Coronavirus disease 2019 (COVID-19) is a novel communicable viral respiratory disease caused by new strains of severe acute respiratory syndrome coronavirus (SARS-CoV-2) [1]. The World Health Organization (WHO) declared the COVID-19 outbreak a public health emergency of international concern (PHEIC) on 30 January 2020, and with the virus spreading worldwide, WHO declared the COVID-19 outbreak could be characterized as a pandemic on 11 March [2]. The first case was reported in Saudi Arabia on 7 March, and increasing numbers were seen all over the world with increased physical distancing and many preventive precautions, including shifting the education system online [3, 4].

COVID-19 doesn’t affect only physical health; it also has a serious negative impact on the psychological well-being of the general population, especially among younger people and females. Many recent Saudi studies have reported significant levels of depression, anxiety, stress, and obsessive-compulsive symptoms among the general population during the pandemic [5–8]. When comparing mental health with pre-COVID-19 in Saudi Arabia, the risk of depression and anxiety was relatively high among general population [9]. Another study showed that the mental health of about one-third of university students in Saudi Arabia were worsened during the pandemic, including anxiety, depression, stress and sleep [10]. And those who were isolating themselves had higher levels of anxiety, depression, and stress [10]. Moreover, in March 2020, as education moved online during the early stage of the pandemic in Saudi Arabia, moderate to high levels of perceived stress were reported among 85% of participating students with a range of educational levels. However, it was significantly higher among university and female students [11]. And in April 2020, two studies were conducted in Saudi Arabia to assess the mental health impact of the pandemic on university students [12, 13]. Symptoms of anxiety, depression, and moderate to high stress were reported among Saudi university students (40.8%, 48.8%, and 86.7%, respectively). These symptoms were significantly higher among females and younger individuals [12]. In addition, symptoms of post-traumatic stress disorder were experienced by 30.9% of Saudi university students; the symptoms were significantly higher in females [13].

Loneliness can arise from a thwarted ability to meet the needs of belongingness and social connection. During the COVID-19 pandemic, students lost interaction, lacked emotional support, and experienced social isolation. These fundamental changes are associated with loneliness, depression, and suicidal thoughts [14, 15]. To our knowledge, no study has evaluated loneliness among university students in Saudi Arabia during the pandemic. This study evaluated quarantine-related loneliness among female university students during the COVID-19 pandemic in Saudi Arabia and investigated its correlation with depression and demographic variables.

To our knowledge, no detailed study had investigated female students’ sense of loneliness and depression in facing the COVID-19 outbreak in Saudi Arabia. This research determines the psychological impact of the outbreak on female students during the 2020 summer vacation. It was found that 63.3% of the female students experienced loneliness and 41.1% experienced depression. And there was a significant positive correlation between loneliness and depression among female students. This can be attributed to the social restrictions calling for physical distancing, which had a negative impact on social activity, networking, and mood [20].

These results were not surprising, as a Saudi national study discovered that the risk of depression increased by 71.2% during the summer of 2020 compared to the pre-pandemic period [9]. Similar results were shown in previous studies conducted in Saudi Arabia during the pandemic. One conducted among people under the Saudi health quarantine noted that the prevalence of depression and anxiety was 49.2% and 44.9%, respectively [21]. Moreover, during the pandemic, moderate to high stress was prevalent (85%) among students studying in virtual classrooms in Saudi Arabia, especially females and university students [11]. Similarly, another two Saudi studies that were conducted during the pandemic showed that university students had significant symptoms of depression (48.8% and 56.3%) and anxiety (40.8% and 40.3%), especially female students [12, 13]. Another study conducted among medical students found that 94% suffered from moderate to high perceived stress, and 47% had anxiety symptoms [22]. Furthermore, an American cross-sectional study showed that loneliness and depression were prevalent among 61.9% and 80%, respectively, of the participants during COVID-19 [23]. In contrast, when comparing our results to some international studies, we noted slight differences. A longitudinal study in Germany comparing the mental health of university students before and during the pandemic found a small increase in depression mean and a medium increase in loneliness [24]. A cross-sectional study conducted in Canada to measure the loneliness among older adults in the community during COVID-19 found that 43.1% of the 4879 participants were lonely during the pandemic [25]. These differences might be due to the difference in the sample size and the age or gender of the participants.

Being married was found to predict a slightly lower level of loneliness in our sample. Marriage has a protective effect on loneliness by building up emotional connectedness [26]. Moreover, this study reported that loneliness and depression were significantly prevalent among female students whose families had insufficient monthly income. This could be explained by the financial cost of virtual socialization and entertainment, including internet bills, websites fees, and electronic devices, which may contribute to social isolation, loneliness, and depression. Also, it was noted that depression is slightly lower among female students with high GPAs, which is consistent with a previous Saudi study among medical students during the pandemic [22]. This can be attributed to academic satisfaction [27, 28]. Additionally, loneliness was reported to be lower among female students in humanities colleges compared to the other colleges. This could be due to the larger number of participants from humanities college (61.5%). It also can be explained by the higher availability of time for socialization compared to other colleges due to less competition or stress.

Furthermore, loneliness and depression were found to be significantly prevalent among female students with a positive history of a psychiatric condition. This finding is in line with previous Saudi studies done during the pandemic among university students [12, 13, 22]. A longitudinal study noted that pre-pandemic depression, distress, and loneliness were predictive factors for depression during the pandemic [24]. This can be explained by the effect of the pandemic in triggering existing psychiatric conditions [29]. This study also noted that loneliness was slightly prevalent among female students with a positive history of a medical condition, which may be due to their strict social isolation to protect themselves from infections. Another Saudi study found that a positive history of a chronic medical condition was a risk factor for depression in university students [12].

Interestingly, the students who had been diagnosed with COVID-19 measured significantly lower loneliness and depression, but having a family or friend with a history of COVID-19 disease didn’t correlate significantly with loneliness or depression. This could be due to social support from the community, which may decrease the sense of loneliness. However, only 14 (1.9%) participants in our study had a positive test of COVID-19, which may limit this finding. Female students’ compliance with home quarantine and the duration spent in quarantine did not correlate significantly with the students’ sense of loneliness. Contrarily, female students who spent 60 days or more in home quarantine had significantly higher depression. Equivalently, a Saudi study done at the beginning of the COVID-19 outbreak stated that depression increased during the later weeks of quarantine [21]. Another Saudi study done during the pandemic found that the duration of quarantine had a notable index of psychological impact [30].

The study had known limitations. First, it had the limitation of convenience sampling, which affects the generalizability of the findings, but we increased the sample size to improve the representation of the sample by recruiting participants from different colleges in the two main universities in the capital city and one of them considered the largest for women in the world. Second, using an online survey might limit our study, but it was a convenient method to reach university students during quarantine. Third, the cross-sectional design of the study does not prove causality relationships and there is a lack of baseline assessment data before the pandemic. Fourth, the sample includes only female students, which limits generalizability to all university students.

In conclusion, loneliness and depression were reported among 63.3% and 41.1% of the female university students in Saudi Arabia over summer vacation during the COVID-19 pandemic and they were correlated positively and significantly. The prevalence of loneliness and depression was significantly higher among students whose families had insufficient monthly income and who had a positive history of a psychiatric condition. This indicates the strong demand for psychosocial interventions for these vulnerable groups during the pandemic. Further longitudinal studies are needed for monitoring and evidence-based interventions.