers who asked their contacts first. Participants (*n* = 1109) completed an online survey through Google Forms in the Arabic language. It took about five minutes to complete, and communication between the researchers and the participants was possible. The participants had the freedom to stop whenever they wanted. Expedited ethics approval was obtained from the Institutional Review Board of the Princess Nourah bint Abdulrahman University (PNU) (20-0215). All respondents provided informed consent.

The public's psychological response and awareness about precautionary measures during the pandemic of COVID-19 was assessed using a cross-sectional survey design. Correct answers were given 3 points, while not knowing the answer received 2 and wrong answers received 0. The questionnaire was adopted from studies where it was pre-tested and validated [10–12]. The questionnaire about depression was from the Center for Epidemiologic Studies Depression Scale (CES-D) excluding three items [13]. The CES-D score ranged between 0–51 points, and higher scores indicated more severe depressive symptomatology [13].

All methods followed the guidelines of the National Committee of Bioethics (NCBE), Saudi Arabia. The questionnaire consisted of questions covering the following areas: (1) Sociodemographic information, (2) commitment to follow precautionary measures, and (3) feelings of depression.

The maximum score for the commitment to follow precautionary measures was 28 and for depression was 51, with higher scores indicating more severe depressive symptoms. The reliability and validity of the scale was assessed using a pilot test with 94 participants. Scale reliability was tested using a Cronbach's Alpha (α) and Spearman–Brown coefficient (0.90). The depression scale demonstrated acceptable internal consistency (α = 0.89). The assessment was based on previous studies [14] where α > 0.70 is acceptable in social science research.

#### *2.2. Statistical Analysis*

One-way ANOVA followed by the least significant difference test (LSD) were used to analyze the differences in the variables of precautionary measures and depression between the sociodemographic groups. The Pearson correlation was calculated, and a regression analysis was carried out between the variables of precautionary measures and depression. *p* < 0.05 was considered to be significant. SPSS Statistic 21.0 ® (IBM SPSS Statistics, Armonk, NY, USA) was used.
