The Impacts of Propensity to Worry and Fear of COVID-19 on Mental Health of University Students

Abstract

Epidemics and pandemics are difficult periods for the affected community, specifically in the proliferation of mental health issues. In such adverse times, factors of psychological vulnerability such as propensity to worry and low emotional stability might have a detrimental effect on the mental health of the individuals. To investigate the impact of such factors on mental health, this study examined the impacts of propensity to worry and fear of COVID-19 on anxiety depending on the individuals’ levels of emotional stability. As a means of such investigation, this study was conducted based on quantitative data, and the research sample was selected using a convenient sampling method. Participants included 304 university students (71.6% were women and 28.4% were men; MAge = 22.37 ± 3.04) and responded to the Penn State Worry Questionnaire, Fear of COVID-19 Scale, Symptom Checklist-90 Revised, and 10-Item Personality Inventory. The moderated mediation analysis using PROCESS macro (Model 14) was performed to examine the study hypotheses. Results revealed that propensity to worry was associated with anxiety symptoms. Fear of COVID-19 mediated this link and emotional stability moderated the relationship between propensity to worry and anxiety. The findings showed that trait worry, trait emotional stability, and fear of COVID-19 are determinants of anxiety symptoms, suggesting that such factors are important in understanding these issues.

Keywords

• Propensity to worry
• fear of COVID-19
• emotional stability
• anxiety
• moderated mediation

References

1. Ahorsu, D. K., Lin, C. Y., Imani, V., Saffari, M., Griffiths, M. D., & Pakpour, A. H. (2020). The fear of COVID-19 scale: Development and initial validation. International Journal of Mental Health and Addiction. Advance online publication. https://doi.org/10.1007/s11469-020-00270-8
2. Alcabes, P. (2010). Dread: How fear and fantasy have fueled epidemics from the Black Death to avian flu. Public Affairs.
3. Arpaci, I., Karataş, K., & Baloğlu, M. (2020). The development and initial tests for the psychometric properties of the COVID-19 Phobia Scale (C19P-S). Personality and Individual Differences, 164, 1-6 . https://doi.org/10.1016/j.paid.2020.110108
4. Atak, H. (2013). The Turkish adaptation of the Ten-Item Personality Inventory. Noro Psikiyatri Arsivi, 50(4), 312–319. https://doi.org/10.4274/npa.y6128
5. Baiano, C., Zappullo, I., & Conson, M. (2020). Tendency to worry and fear of mental health during Italy’s COVID-19 lockdown. International Journal of Environmental Research and Public Health, 17(16), 1-8. https://doi.org/10.3390/ijerph17165928
6. Belen, H. (2020a). Fear of COVID-19 and mental health: The Role of mindfulness in during time of crisis. International Journal of Mental Health and Addiction. Advance online publication. https://doi.org/10.1007/s11469-020-00470-2
7. Belen, H. (2020b). Self-blame regret, fear of COVID-19 and mental health during post-peak pandemic. Research Square. https://doi.org/10.21203/rs.3.rs-56485/v1
8. Bendau, A., Petzold, M. B., Pyrkosch, L., Maricic, L. M., Betzler, F., Rogoll, J., et al. (2020). Associations between COVID-19 related media consumption and symptoms of anxiety, depression and COVID-19 related fear in the general population in Germany. European Archives of Psychiatry and Clinical Neuroscience. Advance online publication. https://doi.org/10.1007/s00406-020-01171-6

9. Bentler, P. M., & Chou, C. P. (1987). Practical issues in structural modeling. Sociological Methods & Research, 16(1), 78-117.
10. Bhuiyan, A. I., Sakib, N., Pakpour, A. H., Griffiths, M. D., & Mamun, M. A. (2020). COVID-19-related suicides in Bangladesh due to lockdown and economic factors: Case study evidence from media reports. International Journal of Mental Health and Addiction. Advance online publication. https://doi.org/10.1007/s11469-020-00307-y
11. Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely, S., Greenberg, N., et al. (2020). The psychological impact of quarantine and how to reduce it: Rapid review of the evidence. The Lancet. Advance online publication. https://doi.org/10.1016/S0140-6736(20)30460-8
12. Cameron, E., Joyce, K., Delaquis, C., Reynolds, K., Protudjer, J., & Roos, L. E. (2020). Maternal psychological distress & mental health services use during the COVID-19 pandemic. Advance online publication. https://doi.org/10.31234/osf.io/a53zb
13. Chong, M. Y., Wang, W. C., Hsieh, W. C., Lee, C. Y., Chiu, N. M., Yeh, W. C., et al. (2004). Psychological impact of severe acute respiratory syndrome on health workers in a tertiary hospital. The British Journal of Psychiatry, 185(2), 127-133.
14. Cohen, L., Manion, L., & Morrison, K. (2018). Research methods in education (8th ed.). Routledge.
15. Costa, P. T., & McCrae, R. R. (2008). The Revised NEO Personality Inventory (NEO-PI-R). Sage Publications Inc.
16. Dağ, I. (1991). Belirti Tarama Listesi (Scl-90-R)'nin üniversite öğrencileri için güvenirliği ve geçerliği [Reliability and validity of the Symptom CheckList (SCL-90-R) for university students]. Türk Psikiyatri Dergisi, 2(1), 5–12.
17. Dai, Y., Hu, G., Xiong, H., Qiu, H., & Yuan, X. (2020). Psychological impact of the coronavirus disease 2019 (COVID-19) outbreak on healthcare workers in China. MedRxiv. https://doi.org/10.1101/2020.03.03.20030874
18. de Hoog, N., Stroebe, W., & de Wit, J. B. (2008). The processing of fear‐arousing communications: How biased processing leads to persuasion. Social Influence, 3(2), 84-113. https://doi.org/10.1080/15534510802185836
19. Deng, J., Zhou, F., Hou, W., Silver, Z., Wong, C. Y., Chang, O., et al. (2020). The prevalence of depression, anxiety, and sleep disturbances in COVID-19 patients: A meta-analysis. Annals of the New York Academy of Sciences. Advance online publication https://doi.org/10.1111/nyas.14506
20. Derogatis, L. R., Lipman, R. S., Rickels, K., Uhlenhuth, E. H., & Covi, L. (1974). The Hopkins Symptom Checklist (HSCL): A self‐report symptom inventory. Behavioral Science, 19(1), 1-15.
21. Di Crosta, A., Palumbo, R., Marchetti, D., Ceccato, I., La Malva, P., Maiella, R., et al. (2020). Individual differences, economic stability, and fear of contagion as risk factors for PTSD symptoms in the COVID-19 emergency. Frontiers in Psychology, 11, 1-9.
22. El-Zoghby, S. M., Soltan, E. M., & Salama, H. M. (2020). Impact of the COVID-19 pandemic on mental health and social support among adult Egyptians. Journal of Community Health, 45, 689-695.
23. European Centre for Disease Prevention and Control. (2020). COVID-19: Situation update worldwide. April 14, 2021, from: https://www.ecdc.europa.eu/en/geographical-distribution-2019-ncov-cases
24. Gates, B. (2020). Responding to Covid-19—a once-in-a-century pandemic? New England Journal of Medicine, 382(18), 1677-1679.
25. Goodwin, H., Yiend, J., & Hirsch, C. R. (2017). Generalized Anxiety Disorder, worry and attention to threat: A systematic review. Clinical Psychology Review, 54, 107-122.
26. Gosling, S. D., Rentfrow, P. J., & Swann Jr, W. B. (2003). A very brief measure of the Big-Five personality domains. Journal of Research in Personality, 37(6), 504-528
27. Grossman, E. S., Hoffman, Y. S., Palgi, Y., & Shrira, A. (2020). COVID-19 related loneliness and sleep problems in older adults: Worries and resilience as potential moderators. Personality and Individual Differences,168, 1-5. https://doi.org/10.1016/j.paid.2020.110371
28. Hair, J. F., Money, A. H., Samouel, P., & Page, M. (2007). Research Methods for Business. John Willey & Sons Limited.
29. Hamama-Raz, Y., Mahat-Shamir, M., Pitcho-Prelorentzos, S., Zaken, A., David, U. Y., Ben-Ezra, M., & Bergman, Y. S. (2016). The link between death anxiety and post-traumatic symptomatology during terror: Direct links and possible moderators. Psychiatry Research, 245, 379-386.
30. Han, L., Wong, F. K. Y., She, D. L. M., Li, S. Y., Yang, Y. F., Jiang, M. Y., et al. (2020). Anxiety and depression of nurses in a North West Province in China during the period of novel coronavirus pneumonia outbreak. Journal of Nursing Scholarship. Advance online publication. doi: 10.1111/jnu.12590
31. Hao, X., Zhou, D., Li, Z., Zeng, G., Hao, N., Li, E., et al. (2020). Severe psychological distress among patients with epilepsy during the COVID‐19 outbreak in southwest China. Epilepsia, 61 (6), 1166-1173. https://doi.org/10.1111/epi.16544
32. Harris, S. E., Hennah, W., Thomson, P. A., Luciano, M., Starr, J. M., Porteous, D. J., & Deary, I. J. (2010). Variation in DISC1 is associated with anxiety, depression and emotional stability in elderly women. Molecular Psychiatry, 15(3), 232-234.
33. Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. The Guilford Press.
34. Hyland, P., Shevlin, M., McBride, O., Murphy, J., Karatzias, T., Bentall, R., et al. (2020). Anxiety and depression in the Republic of Ireland during the COVID-19 pandemic. Acta Psychiatrica Scandinavica, 142, 249-256.
35. Joos, E., Vansteenwegen, D., & Hermans, D. (2012). Worry as a predictor of fear acquisition in a nonclinical sample. Behavior Modification, 36(5), 723-750.
36. Kaparounaki, C. K., Patsali, M. E., Mousa, D. P. V., Papadopoulou, E. V., Papadopoulou, K. K., & Fountoulakis, K. N. (2020). University students’ mental health amidst the COVID-19 quarantine in Greece. Psychiatry Research, 290 (2020), 113111. https://doi.org/10.1016/j.psychres.2020.113111
37. Kılınçel, Ş., Kılınçel, O., Muratdağı, G., Aydın, A., & Usta, M. B. (2020). Factors affecting the anxiety levels of adolescents in home‐quarantine during COVID‐19 pandemic in Turkey. Asia‐Pacific Psychiatry. Advance online publication. https://doi.org/10.1111/appy.12406
38. Korte, K. J., Allan, N. P., & Schmidt, N. B. (2016). Factor mixture modeling of the Penn State Worry Questionnaire: Evidence for distinct classes of worry. Journal of Anxiety Disorders, 37, 40-47.
39. Lee, S. A., Jobe, M. C., Mathis, A. A., & Gibbons, J. A. (2020). Incremental validity of Coronaphobia: Coronavirus anxiety explains depression, generalized anxiety, and death anxiety. Journal of Anxiety Disorders, 74, 1-4. https://doi.org/10.1016/j.janxdis.2020.102268
40. Matthews, G., Campbell, S. E., Falconer, S., Joyner, L. A., Huggins, J., Gilliland, K., et al. (2002). Fundamental dimensions of subjective state in performance settings: Task engagement, distress, and worry. Emotion, 2(4), 315.
41. Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy, 28(6), 487-495.
42. Nickell, L. A., Crighton, E. J., Tracy, C. S., Al-Enazy, H., Bolaji, Y., Hanjrah, S., et al. (2004). Psychosocial effects of SARS on hospital staff: Survey of a large tertiary care institution. Cmaj, 170(5), 793-798.
43. Parmentier, F. B., García-Toro, M., García-Campayo, J., Yañez, A. M., Andrés, P., & Gili, M. (2019). Mindfulness and symptoms of depression and anxiety in the general population: The mediating roles of worry, rumination, reappraisal and suppression. Frontiers in Psychology, 10, 1-10.
44. Penney, A. M., Miedema, V. C., & Mazmanian, D. (2015). Intelligence and emotional disorders: Is the worrying and ruminating mind a more intelligent mind? Personality and Individual Differences, 74, 90-93.
45. Preacher, K. J., & Hayes, A. F. (2008). Contemporary approaches to assessing mediation in communication research. In A. F. Hayes, M. D. Slater, & L. B. Snyder (Eds.), The Sage sourcebook of advanced data analysis methods for communication research (pp. 13-54). Sage.
46. Raes, F. (2010). Rumination and worry as mediators of the relationship between self-compassion and depression and anxiety. Personality and Individual Differences, 48(6), 757-761.
47. Reynolds, D. L., Garay, J. R., Deamond, S. L., Moran, M. K., Gold, W., & Styra, R. (2008). Understanding, compliance and psychological impact of the SARS quarantine experience. Epidemiology & Infection, 136(7), 997-1007.
48. Roy, D., Tripathy, S., Kar, S. K., Sharma, N., Verma, S. K., & Kaushal, V. (2020). Study of knowledge, attitude, anxiety & perceived mental health care need in Indian population during COVID-19 pandemic. Asian Journal of Psychiatry, 51, 1-7. https://doi.org/10.1016/j.ajp.2020.102083
49. Şahin, M. K., Aker, S., Şahin, G., & Karabekiroğlu, A. (2020). Prevalence of depression, anxiety, distress and insomnia and related factors in healthcare workers during COVID-19 pandemic in Turkey. Journal of Community Health, 45, 1168-1177.
50. Satici, B., Gocet-Tekin, E., Deniz, M. E., & Satici, S. A. (2020). Adaptation of the Fear of COVID-19 Scale: Its association with psychological distress and life satisfaction in Turkey. International Journal of Mental Health and Addiction. Advance online publication. https://doi.org/10.1007/s11469-020-00294-0.
51. Shete, A. N., & Garkal, K. D. (2015). A study of stress, anxiety, and depression among postgraduate medical students. CHRISMED Journal of Health and Research, 2(2), 119-123.
52. Shoal, G. D., Castaneda, J. O., & Giancola, P. R. (2005). Worry moderates the relation between negative affectivity and affect-related substance use in adolescent males: A prospective study of maladaptive emotional self-regulation. Personality and Individual Differences, 38(2), 475-485.
53. Sim, M. R. (2020). The COVID-19 pandemic: Major risks to healthcare and other workers on the front line. Occupational and Environmental Medicine, 77(5), 281-282.
54. Smirni, P., Lavanco, G., & Smirni, D. (2020). Anxiety in older adolescents at the time of COVID-19. Journal of Clinical Medicine, 9(10), 1-10. https://doi.org/10.3390/jcm9103064
55. Spence, D. (2020). Isolated already, how COVID‐19 has exacerbated anxiety for Australian cancer patients. Psychooncology, 29, 1427-1429.
56. Spinhoven, P., Penninx, B. W., Krempeniou, A., van Hemert, A. M., & Elzinga, B. (2015). Trait rumination predicts onset of Post-Traumatic Stress Disorder through trauma-related cognitive appraisals: A 4-year longitudinal study. Behaviour Research and Therapy, 71, 101-109.
57. Swee, M. B., Olino, T. M., & Heimberg, R. G. (2019). Worry and anxiety account for unique variance in the relationship between intolerance of uncertainty and depression. Cognitive Behaviour Therapy, 48(3), 253-264.
58. Tang, W., Hu, T., Yang, L., & Xu, J. (2020). The role of alexithymia in the mental health problems of home-quarantined university students during the COVID-19 pandemic in China. Personality and Individual Differences, 165, 1-7. https://doi.org/10.1016/j.paid.2020.110131
59. Taylor, S. (2019). The psychology of pandemics: Preparing for the next global outbreak of infectious disease. Cambridge Scholars Publishing.
60. Tsang, H. W., Scudds, R. J., & Chan, E. Y. (2004). Psychosocial impact of SARS. Emerging Infectious Disease, 10, 1326-1327.
61. West, S. G., Finch, J. F., & Curran, P. J. (1995). Structural equation models with non-normal variables: Problems and remedies. In R. H. Hoyle (Ed.), Structural equation modeling: Concepts, issues, and applications (pp. 56–75). Sage.
62. Xie, Y., Kong, Y., Yang, J., & Chen, F. (2019). Perfectionism, worry, rumination, and distress: A meta-analysis of the evidence for the perfectionism cognition theory. Personality and Individual Differences, 139, 301-312.
63. Yılmaz, A. E., Gençöz, T., & Wells, A. (2008). Psychometric characteristics of the Penn State Worry Questionnaire and Metacognitions Questionnaire‐30 and metacognitive predictors of worry and obsessive–compulsive symptoms in a Turkish sample. Clinical Psychology & Psychotherapy: An International Journal of Theory & Practice, 15(6), 424-439.