**Background:** The COVID-19 pandemic imposed quarantine and social isolation measures that negatively impacted mental health globally. Patients with chronic diseases (e.g., hypertension, diabetes, COPD) faced higher risks of severe COVID-19 outcomes and were particularly vulnerable to psychological distress. This study aimed to assess the effect of COVID-19 on medical care among Egyptian patients with chronic diseases through anxiety, depression, or stress caused by the outbreak.
**Methods:** A cross-sectional study was conducted in Egypt between March and June 2021, approved by the Research Ethics Committee (number FMBSUREC/09052021). A total of 2176 participants were invited via text messages; 1450 responded, 379 were excluded for incomplete data, and 35 did not meet inclusion criteria, yielding 1036 eligible responses. Inclusion criteria were: informed consent, residence in Egypt, age ≥18 years, and confirmed chronic condition diagnosis. Data were collected via an online Google form distributed through social media (WhatsApp, Facebook, email). The questionnaire included socio-demographic information and the DASS-21 (21-item self-administered scale) to evaluate emotional states of anxiety, stress, and depression. The DASS-21 showed good internal consistency (Cronbach's alpha: depression 0.872, anxiety 0.910, stress 0.891). The minimum sample size was calculated as 384 using Epi Info StatCalc (95% confidence level, 5% margin of error), tripled to overcome selection bias. Statistical analysis used SPSS version 25, with Chi-Square tests for categorical associations and binary logistic regression to identify determinants of no follow-up.
**Key Results:** The median age was 32 years (mean 32.8 ± 12.8); 56.8% were male; 86.2% lived in rural areas; 52.4% were married. Diabetes and hypertension were the most common chronic diseases, with 37.5% having more than one chronic disorder. Regarding COVID-19 infection status, 59.3% were clinically suspected of having COVID-19; 32.9% went to the hospital, 29% used telemedicine, and 3.58% self-isolated. Medication collection regularly before COVID-19 was reported by 73.6%, dropping to 43.5% during COVID-19. Overall, 52.2% did not follow up for their chronic disease during COVID-19; the main cause was fear of COVID-19 infection (63.2%), followed by cost of medical care with limited resources (21.3%), far site of medical care (9.8%), and inability to find a physician (5.7%). Telemedicine was preferred by 58.0%. DASS-21 results showed: depression was normal in 47.5%, mild 12.3%, moderate 15.8%, severe 12.7%, very severe 11.7%; anxiety was normal in 42.1%, mild 9.0%, moderate 23.3%, severe 9.7%, very severe 16.0%; stress was normal in 64.4%, mild 10.3%, moderate 9.7%, severe 10.8%, very severe 4.8%. Univariate analysis showed that female sex, younger age, low BMI, being unmarried, low educational level, not working, urban residence, and not preferring telemedicine were significantly associated with less regular follow-up (all p < 0.05). Having both diabetes and hypertension was more significantly associated with follow-up. Multivariable binary logistic regression (adjusted for age, gender, residence, depression, anxiety, and stress) found that the presence of anxiety increased the probability of no follow-up (OR 2.693, 95% CI 1.856–3.908, p = 0.001). Older age (>32 years) decreased the probability of no follow-up (OR 0.318, 95% CI 0.236–0.428, p = 0.001), and male sex also decreased it (OR 0.608, 95% CI 0.450–0.822, p = 0.001). Depression and stress were not significant independent predictors in the multivariable model.
**Clinical Implications:** The study demonstrates that the COVID-19 pandemic severely disrupted regular medical follow-up for chronic disease patients in Egypt, with over half discontinuing care. Fear of infection was the dominant barrier, and anxiety was the strongest psychological predictor of no follow-up. These findings underscore the need for integrating mental health support into chronic disease management during pandemics, expanding telemedicine services (preferred by 58% of patients), and ensuring medication access through community pharmacies. The high prevalence of moderate-to-severe depression (45.1%), anxiety (53.8%), and stress (34.8%) among those who did not follow up highlights the bidirectional relationship between psychological distress and care avoidance. Healthcare systems should proactively provide counseling, simplify prescription refills, and establish remote consultation facilities to maintain continuity of care for vulnerable populations during public health emergencies.