Fear of the coronavirus (COVID-19): Predictors in an online study conducted in March 2020

An Investigation of Associations and Incidence of Anxiety, Depression, Perceived Vulnerability to Diseases, and Fear of COVID-19 Among Nigerian Health Care Workers

Background: Health care workers (HCWs) are the frontline of coping COVID-19 pandemic, which indicates the importance of improving their mental wellness to better cope with the situation. Objectives: The current study aimed to firstly assess the severity of anxiety and depression and perceived vulnerability to diseases, and secondly to investigate their association with the fear of COVID-19 among Nigerian HCWs. Methods: For this cross-sectional study, a purposefully selected sample of 413 HCWs from two tertiary healthcare institutions in Benin City, Edo State, South-South Nigeria, responded to the Fear of COVID-19 Scale, Hospital Anxiety and Depression Scale, and Perceived Vulnerability to Disease Scale. Data was collected between October 2020 and February 2021. Descriptive statistics were used to summarize socio-demographic variables, while inferential statistics (t-test for independent samples, one-way ANOVA, and linear regression) were used to test hypotheses. Results: A high prevalence of anxiety, depression, and perceived vulnerability to diseases (PVD) was observed. Perceived infectability (β = 0.244, P = 0.000), germ aversion (β = 0.166, P = 0.000), and composite PVD (β = 0.96, P = 0.000) were identified as independent and significant predictors of fear of COVID-19, accounting for 7.5; 3.3, and 9.9% variance in the severities of Fear of COVID-19, respectively. Anxiety and depression showed a significant joint prediction of Fear of COVID-19 severity, accounting for a 4.0% variance in the severity. Fear of COVID-19 was not found to be influenced by sex or job type differences among the HCWs. Conclusions: This study demonstrated a high incidence of anxiety, depression, and perceived vulnerability to COVID-19 among Nigerian HCWs. These reported symptoms of psychopathology are also strong independent and joint predictors of fear of COVID-19.

Exploring factors in fear of COVID-19 and its GIS-based nationwide distribution: the case of Bangladesh

BACKGROUND

The COVID-19 pandemic is a public health threat of international concern, intensifying peoples' psychological risk and vulnerability by strengthening mental health stressors such as fear, panic and uncertainty. The unexpected fear of COVID-19 has been reported to be associated with suicide occurrences, similar to prior pandemics.

AIMS

Identifying the factors associated with fear of COVID-19 could help us to develop better mental health strategy and practice to improve the situation here in Bangladesh. This was the first attempt to present a Geographic Information System (GIS)-based distribution of fear of COVID-19 across the country's administrative districts in a nationwide sample.

METHOD

Data for a total of 10 067 individuals were collected by an online survey during the first wave of the pandemic (1 to 10 April 2020); data for 10 052 participants were finally analysed after excluding 15 transgender individuals. The survey questionnaire included items concerning sociodemographic, behavioural and health-related variables, COVID-19-related issues, and the Bangla Fear of COVID-19 Scale.

RESULTS

The mean fear of COVID-19 scores was 21.30 ± 6.01 (out of a possible 35) in the present sample. Female gender, highly educated, non-smoker, non-alcohol consumer, having chronic diseases, using social media, and using social media and not using newspapers as COVID-19 information sources were associated with a higher level of fear of COVID-19. Higher levels of fear of COVID-19 were found in districts of Magura, Panchagarh, Tangail, Sunamganj and Munshiganj; by contrast, Kushtia, Pirojpur, Chapainawabganj, Jhalokathi and Naogaon districts had lower fear of COVID-19. Based on the GIS-distribution, fear of COVID-19 was significantly associated with the district as well as in respect to its gender-based and education-level-based associations. However, fear of COVID-19 and COVID-19 cases were heterogeneously distributed across the districts; that is, no consistent association of higher COVID-19 cases with higher fear of COVID-19 was found.

CONCLUSIONS

This study being exploratory in nature may help to facilitate further studies, as well as directing governmental initiatives for reducing fear of COVID-19 in at-risk individuals. Providing adequate resources and mental health services in the administrative regions identified as highly vulnerable to fear of COVID-19 is recommended.

Quality of life and fear of COVID-19 in 2600 baccalaureate nursing students at five universities: a cross-sectional study

Background

The COVID-19 pandemic has caused significant disruptions in the implementation of programs across educational institutions. Nursing students, being both young adults and by practical training, part of the health care system, may be particularly vulnerable during the COVID-19 pandemic. The purpose of this study was to explore the associations between self-reported fear of COVID-19, general health, psychological distress and overall quality of life (QoL) in a sample of Norwegian baccalaureate nursing students compared to reference data.

Methods

The survey targeted baccalaureate nursing students from five universities in February 2021. An electronic questionnaire consisted of the Fear of COVID-19 Scale (FCV-19S), the Hopkins Symptom Checklist 5 (SCL-5), one general health and one overall QoL question. The respondents’ mean scores were compared to reference data. Hierarchical regression analyses were conducted, and effect sizes (Cohen’s d) were evaluated.

Results

In total, 2605 out of 6088 (43%) students responded. Their FCV-19S scores (mean 2.45, CI 2.42, 2.48) were significantly higher than those of the reference population (mean 1.8, P < 0.001). Nursing students scores showed significantly lower general health (mean 3.50 ± 0.93 SD, population mean = 3.57, Cohen’s d = 0.07), higher levels of psychological distress (mean 2.68 ± 1.03 SD, population mean = 2.12, Cohen’s d = 0.55) and lower overall QoL (mean 5.50 ± 2.16 SD, population mean = 8.00, Cohen’s d = 1.16) compared to pre-pandemic reference data. FCV-19S scores were significantly associated with levels of general health (Cohen’s d = 0.26), psychological distress (Cohen’s d = 0.76) and overall QoL (Cohen’s d = 0.18).

Conclusions

Baccalaureate nursing students reported worse outcomes during the Covid-19 pandemic on general health, psychological distress and overall QoL compared to the reference population. Level of fear of Covid-19, however, accounted for few of these differences. Other factors related to the pandemic may have reduced nursing students’ overall QoL.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12955-021-01837-2.

Psychometric Validation of the Arabic Fear of Illness and Virus Evaluation

Global infectious pandemics can affect the psychology and behavior of human beings. Several tools were developed to evaluate the psychological impact of such outbreaks. The present study aimed to examine the psychometric properties of the Arabic translated version of Fear of Illness and Virus Evaluation scale (FIVE). FIVE is a 35-item tool consisting of four subscales that measure Fears about Contamination and Illness, Fears about Social Distancing, Behaviors Related to Illness and Virus Fears and Impact of Illness and Virus Fears. The tool was translated into Arabic by using a forward-backward translation. The online questionnaire contained the following sections: demographics, FIVE, Fear of COVID-19 Scale (FCV-19S) and face validity questions. Non-probability convenient sampling technique was used to recruit participants via a mobile instant messaging application. Reliability, concurrent validity, face validity and factor analysis were examined. The data consisted of 509 adult participants who reside in Saudi Arabia. The internal consistency of the Arabic FIVE subscales was high (0.84-0.91) with strong concurrent validity indicated by positive correlations of FIVE subscales with FCV-19S. Factor analysis suggested slightly different factor structures (Fears of Getting Sick, Fears that Others Get Sick, Fears of the Impact on Social Life and Behaviors Related to Illness and Virus Fears). Our data showed a better fit using the proposed structures. The Arabic version of the FIVE showed robust validity and reliability qualities to assess fear of COVID-19 on Arabic adult population.

The psychological impact of the COVID-19 pandemic on Dutch people with and without an inflammatory rheumatic disease

OBJECTIVES

To determine the psychological impact of the COVID-19 pandemic on people with and without an inflammatory rheumatic disease and establish whether psychological flexibility buffers this impact.

METHODS

From online surveys in the general Dutch population in 2018 and during the peak of the COVID-19 pandemic in 2020, we analysed data of people with (index group, n = 239) and without (control group, n = 1821) an inflammatory rheumatic disease. Worry, stress, mental well-being (SF-36) and psychological flexibility levels were subjected to covariate-adjusted analyses of variance or linear regression analyses.

RESULTS

During the peak of the COVID-19 pandemic in 2020, as compared with the control group, the index group was more worried about getting infected with the virus (partial η2=0.098; medium effect) and more stressed (partial η2=0.040; small effect). However, as compared with data acquired in 2018, the level of mental well-being during the COVID-19 pandemic peak was not lower in both groups. Levels of psychological flexibility did not moderate associations of group or year with mental well-being.

CONCLUSIONS

Although patients with an inflammatory rheumatic disease were more worried and stressed during the peak of the COVID-19 pandemic, their level of mental well-being was not reduced, which may have prevented us from finding a buffering effect of psychological flexibility. Overall, our results suggest that the psychological impact of the COVID-19 pandemic in patients with inflammatory rheumatic disease is modest, which could imply that common education and health care will do for most patients.

Primary Health Care Nurses' Perceptions of Risk During COVID-19: A Qualitative Study

PURPOSE

COVID-19 has presented health care professionals with unprecedented challenges. Significant risks have emerged as nurses have continued to work in delivering frontline health care during the pandemic. Feeling "at risk" has significant deleterious effects on nurses. The study sought to explore the perceptions of risk by Australian primary health care nurses (PHC) during COVID-19.

METHODS

Twenty-five Australian PHC nurses were purposively recruited from survey respondents who indicated a willingness to be interviewed. Phone interviews were undertaken between June and August 2020. Audio-recordings were transcribed and analyzed thematically.

FINDINGS

Participants shared concerns about risks in the workplace that emerged during COVID-19 and described the strategies used to mitigate these identified risks. Three themes were identified: (a) Professional concerns, (b) Personal/family concerns, and (c) Patient needs.

CONCLUSIONS

Understanding PHC nurses' perceptions of risk during COVID-19 provides an important insight into how they can be better supported to manage the risks that they face and feel safer in their workplace. Ensuring that PHC nurses are well-supported is important to optimize job satisfaction, reduce burnout and improve patient care.

CLINICAL RELEVANCE

There is a need to ensure that nurses feel safe during crises such as pandemics to protect both individual nurses and the broader workforce. Protecting the health workforce is essential to optimizing service delivery and promoting health outcomes.

Exploring the Interrelationship between COVID-19 Phobia, Work–Family Conflict, Family–Work Conflict, and Life Satisfaction among School Administrators for Advancing Sustainable Management

This study aims to investigate the relationships between the COVID-19 phobia experienced by school administrators and their work–family conflict, family–work conflict, and life satisfaction. This descriptive research, designed according to the relational survey model, was conducted with the participation of 356 school administrators. The study data were collected through online questionnaires, and then t-test, ANOVA, correlation analysis, and simple linear regression analysis were employed for the statistical analyses. The results revealed that female school administrators experienced greater levels of COVID-19 phobia than their male peers and that COVID-19 phobia is felt more intensely in the psychological and social sub-dimensions. However, female school administrators’ life satisfaction levels were significantly higher than those of male school administrators. In the current study, it was determined that school administrators in the younger age group experienced greater levels of COVID-19 phobia and family–work/work–family conflict than their peers from other age groups. The results of this study revealed a positive and moderate relationship between school administrators’ COVID-19 phobia and their levels of both work–family and family–work conflict. The findings of the study offer significant implications for policy makers in education, showing the importance of developing strategies that will reduce the effects of the pandemic for a more sustainable and efficient employee performance.

Health-, medication- and dietary supplement-related behaviors and beliefs relatively unchanged during the COVID-19 pandemic lockdown

BACKGROUND

The lockdown imposed to counter the coronavirus disease 2019 (COVID-19) pandemic has evoked an unprecedented phenomenon that could affect health behaviors and beliefs.

OBJECTIVE

To examine how medication-, dietary supplement- and health-related behaviors, beliefs and other psychological constructs changed in Polish online health service users during the COVID-19 pandemic lockdown.

METHODS

A one-time online survey accessed through a health service website was completed before and during the pandemic lockdown by separate samples of respondents. The survey examined beliefs about medicines and dietary supplements, consumption of dietary supplements, trust and contact with their advertisements, sources of dietary supplement knowledge as well as perceived health, diet, physical activity and smoking, among other things.

RESULTS

The study included 1560 participants. Most examined outcomes remained unchanged over COVID-19 pandemic lockdown. Beliefs that the dietary supplement quality is well controlled became significantly more pronounced during the lockdown (adjusted ratio of estimates 1.16, 95%CI 1.06-1.27, p = 0.001). Fewer people reported having contact with dietary supplement advertisements (adjusted odds ratio 0.59, 95%CI 0.43-0.83, p = 0.002).

CONCLUSIONS

The results may help understand some health-related issues associated with COVID-19 pandemic lockdown and may be used to shape aspects of health-related policy.

Social influence matters: We follow pandemic guidelines most when our close circle does

Why do we adopt new rules, such as social distancing? Although human sciences research stresses the key role of social influence in behaviour change, most COVID-19 campaigns emphasize the disease's medical threat. In a global data set (n = 6,675), we investigated how social influences predict people's adherence to distancing rules during the pandemic. Bayesian regression analyses controlling for stringency of local measures showed that people distanced most when they thought their close social circle did. Such social influence mattered more than people thinking distancing was the right thing to do. People's adherence also aligned with their fellow citizens, but only if they felt deeply bonded with their country. Self-vulnerability to the disease predicted distancing more for people with larger social circles. Collective efficacy and collectivism also significantly predicted distancing. To achieve behavioural change during crises, policymakers must emphasize shared values and harness the social influence of close friends and family.

Loneliness during the COVID-19 pandemic: change and predictors of change from strict to discontinued social distancing protocols

BACKGROUND AND OBJECTIVES

The COVID-19 pandemic and the social distancing protocols designed to impede transmission of the corona virus have severe mental health consequences. This study examine changes in loneliness in the general adult population when the corona-related social distancing protocols were largely discontinued (T2) following a period of strict protocols (T1), predictors and correlates of these changes, and the associations between loneliness and depression and anxiety symptoms.

DESIGN

In an online survey, 10,061 responded at T1. At T2, these respondents were asked to complete the survey again, and 4936 (49.1%) of them responded.

RESULTS

Loneliness decreased from T1 to T2, but only to a minor extent. Using a multilevel approach, younger age was found to be related to more reduction of loneliness from T1 to T2. Higher health anxiety was found to predict less reduction of loneliness across time. Reduction of maladaptive coping strategies and negative metacognitive beliefs from T1 to T2 were both associated with reduction in loneliness. In turn, reductions in loneliness were associated with reductions of depression and anxiety symptoms.

CONCLUSIONS

The results suggest that health anxiety, maladaptive coping strategies and negative meta-beliefs are potential targets of intervention to alleviate loneliness.

CLINICAL TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT04444115.

How have journalists been affected psychologically by their coverage of the COVID-19 pandemic? A descriptive study of two international news organisations

OBJECTIVES

The COVID-19 pandemic has presented unprecedented healthcare challenges. Journalists covering the pandemic at close quarters are working in ways akin to first responders, but nothing to date is known of the psychological distress this is potentially causing them. This study aims to determine whether journalists reporting on the COVID-19 crisis have been affected emotionally, and if so to assess the severity of their distress. It also investigates potential demographic and work-related predictors and whether news organisations had provided counselling to their journalists.

PARTICIPANTS

A total of 111 journalists working for two international news organisations were approached of which 73 (66%) participated in the study.

PRIMARY AND SECONDARY OUTCOME MEASURES

Symptoms of anxiety (Generalised Anxiety Disorder Scale-7 (GAD-7)), depression (Patient Health Questionnaire (PHQ-9)), posttraumatic stress disorder (PTSD; PTSD Checklist for DSM-5 (PCL-5)), overall psychological distress (12-item General Health Questionnaire (GHQ-12)), and treatment.

RESULTS

The percentages of journalists exceeding threshold scores for clinically significant anxiety, depression, PTSD and psychological distress were: GAD-7, 26%; PHQ-9, 20.5%; PCL-5, 9.6%; GHQ-12, 82.2%. Journalists assigned to cover the pandemic (n=54 (74%)) were significantly more anxious (p<0.05). Journalists who received counselling (n=38 (52%)) following the onset of the pandemic reported significantly fewer symptoms of anxiety (p<0.01), depression (p<0.01) and overall psychological distress (p<0.01).

CONCLUSIONS

Journalists covering the COVID-19 pandemic are experiencing levels of anxiety and depression similar to those seen in first responders. Psychological therapy provided in a timely manner can significantly alleviate emotional distress.

A Cross-Cultural Study of Distress during COVID-19 Pandemic: Some Protective and Risk Factors

Previous studies on the impact of the COVID-19 pandemic on mental health in different countries found an increase in anxiety, stress, and an exacerbation of previous mental health problems. This research investigated some of the protective and risk factors of distress during the COVID-19 pandemic, among which were the perception of receiving social support from family members and friends, and a chronic tendency to worry. The study was conducted in three European countries: Italy, Serbia, and Romania. A total of 1100 participants (Italy n = 491; Serbia n = 297; Romania n = 312) responded to a questionnaire. Results from this study show that distress during the COVID-19 pandemic is higher for people who are chronic worriers and those who have higher levels of fear of COVID-19. More specifically, it is confirmed that a chronic tendency to worry exacerbates the relationship between fear and distress: it is stronger for people who have a greater tendency to worry.

Prevalence and risk factors of worry among teachers during the COVID-19 epidemic in Henan, China: a cross-sectional survey

OBJECTIVE

To evaluate the level of worry and its influencing factors during the COVID-19 epidemic among teachers in Henan Province in China.

STUDY DESIGN

A cross-sectional study was conducted.

METHODS

We designed a cross-sectional survey that included 88 611 teachers from three cities in Henan Province, China between 4 February 2020 and 12 February 2020. Level of worry was measured using a five-item Likert scale, with 1 being 'not worried' and 5 being 'very worried'. The OR and 95% CI of potential influencing factors for level of worry among study participants were estimated using ordinal logistic regression models.

RESULTS

About 59% of teachers reported being 'very worried' about the COVID-19 epidemic. The proportion of female teachers was higher than of male teachers (60.33% vs 52.89%). In all age groups considered in this study, a 'very worried' condition accounted for the highest proportion. The age group 40-49 years had the lowest proportion of participants who were very worried, 52.34% of whom were men and 58.62% were women. After controlling for potential confounding factors, age, education level, type of teacher, school location, attention level, fear level, anxiety level and behaviour status were all related to level of worry (all p<0.05).

CONCLUSION

During the COVID-19 epidemic, there was a high proportion of teachers who were 'very worried' about the situation in Henan Province, China. Our study may remind policymakers to consider factors including age, educational status, type of teacher, school location, source of information on COVID-19, attention level, anxiety level, fear level and behaviour status to alleviate worry.

Factors Related to COVID-19 Preventive Behaviors: A Structural Equation Model

Background: While COVID-19 has rapidly spread around the world, and vaccines are not widely available to the general population, the World Health Organization outlines preventive behavior as the most effective way to limit the rapid spread of the virus. Preventive behavior is associated with a number of factors that both encourage and discourage prevention. Aim: The aim of this research was to study COVID-19 threat appraisal, fear of COVID-19, trust in COVID-19 information sources, COVID-19 conspiracy beliefs and the relationship of socio-demographic variables (gender, age, level of education, place of residence, and employment status) to COVID-19 preventive behavior. Methods: The data originate from a national cross-sectional online survey (N = 2,608) undertaken in July 2020. The data were analyzed using structural equation modeling. Results: COVID-19 threat appraisal, trust in COVID-19 information sources, and fear of COVID-19 are all significant predictors of COVID-19 preventive behaviors. Together they explain 26.7% of the variance of this variable. COVID-19 conspiracy beliefs significantly negatively predict COVID-19 threat appraisal (R 2 = 0.206) and trust in COVID-19 information sources (R 2 = 0.190). COVID-19 threat appraisal contributes significantly and directly to the explanation of the fear of COVID-19 (R 2 = 0.134). Directly, as well as mediated by COVID-19 conspiracy beliefs, threat appraisal predicts trust in COVID-19 information sources (R 2 = 0.190). The relationship between COVID-19 threat appraisal and COVID-19 preventive behaviors is partially mediated by fear of COVID-19 (indirect effect 28.6%) and trust in information sources (15.8%). Socio-demographic variables add very little in prediction of COVID-19 preventive behavior. Conclusions: The study results demonstrate that COVID-19 threat appraisal is the most important factor associated with COVID-19 preventive behavior. Those Latvian residents with higher COVID-19 threat appraisal, experienced higher levels of fear of COVID-19, had more trust in COVID-19 information sources, and were more actively involved in following COVID-19 preventive behaviors. COVID-19 conspiracy beliefs negatively predict COVID-19 threat appraisal and trust in COVID-19 information sources, but not the COVID-19 preventive behaviors. Socio-demographic factors do not play an important role here.

Impact of the COVID-19 pandemic on stress and emotional reactions in Israel: a mixed-methods study

BACKGROUND

The COVID-19 pandemic has had a profound impact worldwide. This study sought to assess the pandemic's psychological impact on the Israeli public.

METHODS

Using mixed methods we assessed Israeli adults during the COVID-19 outbreak. In the quantitative study, participants (N=1407) completed an online battery of measures assessing psychological variables and perceived threat related to COVID-19. Statistical analyses included tests for between-group differences and Pearson correlations. The qualitative study entailed in-depth, semistructured interviews conducted by telephone (N=38).

RESULTS

The quantitative findings indicate that about 48% of the public had negative emotional reactions and 20% perceived they were liable to contract the virus. Moreover, a positive correlation was found between these feelings and the degree of perceived threat. Three major themes emerged from the qualitative study: 1) a sense of shock and chaos; 2) gradual adjustment to the new reality; and 3) fears and concerns for self and family members. The study's results revealed the following sources of participants' emotional responses and sense of threat: health concerns regarding themselves and their loved ones; employment concerns; problems with children and spouses caused by being together at home; and difficulties entailed in working at home.

CONCLUSIONS

The study reveals many of the psychological variables and perceived threats related to COVID-19 in Israel. While social distancing may make people feel safer, it can also increase their feelings of isolation, stress and frustration and cause difficulties in many life situations. The findings point to the necessity of addressing the public's perceived susceptibility and emotional reactions about COVID-19.

Changes in fears and worries related to COVID-19 during the pandemic among current employees in Japan: a 5-month longitudinal study

Objectives

This study investigates and describes the time course of fears and worries about COVID-19 among current employees during this outbreak.

Study design

This was a longitudinal study.

Methods

This study was a part of the Employee Cohort Study in Japan. The study comprised 4120 individuals from February 2019. A baseline survey in March 2020, a 2-month follow-up survey in May 2020, and a 5-month follow-up survey in August 2020 were conducted. Questions surveyed respondents’ global fear and worry and six items related to COVID-19. A mixed model for repeated measures of an analysis of variance was used.

Results

A total of 1421 respondents completed the baseline survey. At 2- and 5-month follow-ups, 1032 and 1181 respondents completed surveys, respectively. Of those, 64 and 33 individuals who were temporarily laid off or on leave were recorded as missing values. Global fear and worry about COVID-19 significantly increased from March to August 2020. Fears of personal or family infection, limiting one's activities and national and local government policies also significantly increased with time. In contrast, fears of lack of knowledge and difficulty of obtaining hygiene products significantly decreased.

Conclusion

To conduct efficient risk communication during a pandemic, knowing the concerns of the populace, providing correct information and a sufficient supply of products, and setting clear guidelines are essential.

Emotions in Covid-19 Twitter discourse following the introduction of social contact restrictions in Central Europe

Aim

Non-pharmaceutical interventions such as lockdowns have played a critical role in preventing the spread of the Covid-19 pandemic, but may increase psychological burden. This study sought to examine emotions reflected in social media discourse following the introduction of social contact restrictions in Central Europe.

Subjects and methods

German-language Twitter posts containing ‘#corona’ and ‘#covid-19’ were collected between 2020/03/18 – 2020/04/24. A total of 79,760 tweets were included in the final analysis. Rates of expressions of positive emotion, anxiety, sadness and anger were compared over time. Bi-term topic models were applied to extract topics of discussion and examine association with emotions.

Results

Rates of anxiety, sadness and positive emotion decreased in the period following the introduction of social contact restrictions. A total of 16 topics were associated with emotions, which related to four general themes: social contact restrictions, life during lockdown, infection-related issues, and impact of the pandemic on public and private life. Several unique patterns of association between topics and emotions emerged.

Conclusion

Results suggest decreasing polarity of emotions among the public following the introduction of social contact restrictions. Monitoring of social media activity may prove beneficial for an adaptive understanding of changing public concerns during the Covid-19 pandemic.

Competitive anxiety or Coronavirus anxiety? The psychophysiological responses of professional football players after returning to competition during the COVID-19 pandemic

OBJECTIVE

This study aimed to examine the relationship between competitive anxiety, fear/anxiety of COVID-19, and autonomic and endocrine stress responses in professional football players after returning to competition during the COVID-19 pandemic.

METHODS

Ninety male professional football players (age: 26.33 ± 2.48 yr) volunteered to participate in this study, which included an official competition. Psychophysiological responses, including the Fear of COVID-19 Scale, the Coronavirus Anxiety Scale, and the Competitive State Anxiety Inventory-2 Revised, were collected 30 min before the competition. In addition, salivary alpha-amylase (sAA) and salivary cortisol (sCort) were collected at 8 a.m. and 15 min before the competition.

RESULTS

The main findings, based on the Pearson correlation, showed significant positive correlations between COVID-19 anxiety and somatic competitive anxiety (p = 0.01), cognitive competitive anxiety (p = 0.01), and competition response of sCort and sAA (p = 0.01). Moreover, fear of COVID-19 was positively correlated with COVID-19 anxiety (p = 0.01). On the contrary, the awakening response of sCort and sAA was not found to be correlated with psychological parameters (all p > 0.05). The analysis also indicated that there was no significant correlation between self-confidence with other psychological and physiological variables (all p > 0.05). The regression analysis showed that cognitive anxiety was a relevant predictor for the competition response of sCort and sAA (p < 0.05). Moreover, COVID-19 anxiety was the only predictor of somatic and cognitive anxiety (p < 0.05).

CONCLUSIONS

The present study provides the first preliminary evidence that COVID-19 anxiety and competitive anxiety might pose a negative impact on the athletic performance of professional football players during COVID-19 pandemic competitions. Thus, research is needed to build a strategy to reduce the psychophysiological stress related to COVID-19 and competition response.

Pattern of Tobacco Use and Perceived Risk of COVID-19 Following Tobacco Use among the COVID-19 Patients of a Tertiary Health Care Institution in Eastern India

BACKGROUND

COVID-19 presented an unprecedented situation in which behavioural factors including tobacco use were believed to increase the risk of morbidity and mortality. The objective of the present study was to find the tobacco use pattern among the COVID-19 patients and the perceived risk of developing severe COVID-19 following tobacco use.

METHODS

This hospital-based, cross-sectional, analytical study was conducted among 300 COVID-19 patients at the All India Institute of Medical Sciences (AIIMS), Patna, India, during November and December 2020 using a semi-structured, pretested questionnaire. Descriptive and univariate analyses were performed using statistical software and the results were presented as proportion and percentage.

FINDINGS

About 27% and 16% of the COVID-19 patients were ever and current tobacco users, respectively. Quit attempts were found to have increased during the COVID-19 pandemic. A majority (65%) of current tobacco users had reduced their amount of tobacco use. Nearly 2 in every 3 patients perceived high risk of developing severe COVID-19 following tobacco use. Perceived risk was significantly higher among tobacco non-users, patients who were aware of the ill health effects of tobacco use, and patients who had noticed anti-tobacco messages or had been advised to quit tobacco. Among the current tobacco users, a significantly higher proportion of patients who perceived high risk of developing severe COVID-19 following tobacco use had made quit attempts or had reduced tobacco consumption during the pandemic (76.7% vs. 40%; P = 0.032).

CONCLUSION

A high proportion of COVID-19 patients believed that tobacco use aggravated the COVID-19 condition. Increased quit attempts and reduction in tobacco consumption during this pandemic is a positive sign for tobacco control.

Fearing fear itself: Crowdsourced longitudinal data on Covid-19-related fear in Sweden

BACKGROUND

The Covid-19 pandemic has had unprecedented effects on individual lives and livelihoods as well as on social, health, economic and political systems and structures across the world. This article derives from a unique collaboration between researchers and museums using rapid response crowdsourcing to document contemporary life among the general public during the pandemic crisis in Sweden.

METHODS AND FINDINGS

We use qualitative analysis to explore the narrative crowdsourced submissions of the same 88 individuals at two timepoints, during the 1st and 2nd pandemic waves, about what they most fear in relation to the Covid-19 pandemic, and how their descriptions changed over time. In this self-selected group, we found that aspects they most feared generally concerned responses to the pandemic on a societal level, rather than to the Covid-19 disease itself or other health-related issues. The most salient fears included a broad array of societal issues, including general societal collapse and fears about effects on social and political interactions among people with resulting impact on political order. Notably strong support for the Swedish pandemic response was expressed, despite both national and international criticism.

CONCLUSIONS

This analysis fills a notable gap in research literature that lacks subjective and detailed investigation of experiences of the general public, despite recognition of the widespread effects of Covid-19 and its' management strategies. Findings address controversy about the role of experts in formulating and communicating strategy, as well as implications of human responses to existential threats. Based on this analysis, we call for broader focus on societal issues related to this existential threat and the responses to it.

A Comparison of Depression and Anxiety among University Students in Nine Countries during the COVID-19 Pandemic

The mental health of young adults, particularly students, is at high risk during the COVID-19 pandemic. The purpose of this study was to examine differences in mental health between university students in nine countries during the pandemic. The study encompassed 2349 university students (69% female) from Colombia, the Czech Republic (Czechia), Germany, Israel, Poland, Russia, Slovenia, Turkey, and Ukraine. Participants underwent the following tests: Patient Health Questionnaire (PHQ-8), Generalized Anxiety Disorder (GAD-7), Exposure to COVID-19 (EC-19), Perceived Impact of Coronavirus (PIC) on students' well-being, Physical Activity (PA), and General Self-Reported Health (GSRH). The one-way ANOVA showed significant differences between countries. The highest depression and anxiety risk occurred in Turkey, the lowest depression in the Czech Republic and the lowest anxiety in Germany. The χ2 independence test showed that EC-19, PIC, and GSRH were associated with anxiety and depression in most of the countries, whereas PA was associated in less than half of the countries. Logistic regression showed distinct risk factors for each country. Gender and EC-19 were the most frequent predictors of depression and anxiety across the countries. The role of gender and PA for depression and anxiety is not universal and depends on cross-cultural differences. Students' mental health should be addressed from a cross-cultural perspective.

Coping strategies adapted by Ghanaians during the COVID-19 crisis and lockdown: A population-based study

BACKGROUND

The COVID-19 pandemic and control measures adopted by countries globally can lead to stress and anxiety. Investigating the coping strategies to this unprecedented crisis is essential to guide mental health intervention and public health policy. This study examined how people are coping with the COVID-19 crisis in Ghana and identify factors influencing it.

METHODS

This study was part of a multinational online cross-sectional survey on Personal and Family Coping with COVID-19 in the Global South. The study population included adults, ≥18 years and residents in Ghana. Respondents were recruited through different platforms, including social media and phone calls. The questionnaire was composed of different psychometrically validated instruments with coping as the outcome variable measured on the ordinal scale with 3 levels, namely, Not well or worse, Neutral, and Well or better. An ordinal logistic regression model using proportional odds assumption was then applied.

RESULTS

A total of 811 responses were included in the analysis with 45.2% describing their coping level as well/better, 42.4% as neither worse nor better and 12.4% as worse/not well. Many respondents (46.9%) were between 25-34 years, 50.1% were males while 79.2% lived in urban Ghana. Having pre-existing conditions increased the chances of not coping well (aOR = 1.86, 95%CI: 1.15-3.01). Not being concerned about supporting the family financially (aOR = 1.67, 95%CI: 1.06-2.68) or having the feeling that life is better during the pandemic (aOR = 2.37, 95%CI: 1.26-4.62) increased chances of coping well. Praying (aOR: 0.62, 95%CI: 0.43-0.90) or sleeping (aOR: 0.55, 95%CI: 0.34-0.89) more during the pandemic than before reduces coping.

CONCLUSION

In Ghana, during the COVID-19 pandemic, financial security and optimism about the disease increase one's chances of coping well while having pre-existing medical conditions, praying and sleeping more during the pandemic than before reduces one's chances of coping well. These findings should be considered in planning mental health and public health intervention/policy.

Mindfully Reframing the Psychological Impact of the COVID-19 Outbreak Through a Social Media Community for Students: A Pragmatic Study

The COVID-19 outbreak and the restrictions that have been enforced by the health authorities are having a profound psychological impact on the population. Many people, including the students, faced forced modifications to their daily lives and this prompted the need for scalable strategies to promote resilience. We designed an online community intervention for psychology students and recent alumni aimed to promote functional coping strategies through openness and cognitive flexibility. This psycho-educational intervention was delivered through a private group on social media (Facebook) during the acute phase of the lockdown period and it involved the publication of exercises and quick lectures. Contents were posted regularly and members of the community were invited to share their comments. The posts included stimuli that promote open and flexible reflections on the current situation. The overall aim of this group was a cognitive reframing on the epidemic effects, promoting creative and flexible thinking. We ran a thematic analysis of the interactions and we collected qualitative feedback at the end of the intervention. The participants' comments dealt with changes in their perspectives, sharing discomfort, encouragement and support, and building a sense of community. Post-intervention comments were highly satisfied and confirmed the helpfulness of the intervention to promote flexibility and openness, eventually helping to manage the negative emotions related to the COVID-19 outbreak. This study provides preliminary evidence that an online psycho-educational community stimulating flexibility and openness can help to reframe the negative psychological impact of the outbreak, improving their management.

Prevalence and Factors Associated with Fear of COVID-19 Among Homeless Individuals During the COVID-19 Pandemic: Evidence from the Hamburg Survey of Homeless Individuals

PURPOSE

To clarify the prevalence and determinants of fear of COVID-19 among homeless individuals during the COVID-19 pandemic.

PATIENTS AND METHODS

Data were taken from the Hamburg survey of homeless individuals (n=150) covering homeless adults in Hamburg, Germany. Multiple linear regressions were used. Beyond sociodemographic and lifestyle-related independent variables, COVID-19-related factors were also used as independent variables.

RESULTS

In sum, 56.2% of homeless individuals reported no fear of COVID-19, 23.8% reported a little fear of COVID-19, 9.2% reported some fear of COVID-19 and 10.8% reported severe fear of COVID-19. Regressions showed that an increased fear of COVID-19 was significantly associated with younger age (β=-.01, p<0.05), absence of chronic alcohol consume (β=-.55, p<0.01), an increased perceived own risk of getting infected with the coronavirus one day (β=0.42, p<0.001) and a higher agreement that a diagnosis of the coronavirus would ruin his/her life (β=0.13, p<0.01).

CONCLUSION

Given the poor hygienic conditions and their increased vulnerability, data surprisingly suggest a quite low fear of COVID-19 among homeless individuals. Efforts may be beneficial which contribute to thinking rationally about COVID-19 among homeless people, since low levels of fear of COVID-19 may contribute to careless behavior and can lead to super-spreading events.

Are older adults of Rohingya community (Forcibly Displaced Myanmar Nationals or FDMNs) in Bangladesh fearful of COVID-19? Findings from a cross-sectional study

Aim

This study aimed to assess the fear of COVID-19 and its associates among older Rohingya (Forcibly Displaced Myanmar Nationals or FDMNs) in Bangladesh.

Method

We conducted a cross-sectional survey among 416 older FDMNs aged 60 years and above living in camps of Cox’s Bazar, Bangladesh. A semi-structured questionnaire was used to collect information on participants’ socio-demographic and lifestyle characteristics, pre-existing non-communicable chronic conditions, and COVID-19 related information. Level of fear was measured using the seven-item Fear of COVID-19 Scale (FCV-19S) with the cumulative score ranged from 7 to 35. A multiple linear regression examined the factors associated with fear.

Results

Among 416 participants aged 60 years or above, the mean fear score was 14.8 (range 8–28) and 88.9% of the participants had low fear score. Participants who were concerned about COVID-19 (β: 0.63, 95% CI: -0.26 to 1.53) and overwhelmed by COVID-19 (β: 3.54, 95% CI: 2.54 to 4.55) were significantly more likely to be fearful of COVID-19. Other factors significantly associated with higher level of fear were lesser frequency of communication during COVID-19, difficulty in obtaining food during COVID-19, perception that older adults are at highest risk of COVID-19 and receiving COVID-19 related information from Radio/television and friends/family/neighbours.

Conclusions

Our study highlighted that currently there little fear of COVID-19 among the older Rohingya FDMNs. This is probably due to lack of awareness of the severity of the disease in. Dissemination of public health information relevant to COVID-19 and provision of mental health services should be intensified particularly focusing on the individual who were concerned, overwhelmed or fearful of COVID-19. However, further qualitative research is advised to find out the reasons behind this.

Stress levels among an international sample of pregnant and postpartum women during the COVID-19 pandemic

BACKGROUND

Stress is a complex condition that can have a profound effect on an individual's sense of wellbeing and their ability to live a happy and healthy life. COVID-19 and its associated stressors have the potential to disrupt numerous facets of our everyday lives. Pregnant and postpartum women are especially vulnerable to changes in the availability of routine health and social care services and of their support networks. The current study sought to explore stress levels and their influencers among an international cohort of pregnant and postpartum women during the COVID-19 pandemic.

METHODS

We conducted an anonymous, online, cross-sectional survey in 64 countries between May and June 2020. The survey was hosted on the Pregistry platform and made available in 12 languages, with respondents sought through a variety of social media platforms and parenting forums. In addition to levels of stress, we collected data related to demographics, COVID-19 exposure and worries, lifestyle changes, traditional and social media use, precautionary measures related to COVID-19, and mental health.

RESULTS

In total, 7185 women were included in our sample. We found statistically significant (p-value <0.05) reductions in stress score among older women (≥35 years of age), those either living with a partner or married, those who had graduated from college, and those with medical coverage. Higher stress scores were found among women who resided in Africa, Asia and the Pacific, the Middle East, and North America compared with those in Europe. When race and ethnicity were included in the model, black women were found to have higher stress compared to white women. Level of family and community support was inversely associated with level of stress.

CONCLUSION

Our study is one of the first to explore stress levels among pregnant and postpartum women during the COVID-19 pandemic. We found statistically significant differences in stress levels by age, education, marital status, region of residence, race/ethnicity and level of support. Understanding stress during the COVID-19 pandemic, and exploring ways to address it, will be key to contributing to the mental and physical health of expectant and new mothers, as well as their children, in both the short and long term.

Perceived Stress During the First Wave of COVID-19 Outbreak: Results From Nationwide Cross-Sectional Study in Estonia

Objective: To study the population-level mental health responses during the first wave of coronavirus disease 2019 (COVID-19) outbreak in Estonia and analyze its socio-demographic, behavioral, and health-related variations among general population. Methods: This study used nationally representative data on 4,606 individuals, aged 18-79 years from a rapid-response cross-sectional survey conducted in April 2020. Point prevalence and mutually adjusted prevalence rate ratios for perceived stress from log-binomial regression analysis were presented for socio-demographic, behavioral, and health-related variables. Results: This study found that 52.2% of population aged 18-79 reported elevated stress levels in relation to COVID-19 outbreak. Higher levels of perceived stress were found in women, in younger age groups, in Estonians, and in those with higher self-perceived infection risk, presence of respiratory symptoms, and less than optimal health, according to self-reports. Conclusion: Although, the potential long-term health effects of the current crisis are yet unknown, the alarmingly high stress levels among people indicate that the COVID-19 pandemic might have had a widespread effect on people's mental health.

Evaluating the association between urban green spaces and subjective well-being in Mexico city during the COVID-19 pandemic

This paper examines the association between the frequency of use of urban green spaces (UGS) and the subjective well-being (SWB) of Mexico City's residents during the COVID-19 pandemic. We conducted an online survey (N = 1954) regarding individuals' perceptions and use of UGS and their SWB, evaluated through the short version of the Warwick-Edinburgh mental well-being scale. Multilevel mixed-effects regression analyses were performed to investigate the association between the frequency of UGS use and SWB, including individual and municipal level characteristics as covariates. Our results suggest that respondents who used UGS once or more per week during the pandemic reported higher SWB scores (8.7%) than those with zero visits. These findings have public policy implications that could enhance the role of UGS in urban environments during times of crisis.

Systematic Review and Meta-Analysis of Fear of COVID-19

Background: Due to lack of preparedness of health systems, fast spread of the new virus, high mortality rates, and lack of a definite treatment, the outbreak of Coronavirus disease (COVID-19) led to high levels of fear and anxiety in different populations. In addition, isolation, mental disorders, and limitations in social interactions as a result of lockdown and travel ban increased the fear of the new coronavirus. Methods: International databases, including Scopus, PubMed, Web of Science, and Google scholar, were searched without any time limitation, and all observational studies published in English reporting the mean of fear of COVID-19 based on the Fear of COVID-19 scale (FCV-19S) were included in the analysis. Methodological quality was assessed using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Random effects model, subgroup analysis, and meta-regression analysis were used to analyze the data. Heterogeneity across studies was examined using Cochran's Q test and I ² statistic. All the statistical analyses were conducted using R software v4.0.3. Results: A total of 44 articles with a sample size of 52,462 were reviewed. A pooled mean of 18.57 was found for fear of COVID-19. The mean of fear of COVID-19 was higher in women than in men (20.67 vs. 18.21). The highest and lowest means of fear of COVID-19 had been found in Asia (18.36) and Australia (17.43) based on continent, and in hospital staff (19.51) and college students (17.95) based on target population, respectively. In addition, the highest and lowest means of fear of COVID-19 were related to items #1 and #3 of the scale, respectively. According to the results of meta-regression analysis, there was no significant association between the mean of fear of COVID-19 and sample size and participants' age. In addition, publication error was not significant (P = 0.721). Conclusion: The mean of fear of COVID-19 was high around the world; therefore, it seems necessary to pay more attention to the negative effects of the COVID-19 pandemic on mental health.

Fear of the Unknown: Does Fear of Terrorism Differ From Fear of Contracting COVID-19?

The aim of the study was to explore whether living under constant security threat would result in better coping and higher resilience when exposed to an unknown threat such as the COVID-19 pandemic. Thus, fear of COVID-19 and fear of terrorism as well as the associations with coping strategies and resilience were examined among Israelis living in conflict zones as well as Israelis living in the center, where exposure to security incidents is rare. Six hundred and fifteen Israeli adults (260 men and 356 women) were interviewed via the internet while Israel was under mandatory first lockdown. Fear of COVID-19 was found to be higher than fear of terrorism among both groups. those living in the conflict zones and those living in the central Israel. In contradiction to our assumption, we found that those who were living in a conflict zone did not exhibit higher levels of resilience and did not cope better when exposed to a new threat-even though they may be more skilled at handling prolonged exposure to a threat such as terrorism. A regression analysis indicated that the best predictor of both fear of COVID-19 and of terrorism is financial concerns-more than geographical area.

The relationship between fear of COVID-19 and health anxiety among families with COVID-19 infected: The mediating role of metacognitions, intolerance of uncertainty and emotion regulation

The current study aimed to investigate the mediating role of metacognitions, intolerance of uncertainty and emotion regulation in the relationship between fear of COVID-19 (FC-19) and health anxiety, among families with COVID-19 infected. Participants were 541 individuals from family members of patients with COVID-19 (F = 52.3%, mean age = 41.3 ± 13.2 years). Data were collected with a packet including sociodemographic and risk factors, the Fear of COVID-19 Scale, the Short Health Anxiety Inventory, the Metacognitions Questionnaire 30, the Intolerance of Uncertainty Scale-12 and the Emotion Regulation Questionnaire. Structural equation modelling analyses revealed a full mediation of metacognitions (i.e., positive beliefs about worry, negative beliefs about thoughts concerning uncontrollability and danger, cognitive confidence and beliefs about the need to control thoughts), intolerance of uncertainty and expressive suppression in the relation between FC-19 and health anxiety. Moreover, the strongest indirect links were found between FC-19 and health anxiety through negative beliefs about thoughts concerning uncontrollability and danger and intolerance of uncertainty. These associations were independent of gender and risk status. The final model accounted for 71% of the variance of health anxiety. These findings suggest that particularly metacognitions, intolerance of uncertainty and expressive suppression play a full mediational role in the relation between FC-19 and health anxiety.

Traumatic Distress, Alexithymia, Dissociation, and Risk of Addiction During the First Wave of COVID-19 in Italy: Results from a Cross-sectional Online Survey on a Non-clinical Adult Sample

This study aimed to explore the prevalence of post-traumatic distress, alexithymia, dissociation, and addictive behaviors during the stressful situation of the COVID-19 pandemic. It also aimed to determine whether trauma, alexithymia, and dissociation can effectively predict the risk of addiction in non-clinical subjects during the COVID-19 pandemic. Two hundred nineteen subjects completed a web survey during the first COVID-19 lockdown in Italy, including the Impact of Event Scale-Revised (IES-R), the Dissociative Experience Scale-II (DES-II), and the Addictive Behavior Questionnaire (ABQ). Females reported higher levels of COVID-19-related traumatic stress than males (p = 0.009). A greater fear of getting COVID-19 was associated with significantly high IES-R scores (p < 0.0005). IES-R total score was significantly lower in the "not internet-addicted" group than that in the "internet-addicted" group (p < 0.0005). Furthermore, DES-II total score was significantly higher in the "internet-addicted" group than that in the "non internet-addicted" group (p < 0.0005). No statistically significant score differences were highlighted in the "alcohol" group. Future research with longitudinal studies and larger samples will have to clarify whether trauma, alexithymia, and dissociation can effectively predict the risk of addiction in non-clinical subjects during the COVID-19 pandemic.

Self-Perceived Life Satisfaction during the First Wave of the COVID-19 Pandemic in Sweden: A Cross-Sectional Study

Currently, there is limited knowledge on how the Swedish strategy with more lenient public health restrictions during the COVID-19 pandemic has influenced people's life satisfaction. Here, we investigated self-reported life satisfaction during the first wave of the pandemic in Sweden, and perceived changes in life satisfaction in relation to various sociodemographic factors. A total of 1082 people (mean age 48 (SD 12.2); 82% women) responded to an online survey during autumn 2020 including the "Life Satisfaction Questionnaire-11". A majority (69%) were satisfied with life as a whole, and with other important life domains, with the exception of contact with friends and sexual life. An equal share reported that life as a whole had either deteriorated (28%) or improved (29%). Of those that perceived a deterioration, 95% considered it to be due to the pandemic. Regarding deteriorated satisfaction with life as a whole, higher odds were found in the following groups: having no children living at home; being middle aged; having other sources of income than being employed; and having a chronic disease. The Swedish strategy might have contributed to the high proportion of satisfied people. Those who perceived a deterioration in life satisfaction may, however, need attention from Swedish Welfare Authorities.

Using Fear and Anxiety Related to COVID-19 to Predict Cyberchondria: Cross-sectional Survey Study

BACKGROUND

Studies have highlighted that fear and anxiety generated by COVID-19 are important psychological factors that affect all populations. There currently remains a lack of research on specific amplification factors regarding fear and anxiety in the context of the COVID-19 pandemic. Despite established associations between anxiety sensitivity, intolerance of uncertainty, and cyberchondria, empirical data investigating the associations between these three variables, particularly in the context of the COVID-19 pandemic, are currently lacking. Urgent research is needed to better understand the role of repeated media consumption concerning COVID-19 in amplifying fear and anxiety related to COVID-19.

OBJECTIVE

This study investigated the associations between fear of COVID-19, COVID-19 anxiety, and cyberchondria.

METHODS

Convenience sampling was used to recruit respondents to participate in an online survey. The survey, which was distributed via social media and academic forums, comprised the Cyberchondria Severity Scale, Fear of COVID-19 Scale, Coronavirus Anxiety Scale, Anxiety Sensitivity Index, and Intolerance of Uncertainty Scale. Multiple mediation analyses were conducted using structural equation modeling.

RESULTS

A total of 694 respondents (males: n=343, females: n=351) completed the online survey. The results showed that fear and anxiety generated by COVID-19 predicted cyberchondria (fear: β=.39, SE 0.04, P<.001, t=11.16, 95% CI 0.31-0.45; anxiety: β=.25, SE 0.03, P<.001, t=7.67, 95% CI 0.19-0.32). In addition, intolerance of uncertainty and anxiety sensitivity mediated the relationship between fear and anxiety generated by COVID-19 with cyberchondria. In a reciprocal model, the standardized total effects of cyberchondria on fear of COVID-19 (β=.45, SE 0.04, P<.001, t=15.31, 95% CI 0.39-0.51) and COVID-19 anxiety (β=.36, SE 0.03, P<.001, t=11.29, 95% CI 0.30-0.41) were statistically significant, with moderate effect sizes. Compared to males, females obtained significantly higher scores for cyberchondria (t1,692=-2.85, P=.004, Cohen d=0.22), COVID-19 anxiety (t1,692=-3.32, P<.001, Cohen d=0.26), and anxiety sensitivity (t1,692=-3.69, P<.001, Cohen d=0.29).

CONCLUSIONS

The findings provide a better understanding of the role of COVID-19 in amplifying cyberchondria. Based on these results, cyberchondria must be viewed as a significant public health issue. Importantly, increasing awareness about cyberchondria and online behavior at both the individual and collective levels must be prioritized to enhance preparedness and to reduce the adverse effects of current and future medical crises.

Using Fear and Anxiety Related to COVID-19 to Predict Cyberchondria: Cross-sectional Survey Study

Background

Studies have highlighted that fear and anxiety generated by COVID-19 are important psychological factors that affect all populations. There currently remains a lack of research on specific amplification factors regarding fear and anxiety in the context of the COVID-19 pandemic. Despite established associations between anxiety sensitivity, intolerance of uncertainty, and cyberchondria, empirical data investigating the associations between these three variables, particularly in the context of the COVID-19 pandemic, are currently lacking. Urgent research is needed to better understand the role of repeated media consumption concerning COVID-19 in amplifying fear and anxiety related to COVID-19.

Objective

This study investigated the associations between fear of COVID-19, COVID-19 anxiety, and cyberchondria.

Methods

Convenience sampling was used to recruit respondents to participate in an online survey. The survey, which was distributed via social media and academic forums, comprised the Cyberchondria Severity Scale, Fear of COVID-19 Scale, Coronavirus Anxiety Scale, Anxiety Sensitivity Index, and Intolerance of Uncertainty Scale. Multiple mediation analyses were conducted using structural equation modeling.

Results

A total of 694 respondents (males: n=343, females: n=351) completed the online survey. The results showed that fear and anxiety generated by COVID-19 predicted cyberchondria (fear: β=.39, SE 0.04, P<.001, t=11.16, 95% CI 0.31-0.45; anxiety: β=.25, SE 0.03, P<.001, t=7.67, 95% CI 0.19-0.32). In addition, intolerance of uncertainty and anxiety sensitivity mediated the relationship between fear and anxiety generated by COVID-19 with cyberchondria. In a reciprocal model, the standardized total effects of cyberchondria on fear of COVID-19 (β=.45, SE 0.04, P<.001, t=15.31, 95% CI 0.39-0.51) and COVID-19 anxiety (β=.36, SE 0.03, P<.001, t=11.29, 95% CI 0.30-0.41) were statistically significant, with moderate effect sizes. Compared to males, females obtained significantly higher scores for cyberchondria (t1,692=–2.85, P=.004, Cohen d=0.22), COVID-19 anxiety (t1,692=–3.32, P<.001, Cohen d=0.26), and anxiety sensitivity (t1,692=–3.69, P<.001, Cohen d=0.29).

Conclusions

The findings provide a better understanding of the role of COVID-19 in amplifying cyberchondria. Based on these results, cyberchondria must be viewed as a significant public health issue. Importantly, increasing awareness about cyberchondria and online behavior at both the individual and collective levels must be prioritized to enhance preparedness and to reduce the adverse effects of current and future medical crises.

Purchasing under threat: Changes in shopping patterns during the COVID-19 pandemic

The spreading of COVID-19 has led to panic buying all over the world. In this study, we applied an animal model framework to elucidate changes in human purchasing behavior under COVID-19 pandemic conditions. Purchasing behavior and potential predictors were assessed in an online questionnaire format (N = 813). Multiple regression analyses were used to evaluate the role of individually Perceived Threat of COVID-19, anxiety related personality traits (trait-anxiety, intolerance of uncertainty) and the role of media exposure in predicting quantity and frequency of purchasing behavior. High levels of Perceived Threat of COVID-19 were associated significantly with a reported reduction in purchasing frequency (b = -.24, p < .001) and an increase in the quantity of products bought per purchase (b = .22, p < .001). These results are comparable to observed changes in foraging behavior in rodents under threat conditions. Higher levels of intolerance of uncertainty (b = .19, p < .001) and high extend of media exposure (b = .27, p < .001) were positively associated with Perceived Threat of COVID-19 and an increase in purchasing quantity. This study contributes to our understanding of aberrated human purchasing behavior and aims to link findings from animal research to human behavior beyond experimental investigations.

Accepting Restrictions and Compliance With Recommended Preventive Behaviors for COVID-19: A Discussion Based on the Key Approaches and Current Research on Fear Appeals

COVID-19 (Coronavirus disease 2019) is a novel coronavirus which was first detected in late December 2019 in the Wuhan Province of China. This novel coronavirus, caused by a zoonotic beta-coronavirus (SARS-CoV-), is described as highly infectious. The World Health Organization (WHO) named the novel coronavirus as COVID-19 on February 11, 2020, and declared it as a "pandemic." Almost all countries have undertaken wide-scale precautions so as to prevent or limit the spread of the virus, with most having practiced some form of "lockdown" along with "social distancing," as well as dispensed recommendations for proper hand washing, avoiding touching the face, wearing facemasks, and using disposable tissues when either coughing or sneezing. Whereas it is well known that slowing the spread of this new epidemic requires the cooperation of all citizens, some people still seem to willfully disregard the rules and guidelines, and thereby ignore the health risks posed to both themselves and to others they come into contact with. People have responded differently to lockdown rules and social distancing practices. Whilst the majority follow the rules and recommendations with great care, others are more lax or simply refuse to comply. These differences might be accounted for according to a number of factors including personal, social, cultural, mental, and economic variables. Being persuaded to comply with preventive rules, especially those concerned with health-related behaviors, also bring certain other factors into play. Fear is one of those factors, and is one of the most powerful. It is well known that fear-based appeals can be effective in inculcating health behaviors, with many theories having been developed in this area. However, both the content of the message (the level of the fear it contains) and certain personal variables can determine the persuasive power of the fear appeal. It can even have an adverse effect if not properly applied. Many theories have been developed to address the persuasive effectiveness of the fear appeal (e.g., fear-drive theory, protection-motivation theory), and this study aims to discuss these individual differences in precautionary and preventive measures for the COVID-19 pandemic within the framework of the basic assumptions of these theoretical approaches.

The Moderating Role of Caregiving on Fear of COVID-19 and Post-Traumatic Stress Symptoms

Caregiving has been associated with increased levels of fear and post-traumatic stress symptoms (PTSS) during COVID-19 pandemic. However, there is a lack of studies that analyze when the relationship between fear and PTSS occur, using informal caregiving as a moderator variable. To explore this moderating role, we conducted a cross-sectional online study between November 2020 and January 2021. A total of 503 men and women from the Spanish general population completed the survey. Sociodemographic and Covid-19-related data, fear of COVID-19, PTSS symptoms, and current psychological history were assessed. Prevalence of informal caregiving in the sample was 16.5%. Increased levels of fear and PTSS were found in caregivers compared to non-caregivers. Female gender and high number of COVID-19 related risk factors was also associated with fear and PTSS severity. The moderation analyses showed an interaction effect between caregiving and fear of COVID-19 when predicting PTSS symptoms. Particularly, results showed that informal caregivers reported greater PTSS symptoms, when compared to non-caregivers with same levels of fear of COVID-19. This evidence suggests that being a caregiver could increase the fear's impact on PTSS severity in the context of pandemics. Further studies with larger samples are needed to confirm these findings.

Community cohesion during the first peak of the COVID-19 pandemic: A social antidote to health anxiety and stress

Social support gained through community ties has been pivotal in dealing with stressful events. A cross-sectional community sample (N = 2,329) was gathered to assess community cohesion buffering against heath anxiety and perceived stress during the first peak of the pandemic in the UK, using structural equation modeling analyses. Community cohesion acted as a protective mechanism against both health anxiety and stress during the first national lockdown. A strong positive association was also found between health anxiety and stress. Stress and health anxiety scores peaked in the first weeks of the imposed quarantine; as the lockdown was extended, participants reported lower stress, health anxiety and community cohesion scores. The reduction of community cohesion scores was greater for those younger than 45 while the positive association between stress and health anxiety was stronger among males during the lockdown. While community cohesion effects against health anxiety were enhanced for females, community's buffering against stress were greater for males. Strengthening citizens' psychological sense of community through the publicization and support of local initiatives and mutual-aid groups and utilizing methodically green (and blue) spaces to boost neighborhood attraction might be viable strategies within which stress and health anxiety can be suppressed. Conversely, allowing community, regional and national cracks to deepen can exacerbate the impact of stressful events experienced during the COVID-19 pandemic.

Perceived Stress During the COVID-19-Related Confinement in Cyprus

The COVID-19 pandemic is a serious global health emergency that could potentially have a significant impact on both somatic as well as psychological level. The aim of this study was to assess the prevalence of perceived stress in the general adult population of Cyprus during the first COVID-19 lockdown period. This was an internet-based cross-sectional study conducted between 6 April and 20 June 2020, one to two and a half months after the introduction of and the first mandatory lockdown on its entire territory imposed by the government of the Republic of Cyprus on 24 March 2020. Data collection was done using a self-administered questionnaire that included information about socioeconomic and demographic characteristics, physical activity, smoking habits, and stress level. A total of 1,485 adults participated in the study. The median perceived stress score was 10 (q1 = 6, q3 = 15). Linear regression models showed that having a medium monthly income (€501-1,500) and being a current smoker was positively associated with the perceived stress score, while being male and physically active was negatively associated with the perceived stress score (all p <0.05). People with medium average salary and current smokers were at a higher risk for perceived stress. Psychological interventions and/or psychological services provided in certain vulnerable groups would be beneficial in future lockdowns due to either COVID-19 or a new pandemic.

Real versus illusory personal growth in response to COVID-19 pandemic stressors

BACKGROUND

There is considerable evidence of widespread emotional distress associated with the COVID-19 pandemic. A growing number of studies have assessed posttraumatic growth related to the current pandemic; but, none have considered whether reported growth is real or illusory (i.e., characterized by avoidant or defensive coping that results in higher levels of distress). The purpose of this study was to extend this literature by assessing growth specific to the pandemic in people reporting high levels of COVID-related stress and estimating the extent of real and illusory COVID-19-related growth.

METHODS

Participants were 893 adults from Canada and the United States with high levels of COVID-related stress who provided complete responses on measures of posttraumatic growth, disability, and measures of general and COVID-related distress as part of a larger longitudinal survey.

RESULTS

Approximately 77 % of participants reported moderate to high growth in at least one respect, the most common being developing greater appreciation for healthcare workers, for the value of one's own life, for friends and family, for each day, as well as changing priorities about what is important in life and greater feelings of self-reliance. Consistent with predictions, cluster analysis identified two clusters characterized by high growth, one comprising 32 % of the sample and reflective of real growth (i.e., reporting little disability and stable symptoms across time) and the other comprising 17 % of the sample and reflective of illusory growth (i.e., reporting high disability and worsening symptoms). These clusters did not differ in terms of socially desirable response tendencies; but, the illusory growth cluster reported greater increases in alcohol use since onset of the pandemic.

CONCLUSION

Consistent with research regarding personal growth in response to prior pandemics and COVID-19, we found evidence to suggest moderate to high levels of COVID-related growth with respect to appreciation for healthcare workers, life, friends and family, and self-reliance. Findings from our cluster analysis support the thesis that many reports of COVID-related personal growth reflect ineffectual pandemic-related coping as opposed to true growth. These findings have important implications for developing strategies to optimize stress resilience and posttraumatic growth during chronically stressful events such as pandemics.

Can Personality Traits Predict Depression during the COVID-19 Pandemic?

The emotional costs of the COVID-19 pandemic have raised concerns among clinicians and scholars. The goal of the current study was to test whether or not neuroticism, conscientiousness, and personal belief in a just world are associated with depression during the COVID-19 pandemic. Moreover, the contribution of neuroticism and conscientiousness was assessed over and above demographic variables and COVID-19 perceptions, and the unique contribution of personal belief in a just world was evaluated beyond all the other study variables. Samples were collected in three different countries-Israel (N = 917), Germany (N = 213), and India (N = 160). Online self-report questionnaires were utilized to measure age, gender, COVID-19 perceptions (probability, severity, and self-efficacy), neuroticism, conscientiousness, personal belief in a just world, and depression. The findings indicated that, across the three countries, neuroticism was positively associated with depression (correlations ranging from .24 to .44), and conscientiousness and personal belief in a just world were negatively associated with depression (correlations ranging from - .31 to - .21, and from - .35 to - .23, respectively). Moreover, neuroticism and conscientiousness explained unique variance over and above demographic variables and COVID-19 perceptions (except conscientiousness in India), and the effect of personal belief in a just world on depression was significant beyond the effects of all other study variables. These findings support the role of personality in explaining depression regardless of situational characteristics and stress the role of just world beliefs as protective factors against negative emotions.

Optimism, mindfulness, and resilience as potential protective factors for the mental health consequences of fear of the coronavirus

The COVID-19 pandemic has a substantial impact on mental health. Prior reports have shown that depression, anxiety, and stress have increased throughout the pandemic. Nonetheless, not everyone is affected by these negative consequences and some people may be relatively unaffected. In this online study in a predominantly Dutch and Belgian sample (N = 546), we investigated whether positive personality traits such as optimism, mindfulness, and resilience may protect against the negative mental health consequences (i.e., fear of the coronavirus, depression, stress, and anxiety) of the COVID-19 pandemic. We found that fear of COVID-19 was related to higher depression, stress, and anxiety. However, for participants scoring high on mindfulness, optimism, and resilience, this relationship was weakened. In addition to these findings, we present the results of network analyses to explore the network structure between these constructs. These results help to identify possible ways through which psychological well-being can be promoted during the COVID-19 pandemic.

The latent and item structure of COVID-19 fear: A comparison of four COVID-19 fear questionnaires using SEM and network analyses

Since the outbreak of the coronavirus disease (COVID-19), several reports have shown that fear relating to COVID-19 has sharply increased. To measure fear of COVID-19, various questionnaires have been developed in parallel. However, fear concerning COVID-19 is not necessarily a uniform construct and the different questionnaires may cover diverse aspects. To examine the underlying structure of fear of COVID-19, we conducted structural equation modelling and network analyses on four scales in an online convenience sample (N = 829). Particularly, the Fear of COVID-19 Scale (Ahorsu et al., 2020), the Fear of the Coronavirus Questionnaire (Mertens et al., 2020), and the COVID Stress Scales (Taylor, Landry, Paluszek, Fergus et al., 2020, Taylor, Landry, Paluszek, Rachor et al., 2020) were included in our study, along with a new scale that also assessed socio-economic worries relating to COVID-19. We found that fear of COVID-19 was best classified into four clusters: Fear of health-related consequences, fear of supplies shortages and xenophobia, fear about socio-economic consequences, and symptoms of fear (e.g., compulsions, nightmares). We also find that a central cluster of items centered on fear of health, which likely represents the core of fear of COVID-19. These results help to characterize fear due to COVID-19 and inform future research.

The repercussions of perceived threat from COVID-19 on the mental health of actively employed nurses

In the confrontation with the COVID-19 pandemic, threat perceived by the nursing population, and its association with sociodemographic and contextual characteristics, must be measured and evaluated as well as their repercussions on their mental health. Therefore, the purpose of this study was to analyse the repercussion of perceived threat from COVID-19 on the mental health of actively employed nurses, considering a COVID-19 diagnosis, whether their own or of someone close to them. The sample was comprised of 351 nurses. Sociodemographic data were collected, and the Questionnaire on Perception of Threat from COVID-19 and the General Health Questionnaire were administered. The three demographic and contextual variables mentioned were related to mental health, mediated in some symptoms by perceived threat. These results provide important information for implementing measures or psychoeducational programs for nurses, essential in the present pandemic for improving psychological adaptation and reducing the effects on their mental health.

Exploring the Occupational Balance of Young Adults during Social Distancing Measures in the COVID-19 Pandemic

(1) Background: A balanced life is related to good health in young people, one of the groups most affected by confinement and social distancing measures during the COVID-19 pandemic. This study aims to explore the occupational balance of young adults during home confinement and its association with different sociodemographic factors. (2) Methods: A cross-sectional study was designed, and an online survey was disseminated to collect sociodemographic and occupational balance data, using the Occupational Balance Questionnaire (OBQ). The statistical analysis was performed using the SPSS statistical software package version 24.0. (3) Results: 965 young adults between 18 and 30 years old participated in the study. A predictive model showed that the main predictors of a lower occupational balance were a negative self-perception (β= 0.377; p = <0.0001), student status (β = 0.521; p = 0.001), not receiving enough information (β = 0.951; p = 0.001) and long periods of quarantine (β = 0.036; p = 0.007). (4) Conclusions: Considering people's occupational health and related factors could lessen many of the psychosocial consequences of isolation and contribute to the well-being of young people.

Mindfulness practice for protecting mental health during the COVID-19 pandemic

Emerging evidence shows that the coronavirus disease 2019 (COVID-19) pandemic is negatively affecting mental health around the globe. Interventions to alleviate the psychological impact of the pandemic are urgently needed. Whether mindfulness practice may protect against the harmful emotional effects of a pandemic crisis remains hitherto unknown. We investigated the influence of mindfulness training on mental health during the COVID-19 outbreak in China. We hypothesized that mindfulness practitioners might manifest less pandemic-related distress, depression, anxiety, and stress than non-practitioners and that more frequent practice would be associated with an improvement in mental health during the pandemic. Therefore, we assessed pandemic-related distress and symptoms of depression, anxiety, and stress, as well as the frequency of meditation practice at the peak of new infections (Feb 4-5; N = 673) and three weeks later (Feb 29-30; N = 521) in mindfulness practitioners via online questionnaires. Self-reported symptoms were also collected from non-practitioners at peak time only (N = 1550). We found lower scores of pandemic-related distress in mindfulness practitioners compared to non-practitioners. In general, older participants showed fewer symptoms of depression and anxiety. In younger practitioners, pandemic-related distress decreased from peak to follow-up. Importantly, increased mindfulness training during the preceding two weeks was associated with lower scores of depression and anxiety at both assessments. Likewise, practice frequency predicted individual improvement in scores of depression, anxiety, and stress at follow-up. Our results indicate that mindfulness meditation might be a viable low-cost intervention to mitigate the psychological impact of the COVID-19 crisis and future pandemics.

Experiencing COVID-19 symptoms without the disease: The role of nocebo in reporting of symptoms

Background:

A nocebo effect occurs when inactive factors lead to worsening of symptoms or reduce treatment outcomes. Believing that one is or has been infected with COVID-19 may act as a nocebo. However, not much is known about potential nocebo effects associated with the reporting of COVID-19 symptoms.

Aim:

An online survey investigated whether certainty of being infected with COVID-19, age, sex, cognitive, emotional and personality factors were associated with perceived severity of COVID-19 symptoms.

Methods:

Participants (N=375) filled out an online survey containing 57 questions asking about symptoms resembling COVID-19, certainty of being infected with COVID-19, anxiety, stress and personality dimensions.

Results:

Certainty of being infected with COVID-19 and anxiety predicted 27% of the variance in reporting of COVID-like symptoms. The mediation analysis showed that both higher certainty of being infected and anxiety independently predicted increased reports of COVID-like symptom. Females had higher anxiety and stress levels, and reported more COVID-like symptoms than males did. Older age was not associated with reporting COVID-like symptoms.

Conclusions:

Believing to be infected with COVID-19, along with anxiety, can enhance the severity of COVID-like symptoms. Thus, the nocebo effect was due to both cognitive and emotional factors and was higher in females.

Physical Activity during the First Lockdown of the COVID-19 Pandemic: Investigating the Reliance on Digital Technologies, Perceived Benefits, Barriers and the Impact of Affect

The measures to fight the spread of the COVID-19 pandemic have been concentrated on inviting people to stay at home. This has reduced opportunities to exercise while also shedding some light on the importance of physical health. Based on an online survey, this paper investigated physical activity behaviours of a Belgians sample (n = 427) during the lockdown period between the end of May 2020 and the beginning of June 2020 and found that, during this period, the gap between sufficiently and insufficiently active individuals widened even more. This paper analysed important moderators of physical activity behaviours, such as barriers and benefits to exercise, digital support used to exercise, and individuals’ emotional well-being. Descriptive analysis and analyses of variance indicated that, generally, individuals significantly increased their engagement in exercise, especially light- and moderate-intensity activities, mostly accepted the listed benefits but refused the listed barriers, increased their engagement in digital support and did not score high on any affective measures. A comparison between sufficiently active and insufficiently active individuals during the lockdown showed that the former engaged even more in physical activity, whereas the latter exercised equally (i.e., not enough) or even less compared to before the lockdown. By means of a logistic regression, five key factors of belonging to the sufficiently active group were revealed and discussed. Practical implications for government and policies are reviewed.