The prospective influence of COVID-19 affective risk assessments and intolerance of uncertainty on later dimensions of health anxiety

Profiles of Intolerance of Uncertainty Among 108,540 Adolescents: Associations with Sociodemographic Variables and Mental Health

Intolerance of uncertainty (IU) is widely considered a transdiagnostic risk and maintaining factor for psychiatric disorders. However, little is known about the overall nature and profile of IU among adolescents. This study aims to investigate the profiles of IU among Chinese adolescents and explore their associations with sociodemographic characteristics and mental health problems. A sample of 108,540 adolescents provided data on IU, sociodemographic characteristics, and mental health via an online platform. Latent profile analysis revealed three profiles: Low IU, Medium IU, and High IU. Girls, older adolescents, and those with specific sociodemographics were more likely to belong to the "High IU" profile. Furthermore, the "High IU" profile was associated with the highest risk of several mental health problems. These findings provided valuable information for early prevention and intervention strategies targeting IU and highlighted the importance of IU-based interventions for mental health among adolescents.

The Effects of General Mental Health Symptomatology, COVID Anxiety, and Sociodemographic Factors on Pandemic-Induced Negative and Positive Trauma Effects: A Polish Survey from the Late Stages of the Pandemic

Background/Objectives: COVID-19, caused by the SARS-CoV-2 virus, emerged in late 2019 and rapidly became a global pandemic, affecting over 200 countries. The pandemic has had profound impacts on global health, the economy, and mental health, leading to increased anxiety and more cases of posttraumatic stress disorder in the general population. This study aimed to evaluate the factors influencing the long-term psychological effects, both positive and negative, seen in the late stages of the COVID-19 pandemic in Poland (starting in the second half of 2021). It combined specific COVID-19 anxiety factors with a broader general mental health assessment to identify significant associations. Methods: Data were collected from 416 participants through paper-based and online questionnaires, with 235 valid responses gathered in total. This study utilized the Coronavirus Anxiety Scale; General Health Questionnaire (GHQ-28); and, to study Positive Trauma Effects (PTEs) and Negative Trauma Effects (NTEs), the Changes in Outlook Questionnaire. Data analysis was performed using the R language and a Generalized Additive Model analysis was also performed. Results: The study found generally low levels of COVID-19 anxiety and mental distress among participants. Significant predictors of NTEs included COVID-19 anxiety and general mental health status, which explained 47% of the variance. PTEs were significantly associated with gender, with women experiencing higher PTE levels relative to men. Conclusions: The findings indicate that combining specific ailment anxiety measurements with general mental health assessments enhances our ability to predict Negative Trauma Effects. Addressing mental health symptomatology and well-being during mass health crises is crucial to mitigate long-lasting psychological damage.

Impact of Self-Reported Long-Term Mental Health Morbidity on Help-Seeking and Diagnostic Testing for Bowel-Related Cancer Symptoms: A Vignette Study

OBJECTIVE

To investigate if pre-existing mental health morbidity (MHM) might influence help-seeking and willingness to undergo diagnostic investigations for potential colorectal cancer (CRC) symptoms.

METHODS

An online vignette survey was completed by 1307 adults aged > 50 years recruited through Prolific, a UK panel provider. Participants self-reported any chronic physical or MHM. After having been presented with vignettes describing new onset symptoms (rectal bleeding or change in bowel habit), participants answered questions on symptom attribution and attitudes to investigations. Using multivariable logistic regression we examined the association between MHM and symptom attribution, intended help-seeking, and willingness to undergo investigations, controlling for socio-demographic factors and physical morbidities.

RESULTS

Self-reported MHM (reported by 14% of participants) was not associated with cancer symptom attribution (29% of participants with or without MHM mentioned cancer as a possible reason for rectal bleeding and 14% for change in bowel habit). Individuals with self-reported MHM were less likely to contact a GP if experiencing a change in bowel habit (19% vs. 39%; adjusted (a)OR = 0.34, 95% CI 0.19-0.60) and to mention rectal bleeding to their GP (83% vs. 89%, aOR = 0.49, 95% CI 0.26-0.94). Although most participants would be willing to undergo a colonoscopy for these high-risk symptoms, those with depression/anxiety were less willing (90% vs. 96%; aOR: 0.37, 95% CI 0.16-0.87).

CONCLUSIONS

Individuals with self-reported MHM are less likely to seek help and less willing to undergo investigations for high-risk symptoms. Targeted support, for example, through additional mental health nurses, might facilitate prompt cancer diagnosis for the large group of people with MHM.

Intolerance of Uncertainty as a Situational Vulnerability Factor in the Context of the Pandemic: A Systematic Review and Meta-Analysis of COVID-19-Related Psychological Impacts

BACKGROUND

Intolerance of uncertainty (IU) is widely accepted as a transdiagnostic vulnerability factor for a range of mental health problems. It is considered a transsituational vulnerability factor associated with a range of responses to different stressful life situations. The aim of this systematic review and meta-analysis is to examine the association between IU and specific psychological responses to the COVID-19 pandemic and the moderators of this relationship drawn from IU research and other studies on COVID-19.

METHOD

The studies included were as follows: (i) English-language articles published in peer-reviewed journals or thesis/dissertations; (ii) reporting specific psychological impacts of COVID-19; (c) reporting IU; (iii) case-control studies, prospective cohort studies, experimental studies and cross-sectional studies of large populations and (iv) reporting correlation coefficients between the variables of interest. Studies on participants with a diagnosis of neurological and/or organic impairment were excluded. The databases searched were Google Scholar, PubMed, ScienceDirect, and ProQuest, up until 31 December 2022. The risk of bias was assessed using the Risk of Bias Utilized for Surveys Tool (ROBUST, Nudelman et al., 2020). Sensitivity analysis was conducted using the one-study remove method, and studentized residuals and Cook's distance were examined. A random effects model was used.

RESULTS

We examined the association between IU and COVID-19-related psychological impacts across 85 studies from 22 countries (N = 69,997; 64.95% female; mean sample age, 32.90 ± 9.70). There was no evidence of publication bias. We found a medium and positive association between IU and COVID-19-related psychological impacts (N = 69,562, r = 0.35, k = 89, 95% CI [0.32, 0.37]), which was independent of the IU measure used or whether the psychological impact was measured in relation to the virus alone or broader aspects of the pandemic. It was also independent of severity, publication year, sample type and size, study quality, age and sample levels of anxiety, depressive symptoms, stress, mental well-being and social support. However, the observed association varied significantly between countries and country income levels (stronger among low-incomes) and across genders (stronger among males) and was stronger for measures with greater reliability and more items, but lower among samples with more people who had been exposed to COVID-19.

CONCLUSIONS

The findings support that IU is a higher order transsituational vulnerability factor related to cognitive, behavioural and distress responses during the pandemic. Limitations include English-language-only sources, reliance on a wide range of measures that were coded using a novel system and variable risk of bias across studies. The implications are considered in relation to the management of psychological consequences of major situational stressors experienced at a global scale, but the variations at a national and socioeconomic level also have implications for different or localized stressors at a regional or community level.

Intolerance of uncertainty as a predictor of anxiety severity and trajectory during the COVID-19 pandemic

BACKGROUND

Efforts to identify risk and resilience factors for anxiety severity and course during the COVID-19 pandemic have focused primarily on demographic rather than psychological variables. Intolerance of uncertainty (IU), a transdiagnostic risk factor for anxiety, may be a particularly relevant vulnerability factor.

METHOD

N = 641 adults with pre-pandemic anxiety data reported their anxiety, IU, and other pandemic and mental health-related variables at least once and up to four times during the COVID-19 pandemic, with assessments beginning in May 2020 through March 2021.

RESULTS

In preregistered analyses using latent growth models, higher IU at the first pandemic timepoint predicted more severe anxiety, but also a sharper decline in anxiety, across timepoints. This finding was robust to the addition of pre-pandemic anxiety and demographic predictors as covariates (in the full sample) as well as pre-pandemic depression severity (in participants for whom pre-pandemic depression data were available). Younger age, lower self/parent education, and self-reported history of COVID-19 illness at the first pandemic timepoint predicted more severe anxiety across timepoints with strong model fit, but did not predict anxiety trajectory.

CONCLUSIONS

IU prospectively predicted more severe anxiety but a sharper decrease in anxiety over time during the pandemic, including after adjustment for covariates. IU therefore appears to have unique and specific predictive utility with respect to anxiety in the context of the COVID-19 pandemic.

The association between intolerance of uncertainty and academic burnout among university students: the role of self-regulatory fatigue and self-compassion

Introduction

Increased uncertainty is a major feature of the current society that poses significant challenges to university students' mental health and academics. However, current research has not paid sufficient attention to this issue, and no study has explored the underlying mechanisms between intolerance of uncertainty and academic burnout among university students.

Methods

This study examined the association between uncertainty intolerance and academic burnout among university students and the role of self-regulatory fatigue and self-compassion in light of the theory of limited resources. Convenience sampling was used to survey 1,022 Chinese university students.

Results

The findings demonstrated that intolerance of uncertainty significantly influenced university students' academic burnout with self-regulatory fatigue serving as a key mediator. Additionally, self-compassion can effectively moderate the effects of intolerance of uncertainty on self-regulatory fatigue and academic burnout.

Discussion

These results indicated that the depletion of cognitive resources brought about by uncertainty in the current highly uncertain social environment may be one of the key pathways to academic burnout among university students. Furthermore, current research provides insights into how to mitigate the negative effects of uncertainty on university students.

Demoralization and well-being among self-employed individuals with cardiac disease: the role of intolerance of uncertainty

Background

Individuals with cardiac disease (CD) who are self-employed may experience ability limitations and especially intensive challenges and uncertainties. These challenges may cause demoralization and impaired well-being.

Objectives

To examine: (a) whether work ability limitations are related to demoralization and well-being among self-employed people with CD; (b) rates of demoralization; and (c) how demoralization and intolerance of uncertainty (IU) are associated with well-being.

Methods

The study involved 120 self-employed individuals with CD. The PROCESS macro was used to analyze mediation and moderation processes.

Results

The prevalence of demoralization syndrome was 37.4%. Work ability-limitations were associated with higher demoralization levels. Demoralization was associated with well-being only among participants with high IU. Further, demoralization mediated the relationship between work ability limitations and well-being only for individuals with high IU.

Conclusion

Encountering limitations among self-employed was associated with demoralization and lower levels of well-being, especially among those with high IU. In addition, demoralization syndrome is prevalent among individuals with CD in general. Early recognition and treatment of demoralization as a treatable psychological syndrome are essential for preventing its degeneration into more complex forms. In addition to uncertainty related to health, it is important to pay special attention to other sources of uncertainty.

What drives preventative health behaviors one year into a pandemic? A replication and extension

Objective: There is continued interest in understanding what leads people to engage in CDC-recommended COVID-19 prevention behaviors. We tested whether fear and COVID-19 worry would replicate as the primary drivers of six CDC recommended prevention behaviors. Methods and Measures: We recruited 741 adult participants during the second major peak of the COVID-19 pandemic in the United States (early 2021). Using very similar methods to the original study, participants completed a 10-day daily diary. Mixed effects models identified the strongest predictors of each individual prevention behavior as well as approach and avoidance behavior clusters. Results: At the between-person level, COVID-19 worry, COVID-19 perceived susceptibility, fear, and positive emotions all had positive zero-order associations with the prevention behaviors. However, with all predictors in the same model together, primarily COVID-19 worry remained significant for both the individual behaviors and behavior clusters. At the within-person level, only fear related to assessing oneself for COVID-19 and approach behaviors on the same day, but not the next day. Mediational analyses suggested COVID-19 worry, but not COVID-19 susceptibility, mediated the links between fear and approach/avoidance behaviors. Conclusion: Findings replicated worry about yourself or a loved one getting COVID-19 as the strongest predictor of prevention behaviors.

Alexithymia, intolerance to uncertainty and mental health difficulties in adolescents with Type 1 diabetes mellitus

BACKGROUND

Type 1 Diabetes Mellitus (T1DM) represents a serious chronic condition affecting a wide number of people. Discussion of the physical issues associated with T1DM pervades the literature, however, there is less discussion of the psychological consequences. Mental health difficulties, alexithymia and uncertainty are present in this population, and known to be harmful for the onset, maintenance and worsening of T1DM. This study aimed to evaluate the presence of these phenomena in people with T1DM.

METHODS

105 participants aged between 11 and 17 years old (M: 13.88; SD: 2.16) affected by T1DM were included in the sample. To assess the presence of mental health difficulties, SAFA scales (Depression, Anxiety and Somatic symptoms) were included in the protocol together with TAS-20 and IUS-12, which evaluate the presence and role of alexithymia and intolerance to uncertainty in the sample, respectively.

RESULTS

A concerning presence of anxiety, depression and somatic symptoms was found in the sample. Mental health difficulties appeared to be consistently present in the sample, often overcoming pathological thesholds. Alexithymia and uncertainty were also common, highlighting their role in T1DM.

CONCLUSIONS

Active mental health difficulties together with high rates of alexithymia and intolerance to uncertainty were prevalent in the sample of adolescents with diabetes.

The impact of online health information source preference on intolerance to uncertainty and cyberchondria in a youthful generation

Background

The increasing utilization of the Internet to access health-related information is believed to heighten anxiety and trigger cyberchondria due to the presence of conflicting and sometimes overly detailed information.

Aim

To investigate the levels of cyberchondria and intolerance of uncertainty among university students and their relationship with different online health information sources.

Methods

Between June and July 2022, 420 university students (mean age = 21.5 ± 2 years, 54% female) participated in this cross-sectional study. The socio-demographic form, Uncertainty Intolerance Scale (IUS), and Cyberchondria Severity Scale (CSS) were used in data collection. Pearson correlation test and binary logistic regression analysis were used to identify factors associated with cyberchondria.

Results

Forums and private hospital/clinic websites were the most frequently utilized online health information sources, while governmental websites were the least. The mean scores for CSS and IUS were 81.5 and 41.0, respectively. There was no significant gender-based difference in CSS and IUS scores. Students who used newspapers/magazines and social media for health information had significantly higher scores on both scales. Cyberchondria had a negative association with age [odds ratio (OR) = 0.90], a positive significant relationship with newspaper/magazine website use (OR = 7.24), and IUS score (OR = 1.09). There was a positive and moderate correlation between CSS and IUS scores (r = 0.39, P < 0.001).

Conclusions

Our results underline the susceptibility to cyberchondria and intolerance of uncertainty among young adults who used less reliable online health information sources and highlight promoting online health literacy to reduce vulnerabilities and the need for further research on socio-demographic determinants in both mental problems.

Emotional experiences and study motivation among Italian university students during the second wave of COVID-19

Objective: This study aimed to investigate the relationships between emotional experiences and study motivation in a group of nonworking and never-infected university students, during the second wave of the COVID-19 pandemic. Participants: Participants (N = 353; aged M = 21.5; SD = 2.8) were mostly female (76.2%) Italian university students. Methods: They completed an online assessment that included self-report measures of fear during the second wave of the COVID-19 pandemic, intolerance of uncertainty, optimism, and study motivation. Results: Our findings showed that older students were more optimistic than younger students. Besides, fear of COVID-19, intolerance of uncertainty, and pessimism predicted worse study motivation. Conclusions: Greater psychological support should be reserved for younger students to prevent emotional experiences that might affect the learning goal.

Resilience, Satisfaction with Life and Anxiety in the Israeli Population after Mass Vaccination for COVID-19

OBJECTIVES

The current study aimed to examine the relationships between resilience and personal characteristics such as socio-economic status, employment, satisfaction with life, and anxiety, during the period of returning to routine life after mass vaccination for COVID-19.

METHOD

993 Israeli participants, 52% female and 48% male, with a mean age of 40 years (18 to 89 years old) responded to an online questionnaire during March 2021. We hypothesized that (1) unemployed individuals and those with a low SES would have lower resilience, lower satisfaction with life and higher anxiety, (2) individuals who were ill with COVID-19 would have lower resilience and satisfaction with life and a higher level of anxiety, and (3) a higher resilience would be related to a lower level of anxiety.

RESULTS

The findings showed that unemployed individuals had lower levels of resilience and satisfaction with life and higher levels of anxiety than employed individuals. Specifically, those who experience a large gap between their socio-economic and employment statuses are at a greater risk than others. In addition, differences were found between people who had experienced COVID-19 illness and those who had not, but only with their satisfaction with life. People who had been ill were more satisfied than those who had not been ill. Eventually, as expected, a higher resilience was related to a lower level of anxiety, specifically at the lower levels of resilience.

CONCLUSIONS

The findings of this study can provide additional perspectives on the day after a crisis (COVID-19) and the need for the development of intervention programs to strengthen the resilience of individuals who experience a gap between their SES and employment statuses when returning to their routine life after a crisis. The study also shed light on the unique correlation between anxiety and resilience, implying that following a crisis, high-resilience individuals face their anxiety better than low-resilience individuals.

Anxiety symptoms before and during the COVID-19 pandemic: A longitudinal examination of Canadian young adults

The COVID-19 pandemic has resulted in many changes that may impact anxiety symptoms (i.e., general anxiety and somatization), particularly for young adults who were at higher risk for anxiety than older adults. We examined anxiety symptoms before (age 19, 20, 21, and 22) and during the pandemic (age 23 and 24) in a cohort of Canadian young adults (n = 396). Latent growth curve models were performed for general anxiety and somatization and the pandemic time points were estimated as structured residuals to quantify the change from participants' expected trajectories. We also examined whether fear of COVID-19 predicted the changes in anxiety symptoms during the pandemic. Results indicated that a history of general anxiety and somatization positively predicted fear of COVID-19 during the pandemic and negatively predicted pandemic change from predicted values for both general anxiety and somatization. Increased COVID-19 fear was related within time to increases in general anxiety at ages 23 and 24 and increases in somatization at age 24. We also found that the proportion of individuals in the subclinical/clinical range of somatization was higher from age 23-24, but not from age 22-23 and there were no differences for general anxiety. Results highlight the need to consider within-person change and development in evaluating anxiety symptom changes and predictors of changes in anxiety symptoms.

Health anxiety, death anxiety and coronaphobia: Predictors of postpartum depression symptomatology during the COVID-19 pandemic

OBJECTIVE

To determine levels of postpartum depression symptoms and possible relevant predictors, such as death anxiety, health anxiety, and coronavirus-related anxiety.

DESIGN

Cross-sectional web-based survey using quantitative methods.

SETTING

Exclusively online recruiting via social media and unpaid cross-posting conducted during the third wave of the COVID-19 pandemic in Romania.

PARTICIPANTS

Women were eligible to take part in the study if they were mothers over the age of 18 and had a baby aged between 4 weeks - 12 months of age; 1024 women were included in the final sample.

MEASUREMENTS AND FINDINGS

Health anxiety, death anxiety, coronavirus-related anxiety, and postpartum depression symptoms were measured using validated instruments. Current depression symptomatology was 67.6%, 26.7% scored above the cut-off for high health anxiety, 1% for coronavirus-related anxiety, and 62.7% for death anxiety. Significant predictors for depressive symptomatology were breastfeeding, history of depression, family income, number of children, health anxiety, death anxiety, and coronavirus anxiety. Further, hierarchical multiple regression analysis indicated that death anxiety, health anxiety, and coronavirus anxiety predicted postpartum depression symptoms over and above socio-demographic factors.

KEY CONCLUSIONS

Supported by previous studies, our results suggest that postpartum depression symptomatology levels during the COVID-19 pandemic are high and that they are predicted by health and death anxiety, which are also increased during the pandemic.

IMPLICATION FOR PRACTICE

The findings provide information to identify the risk for depression symptoms in postpartum mothers during acute public health situations.

Anticipatory stress, state policy contexts, and mental health during the COVID-19 pandemic

Substantial economic disruptions during the COVID-19 pandemic upended daily life and contributed to a widespread symptom of psychological distress during this period. Disruptions also led to more concerns about future stressful events related to financial hardship, or economic-related anticipatory stress, with the potential to undermine mental health. Although prior research provides ample evidence that state policies can impact mental and physical health, it has not considered how state policy contexts reduce adverse psychological outcomes stemming from economic-related anticipatory stress. The present study uses national survey data from the Census Bureau's Household Pulse Survey (April 2020-October 2020) to examine the extent to which state policy contexts moderate the association between economic-related anticipatory stress and depression/anxiety. We find that states with stronger social safety nets weakened the impact of anticipatory stress on depression/anxiety. This finding held for different types of anticipated economic hardships (i.e., reduced income, difficulty paying rent, difficulty affording food), as well as for policies that existed prior to COVID-19 and policies enacted in response to COVID-19. Findings provide strong evidence that state policies may buffer against poor mental outcomes for people who even anticipate facing economic uncertainty during the COVID-19 pandemic. We provide insight into how state policy contexts can shape individual experiences in ways that impact the mental health outcomes of the United States population.

Cyberchondria and Chinese Adolescent Mental Health in the Age of COVID-19 Pandemic

One of the far-reaching impacts of the COVID-19 pandemic is that it has become the fertile soil of cyberchondria. Adolescents' mental health was severely hit by this by-product of the COVID-19 pandemic both due to the direct effects and its indirect effects on security. This study investigated whether and how cyberchondria was associated with Chinese adolescents' mental health (i.e., well-being and depressive symptoms). Based on a large Internet sample (N = 1,108, 67.5 percent female, M_age = 16.78 years), cyberchondria, psychological insecurity, mental health, and a series of covariates were assessed. Preliminary analyses were conducted in SPSS Statistics software and main analyses were conducted in Mplus. Path analyses indicated that (a) cyberchondria was negatively associated with well-being (b = -0.12, p = 0.001) and positively associated with depressive symptoms (b = 0.17, p < 0.001); (b) psychological insecurity could fully mediate the association between cyberchondria and mental health (indirect effect _well-being = -0.15, 95% confidence interval [CI -0.19 to -0.12] and indirect effect _{depressive symptoms} = 0.15, 95% CI [0.12 to 0.19]); (c) the two dimensions (social insecurity and uncertainty) of psychological insecurity could play the mediating role in the associations between cyberchondria and mental health, uniquely and parallelly; and (d) these results did not vary by gender. This study suggests that cyberchondria may arouse individuals' psychological insecurity about interpersonal interaction and the development of events, which ultimately decreases their well-being and increases the risk of depressive symptoms. These findings facilitate the establishment and implementation of relevant prevention and intervention programs.

The level of health anxiety before and during the COVID-19 pandemic

BACKGROUND

Concerns about disease and an increase in health anxiety levels are expected consequences of the COVID-19 pandemic. However, there have been few longitudinal studies of health anxiety in the general population during this time period. The aim of this study was to examine health anxiety levels before and during the COVID-19 pandemic in an adult, working population in Norway.

MATERIAL AND METHODS

This study included 1012 participants aged 18-70 years with one or more measurements of health anxiety (1402 measurements total) from the pre-pandemic period (2015 to March 11, 2020) and/or during the COVID-19 pandemic (March 12, 2020 to March 31, 2022). Health anxiety was measured with the revised version of the Whiteley Index-6 scale (WI-6-R). We estimated the effect of the COVID-19 pandemic on health anxiety scores with a general estimation equation analysis, and age, gender, education, and friendship were included in subgroup analyses.

RESULTS

We found no significant change in health anxiety scores during the COVID-19 pandemic compared to the pre-pandemic period in our adult, working population. A sensitivity analysis restricted to participants with two or more measurements showed similar results. Moreover, the effect of the COVID-19 pandemic on health anxiety scores was not significant in any subgroup analysis.

CONCLUSION

Health anxiety remained stable, with no significant change observed between the pre-pandemic period and the first 2 years of the COVID-19 pandemic in an adult, working population in Norway.

The Moderating Role of Intolerance of Uncertainty in the Relationship Between Health Anxiety and Pandemic-Related Stress

Background and Objectives

Global pandemics, including COVID-19, have a significant effect on mental health, and this may be especially true for individuals with health anxiety. Although health anxiety is related to both pandemic-related fears and perceptions of health risks, there is a paucity of research on individual difference variables that might exert an influence on these relationships. The present study examined intolerance of uncertainty (IU) as a potential moderator of the relationship between health anxiety and COVID-related stress, and the relationship between health anxiety and perceived risk of contracting COVID.

Design and Methods

A nationally representative sample of North American adults (N = 204) completed self-report measures of health anxiety, IU, COVID-related stress, and perceived risk of contracting COVID.

Results

Prospective IU moderated the positive relationship between health anxiety and COVID-related stress, as the relationship was strengthened at average and higher levels of prospective IU. Neither IU subscale moderated the relationship between health anxiety and perceived risk.

Conclusion

These results suggest that individuals with elevated health anxiety and high prospective IU may be at higher risk of experiencing COVID-related stress, illuminating the interplay of risk factors that place anxious populations at an increased risk of experiencing stress during acute health risks.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10608-023-10365-w.

Intolerance of uncertainty, fear of contamination and perceived social support as predictors of psychological distress in NHS healthcare workers during the COVID-19 pandemic

Psychological distress has been repeatedly quantified over the course of the pandemic, however this has not always included broader healthcare workers, and has mostly focused on prevalence and occupational factors. This study investigated intolerance of uncertainty (IOU), fear of contamination and perceived social support as key predictors of psychological distress in healthcare professionals, between the 10^th and 23 June 2020, during the first wave of the COVID-19 pandemic. This study was a cross-sectional, online survey design. Opportunity sampling was used to recruit to the study, primarily using social media sites and snowballing techniques. The final sample included 342 National Health Service (NHS) healthcare workers. IU (p < .001), gender (p < .001), fear of contamination (p = .007), perceived social support (p = .012), and age (p = .017) significantly predicted psychological distress in the sample and accounted for 36.2% of variance in psychological distress scores. IOU accounted for 28.2% of this variance. A two-way post hoc ANOVA, looking at gender and profession, showed a significant main effect of gender on psychological distress scores (F(1,218) = 7.156, p = .008, η_p² = .032), with females reporting significantly higher psychological distress scores compared to males. In conclusion, higher levels of intolerance of uncertainty, fear of contamination and lower levels of perceived social support significantly influenced higher scores of psychological distress. These factors should be considered when adapting and delivering evidence-based interventions to healthcare staff during this crisis.

Psychological Correlates of Health anxiety in Response to the Coronavirus (COVID-19) Pandemic: a Cross-Sectional Online Study in Iran

Current models suggest health anxiety as a fundamental variable associated with fear and anxiety related to COVID-19. The investigation was carried out in separate two studies on the Iranian population. The first study aims to test the COVID-19 Anxiety Inventory (N = 202). The findings indicate a two-factor structure of the scale. Participants (N = 1638) completed the online survey anonymously in the second study, including the COVID-19 Anxiety Inventory, Short Health Anxiety Inventory, The Intolerance of Uncertainty Scale, Anxiety Sensitivity Index-3, Body Vigilance Scale, Depression Anxiety Stress Scales 21, and Contamination Cognitions Scale. Results showed that health anxiety, anxiety sensitivity, and body vigilance would significantly contribute to fears of contracting COVID-19. Moreover, the findings support a central role of intolerance of uncertainty in predicting COVID-19 anxiety. The study results provided both theoretical and practical implications for understanding psychosocial predictors during the COVID-19 pandemic.

Core self-evaluations as resilience and risk factors of psychological distress during the COVID-19 pandemic

In view of the grave consequences of distress reactions to the COVID-19 pandemic, this study investigated CSE (Core Self-evaluations) - internal/external health locus of control, generalized self-efficacy and trait optimism - and intolerance of uncertainty as potential correlates of distress reactions. We conducted an online questionnaire-based cross-sectional study with 422 Israeli respondents. Pandemic-related distress was defined by perceived stress, negative and positive affect, and worries. Predictors were: health locus of control, generalized self-efficacy, trait optimism, and intolerance of uncertainty. The findings show that CSEs and intolerance of uncertainty added between 11% (to perceived stress) and 22% (to negative affect) of explained variance beyond the background variables. Specifically, higher trait optimism and generalized self-efficacy were associated with less distress, and greater intolerance of uncertainty was correlated with higher distress. In conclusion, the CSE framework is useful for explaining psychological distress during the COVID-19 pandemic. Beyond their theoretical contribution, the findings may have practical implications for increasing resilience and ameliorating distress during a pandemic.

Intolerance of uncertainty, anxiety sensitivity, and health anxiety during the COVID-19 pandemic: Exploring temporal relationships using cross-lag analysis

Intolerance of uncertainty (IU) and anxiety sensitivity (AS) have been widely discussed and explored as factors that may contribute to health anxiety. We propose that IU and AS are salient issues for many during the COVID-19 pandemic, and may play a role in the development or exacerbation of health anxiety during the pandemic. Studies have examined links between IU and AS with health anxiety during the pandemic, but these relationships have not been tested together using a longitudinal study design. In the present study, measures of IU, AS, and health anxiety were collected from 301 adults at two time points 6 months apart during (early stages of) the COVID-19 pandemic using an online survey platform. Cross-lagged analysis was utilized to simultaneously estimate cross-sectional and longitudinal associations between these three variables. Robust cross-sectional associations were observed, and IU prospectively predicted changes in both health anxiety and AS. No other statistically significant prospective associations emerged. Present findings support the putative role of IU in health anxiety, suggesting that some observed links between AS and health anxiety could be driven by shared variance with IU. IU may be an important factor to monitor and target in health anxiety interventions during the pandemic.

Relationships between stress appraisals and intolerance of uncertainty with psychological health during early COVID-19 in the USA

BACKGROUND AND OBJECTIVES

The COVID-19 pandemic has caused increased psychological distress and decreased quality of life (QoL), but limited research has evaluated cognitive appraisals of COVID-19. This study aimed to examine the role of three stress appraisals of the COVID-19 pandemic - threat appraisal, harm/loss appraisal, and challenge appraisal - and the interaction between these appraisals and intolerance of uncertainty (IU) on psychological distress and QoL.

DESIGN

This was a cross-sectional survey study using Amazon's Mechanical Turk.

METHODS

A sample of 327 adults living in the U.S. completed a series of questionnaires investigating IU, appraisal of the pandemic, psychological distress, and QoL in May 2020 during the first wave of the COVID-19 pandemic.

RESULTS

Controlling for demographic variables, IU and harm/loss appraisal positively related to psychological distress and negatively related to QoL. Challenge appraisals negatively related to distress and positively related to QoL. Moderation analyses revealed that higher levels of IU led to stronger positive relationships between threat appraisal and psychological distress.

CONCLUSIONS

Cognitive appraisals of COVID-19 are associated with psychological health, though the relationship between threat appraisal and psychological distress are strongest for those with difficulty tolerating uncertainty. Theoretical and practical implications are discussed.

COVID-19-related health worries and generalized anxiety symptoms: Higher risks in perinatal women without a pre-existing generalized anxiety diagnosis

The perinatal period has been well-established as a time of vulnerability to anxiety, as has the COVID-19 pandemic. Perinatal women with a prior diagnosis of Generalized Anxiety Disorder (GAD) may be anticipated to be at particular risk for elevated symptom burden when facing the overlay of these stressors. This study examined whether pre-existing anxiety exacerbates COVID-19-related health worries on anxiety symptom severity among a sample of women who entered perinatal status during the COVID-19 pandemic. We assessed COVID-19-related health worries, past diagnosis of GAD, and current generalized anxiety symptoms cross-sectionally in 1,587 perinatal U.S. women during the COVID-19 pandemic (May 21, 2020 to June 24, 2021). Among perinatal women who reported high levels of COVID-19-related health worries, those with a pre-existing GAD diagnosis were 3.56 times more likely to score at clinically significant levels of generalized anxiety, while those without a pre-existing GAD diagnosis were 6.51 times more likely. COVID-19-related health worries posed a larger risk for elevated anxiety symptoms among those without a pre-existing diagnosis of GAD. Greater access to treatment and psychoeducation for such individuals may be warranted for individuals without a pre-existing mental health diagnosis.

Searching for Certainty During a Pandemic: A Longitudinal Investigation of the Moderating Role of Media Consumption on the Development of Posttraumatic Stress Symptoms During COVID-19

ABSTRACT

The current study longitudinally examined the moderating effects of consuming different types of media ( i.e. , formal [news] and informal [social media, WhatsApp]) in the association among COVID-19-related worries, intolerance of uncertainty (IU), and posttraumatic stress symptoms (PTSSs). Data were collected at two time points during July and September 2020, with approximately 60 days between measurements. Results showed that both COVID-19-related worries and IU were found to be positively associated with PTSSs. An interaction with formal media consumption was found, so that when one's formal media consumption was high, he or she were most vulnerable to the aforementioned effects on the development of PTSSs. Our findings point to the interactive effects of both COVID-19 worries and IU with media consumption on the development of PTSSs. Although media consumption might provide information during uncertainty, it may also intensify PTSSs during times of crisis. Implications and limitations are discussed.

Causal Model Analysis of Police Officers' COVID-19 Fear, Resistance to Organizational Change Effect on Emotional Exhaustion and Insomnia

Since the end of 2019, COVID-19 has continued to spread around the world. The police have performed various epidemic prevention and routine duties. This study explores how police officers' COVID-19 fear, resistance to organizational change, intolerance of uncertainty, and secondary trauma affect emotional exhaustion and insomnia in the context of COVID-19. A total of 205 valid police samples were collected in this study, and the established hypotheses were tested using confirmatory factor analysis and structural equation modeling. The results of the study confirmed that during the COVID-19 outbreak, secondary trauma of police officers positively affects emotional exhaustion and insomnia; intolerance of uncertainty positively affects emotional exhaustion; resistance to organizational change positively affects intolerance of uncertainty and emotional exhaustion; intolerance of uncertainty mediates the relationship between resistance to organizational change and emotional exhaustion; COVID-19 fear positively influences secondary trauma.

Worrying But Not Acting: The Role of Intolerance of Uncertainty in Explaining the Discrepancy in COVID-19-Related Responses

Research indicates that Intolerance of Uncertainty (IU) is associated with COVID-19 emotional responses, but not necessarily with engaging in COVID-19 preventative behaviors. The current study was designed to further evaluate this discrepancy. Participants (N = 454) completed self-report forms about COVID-19 emotional responses (i.e., fear, worry, sensitivity to symptoms) and COVID-19 behavioral interference/responses (i.e., interference in daily activities, interference due to worry, and engagement in preventative behaviors). IU was positively associated with COVID-19-related emotional responses as well as two of the COVID-19-related behavioral interference/responses (i.e., interference in daily activities and interference due to worry), but negatively predicted engagement in COVID-19 preventative behaviors. Exploratory analyses revealed a significant indirect effect of IU on lower engagement in preventative behaviors through lower belief in the effectiveness of such behaviors. Thus, we further document the role of IU in statistically predicting higher distress but lower levels of adaptive health behaviors. Furthermore, we provide preliminary support for the hypothesis that these relationships may be explained by associations between IU and lower belief in the efficacy of health behaviors. Because some current analyses indicate small effect sizes, future studies should investigate IU alongside other potentially important markers.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10608-022-10321-0.

Using what we know about threat reactivity models to understand mental health during the COVID-19 pandemic

The COVID-19 pandemic has been accompanied by unprecedented levels of stress and threats in a variety of domains (e.g., health, livelihood). Individual differences in threat reactivity may explain why some individuals are at elevated risk for the development or maintenance of psychopathology during the COVID-19 pandemic. This article describes several prominent models, mechanisms, and components of threat reactivity (e.g., appraisals, intolerance of uncertainty, avoidance) and discusses how they might help improve understanding of changes in psychopathology during and following the COVID-19 pandemic.

Intolerance of Uncertainty and Risk Perception during the COVID-19 Pandemic: The Mediating Role of Fear of COVID-19

The COVID-19 pandemic, a period of uncertainty and risk, has presented a threat to people’s physical and mental health worldwide. Previous research has shown that pandemic-related uncertainty can contribute to individuals’ psychological distress and coping responses. Therefore, the aim of this study was to investigate the relationship between intolerance of uncertainty and risk perception (i.e., individual’s perceived likelihood of becoming infected both for themselves and people in one’s own country and perceived severity of the infection), and the mediating role of fear of COVID-19. This two-wave longitudinal study (T1 = April 2020; T2 = May 2020) involved 486 young adults (age range = 18–29 years; Mage = 23.84 ± 2.94). Participants provided demographic data as well as measures of intolerance of uncertainty, fear of COVID-19, and risk perception. Structural equation modeling showed that intolerance of uncertainty was indirectly related to risk perception through fear of COVID-19. The study confirms the central role of IU in fear management and, consequently, in determining individuals’ risk estimates.

The role of emotion regulation and intolerance to uncertainty on the relationship between fear of COVID-19 and distress

The COVID-19 pandemic is increasing negative consequences on mental health around the globe. To date, research on what psychological factors could influence individuals' distress is still scarce. The current study aims to test a multiple mediation model to examine the role of Intolerance of Uncertainty (IU) and emotional regulation (i.e., expressive suppression and cognitive reappraisal) as joint factors, which can increase understanding of psychological distress due to the COVID-19 outbreak. An online survey measuring fear of COVID-19, IU, emotional regulation, and psychological distress was administered to 3863 Italian adults (females 73.3%; M age  = 36.44; SD = 14.74) during lockdown. Results showed that IU partially mediated the effect of fear of COVID-19 on depression, anxiety and stress. Moreover, individuals with difficulties in managing the uncertainties due to their fear of COVID-19 may be at risk for heightened use of expressive suppression and depression. However, individuals with both higher IU and expressive suppression showed lower level of stress. High cognitive reappraisal has a mediational effect on the relationship between fear of COVID-19, IU, and lower psychological distress. Findings suggest that IU and emotional regulation should be targeted for informing the development of tailored treatments to reduce the negative consequences of the outbreak.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-022-03071-5.

Exploring Factors and Associate Responses for Anxiety in the Coronavirus Disease 2019 Pandemic: A Web-Based Survey in Japan

Background and Objectives

Anxiety plays an important role in psychology. An exploration of anxiety and its associated reactions may provide insight into measures for addressing mental health problems caused by the coronavirus disease 2019 (COVID-19) pandemic. Data from this study provide potential correlational responses to anxiety.

Methods

A cross-sectional study using data collected via an online self-reported questionnaire was conducted in Japan during the COVID-19 pandemic. Using the State-Trait Anxiety Inventory (STAI-6), we assessed anxiety levels and explored the relationship between anxiety STAI-6 score, sources of COVID-19 information, the influences of COVID-19, social anxiety symptoms, discrimination, and evaluation of the government.

Results

A total of 4,127 participants were included in the analysis. The level of anxiety was not equally distributed across the general population with respect to age, gender, educational level, occupation, income, presence of underlying disease, and location (p < 0.05). The number of sources of information on COVID-19 had a positive correlation with the STAI-6 score (Spearman’s rho = 0.176, p < 0.001). The influence of the pandemic was correlated with moderate–severe anxiety. A high level of anxiety added to social anxiety (Spearman’s rho = 0.04, p < 0.05) and discriminatory behavior (Spearman’s rho = 0.11, p < 0.01). Being female (Estimate = 0.926) and from a non-emergency area (Estimate = −0.308) was related to higher STAI scores, and higher education (Estimate = −0.305), and income (Estimate = −0.168) decreased the STAI score. The respondents who had a lower evaluative score of the preventive activities undertaken by the national and local governments had higher STAI-6 scores.

Conclusion

Our findings provide statistical evidence for the associated reaction of anxiety and that anxiety reactions may vary in predictable ways. Further studies should focus on the strategic interventions that may decrease the associated responses to anxiety, to address mental health issues due to the pandemic.

The Intolerance of Uncertainty and "Untact" Buying Behavior: The Mediating Role of the Perceived Risk of COVID-19 Variants and Protection Motivation

Draw on the protection motivation theory, this study investigated the impacts of intolerance of uncertainty on "untact" buying behavior, and examined the sequential mediating role of the perceived risk of COVID-19 variants and protection motivation. A total of 1,564 (M age = 20.75, SD = 1.92) young individuals participated in the survey. The serial mediation analysis results reveal that intolerance of uncertainty influences one's "untact" buying behavior through "perceived risk of COVID-19 variants - protection motivation." Both internal (intolerance of uncertainty, protection motivation) and external (risk of COVID-19) factors worked together to accelerate the transition of individuals' consumption behavior during COVID-19 pandemic. Therefore, our findings generate important implications for public mental health and economic recovery in the post-COVID-19 era.

The effect of the COVID-19 pandemic on health anxiety and cyberchondria levels of university students

OBJECTIVE

Our study hypothesizes that the fear and panic of COVID-19 triggers cyberchondria (CYB) in students thus increasing health anxiety. In this way, we aim to determine the effect of the belief of previously having had and not having had COVID-19 on health anxiety and CYB levels of the university students.

METHODS

Our study is a descriptive cross-sectional study. The target population of our study consisted of 950 students who were continuing their education in the Vocational School of Health Services, an associate degree program of a university, and the samples consisted of 794 students (85.5%) who filled out our questionnaire (n = 794). The questionnaire form included the information regarding sociodemographic characteristics and the symptoms of COVID-19, and the obtained data were electronically collected altogether with Cyberchondria Scale (CS) and Health Anxiety Inventory.

FINDINGS

Health anxiety mean scores were significantly higher in people who lived alone, had a chronic disease, searched for symptoms online, and took herbal supplements against COVID-19 (p < 0.05). The mean total scores of Health Anxiety Inventory, CS, Anxiety-Increasing Factors Subscale of the students who believe they have had COVID-19 were significantly lower compared to the scores of those who believe they have not had COVID-19. Nevertheless, women and people living alone and in cities had significantly high CS scores (p < 0.05).

CONCLUSION

The increase in infodemia can be prevented with the services offered by specialists through mental health helpline or websites to people with high health anxiety or CYB levels, especially to women, and to people living alone and in urban areas.

Association Between Awareness, Perceived Severity, and Behavioral Control of COVID -19 With Self-Care and Anxiety in Pregnancy: A Cross-Sectional Study

COVID-19 pandemic has caused a tidal wave of anxiety and stress among Iranians, especially pregnant women. This study aimed to assess the association between knowledge, perceived severity, and controllability of COVID-19 with self-care and health anxiety specially in pregnancy. This cross-sectional study was performed on 440 pregnant women. Data were collected using demographic-obstetrics characteristics, as well as the questionnaires of knowledge, perceived severity, and perceived controllability of the COVID-19, health anxiety, and self-care. Self-care was positively correlated with knowledge, perceived severity, and perceived controllability of the COVID-19. Nonetheless, health anxiety had a significant and inverse association with knowledge and perceived controllability, while there was a positive and significant correlation between perceived severity and health anxiety. Based on linear regression, three variables of knowledge, perceived severity, and perceived controllability of the COVID-19 could explain 46.3 and 17.5% of variations in self-care and health anxiety, respectively. It is suggested that due to the critical importance of prenatal care, managers, and health-care providers promote the use of such methods as telehealth and home-based caregivers, especially in areas with inadequate access to health care. So, the pregnant women can be followed up and receive medical care devoid of any stress and anxiety.

Intolerance of uncertainty predicts fear of healthcare settings but not desire for testing during the novel coronavirus pandemic

The novel coronavirus (COVID-19) pandemic has caused unprecedented uncertainty, and differences in how people cope with this uncertainty will influence the cost of viral pandemics to both individuals and society. The personality trait of intolerance of uncertainty (IU), defined as a dispositional fear of the unknown, has been linked to higher health anxiety and fear of the virus. Although IU may increase the desire for medical information and treatment, during pandemics, this might be weighed against the risk of becoming infected while in a healthcare setting. We examined whether people with higher IU report greater fear of healthcare settings, and show more desire to be tested for the virus. Residents of the United States (n = 149) were surveyed in early May 2020, while most states had active stay-at-home orders. Higher prospective but not inhibitory IU predicted more fear of healthcare settings. The largest effect size, however, was for fear of leaving the home, indicating a general tendency toward fear and avoidance. Fear of leaving the home, perceiving the virus as dangerous, access to testing, and having symptoms were significant predictors of desire for testing.

Mental health among pregnant women with COVID-19-related stressors and worries in the United States

BACKGROUND

Few studies have evaluated whether pandemic-related stressors, worries, and social distancing have affected the mental health of pregnant women during the COVID-19 pandemic.

METHODS

Data came from an online survey of United States pregnant women (n = 715), conducted in May 2020. The Edinburgh Postnatal Depression Scale and Generalized Anxiety Disorder Scale were used to assess depressive symptoms, thoughts of self-harm, and moderate or severe anxiety. Multiple logistic regressions were used to examine the associations of COVID-19 experiences with mental health outcomes.

RESULTS

Participants were racially diverse. The prevalence of adverse mental health outcomes was 36% for probable depression, 20% for thoughts of self-harm, and 22% for anxiety. Women who reported family members dying from COVID-19 had four times higher odds of having thoughts of self-harm than women who did not experience family death. Depression was more prevalent among women who canceled or reduced medical appointments. Women were more likely to have worse mental health outcomes if they expressed worry about getting financial or emotional/social support, about their pregnancy, or about family or friends. Strict social distancing was positively associated with depression. A higher proportion of adults working from home was inversely associated with depression and thoughts of self-harm.

CONCLUSION

High percentages of pregnant women had symptoms of depression or anxiety, suggesting an urgent need to screen and treat mental health conditions among pregnant women during the pandemic. Pandemic-related risks and protective factors are relevant to developing tailored interventions to address the mental health of pregnant women during pandemic circumstances.

Do patients with pathological health anxiety fear COVID-19? A time-course analysis of 12 single cases during the "first wave" of the COVID-19 pandemic in Germany

OBJECTIVE

Pre-existing health anxiety is associated with an intensified affective response to the novel COVID-19 pandemic in the general population. Still, results on the reaction of people with a diagnosis of pathological health anxiety (i.e., hypochondriasis) are scarce.

METHODS

In the present study, we investigated the course of (health) anxiety related to SARS-CoV-2/COVID-19 in comparison to (health) anxiety related to other severe diseases (e.g., cancer) in a sample of 12 patients with the diagnosis of pathological health anxiety during the "first wave" of the COVID-19 pandemic in Germany. Both SARS-CoV-2 related anxiety and anxiety related to other severe diseases were assessed weekly over 16 measurement points (30.03.-19.07.2020) and primarily analyzed with fixed effects regression analyses.

RESULTS

Unexpectedly, SARS-CoV-2 related anxiety was on average significantly lower than anxiety related to other severe diseases (d = -0.54, p < .001) and not significantly associated with anxiety related to other severe diseases or pre-COVID-19 health anxiety.

CONCLUSION

It therefore appears premature to assume that SARS-CoV-2 related anxiety and other health worries are necessarily strongly interrelated and comparably high in people with pathological health anxiety.

Community psychological and behavioural responses to coronavirus disease 2019 over one year of the pandemic in 2020 in Hong Kong

Monitoring community psychological and behavioural responses to coronavirus disease 2019 (COVID-19) is important for informing policy making and risk communication to sustain public compliance with challenging precautionary behaviours and mitigating the psychological impacts. Monthly telephone-based cross-sectional surveys in January-April 2020 and then weekly surveys from May through December 2020 were conducted to monitor changes in public risk perception of COVID-19, personal efficacy in self-protection, confidence in government's ability to control the pandemic, precautionary behaviours, perceived impact of precautionary behaviours, psychological fatigue and distress in Hong Kong, and examine their inter-relationships. While worry about contracting COVID-19 increased, personal efficacy and confidence in government declined as the community incidence of COVID-19 increased. The public maintained high compliance with most precautionary behaviours throughout but relaxed behaviours that were more challenging when disease incidence declined. Public confidence in government was persistently low throughout, of which, a lower level was associated with more psychological fatigue, lower compliance with precautionary behaviours and greater psychological distress. Perceived greater negative impact of precautionary behaviours was also associated with more psychological fatigue which in turn was associated with relaxation of precautionary behaviours. Female, younger and unemployed individuals reported greater psychological distress throughout different stages of the pandemic. Risk communication should focus on promoting confidence in self-protection and pandemic control to avoid helplessness to act when the pandemic resurges. Policy making should prioritize building public trust, enhancing support for sustaining precautionary behaviours, and helping vulnerable groups to adapt to the stress during the pandemic.

The associations of obsessive-compulsive symptom dimensions and general severity with suicidal ideation in patients with obsessive-compulsive disorder: The role of specific stress responses to COVID-19

Suicidal ideation is prevalent in patients with obsessive-compulsive disorder (OCD); but, during COVID-19, it may be increased. The present study aimed to examine the effects of obsessive-compulsive (OC) symptom dimensions and OCD severity on suicidal ideation by considering the role of stress responses in reaction to COVID-19 in a clinical sample of patients with OCD. In a cross-sectional study, 304 patients with OCD completed measures of OC symptom dimensions, OCD severity, general mental health (depression and anxiety), and COVID-19-related stress. Results showed that after controlling for depression, anxiety, comorbidity, and lifetime suicide attempts, the OC symptom dimensions of responsibility for harm and unacceptable obsessional thoughts as well as general severity had indirect effects on suicidal ideation through the specific stress responses to COVID-19, including traumatic stress and compulsive checking. The study shows that OCD patients with specific OC symptom dimensions and severe OCD are more likely to have suicidal ideation during the pandemic. Further, the specific stress responses to COVID-19 may be an underlying mechanism. Clinicians should carefully assess suicidal ideation in patients with OCD who experience responsibility for harm and unacceptable thoughts, particularly during the pandemic.

Intolerance of Uncertainty, Anxiety and Depression in the Context of Covid-19 in Indonesia

"This Covid-19 pandemic brings uncertainty and may lead to mental problems. Yet, in this context, no study has examined the relationship between intolerance of uncertainty (IU) and either anxiety or depression during pandemic among Indonesians. This study investigated the pathway between IU, anxiety and depression serially mediated by cognitive appraisals (perceived severity, controllability, and knowledge) and emotional and behavioural responses to COVID-19. Online psychological measures were administered to 406 participants, including the IUS-12, the DASS-21, cognitive appraisal scales, and emotional and behavioural response scale. An indirect pathway was found between IU and depression, and the effect was serially mediated by perceived of severity and emotional and behavioural responses to COVID-19. Perceived knowledge and perceived controllability of COVID-19 did not significantly contribute to the model. A similar pathway was found for IU predicting anxiety. As conclusion, IU represents a risk factor for heightened emotional and behavioural difficulties that eventually, could lead to either anxiety or depression during COVID-19."

Psychometric Properties of the Coronavirus Stress Measure with Malaysian Young Adults: Association with Psychological Inflexibility and Psychological Distress

The COVID-19 pandemic has resulted in multiple physical and psychological stressors, which require quantification and establishment of association with other psychological process variables. The Coronavirus Stress Measure (CSM) is a validated instrument with acceptable validity and reliability. This study aimed to examine the psychometric properties of the CSM in a Malaysian population. University participants were recruited via convenience sampling using snowball methods. The reliability and validity of the Malay CSM (CSM-M) were rigorously evaluated, utilising both confirmatory factor analysis and Rasch analysis, in relation to sociodemographic variables and response to the depression, anxiety, and stress subscales of the Malay validation of the DASS-21, and also perceived stress (measured by the PSS) and psychological flexibility (AAQ-II). The sample comprised of 247 Malaysian participants. The McDonald's omega value for the Malay CSM was 0.935 indicating very good internal reliability. The CSM was significantly correlated with stress, anxiety, depression, perceived stress, and psychological flexibility. The Malay CSM properties were examined also with Rasch analysis, with satisfactory outcomes. There was positive correlated error between items 1 and 3, as well as negative correlated error between items 1 and 4. Hence, item 1 was excluded, leaving with 4 items. Confirmatory factor analysis demonstrated good data-model fit, and model fit statistics confirmed that Malay CSM showed a single-factor model. The Malay CSM hence demonstrates good validity and reliability, with both classical and modern psychometric methods demonstrating robust outcomes. It is therefore crucial in operational and research settings in establishing the true extent of stress levels as a consequence of the COVID-19 pandemic.

Associations between Personality Traits, Intolerance of Uncertainty, Coping Strategies, and Stress in Italian Frontline and Non-Frontline HCWs during the COVID-19 Pandemic-A Multi-Group Path-Analysis

The COVID-19 pandemic represented a very difficult physical and psychological challenge for the general population and even more for healthcare workers (HCWs). The main aim of the present study is to test whether there were significant differences between frontline and non-frontline Italian HCWs concerning (a) personality traits, intolerance of uncertainty, coping strategies and perceived stress, and (b) the models of their associations. A total of 682 Italian HCWs completed a self-report questionnaire: 280 employed in COVID-19 wards and 402 in other wards. The analysis of variance omnibus test revealed significant differences between the two groups only for perceived stress, which was higher among the frontline. The multi-group path analysis revealed significant differences in the structure of the associations between the two groups of HCWs, specifically concerning the relations between: personality traits and intolerance of uncertainty; intolerance of uncertainty and coping strategies. Regarding the relation between coping strategies and stress no difference was identified between the two groups. In both of them, emotionally focused coping was negatively related with perceived stress, whereas dysfunctional coping was positively related with stress. These results could be useful in planning actions aiming to reduce stress and improve the effectiveness of HCWs' interventions. Training programs aimed to provide HCWs with a skillset to tackle uncertain and stressful circumstances could represent an appropriate support to develop a preventive approach during outbreaks.

Self-controlled responses to COVID-19: Self-control and uncertainty predict responses to the COVID-19 pandemic

Two online studies (Total N = 331) tested the hypothesis that individual differences in self-control and responses to uncertainty would predict adherence to Centers for Disease Control and Prevention (CDC, 2020a) guidelines, reported stockpiling, and intentions to engage in hedonic behavior in response to the COVID-19 pandemic. Trait self-control (b = 0.27, p = .015), desire for self-control (Study 1: b = 0.28, p = .001; Study 2: b = 0.27, p = .005), and cognitive uncertainty (b = 0.73, p < .001) predicted more CDC adherence. State self-control (Study 1: b = -0.15, p = .012; Study 2: b = -0.26, p < .001) predicted less stockpiling, whereas emotional uncertainty (b = 0.56, p < .001) and cognitive uncertainty (b = 0.61, p < .001) predicted more stockpiling. State self-control (b = -0.18, p = .003) predicted less hedonic behavior, whereas desire for self-control (b = 0.42, p < .001) and emotional uncertainty (b = 0.26, p = .018) predicted more hedonic behavior. Study 2 (pre-registered) also found that emotional uncertainty predicted more stockpiling and hedonic behavior for participants low in state self-control (stockpiling: b = -0.31, p < .001; hedonic behavior: b = 0.28, p = .025), but not for participants high in state self-control (stockpiling: b = 0.03, p = .795; hedonic behavior: b = -0.24, p = .066). These findings provide evidence that some forms of self-control and uncertainty influenced compliance with behavioral recommendations during the COVID-19 pandemic.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-021-02066-y.

Anxiety Sensitivity Mediates Relations Between Mental Distress Symptoms and Medical Care Utilization During COVID-19 Pandemic

Anxiety and uncertainty are common during pandemics. The present study extended previous pandemic research by investigating the role of two transdiagnostic risk factors — anxiety sensitivity (AS: fear of physiological anxiety or “fear of fear”; Reiss & McNally, 1985) and intolerance of uncertainty (IU; Buhr & Dugas, 2009) — in explaining relations between mental distress symptoms and behavioural responding during the COVID-19 pandemic. Student and community-based participants (N=457; 87.6% female) were recruited between May and July 2020 to complete measures of anxiety (health, panic, general), depression, and stress. Anxiety and related symptoms were found to be higher than in previous studies. Parallel mediation analyses showed that clinically meaningful levels of mental distress symptoms directly influenced safety behaviours and medical care utilization but also indirectly influenced the latter (vs. former) through AS-physical concerns (vs. IU). CBT interventions, targeting AS-physical concerns, may reduce mental distress symptoms during pandemic and prevent overuse of healthcare.

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.

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.