Predictors of Persistence of Anxiety, Hyperarousal Stress, and Resilience During the COVID-19 Epidemic: A National Study in Iran

A systematic review on the relationship between socioeconomic conditions and emotional disorder symptoms during Covid-19: unearthing the potential role of economic concerns and financial strain

BACKGROUND

Covid-19 has disrupted the lives of many and resulted in high prevalence rates of mental disorders. Despite a vast amount of research into the social determinants of mental health during Covid-19, little is known about whether the results are consistent with the social gradient in mental health. Here we report a systematic review of studies that investigated how socioeconomic condition (SEC)-a multifaceted construct that measures a person's socioeconomic standing in society, using indicators such as education and income, predicts emotional health (depression and anxiety) risk during the pandemic. Furthermore, we examined which classes of SEC indicators would best predict symptoms of emotional disorders.

METHODS

Following PRISMA guidelines, we conducted search over six databases, including Scopus, PubMed, etc., between November 4, 2021 and November 11, 2021 for studies that investigated how SEC indicators predict emotional health risks during Covid-19, after obtaining approval from PROSPERO (ID: CRD42021288508). Using Covidence as the platform, 362 articles (324 cross-sectional/repeated cross-sectional and 38 longitudinal) were included in this review according to the eligibility criteria. We categorized SEC indicators into 'actual versus perceived' and 'static versus fluid' classes to explore their differential effects on emotional health.

RESULTS

Out of the 1479 SEC indicators used in these 362 studies, our results showed that 43.68% of the SEC indicators showed 'expected' results (i.e., higher SEC predicting better emotional health outcomes); 51.86% reported non-significant results and 4.46% reported the reverse. Economic concerns (67.16% expected results) and financial strains (64.16%) emerged as the best predictors while education (26.85%) and living conditions (30.14%) were the worst.

CONCLUSIONS

This review summarizes how different SEC indicators influenced emotional health risks across 98 countries, with a total of 5,677,007 participants, ranging from high to low-income countries. Our findings showed that not all SEC indicators were strongly predictive of emotional health risks. In fact, over half of the SEC indicators studied showed a null effect. We found that perceived and fluid SEC indicators, particularly economic concerns and financial strain could best predict depressive and anxiety symptoms. These findings have implications for policymakers to further understand how different SEC classes affect mental health during a pandemic in order to tackle associated social issues effectively.

The effect of exposure to COVID-19 on life satisfaction: The mediating role of hyperarousal and moderating/mediating role of affective forecasting

BACKGROUND

As a global trauma event, the Coronavirus disease (COVID-19) hugely impacts people's mental health and well-being. The purpose of our study is threefold: first, investigate the relationship between exposure to COVID-19 and life satisfaction among a large sample in China. Second, test the mediating role of hyperarousal in the association between exposure to COVID-19 and life satisfaction. Third, explore the moderating/mediating role of affective forecasting in the association between hyperarousal and life satisfaction.

METHOD

The current study recruited 5546 participants to complete a set of self-report questionnaires online from April 22, 2020 to April 24, 2020. The moderated mediation and chain mediation model analyses were conducted using the SPSS software and PROCESS macro program.

RESULTS

Exposure to COVID-19 negatively predicted life satisfaction (Effect = -0.058, p < 0.001). This relationship was partially mediated by the hyperarousal level (Effect = -0.018, CI = [-0.024, -0.013]). The moderating role of forecasted positive affect (PA)/forecasted negative affect (NA) between hyperarousal and life satisfaction was significant (β = 0.058, CI = [0.035, 0.081]; β = 0.037, CI = [0.014, 0.06]). The chain mediating effect of hyperarousal and forecasted PA/forecasted NA on the relationship between exposure to COVID-19 and life satisfaction was also significant (Effect = -0.003, CI = [-0.004, -0.002]; Effect = -0.006, CI = [-0.008, -0.004]).

LIMITATIONS

The cross-sectional design precludes causal inference.

CONCLUSION

Greater exposure to COVID-19 was associated with more severe hyperarousal symptoms, decreased life satisfaction. Forecasted PA and forecasted NA could moderate and mediate the negative impact of hyperarousal on life satisfaction. The moderating/mediating role of forecasted PA/NA implied that future interventions targeting at improving affective forecasting and reducing hyperarousal might be helpful to improve life satisfaction during the post-COVID-19 era.

Psychometric evaluation of the Connor-Davidson Resilience Scale among Iranian population

BACKGROUND

The resilience construct is considered a personal trait composed of multiple aspects. Connor-Davidson Resilience Scale is a standard tool composed of five factors and 25 items. This study aimed to determine the psychometric properties of this scale.

METHODS

In this cross-sectional study, after the scale translation, the factorial structural validity was assessed via the confirmatory factor analysis with 70 180 samples. Internal consistency, composite reliability, convergent validity were assessed by calculating Cronbach's alpha, composite reliability, maximum reliability, and Average Variance Extracted. The discriminant validity was assessed using Heterotrait-monotrait ratio of correlations matrix and also, measure invariance was evaluated.

RESULTS

The original five-factor model had good model fit indices but due to low factor loading of item 2 and 20, the model was modified. The Cronbach's alpha and composite reliability for four factors were above 0.7 (except for factor 5). The convergent validity for all five factors were achieved. Between factors 1 with 2 and 4, 2 with 3 and 4 discriminant validity was not established (correlations > 0.9) and the results suggested that there might be a second-order latent construct behind these factors. Therefore, a second-order assessment was performed. The results of the second-order latent construct assessment showed a good goodness-of fit and strong measurement invariance for both men and women.

CONCLUSION

The 23-item version of Connor-Davidson Resilience Scale is a reliable and valid scale to measure resilience as a complex construct in the Iran context.

The role of left insula mediating impaired error processing in response inhibition in adult heavy drinkers

Identification of neurobiological mechanisms underlying development of alcohol use disorder is critical to ensuring the appropriate early-phase treatment and prevention of the disorder. To this aim, we tried to elucidate the disturbance of neural functions in heavy drinking, which can lead to alcohol use disorder. Because response inhibition is affected by alcohol use disorder, we examined neural activation and task performance for response inhibition using the Go/No-Go task in an fMRI paradigm in adult non-dependent heavy and light drinkers. We examined the neural activation for error processing and inhibitory control, components of response inhibition. We then investigated the mediating effect of the relevant neural substrate on the relationship between the level of alcohol drinking and task performance using mediation analysis. We found that heavy drinking significantly decreased activation in the left insula during error processing and increased the mean commission error rate for No-Go trials compared with light drinking. Mediation analysis demonstrated full mediation of the left insula activation during error processing for the relationship between drinking level and commission error rate. Our results suggested that left insula activation may be a neural marker pivotal for potential conversion to alcohol use disorder in individuals with high clinical risk such as heavy drinking.

When a Pandemic Strikes: Resilience of Swedish Academics in the Face of Coronavirus

BACKGROUND

The COVID-19 pandemic hit the world with severe health consequences, affecting some populations more than others. One understudied population is the academic community. This study, part of a larger project looking at COVID-19 in Sweden and internationally, aims to understand the individual and collective dimensions of resilience among academics in Sweden during the early wave of the pandemic.

METHOD

A quantitative research design was applied for this cross-sectional study. We used simple random sampling, administered through an online survey, on academics at Swedish universities (n = 278, 64% women). We employed the CD-RISC 2 (the Connor-Davidson Resilience Scale) to measure personal/individual resilience, additional items for social/collective resilience, and a meaning-making coping instrument (meaning, control, comfort/spirituality, intimacy/spirituality, life transformation).

RESULTS

The results revealed a strong level of personal/individual resilience among men (M = 6.05) and a level just below strong among women (M = 5.90). By age group, those 35-49-year-olds showed strong resilience (M = 6.31). Family was the dominant social/collective resilience factor, followed by friends, nature, work/school, and, lastly, religion/spirituality. There was a positive and significant correlation between self-rated health and personal/individual resilience (r = 0.252, p = 0.001) and positive but weak correlations and negative significant correlations between personal/individual resilience and religious coping methods.

CONCLUSIONS

During the pandemic, the family took priority in meaning-making, which is an interesting change in a strong individual-oriented society such as Sweden.

Validity and Reliability of the Persian Version of COVID-19 Anxiety Syndrome Scale Among the Iranian General Population

The crisis of the COVID-19 prevalence in Iran, as well as the world, caused mental disorders and anxiety syndrome. The COVID-19 anxiety syndrome scale (C-19ASS) assesses conceptually and psychometrically the nature of the COVID-19 threat experience instead of a response to the threat, fear, and COVID-19 anxiety. Therefore, the aim of this study is to evaluate the psychometric properties of the Persian version of the anxiety syndrome scale of COVID-19 in the population of Iran. The Persian version of C-19ASS was sent to Iranian adults via online social networking applications and finally, 932 adults responded to the questionnaire. The results of exploratory factor analysis revealed two-factor structures for C-19ASS, which explained 48.70% of the total variance. Given the confirmatory factor analysis findings, all goodness of fit indices confirmed the model fit. All coefficients of internal consistency were estimated as acceptable reliability. The results showed that the C-19ASS has good psychometric properties, and can be used by researchers, psychologists, and healthcare providers to assess the anxiety syndrome of the Iranian population during the COVID-19 pandemic.

The Moderating Effect of Resilience on Mental Health Deterioration among COVID-19 Survivors in a Mexican Sample

Resilience has been reported to be a protective psychological variable of mental health; however, little is known about its role in COVID-19 survivors. Thus, in this study, we aimed to evaluate the levels of depression, anxiety, stress, traumatic impact, and resilience associated with COVID-19, as well as to investigate the role of resilience as a moderating variable. A sample of 253 participants responded to an online survey; all were previously diagnosed with COVID-19 by a nasopharyngeal swab RT-PCR test, were older than 18 years, and signed an informed consent form. Significant negative correlations were found between resilience and the mental health variables. Higher resilience was significantly related to a lower impact of the event, stress, anxiety, and depression when the number of symptoms was low. Only when the duration of COVID-19 was short and resilience levels were medium or high was psychological distress reduced. Moreover, resilience moderated the effects of COVID-19 on mental health, even if a relapse occurred. The results emphasize the need for interdisciplinary interventions aimed at providing COVID-19 patients with psychological and social resources to cope with the disease, as well as with probable relapses.

A Predictive Study Between Anxiety and Fear of COVID-19 With Psychological Behavior Response: The Mediation Role of Perceived Stress

OBJECTIVE

Despite the abundance of studies linking fear and anxiety to COVID-19, there are limited studies that examine how these elements impact psychological behavioral responses, especially in Iran. The aim of this study was to investigate the relationship between anxiety and fear of COVID-19 with psychological behavior response, whether this relationship is mediated by role of perceived stress among Iranian population during the COVID-19 pandemic.

METHODS

A predictive cross-sectional study was used to investigate the relationships between COVID-19 anxiety syndrome, fear of COVID-19 with psychological behavioral responses due to the pandemic, and the mediating role of the COVID-19 perceived stress in these relationships.

RESULTS

The current study revealed that during the COVID-19 pandemic, fear and anxiety of COVID-19 can influence the psychological behavioral responses of individuals; however, this can be explained through perceived stress.

CONCLUSION

As such, the current study points out that the individuals who perceived high stress due to COVID-19 were more likely to comply with guidelines, which has given new insight into this field. The current study findings are applicable for health policymakers in order to help them in understanding human behavior for developing health promotion programs and also for fostering resilience among the general population.

Resilience in Iranian adolescents during the COVID-19 pandemic: Psychometric Evaluation of the Connor-Davidson Resilience Scale

Background: Resilience is a measure of the ability to cope with stress and the accurate measurement of it is critical. This study aimed to translate and evaluate the psychometric properties of the Connor-Davidson Resilience Scale in Iranian adolescents during the Coronavirus Disease (COVID-19) pandemic.Methods: In this cross-sectional study, after the scale translation, the content and construct validity were assessed using exploratory and confirmatory factor analysis. Moreover, internal consistency, composite reliability, and invariance measurement were evaluated.Results: The content validity ratio was greater than 0.49, and the modified kappa coefficient for all items was higher than 0.6. With exploratory factor analysis, two factors were extracted consisting of 16 items and explaining 43% of the total variance. The results of confirmatory factor analysis indicated a good fit for the model. Cronbach's alpha and composite reliability for both factors were greater than 0.7. Although there is no significant difference (p = 0.09) in the average resilience of adolescents in different provinces, boys (42.64 ± 10.90) had a significantly (p < 0.001) higher resilience score than girls (40.10 ± 11.92).Conclusion: The study results showed that the Persian 16-item version of the Connor-Davidson Resilience Scale has acceptable reliability and validity in the Iranian adolescent population.