Health Anxiety and Its Correlations with Self-Perceived Risk and Attitude on COVID-19 among Malaysian Healthcare Workers during the Pandemic

The Role of Perceived Risk in the Relationship Between Disgust Sensitivity and COVID-19 Vaccine Hesitancy

Background

Despite widespread availability of COVID vaccines and evidence of their efficacy, vaccine hesitancy remains prevalent. Several studies have examined the relationship between disgust sensitivity and vaccine hesitancy. Although results from studies using data collected prior to the COVID pandemic indicate that higher disgust sensitivity is related to greater vaccine hesitancy, results from studies using data collected during the COVID pandemic are equivocal. The present study examined whether perceived risk of contracting COVID moderated the relationship between disgust sensitivity and vaccine hesitancy.

Methods

Participants (n = 152) completed self-report measures of disgust sensitivity, perceived risk of contracting COVID, and COVID vaccine hesitancy (defined as both vaccine confidence and vaccine complacency).

Results

Perceived risk of contracting COVID significantly moderated the relationship between disgust sensitivity and vaccine complacency, with the association strengthened at low levels of perceived risk. Perceived risk of contracting COVID also marginally moderated the relationship between disgust sensitivity and vaccine confidence, with the association strengthened at low and average levels of perceived risk.

Conclusions

Results suggest that individuals with elevated disgust sensitivity who also report low levels of perceived risk of contracting COVID are more likely to express vaccine hesitancy. Implications of these findings are discussed.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10608-023-10391-8.

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.

Stigma, Sociodemographic Factors, and Clinical Factors Associated with Psychological Distress among COVID-19 Survivors during the Convalescence Period: A Multi-Centre Study in Malaysia

High rates of psychological distress among COVID-19 survivors and stigmatisation have been reported in both early and late convalescence. This study aimed to compare the severity of psychological distress and to determine the associations among sociodemographic and clinical characteristics, stigma, and psychological distress among COVID-19 survivors across two different cohorts at two different time points. Data were collected cross-sectionally in two groups at one month and six months post-hospitalisation among COVID-19 patient from three hospitals in Malaysia. This study assessed psychological distress and the level of stigma using the Kessler Screening Scale for Psychological Distress (K6) and the Explanatory Model Interview Catalogue (EMIC) stigma scale, respectively. At one month after discharge, significantly lower psychological distress was found among retirees (B = -2.207, 95% confidence interval [95% CI] = -4.139 to -0.068, p = 0.034), those who received up to primary education (B = -2.474, 95% CI = -4.500 to -0.521, p = 0.014), and those who had an income of more than RM 10,000 per month (B = -1.576, 95% CI = -2.714 to -0.505, p = 0.006). Moreover, those with a history of psychiatric illness [one month: (B = 6.363, 95% CI = 2.599 to 9.676, p = 0.002), six months: (B = 2.887, CI = 0.469-6.437, p = 0.038)] and sought counselling services [one month: (B = 1.737, 95% CI = 0.385 to 3.117, p = 0.016), six months: (B = 1.480, CI = 0.173-2.618, p = 0.032)] had a significantly higher severity of psychological distress at one month and six months after discharge from the hospital. The perceived stigma of being infected with COVID-19 contributed to greater severity of psychological distress. (B = 0.197, CI = 0.089-0.300, p = 0.002). Different factors may affect psychological distress at different periods of convalescence after a COVID-19 infection. A persistent stigma contributed to psychological distress later in the convalescence period.

Stigma and posttraumatic growth among COVID-19 survivors during the first wave of the COVID-19 pandemic in Malaysia: a multicenter cross-sectional study

Background

Contracting COVID-19 can cause negative and distressing psychological sequelae, but traumatic stressors may also facilitate the development of positive psychological change beyond an individual's previous level of adaptation, known as posttraumatic growth (PTG). As a result, studies have investigated the negative effects of COVID-19 on mental health, but data on PTG among patients who have recovered from COVID-19 remains limited. This study aims to evaluate the level of PTG and its associations with stigma, psychological complications, and sociodemographic factors among COVID-19 patients 6 months post-hospitalization.

Method

A cross-sectional online survey of 152 COVID-19 patients was conducted after 6 months of being discharged from Hospital Canselor Tuanku Muhriz, MAEPS Quarantine Center, or Hospital Sungai Buloh, Malaysia. Patients completed a set of questionnaires on sociodemographic and clinical data. The Posttraumatic Growth Inventory (PTGI-SF) was used to assess the level of PTG, the Kessler Psychological Distress (K6) was used to measure the degree of psychological distress, the General Anxiety Disorder-7 (GAD-7) was used to evaluate the severity of anxiety symptoms, the Patient Health Questionnaire (PHQ-9) was used to assess the severity of depression symptoms, and the Explanatory Model Interview Catalog Stigma Scale (EMIC-SS) was used to record the degree of perceived stigma toward COVID-19.

Results

The median PTGI SF score of the respondents was 40.0 (Interquartile range 16.0). Multivariable general linear model with bootstrapping (2,000 replications) revealed factors that significantly predicted PTG, which were at the higher level of the perceived stigma score, at 37 (B = 0.367, 95% CI = 0.041 to 0.691, p = 0.026), among the Malay ethnicity (B = 12.767, 95% CI 38 = 7.541 to 17.993, p < 0.001), retirees (B = -12.060, 95% CI = -21.310 to -2.811, p = 0.011), and those with a history of medical illness (B = 4.971, 95% CI = 0.096 to 9.845, p = 0.046).

Conclusion

Experiencing stigma contributed to patients' PTG in addition to psychosocial factors such as ethnicity, history of medical illness, and retirement.

The relationships between knowledge levels, health-protective practices, and anxiety in nurses in the workplace during the COVID-19 pandemic

BACKGROUND

It is important to determine nurses' levels of knowledge, health-protective practices for work and social life, and mental health states at the beginning of the COVID-19 pandemic to combat the pandemic and minimize further problems.

OBJECTIVES

To determine the relationships between knowledge levels, health-protective practices, and anxiety among nurses during the COVID-19 pandemic.

METHODS

This cross-sectional study was carried out with the online participation of 605 nurses in Turkey. The researchers prepared a questionnaire form to evaluate the participants' knowledge of COVID-19 and their awareness and health-protective behaviours in work and social life. The mental health statuses of the participants were assessed with the Generalized Anxiety Disorder (GAD-7) questionnaire.

RESULTS

Most of the participants (87.8%) had high levels of knowledge of COVID-19, while 28.8% had severe levels of anxiety disorder. The use of alcohol-based hand disinfectants (88.2%) and the use of N95 or N99 masks (88.5%) were the least frequently practiced protective behaviours at work, while in social life, a healthy and balanced diet (61.6%), social distancing (72.8%), and paying attention to one's sleep pattern (77.3%) were the least frequently practiced protective behaviours. Older age (41-50 years), higher education (master's degree) and having a work experience of 10 years or more were determined to increase the knowledge levels of the participants about COVID-19 (p <  0.001). Anxiety levels were higher in those with a history of mental illness (p <  0.001).

CONCLUSIONS

Determining the knowledge levels, health-protective practices, and anxiety levels of nurses who are struggling in the frontlines in the field of health during the pandemic period can make a great contribution to the management of different current epidemics and pandemics and future ones by showing the areas in which nurses need to be empowered.

Impact of COVID-19 Outbreak Risk Perception on Willingness to Consume Products from Restaurants: Mediation Effect of Risk Attitude

The COVID-19 outbreak caused huge losses for the catering industry. The outbreak’s influence on consumers’ risk perception and risk attitude was an important factor for these heavy losses. The aim of this study was to investigate the change in epidemic risk perception, risk attitude, and the consumers’ willingness to consume products from restaurants during the spread of the COVID-19 epidemic. The study collected 502 questionnaires at the end of 2021, and structural analysis was conducted using SPSS 26.0 and AMOS 20.0 statistical programs. The results showed that consumers’ awareness of the coronavirus pandemic (consumers’ epidemic risk perception) had a significant positive effect on their decision-making behavior under uncertain conditions (risk attitude); consumers’ decision-making behavior under uncertain conditions (risk attitude) had a significant negative effect on their willingness to purchase from restaurants; consumers’ awareness of the coronavirus pandemic (consumers’ epidemic risk perception) had a significant negative effect on their willingness to consume products from restaurants; and risk attitude played a mediating role in the influence of consumers’ epidemic risk perception on their willingness to consume products from restaurants. This study can provide guidance and reference for restaurants on how to deal with the epidemic situation, help them undertake risk prevention work and reduce losses, and promote the healthy and sustainable development of the restaurant.

Increased Risk Perception, Distress Intolerance and Health Anxiety in Stricter Lockdowns: Self-Control as a Key Protective Factor in Early Response to the COVID-19 Pandemic

Studies provide evidence that distress, (health) anxiety, and depressive symptoms were high during the first weeks of COVID-19 lockdown restrictions, decreasing over time (possibly due to individuals’ protective psychological factors). Relations between different lockdown restrictions, mental health issues, and protective factors need to be explored, since even small lockdown effects might increase the risk of future mental health issues. We merged objective lockdown stringency data with individual data (N = 1001) to examine differences in lockdown effects in strict lockdown (Romania) and mild lockdown (Hungary) conditions between March and May 2020 on stressors and mental health symptoms, taking protective factors into account. The stricter lockdown in Romania revealed higher levels of perceived risk of infection, distress intolerance, and COVID-19 health anxiety. Protective psychological factors were not affected by the lockdown measures. Surpassing psychological flexibility and resilient coping, self-control proved to be the most promising protective factor. It is recommended that future research merge objective data with study data to investigate the effects of different COVID-19 lockdown measures on mental health and protective factors. Policy decisions should consider lockdown-dependent consequences of mental health issues. Intervention programs are suggested to mitigate mental health issues and to strengthen peoples’ protective psychological factors.

[Perceived risk from COVID-19 and depression, anxiety, and stress among workers in healthcare units]

The objective was to analyze associations between perceived risk from COVID-19 and symptoms of depression, anxiety, and stress among workers in healthcare units. This was a cross-sectional study of workers from different professions who appeared voluntarily at one of the first COVID-19 Testing Centers in the municipality of Rio de Janeiro, Brazil. The workers were invited to answer an online questionnaire from May to August 2020. The COVID-19 Risk Perception Scale and the Depression, Anxiety, and Stress Scale (DASS-21) were used. Odds ratios (OR) and 95% confidence intervals were estimated. Of the total sample (N = 2,996), 81.5% were women, and mean age was 40.7 years. About half presented mild, moderate, or severe depression, anxiety, or stress, and the rates for workers with severe symptoms were 18.5%, 29.6%, and 21.5%, respectively. The associations between perceived risk and symptoms of depression, anxiety, and stress increased with the increase in each symptom's severity. Workers with higher perceived risk from COVID-19 showed higher OR for severe symptoms of depression (OR = 4.67), anxiety (OR = 4.35), and stress (OR = 4.97). The findings point to the demand for measures to protect workers' health and that should not be limited to personal protective equipment. It is essential for health system administrators to promote collective spaces for discussion and actions to favor workers' recovery in the context of a prolonged pandemic.

The Relationship between Internet Addiction, Internet Gaming and Anxiety among Medical Students in a Malaysian Public University during COVID-19 Pandemic

The internet has become an important medium for learning and communication during the COVID-19 pandemic, particularly for university students. Nevertheless, an increase in internet usage could predispose people to internet addiction (IA) and internet gaming (IG). Equally, there is concern that anxiety levels have increased during the pandemic. The aim of this study is to determine the prevalence of IA and IG, and their associations with anxiety among medical students during the pandemic. Data were collected during the second wave of the “Conditional Movement Control Order” (CMCO) in Malaysia between 12 November and 10 December 2020. A total of 237 students participated through proportionate stratified random sampling in this cross-sectional study. They completed a set of online questionnaires which consisted of a sociodemographic profile, the Malay version of the internet addiction test (MVIAT), the Malay version of the internet gaming disorder-short form (IGDS9-SF) and the Malay version of the depression, anxiety and stress scale (DASS-21). The prevalence of IA and internet gaming disorder (IGD) were 83.5% and 2.5%, respectively. A multiple logistic regression showed that those in pre-clinical years had a greater risk of anxiety than those in clinical years [(AOR) = 2.49, p-value 0.01, 95% CI = 1.22–5.07]. In contrast, those who scored high on IA were protected against anxiety [AOR = 0.100, p-value 0.03, 95% CI = 0.01–0.76)]. In conclusion, IA was highly prevalent during the COVID-19 pandemic and its high usage might serve as a protective factor against anxiety among the medical students in this study sample.

The Cross-Sectional Relations of COVID-19 Fear and Stress to Psychological Distress among Frontline Healthcare Workers in Selangor, Malaysia

Previous pandemics have demonstrated short and long-term impacts on healthcare workers’ mental health, causing knock-on effects on patient care and professional functioning. Indeed, the present COVID-19 pandemic has created unprecedented disruption in social interactions and working conditions. Malaysia has been under the Recovery Movement Control Order since June 2020; however, with the upsurge of cases, healthcare workers face pressure not only from working in resource-deprived settings but also from the increasing patient load. The primary objective of the present study was to examine the cross-sectional relationship of COVID-19 fear and stress to psychological distress (operationalized as anxiety and depression) in healthcare workers. The present sample included 286 frontline healthcare workers from three hospitals in Selangor, Malaysia. Self-administered questionnaires containing sociodemographic and occupational items, the Malay versions of the Coronavirus Stress Measure scale, the Fear of Coronavirus-19 scale, the Generalized Anxiety Disorder-7, and the Patient Health Questionnaire-9 were distributed via online platforms. Hierarchical multiple regression findings suggest that age, shift work, and COVID-19 stress consistently predicted anxiety and depression among frontline healthcare workers after adjusting for sociodemographic and occupational variables. The present findings suggest that frontline healthcare workers are not only inoculated against COVID-19 itself but also against the psychological sequelae of the pandemic.