*3.3. Age, Work Nature, and COVID-19 Are Associated with Depression, Whereas Only Age Is Associated with Anxiety*

A series of multiple linear regression tests were used to assess the effect of different demographic factors (age, gender, marital status, residence location, and nature of work), clinical factors (chronic illness or having COVID-19), and attitude towards COVID-19 in the development of depression or anxiety among our Egyptian population. We found that age had a significantly negative correlation with depression. However, mental effort at work and COVID-19 disease had significant positive correlations with depression. On the other hand, only age negatively correlated with anxiety (Table 3). These findings indicate that young age, high level of mental effort at work, and COVID-19 disease are significant

predictors of depression in our study, whereas young age is the only significant predictor of anxiety in our population.

**Table 3. Predictors of depression or anxiety in the Egyptian population.** Linear regression tests were used to determine factors that significantly correlated with depression and anxiety. Linear-regression-dependent (dep.) variables included depression or anxiety, whereas the independent (indep.) variables included age, gender, mental effort at work, marital status, chronic illnesses, and COVID-19 disease.


*3.4. Anxiety Management Is the Only Coping Strategy That Is Significantly Different between Males and Females*

Our newly developed questionnaire was designed to identify the personal coping strategies used by the Egyptian population during COVID-19. Our questionnaire results indicated that anxiety management was the only coping strategy that was more significantly used by females than males (Table 4; *p* = 0.037). The use of personal coping strategies such as ignoring guidelines for disease prevention, following the guidelines of disease prevention, and rational handling of the problem was not significantly different between males and females.

**Table 4. Coping strategies of males and females in the Egyptian population.** A coping strategies questionnaire was used to identify coping strategies in the population. Respondents were given a score for each strategy based on their answers to the questionnaire. Data are expressed as mean ± SD, and an independent sample *t*-test was used to compare coping strategies between males (*N* = 73) and females (*N* = 210). Asterisk (\*) indicates significant difference (*p* = 0.037).


*3.5. Coping Strategies during COVID-19 Negatively Correlated with Anxiety and Depression*

Next, a series of Pearson correlations were performed to correlate coping strategies to the occurrence of depression or anxiety. Anxiety management had a significant positive correlation with anxiety and depression, whereas religious practices had a significant negative correlation with anxiety and depression. However, rational handling of the problem showed a significantly negative correlation only with depression (Table 5). These results indicate that certain coping strategies are effective in reducing the levels of anxiety and/or depression.


**Table 5. Correlation between depression or anxiety and coping strategies in the Egyptian population.** Pearson correlations were performed to correlate coping strategies to the occurrence of depression or anxiety. Asterisk (\*) indicates a significant correlation (*p* < 0.05), whereas (\*\*) indicate significant correlation (*p* < 0.01).

#### **4. Discussion**

The COVID-19 pandemic imposes many challenges that could lead to stress and depression. Different populations react differently to COVID-19-induced challenges. This study reports the prevalence of anxiety and depression due to COVID-19, factors that associate with anxiety and depression, and the coping strategies to deal with the pandemic in a sample of the Egyptian population.

Although our study is a cross-sectional study that does not represent the entire Egyptian population and is limited by the inability to assess incidence or make a causal inference, it provides insight into the reaction of the Egyptian population towards anxiety, depression, and coping strategies to overcome anxiety and depression. Three-quarters of our population had moderate anxiety (62.9%) to severe anxiety (12.4%). This is consistent with a study conducted in Iran, which revealed that approximately one-fifth of Iranians had experienced severe/very severe anxiety [3]. Depression was recorded among half of the studied sample. Most of them had mild (21.9%), moderate (13.8%), and severe depression (14.1%) according to scores of Beck's Depression Inventory II [18,19]. Another online study reported an increase in anxiety among the Indian population.

Anxiety and depression play a role in immune system dysfunctions and, consequently, increase the risk of viral infection [3]. Moreover, anxiety and depression may trigger public disruptive behaviors due to the attitude of people towards diseased individuals. Panic buying due to anxiety or depression leads to the exhaustion of resources, which could affect daily activities, whereas avoidance behavior causes limited socialization. Furthermore, anxious people can adopt various unwanted lifestyle and dietary modifications under the influence of their emotions.

In our study, 17% of the studied sample had COVID-19, and about 9.9% had direct contact with COVID-19 patients. High levels of anxiety were associated with a negative attitude towards COVID-19 patients. About 12% of our study population performed a laboratory test to check for COVID-19 infection, 26.1% consulted a doctor, 2.8% consulted a psychiatrist, and about 9.5% took medications for anxiety, depression, or sleep disturbance. These attitudes confirm the fear and panic among societies due to COVID-19 and can be attributed to lack of knowledge about the disease, deficiency of protective measures, and mistrusted social media news. To reduce stress, people resort to different strategies, including ignoring the guidelines for the prevention of disease spread, increased religious practices, anxiety management, and rational handling of the problem. All these methods are strategic in dealing with epidemics. In our study, the test to identify coping strategies was designed to be compatible with Egyptian society, with its various challenges. We found that the ability of women to adapt to this pandemic and to relieve emotions was significantly greater than that of men. This can be attributed to the ability of women to endure and adapt to surrounding conditions and the ability of women to better implement protective measures to reduce COVID-19 spread.

Our study showed that younger age, high mental effort at work, and getting infected with COVID-19 were significantly associated with higher levels of depression, whereas younger age was the only factor that was associated with higher levels of anxiety. As a result of increased rates of depression and/or anxiety, more patients sought medical

advice and received medications. Next, we sought to determine the effectiveness of coping strategies that were used by our population. Our correlation studies showed that coping strategies such as anxiety management and religious practices were significantly correlated with anxiety and depression. However, rational handling of the problem had a significant negative correlation only with depression. Our results highlight the effectiveness of coping strategies in managing anxiety and/or depression. Therefore, identifying the coping strategies in any population is critical in order to determine which ones will be effective in dealing with stress-related anxiety or depression.

**Author Contributions:** Conceptualization, G.A.S., R.G., S.E., and H.A.E.; methodology, G.A.S., R.G., S.E., and H.A.E.; software, G.A.S., R.G., and S.E.; writing—original drafts, G.A.S., R.G., and S.E.; data collection, G.A.S., R.G., and S.E.; data analysis, G.A.S., R.G., S.E., M.E., D.E.G., and H.A.E.; writing—review and editing, G.A.S., R.G., S.E., M.E., D.E.G., and H.A.E.; investigation, G.A.S., and H.A.E.; validation, G.A.S., R.G., S.E., and H.A.E.; supervision, H.A.E.; project administration, H.A.E.; critical revisions and writing, H.A.E. All authors have read and agreed to the published version of the manuscript.

**Funding:** This research received no external funding.

**Institutional Review Board Statement:** The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Research and Ethics Committee of Assiut University (protocol code 173000433).

**Informed Consent Statement:** Informed consent was obtained from all subjects involved in the study.

**Data Availability Statement:** Not applicable.

**Acknowledgments:** Thanks to all who contributed to this study. We would like to thank Wafaa Farghaly for revising this paper.

**Conflicts of Interest:** The authors declare no conflict of interest.
