Resilience of people with chronic medical conditions during the COVID-19 pandemic: a 1-year longitudinal prospective survey

BACKGROUNDS

Individuals with chronic medical conditions are considered highly exposed to COVID-19 pandemic stress, but emerging evidence is demonstrating that resilience is common even among them. We aimed at identifying sustained resilient outcomes and their predictors in chronically ill people during the first year of the pandemic.

METHODS

This international 4-wave 1-year longitudinal online survey included items on socio-demographic characteristics, economic and living situation, lifestyle and habits, pandemic-related issues, and history of mental disorders. Adherence to and approval of imposed restrictions, trust in governments and in scientific community during the pandemic were also investigated. The following tools were administered: the Patient Health Questionnaire, the Generalized Anxiety Disorder scale, the PTSD Checklist DSM-5, the Oslo Social Support Scale, the Padua Inventory, and the Portrait Values Questionnaire.

RESULTS

One thousand fifty-two individuals reporting a chronic condition out of 8011 total participants from 13 countries were included in the study, and 965 had data available for the final model. The estimated probability of being "sustained-resilient" was 34%. Older male individuals, participants employed before and during the pandemic or with perceived social support were more likely to belong to the sustained-resilience group. Loneliness, a previous mental disorder, high hedonism, fear of COVID-19 contamination, concern for the health of loved ones, and non-approving pandemic restrictions were predictors of not-resilient outcomes in our sample.

CONCLUSIONS

We found similarities and differences from established predictors of resilience and identified some new ones specific to pandemics. Further investigation is warranted and could inform the design of resilience-building interventions in people with chronic diseases.

Health and Culture: The Association between Healthcare Preferences for Non-Acute Conditions, Human Values and Social Norms

Preference for professional vs. non-professional or informal healthcare for non-acute medical situations influences healthcare use and varies strongly across countries. Important individual and country-level drivers of these preferences may be human values (the fundamental values that individuals hold and guide their behavior) and country-level characteristics such as social tightness (societal pressure for “acceptable” behavior). The aim of this study was to examine the relation of these individual and country-level characteristics with healthcare preferences. We examined European Social Survey data from 23,312 individuals in 16 European countries, using a multi-level, random effect approach, including individual and country-level factors. Healthcare preferences were explained by both human values (i.e., Schwartz values) and societal tightness (i.e., tightness-looseness scores by Gelfand). Stronger conservation increased, whereas self-transcendence and openness to change decreased preference for professional healthcare. In socially tight countries, we found a higher preference for professional healthcare. Furthermore, we found interactions between social tightness and human values. These results suggest that professional healthcare preference is related to both people’s values and societal tightness. This improved understanding is useful for both predicting and channeling healthcare seeking behavior across and within nations.

Health and culture: National and individual drivers of preference for professional medical help

Background

Preferences for professional medical healthcare in case of non-acute medical situations influence a major amount of healthcare use, and vary strongly across countries. Personal values and country culture have been shown to be important predictors of human preferences in many areas. We therefore investigated the impact of both individual and country-level characteristics across Europe on individual healthcare preferences related to non-acute medical conditions.

Methods

Data from 17,710 individuals from 16 European countries were analysed using a multi-level approach, simultaneously including individual- and country level predictors.

Results

Healthcare preferences were explained by both human values (Conservation γ = 0.097, p < .01, Self Enhancement γ = 0.038, p < .05) and trust in the doctor (γ 0.054, p < .01). Socio-demographics played a minor role. Societal tightness-looseness (TL) strongly predicted healthcare use preferences on the country level (γ 0.109, p < .05). Also TL enhanced the relation between conservation and preference (γ 0.024, p <.05), and decreased the relation between self-enhancement and preference (γ -0.021, p <.01).

Conclusions

Our results suggest that healthcare behavior is related to people's motivations and the extent to which the society they live in is more tight or loose. Stronger conservation values increase preference for professional medical care, while self-transcendence- and openness-to-change values decrease preference. Societal tightness is positively related to preference on the country level. Furthermore, in tight societies the effect of conservation is enhanced and the effect of self enhancement is suppressed, related to an additional higher preference for professional medical help. Our results may help key actors within the health system to predict and channel healthcare choice behavior across and within nations.

Key messages

Culture plays an important role in developing a preference for medical help, on both individual as well as country level. Personal values the as well as cultural tightness looseness are fruitful tools for the analysis of national and international health care research.