Distress and Resilience in the Days of COVID-19: Comparing Two Ethnicities

Economic disadvantage and depressive symptoms among Arab and Jewish women in Israel: the role of social support and formal services

OBJECTIVES

Depression is a major public health concern due to its high prevalence and association with functioning. Ethnic minorities in Western countries are more likely to experience economic disadvantage and exposure to stressors that may put them at higher risk of developing depression. One major protective factor associated with reduced depressive symptoms is an existing support network. This study examined the associations between economic disadvantage, formal and informal social support, and depressive symptoms among two ethnicity groups in Israel: Arab and Jewish mothers of young children, as well as the potential mediating role of formal and informal social support in the associations between economic disadvantage and depressive symptoms.

DESIGN

We recruited a representative sample of 837 Jewish and Arab mothers of children aged 2-6 years. We collected data via structured face-to-face interviews following approval of the university ethic committee. We used the Center for Epidemiologic Studies Depression Scale (CES-D), the Medical Outcomes Study (MOS) scale to measure maternal perceived social support, and a measure designed for this study to quantify formal social support.

RESULTS

Compared to the Jewish mothers, Arab mothers reported more depressive symptoms, greater economic disadvantage, and fewer informal and formal support networks. Economic disadvantage was negatively associated with informal support but positively associated with formal support among both Jewish and Arab mothers. Results further revealed that informal and formal social support mediated the associations between economic disadvantage and symptoms of depression.

CONCLUSIONS

More attention should be paid to the associations between social determinants and mothers' mental health, with a possible shift of focus to macro-level factors, such as economic inequality and minority status.

Factors Associated with Post-Traumatic Growth during the COVID-19 Pandemic: A Systematic Review

The COVID-19 pandemic was an unprecedented event that further stimulated the debate on the concept of trauma. To increase knowledge about the traumatic potential of the pandemic, the main objective of this study was to identify, through a systematic literature review, the main factors associated with the adaptive outcome of post-traumatic growth caused by COVID-19. Studies were selected from the PsychInfo, Embase, and PubMed databases, and 29 articles were included at the end of the screening process. The identified factors are of different natures, including personal variables such as personality traits, coping, and cognitive strategies used to face adversity, and interpersonal variables, one of the most important of which is the level of social support. In addition, several results confirmed a relationship between post-traumatic growth and post-traumatic stress symptoms, as well as indices related to psychological well-being. Finally, the results are discussed by comparing them with those already present in the literature, as well as with some of the main explanatory models of post-traumatic growth. In this regard, some of the factors identified, such as maladaptive coping, avoidance symptoms, optimism, and low-stress tolerance, suggest the possibility that the process of post-traumatic growth may also be characterized by an illusory dimension.

Parenthood during the COVID-19 pandemic: Post-traumatic growth amongst university students

This study sought to investigate a positive dimension of coping with the COVID-19 pandemic, that of post-traumatic growth (PTG). This study investigated coping difficulties and PTG amongst parent and nonparent students in Israeli Universities. A total of 4022 parents (3648 Jews and 374 Palestinian-Arab Citizens [PACs]) and 14,651 nonparents (12,010 Jews and 2641 PACs) completed measures of coping, social support and PTG. Parents demonstrated significantly higher levels of coping and PTG. Amongst parents, fathers coped slightly better than mothers; however, while Jewish mothers demonstrated greater PTG than Jewish fathers, PAC fathers had significantly greater PTG than both PAC mothers and Jewish parents. These findings, while specific to COVID-19, indicate that PTG should be studied in greater depth in different ethnic and minority groups in order to develop enhanced understanding and facilitate promotion of post-traumatic growth, in addition to the prevention of COVID-19-related distress.

Women’s self-care for Coronavirus prevention and the related factors in Iran: A cross-sectional study

Promoting self-care can be an effective way to decrease the rate of transmission and expansion of the infection. However, there seem to be different related factors to self-care by gender. This study aims to assess women’s self-care for COVID-19 prevention and some related factors in Tehran-Iran in 2021. This was a descriptive cross-sectional study that was performed on 403 women living in Tehran in 2021. Subjects of the study were recruited using a multi-stage sampling method. Data was collected using a socio-demographic questionnaire as well as a valid and reliable questionnaire to assess women’s self-care for COVID-19 prevention (SCVP-38). The questionnaires were sent on the Google platform to the eligible participants. After completion of the forms, the created data in the Excel software in Google Drive were converted to SPSS 24 and then analyzed by using t-test, ANOVA, Pearson correlation, and multiple linear regression tests. The overall mean score of self-care was 71.84±17.81 percent. The highest and lowest scores were respectively related to using masks in public vehicles and not touching the face. Significant negative correlations were shown between the women’s self-care on Corona prevention with stress, anxiety, concerns, and fear (P<0.001). Linear multiple regression showed two factors including women’s age (p = 0.033) and their number of children (p = 0.042) predict the self-care, so that, for increasing each year to women’s age, SCVP increases by 0.463 units, and with increasing each child, SCVP decreases by 3.608 units. We concluded that in the COVID-19 pandemic, women in Tehran are performing more than 70% of measures of self-care. Also, education about self-care is recommended for younger women with more children. Moreover, promoting the self-care program can improve women’s mental health during the COVID-19 pandemic.

Women's self-care for Coronavirus prevention and the related factors in Iran: A cross-sectional study

Promoting self-care can be an effective way to decrease the rate of transmission and expansion of the infection. However, there seem to be different related factors to self-care by gender. This study aims to assess women's self-care for COVID-19 prevention and some related factors in Tehran-Iran in 2021. This was a descriptive cross-sectional study that was performed on 403 women living in Tehran in 2021. Subjects of the study were recruited using a multi-stage sampling method. Data was collected using a socio-demographic questionnaire as well as a valid and reliable questionnaire to assess women's self-care for COVID-19 prevention (SCVP-38). The questionnaires were sent on the Google platform to the eligible participants. After completion of the forms, the created data in the Excel software in Google Drive were converted to SPSS 24 and then analyzed by using t-test, ANOVA, Pearson correlation, and multiple linear regression tests. The overall mean score of self-care was 71.84±17.81 percent. The highest and lowest scores were respectively related to using masks in public vehicles and not touching the face. Significant negative correlations were shown between the women's self-care on Corona prevention with stress, anxiety, concerns, and fear (P<0.001). Linear multiple regression showed two factors including women's age (p = 0.033) and their number of children (p = 0.042) predict the self-care, so that, for increasing each year to women's age, SCVP increases by 0.463 units, and with increasing each child, SCVP decreases by 3.608 units. We concluded that in the COVID-19 pandemic, women in Tehran are performing more than 70% of measures of self-care. Also, education about self-care is recommended for younger women with more children. Moreover, promoting the self-care program can improve women's mental health during the COVID-19 pandemic.

Changes in Quality of Life Following SARS-CoV-2 Infection Among Jewish and Arab Populations in Israel: A Cross-Sectional Study

Objectives: The long-term impact of COVID-19 on health inequalities is under-researched. We investigated changes in health-related inequalities following SARS-CoV-2 infection between the Jewish majority and the Arab/Druze minority in Israel. Methods: Patients with a positive SARS-CoV-2 RT-PCR test processed from one of the Northern-Israeli government hospitals between 03/2021 and 05/2022 were invited to participate. We collected socio-demographic, COVID-19-related, and health-related quality of life (HRQoL) information using a validated questionnaire. We compared pre- and post COVID-19 HRQoL changes between Jews and Arabs/Druze, up to 12+ months post-infection using an adjusted linear regression model. Results: Among the 881 included participants the average post-COVID HRQoL score was lower among Arabs/Druze than Jews (0.83 vs. 0.88; p = 0.005). Until 12 months post-infection, HRQoL changes were similar for Arabs/Druze and Jews. After 12 months, HRQoL dropped significantly more among Arabs/Druze than among Jews (0.11 points difference between the groups; p = 0.014), despite adjusting for socioeconomic variables. Conclusion: 12 months post-infection, COVID-19 affected the HRQoL of Arabs/Druze more than Jews, with the gap not fully explained by socio-economic differences. The COVID-19 pandemic may widen pre-existing long-term health inequalities.

Uncovering Resilience Disparities among Religious Groups in Israel's Mass COVID-19 Vaccination Drive: Lessons Learned to the Post-COVID Era

The aim of the current study was to examine the emotional resilience, satisfaction with life, social support, and anxiety during the vaccination process of the Israeli population after the end of the third lockdown, according to religiosity degree. We hypothesized that a higher degree of religiosity (ultra-Orthodox and religious participants) would be associated with higher levels of resilience and with lower levels of anxiety than in secular individuals. In addition, it was hypothesized that satisfaction with life, social support, anxiety, and religiosity will predict resilience and anxiety. Nine hundred and ninety-three native Jewish Hebrew-speaking respondents representing ultra-Orthodox, religious, observant, and secular Jews participated in this study. Ultra-Orthodox participants showed higher resilience and satisfaction with life than other groups, and lower levels of anxiety. Satisfaction with life and social support predicted higher resilience. It is suggested that religious faith as well as satisfaction with life may provide a source of strength and resilience in stressful life events.

Psychological distress, optimism and emotion regulation among Israeli Jewish and Arab pregnant women during COVID-19

BACKGROUND

Pregnancy is a vulnerable period for women, and it is especially so under the worldwide COVID-19 pandemic. Whereas there is some evidence for distress among pregnant women during the outspread of COVID-19, little is known about the second wave of the pandemic. We therefore sought to examine the contribution of background variables, ethnicity (Jewish, Arab), personal resources (optimism, emotion regulation), and COVID-19-related anxieties to pregnant Israeli women's psychological distress.

METHOD

A convenience sample of 1127 Israeli women was recruited from 5 July to 7 October 2020.

RESULTS

Not having an academic degree, lower economic status, being an Arab woman, poorer physical health, lower levels of optimism and cognitive reappraisal, higher levels of emotion suppression and COVID-19-related anxieties all contributed significantly to greater psychological distress. Finally, ethnicity moderated the relationship between optimism and emotion suppression and the woman's level of psychological distress.

CONCLUSIONS

The findings reveal risk and resilience factors associated with the psychological distress of pregnant women during the second wave of the COVID-19 pandemic and highlight the potentially greater vulnerability of women from a minority group, showing that ethnicity plays a central role in the way personal resources are related to psychological distress at such times.

Can Views and Contact with Nature at Home Help Combat Anxiety and Depression during the Pandemic? Results of the GreenCOVID study

BACKGROUND

The COVID-19 pandemic and the lockdown measures have had important consequences on the mental health of the population, although little is known about the role played by nature and its benefits.

OBJECTIVES

The present study aims to evaluate the risk of anxiety and depression during the first wave of the COVID-19 pandemic in Spain and to identify the factors most strongly associated with anxiety and depression, including sociodemographic, household characteristics, and access to or contact with natural environment.

METHODS

GreenCOVID is an online cross-sectional study promoted by the Health & Territory Research (HTR) of the University of Seville in Spain, Maynooth University in Ireland, and the University of Winchester in the United Kingdom. This study includes only data from Spain which were collected between April 8, 2020 and April 27, 2020. Binary logistic regression was conducted to identify the factors associated with anxiety and depression through the HADS scale.

RESULTS

Of the total of 2,464 adults who participated in GreenCOVID Spain, mean age was 38.1 years, 72.6% were female, 58.1% were at risk of anxiety, and 32.3% of depression. In the multivariable logistic regression, the factors associated with risk of anxiety were female: gender, being a student and problems at home. Regarding the risk of depression, the factors most associated were being a student, female gender, problems at home, worse evaluation of views from home and less help from outside views to cope with lockdown.

CONCLUSIONS

Our findings show that during COVID-19 pandemic, in addition to sociodemographic factors female gender and being a student, problems at home, lack of natural elements in the home, and worse appreciation of views from home were associated with mental health problems. Thus, housing conditions and access to the natural environment were important for mental health during COVID-19 lockdown.

Resilience, Stress, Well-Being, and Sleep Quality in Multiple Sclerosis

(1) Background: Multiple Sclerosis (MS) is a chronic, progressive, immune-mediated disorder that affects the Central Nervous System and is the most common cause of non-traumatic neurological disability in young adults. The study aimed to assess the levels of stress, resilience, well-being, sleep quality, and fatigue in Israeli people with MS (PwMS), and to examine the associations between these factors and the sociodemographic and clinical characteristics. These factors had never before been studied in conjunction in PwMS, nor had they been systematically addressed in Israel, the unique geopolitical situation of which may pose unique challenges. (2) Methods: This was a survey-based, cross-sectional study conducted through an Internet platform. (3) Results: Israeli PwMS who participated in the study were experiencing relatively high levels of stress and low resilience, poor sleep quality, and severe fatigue. The analysis revealed significant associations between resilience and stress, well-being, and anxiety, as well as stress and well-being, resilience, sleep quality, fatigue, and Clinically Isolated Syndrome (CIS). (4) Conclusions: the Israeli PwMS who participated in the study were experiencing higher levels of stress, lower resilience and worse sleep quality than PwMS in other countries, as compared to results previously reported in literature. The findings of this study ought to serve as a call to action for the MS care providers in Israel and warrant further research into the possible causes of the phenomenon and strategies to address it.

Rise in depression and anxiety during the COVID-19 pandemic: results from a cross-sectional national survey

The Coronavirus disease 2019 (COVID-19) pandemic has introduced many mental stressors. This study aimed to evaluate the prevalence of depression and anxiety during the pandemic and characterize those at higher risk. We conducted a national cross-sectional telephone interview survey among Israeli adults from May to September 2020, between the first two national lockdowns. Mental health status was measured using the 5-item Mental Health Inventory (MHI-5). A score of ≤60 was defined as poor mental health with moderate to high anxiety and depression symptoms. Multivariate analysis was used to identify demographic, health-related, and COVID-19-related risk factors associated with poor mental health. From 4,712 households that were eligible for inclusion in this study, 2,634 participants (55.9%) completed the survey. Levels of anxiety and depression symptoms increased significantly throughout the pandemic (from 12.9% to 20.3%, P < 0.001). Loneliness also increased over time (from 48.8% to 58.8%, P < 0.001), and fear of the pandemic remained high (66.5%) throughout the study. According to the multivariate analysis, poor mental health was associated with younger age, female gender, lower education, Arab ethnicity, decrease in household income during the pandemic, having a pre-existing chronic illness, obesity, smoking, ever being quarantined, feeling lonely and fear of the pandemic. Our findings show an increase in anxiety and depression over time among the Israeli population during the COVID-19 pandemic. These findings highlight the need for strengthened mental health services and the flexibility of reallocation of funds and health resources to support the growing mental health needs during the health crisis.

Exploring People's Perception of COVID-19 Risk: A Case Study of Greater Jakarta, Indonesia

This study aims to understand people's perceptions of COVID-19 risk in Greater Jakarta, Indonesia. In response to the COVID-19 pandemic, the Indonesian government enacted a health protocol campaign and highlighted the community as an important unit of protocol compliance. We hypothesized that people's perception of the likelihood of being infected with COVID-19 is associated with health protocol compliance at the community level and their perception of community resilience. As the number of infected persons drastically increased, the "family cluster" also became a significant issue in the pandemic response, especially in Indonesia. In this study, we explored both community and family aspects that influence people's perceptions. We conducted an online survey in March 2021 with 370 respondents residing in the Greater Jakarta area. The respondents were classified into four age groups (20s, 30s, 40s, and 50-and-over), with gender-balanced samples allocated to each group. We used a questionnaire to measure the perception of COVID-19 risk along with the Conjoint Community Resiliency Assessment Measure (CCRAM). Multiple regression analysis revealed that family factors have a much larger influence on the individual perception of the likelihood of contracting COVID-19 than community factors. The results suggest that the link between family-level efforts against COVID-19 and individual-level perceptions cannot be separated in response to the pandemic.

Contributors to COVID-19-Related Childbirth Anxiety among Pregnant Women in Two Pandemic Waves

COVID-19 has impacted all levels of daily life for people everywhere, with particularly serious implications for pregnant women. This paper examines the COVID-19-related childbirth anxiety (CCA) of Israeli women in the first two waves of the pandemic. We first present two psychotherapeutic case studies with pregnant women in the two waves. This is followed by an empirical study that compared the contribution of background variables, psychological distress, economic concerns, and personal resources to CCA in two samples, Wave 1, March-April 2020 (n = 403) and Wave 2, September-October 2020 (n = 1401), and two subpopulations, Jewish and Arab women. Findings reveal that CCA was significantly lower in Wave 2 than in Wave 1. Furthermore, poorer health, higher education, being an Arab, later gestational week, at-risk pregnancy, wave, higher psychological distress, greater economic concerns, and lower self-compassion contributed to higher childbirth anxiety. Wave moderated the association between optimism and anxiety. The findings of the empirical study, together with insights from the case studies, provide evidence of a decrease in CCA later in the crisis, and indicate the significance of resources for coping with the psychological implications of the pandemic. Moreover, they suggest the importance of empowering self-reliance techniques, such as self-compassion, which was significantly associated with lower anxiety, above and beyond the background and psychological variables. Clinical Impact Statement: Using both psychotherapeutic cases and empirical findings, this study points to the risk and resilience factors that contributed to pregnant women's COVID-19-related childbirth anxiety (CCA) in the first two waves of the pandemic. The study suggests that CCA was higher in the first wave, as well as among women from a minority group. At the same time, the research shows that resilience resources of optimism and self-compassion contributed to the reduction of anxiety. These findings may guide interventions for the vulnerable group of pregnant women in times of crisis.

Cross-Sectional Study of Factors Influencing Perceived Threat and Stress among the Arab Minority in Israel during the COVID-19 Pandemic

This study aimed to examine the impact of the locus of control, coping strategies and loneliness on perceived threat and stress among the Arab minority in Israel during the first COVID-19 closure. This was a cross-sectional online study, with 486 participants who completed a questionnaire measuring the study variables during the period of 28-31 March 2020. Statistical analyses included t-tests and analyses of variance. Means, standard deviations and intercorrelations for the study variables were calculated. The results revealed a moderate-low level of stress and a moderate-high level of perceived threat. Higher stress was related to higher perceived threat, a greater external locus of control, lower problem-focused coping, higher emotion-focused coping and social support-seeking and higher loneliness. Perceived threat was positively related to both problem-focused coping and emotion-focused coping. The results show that the Arab population in Israel coped as a strong minority group. This study contributes to our understanding of how minority groups cope in the current epidemic and to the identification of effective strategies for reducing stress during this challenging period. The study's results may help devise intervention programs that foster more effective coping capabilities among this and other minority populations.

Difference between Minorities and Majorities in the Association between COVID-19-Related Stress and Psychological Distress: A Socio-Ecological Perspective and the Moderating Role of Parenthood

This study introduces a socio-ecological perspective of differences in psychological distress between the Palestinian minority and Jewish majority citizens of Israel during lockdown due to COVID-19. The study examines the association between COVID-19-related stress and psychological distress, and the moderating effect of parenthood. Online questionnaires, completed by 1934 participants (1391 Jews, 552 Palestinians; 1306 parents, 637 without children; 54.86% female, 45.13% male; M age = 40.38, SD = 13.77) assessed COVID-19-related stressors and depression, anxiety, and stress. The Palestinian minority showed a higher level of COVID-19-related stress and psychological distress than the Jewish majority. Parenthood showed a moderating effect on the association between COVID-19-related stress and distress for the Jewish majority but not the Palestinian minority. The results emphasize the significance of considering social status when seeking to understand the differences between minorities and majorities in terms of distress and resilience during pandemic events, and the need for cultural sensitivity and awareness when issuing instructions in such circumstances. Additionally, the results highlight the potential role of parenthood as a resilience factor, depending upon social status.

Resilience and Risk Factors Predict Family Stress Among Married Palestinians in Israel During the COVID-19 Pandemic

The present study examined effects of sociodemographic, risk, and resilience factors on marital, parental, and financial stress early in the COVID-19 pandemic. A cross-sectional online survey was conducted among 480 married Palestinians living in Israel, using self-report questionnaires. Descriptive statistics and bivariate correlations were computed. Then, hierarchical multiple regression analyses were conducted to predict each of the three stress measures. Finally, dominance analyses were conducted to compare the contributions of sociodemographic, risk, and resilience factors. The results showed considerable differences between predictors of marital and parental stress and predictors of financial stress. For marital and parental stress, resilience factors mainly family resilience were the strongest predictors, followed by risk factors and then sociodemographic characteristics. For financial stress, risk factors (mainly financial damage and prior stressful life events) were the strongest predictors, followed by sociodemographic characteristics and resilience factors (mainly individual resilience). These results suggest that family and individual resilience reduce marital and parental stress under difficult conditions, including the COVID-19 pandemic. Though resilience has been found to ameliorate financial stress to some extent, it appears that other measures are required to manage stress related to financial difficulties.

A comparison of COVID-19 vaccination status among pregnant Israeli Jewish and Arab women and psychological distress among the Arab women

The public debate surrounding the COVID-19 vaccine is especially intense regarding pregnant women, who are concerned with its effects on themselves and their fetus, and a vulnerable at-risk population for psychological distress. We aimed at describing differences in vaccination status between pregnant Jewish and Arab women and understanding factors contributing to psychological distress among Arab women. Pregnant women (n = 860) aged 19-46 completed self-report questionnaires during the national vaccination program (March-April 2021). The questionnaires related to background, COVID-19-related vaccination status and intentions in this regard, COVID-19-related anxiety, and the Mental Health Inventory-Short Form. Data were analyzed using descriptive statistics, t- and chi-square tests, Pearson correlations, and a hierarchical regression. Considerably fewer Jewish women had been infected and more were vaccinated than Arab women. Poorer health, lower economic status, being a mother, not being vaccinated, higher anxiety over economic damage, a family member being infected, delivery, and raising the baby contributed to higher distress. Findings offer novel insights for nurses in their efforts to encourage vaccination, highlighting the need to understand women's concerns during the vulnerable period of pregnancy.

Using an Intersectional Lens on Vulnerability and Resilience in Minority and/or Marginalized Groups During the COVID-19 Pandemic: A Narrative Review

Throughout the pandemic, the media and scholars have widely discussed increasing social inequality and thereby publicly pointed to often hidden and neglected forms of inequality. However, the "newly" arisen awareness has not yet been put into action to reduce this inequality. Dealing with social inequality implies exploring and confronting social privileges, which are often seen as the other side of inequality. These social constructs, inequality and privilege, are often discussed in light of vulnerability and resilience. This is particularly important in the context of the worldwide coronavirus disease 2019 (COVID-19) pandemic and efforts to end the pandemic, as both constructs are discussed regarding access to healthcare, vaccination, and education and knowledge, misinformation, social resources, economic resources, and so forth. Minority and/or marginalized groups may be particularly vulnerable to the impact of the COVID-19 pandemic. However, resilience factors in these groups may be neglected and underreported. This narrative review aims at illustrating the specific and intertwined aspects of resilience and vulnerability in minority and/or marginalized groups during the COVID-19 pandemic. To achieve this, we use an intersectional lens based on recommendations made by Moradi and Grzanka. A total of 48 articles were included in the narrative review. Most of them were commentaries focusing on social inequality, vulnerability, and/or resilience. Based on the dissection of articles at structural, systemic, and individual levels, we propose three hypothesis on vulnerability and resilience in minority and marginalized individuals and groups: (1) social inequality must be considered at a global level; inequality at a global level translates into a vulnerable context for an individual; (2) vulnerability is historically situated: vulnerability (experienced during the pandemic) is maintained and reinforced by history; (3) strength through collective (historical) hardship: vulnerability is not the opposite of resilience but may serve as an aspect of resilience. The conclusions drawn from this review show that we need to include diverse voices to advance concepts, such as vulnerability and resilience, in minority and marginalized groups. Additionally, these concepts are not necessarily in opposition to each other, but vulnerability should be understood as an integral part of resilience.

Are Personal Resources and Perceived Stress Associated with Psychological Outcomes among Israeli Teachers during the Third COVID-19 Lockdown?

Teachers’ psychological responses during a pandemic, such as COVID-19, play an important role in their adaptation to the new routine. This research aimed to explore the association between personal resources (sense of control, social support), perceived stress, and three psychological outcomes (resilience, depression, loneliness) among teachers during the third COVID-19 lockdown in Israel. A cross-sectional study was conducted among 208 teachers. Significant associations were found between perceived stress, resilience, depression, and loneliness. Sense of control was significantly associated with perceived social support. The research model was tested using Structural Equation Modeling. The model yielded appropriate indices of fit (χ2(10) = 10.31, χ2/df = 1.03, p = 0.413, NFI = 0.970, NNFI = 0.997, CFI = 0.999, RMSEA = 0.012, 95%CI RMSEA = 0.077), demonstrating that the model fits the data well. Findings suggest that in order to improve teachers’ psychological health during a virus outbreak, it is recommended to pay attention to their personal resources and perceived stress.

Adolescents and Resilience: Factors Contributing to Health-Related Quality of Life during the COVID-19 Pandemic

This study aimed to examine health-related quality of life of adolescents before and during the COVID-19 outbreak, and its relationship to resilience embodied in hope and a sense of coherence. Typically developed adolescents between the ages of 13 to 18 participated in the study; 84 were recruited before the pandemic outbreak and 64 in March to April 2020 during the worldwide outbreak. The participants completed the Pediatric Quality of Life Inventory, Sense of Coherence Scale, and Children’s Hope Scale. During the outbreak, adolescents reported higher physical health-related quality of life scores (F(1146) = 3.710, p < 0.05, η² = 0.027) and lower school health-related quality of life scores (F(1146) = 5.748, p < 0.05, η2 = 0.028), compared to adolescents during the pre-outbreak period. Furthermore, adolescents during the outbreak reported a significantly (p < 0.05) higher sense of coherence but no difference in levels of hope. Finally, the results of multiple linear regression indicated that resilience factors (hope and sense of coherence) contributed to the prediction of health-related quality of life, independent of socio-demographic variables. Hope and a sense of coherence were both found to positively impact one core aspect of health, which highlights the importance of addressing resilience factors in educational and therapeutic settings for adolescents thus that they are better able to adapt to stressful events such as pandemics.

The Relationship between Religious Beliefs and Attitudes towards Public Health Infection Prevention Measures among an Ultra-Orthodox Jewish Population during the COVID-19 Pandemic

The ultra-Orthodox population in Israel was heavily impacted by COVID-19; it is important to understand the factors that contributed to this. There may be a friction between religious versus governmental guidelines that may reduce adherence to COVID mitigation guidelines, such as social distancing and masking. The purpose of this study is to explore this tension and the extent to which it existed in the surveyed sample. The study identified attitudes of ultra-Orthodox individuals concerning religious and public health measures to mitigate COVID-19 infection. A closed-ended questionnaire was completed by 405 ultra-Orthodox Jews. Most respondents believe that religious learning protects from harm (91%); 74% believe that periodically there are inconsistencies between religious guidelines and medical guidelines; 59% believe that preventive medicine may clash with “Divine protection”. Some public health measures applied to contain the pandemic threaten religious lifestyle; this is a source of dissonance among ultra-religious populations, which may substantially decrease willingness to comply with public health measures.

The mediating role of psychological distress on the link between socio-ecological factors and quality of life of Filipino adults during COVID-19 crisis

Anchored on the Ecological Systems Theory, this study aimed to determine how psychological distress operates as an underlying mechanism in the impact of socio-ecological factors on the quality of life of Filipino adults during coronavirus disease 2019 (COVID-19) crisis. A cross-sectional online survey was conducted to assess perceptions of 401 adults on socio-ecological factors (i.e., safety at home, trust in public institutions, and financial difficulties), psychological distress, and quality of life during the early phase of COVID-19 community quarantine in the Philippines. Using latent variable path analysis, all three socio-ecological factors have significant direct effects on both psychological distress and quality of life. More importantly, the proposed model was confirmed in terms of a significant partial mediation of psychological distress on the impact of safety at home, trust in public institutions, and financial difficulties on the quality of life of Filipino adults. The study offers novel insights into the role of psychological distress as an underlying mechanism that operates on the influence of socio-ecological factors on the quality of life of adults during a global health crisis. Implications on psychological interventions and policies in preventing mental health problems vis-à-vis improving Filipinos' quality of life during the COVID-19 pandemic are discussed.

Relationship between self-care activities, stress and well-being during COVID-19 lockdown: a cross-cultural mediation model

OBJECTIVES

To examine the mediation role of self-care between stress and psychological well-being in the general population of four countries and to assess the impact of sociodemographic variables on this relationship.

DESIGN

Cross-sectional, online survey.

PARTICIPANTS

A stratified sample of confined general population (N=1082) from four Ibero-American countries-Chile (n=261), Colombia (n=268), Ecuador (n=282) and Spain (n=271)-balanced by age and gender.

PRIMARY OUTCOMES MEASURES

Sociodemographic information (age, gender, country, education and income level), information related to COVID-19 lockdown (number of days in quarantine, number of people with whom the individuals live, absence/presence of adults and minors in charge and attitude towards the search of information related to COVID-19), Perceived Stress Scale-10, Ryff's Psychological Well-Being Scale-29 and Self-Care Activities Screening Scale-14.

RESULTS

Self-care partially mediates the relationship between stress and well-being during COVID-19 confinement in the general population in the total sample (F (3,1078)=370.01, p<0.001, R²=0.507) and in each country. On the other hand, among the evaluated sociodemographic variables, only age affects this relationship.

CONCLUSION

The results have broad implications for public health, highlighting the importance of promoting people's active role in their own care and health behaviour to improve psychological well-being if stress management and social determinants of health are jointly addressed first. The present study provides the first transnational evidence from the earlier stages of the COVID-19 lockdown, showing that the higher perception of stress, the less self-care activities are adopted, and in turn the lower the beneficial effects on well-being.

Effects of social position and household affordances on COVID-19 lockdown resilience and coping

In France, the COVID-19 pandemic and ensuing lockdown measures have created unprecedented circumstances that increase stress and anxiety, thus leading individuals experiencing home confinement to adopt various coping strategies that contribute to building resilience. Given the novelty and recency of the COVID-19 lockdown, factors of coping and resilience in this specific context of home confinement remain undefined. Based on some recent observations, we conducted a study on a convenience sample in France (N = 809) in order to investigate two potential factors of lockdown resilience and coping: social position and household affordances, while also exploring some complementary hypotheses based on the literature. Social position and household affordances were identified as significant predictors of lockdown coping and resilience, and low social position was found to coincide with less social support coping strategies. Results are discussed in relation to the theory and the limits identified in this study. Recommendations are made for potential second waves of COVID-19 spread or similar pandemics in the future.

Factors that enhance or impede compliance of the public with governmental regulation of lockdown during COVID-19 in Israel

INTRODUCTION

In the ongoing COVID-19 global pandemic, compliance to governmental orders is a challenge in the effort to contain the spread of the virus. A cross-sectional study of the Israeli population during the first wave of the outbreak is utilized to elucidate factors that enhance or impede public compliance to the governmental regulation of lockdown and illustrate the practical complexities of staying at home for an elongated time duration.

METHODS

A structured questionnaire was utilized to investigate compliance with home isolation, factors that enhance and impede compliance, activities engaged during lockdown, personal resilience, and level of individual distress during the first wave of COVID-19 in Israel.

RESULTS

The most salient factors for enhanced compliance were concern for family or self-health (63.4 % and 56.3 % respectively), while deterrence played little role (18.5 %). Desire to maintain a normal life and fear of economic loss were the most significant factors that impeded compliance. A negative correlation between the levels of resilience and distress symptoms (r = 0.318 p < .001), and a positive correlation between resilience and enhanced compliance with home isolation (r = 0.225 p < .001) were identified.

CONCLUSIONS

Utilizing tools for empowering the population rather than instilling fear or other deterrence measures are more effective approaches to increase compliance with governmental directives during the COVID-19 pandemic. Public health officials and authorities need to engage the public in resilience building activities, in order to promote compliance to isolation measures. These findings have valuable implications for authorities in ensuring compliance to current and potential future stay-at-home orders for outbreaks.

Mediating role of resilience on the relationship between stress and quality of life among Jordanian registered nurses during COVID-19 pandemic

Rationale

Registered nurses are struggling on the front line to manage patients with COVID-19 and other illnesses, placing them at increased risks for severe perceived stress. Although perceived stress has often been considered a significant risk factor for impaired quality of life among registered nurses, having resilience has been generally shown to be associated with better quality of life.

Purpose

This study aimed to investigate the mediating effects of resilience on the relationship between perceived stress and quality of life in Jordanian clinical registered nurses during the COVID-19 pandemic.

Methods

The study used a cross-sectional correlational design with an online survey and adhered to the STROBE guideline for cross-sectional studies. A total of 550 registered nurses working in 6 hospitals were conveniently selected. Data were collected via a demographic questionnaire, the Perceived Stress Scale (PSS), the Connor-Davidson Resilience Scale (CD-RISC), and the WHOQOL scale. Descriptive, Pearson correlation, t-test, one-way ANOVA, and hierarchical linear regression analyses were used to analyze the data.

Results

The results indicated that resilience was negatively correlated with perceived stress and quality of life. Further, resilience was found to play a partial mediating role in the relationship between perceived stress and quality of life. Therefore, the results partially supported our study hypotheses.

Conclusion

Health policy makers and administrators in Jordan should be aware of the importance of assessing and improving nurses' resilience to decrease devastating effects of stress on quality of life.

Institution efficiency satisfaction and emotional responses to the COVID-19 pandemic in Arab citizens of Israel: An exploratory cross-sectional study

The COVID-19 pandemic has led to the emergence of various stressors among people around the world. However, rare are the studies that investigate stressors by employing institution evaluations as their predictors in ethnic minorities. The goal of the current study was to examine the association between satisfaction with the efficiency of institutions' work on mitigation of the COVID-19 spread, and stressors - emotional responses to the pandemic: worry of the COVID-19 spread, and fear of being hurt by its spread. The study was conducted among Israeli Arab citizens (N = 697), who participated in an annual personal security index survey. Multinomial logistic regression was used for the multivariate analysis. The main finding suggests that satisfaction with efficiency of the emergency institutions performance was associated with a lower likelihood of being highly worried of COVID-19 spread, as well as with a lower likelihood of having a great fear of being hurt by its spread. Satisfaction with efficiency of societal institutions performance was associated only with lower likelihood of being moderately worried of the COVID-19 spread. The results imply that the institutions have an ability to reduce the stressors in population by means of efficient performance in mitigating the consequences of the pandemic. The results also imply that institutions differ in this ability. The main policy implication is that institutions, which efficiency satisfaction was unrelated to the stressors, should significantly improve such performance in order to reduce the magnitude of negative emotional responses in ethnic minorities.

Bouncing back from COVID-19: Individual and ecological factors influence national resilience in adults from Israel, the Philippines, and Brazil

One way that countries may differ in responding to the COVID‐19 pandemic is how they withstand extreme adversity while maintaining their societal values and institutions. This study explored national resilience in Israel, the Philippines, and Brazil during the COVID‐19 pandemic. Using Crisis in Context Theory, cross‐national understanding of national resilience was examined by assessing measurement models, exploring country differences in perceptions, and determining its predictors. Data from an internationally diverse sample of 1,587 adults were collected using multiple measures and subsequently subjected to various analytical strategies. Results on the factor structure of NR‐13 demonstrated acceptable fit of both first‐order and higher‐order models for each country, with generally high factor loadings. However, measurement invariance was only supported at the configural level for the first‐order model. Among the three countries, national resilience was highest in Israel, followed by the Philippines, and lowest in Brazil. Taken collectively, both individual and ecological variables contributed a significant variance in national resilience in each country. Community resilience, quality of life, and perceived threats were consistently strong predictors of national resilience across countries. Results are discussed. The Community and Social Impact Statement of the study can be found in the Supplementary Material section.

Childbirth anxieties in the shadow of COVID-19: Self-compassion and social support among Jewish and Arab pregnant women in Israel

The study examined two angles of childbirth anxieties of Jewish and Arab pregnant women in Israel during the COVID-19 pandemic (March-April, 2020). Specifically, we examined the contribution of personal resources: self-compassion and perceived social support, as well as a couple of COVID-19-related fears of being infected and concern for the foetus, to both the woman's global fear of childbirth (FOC) and her COVID-19-related childbirth anxiety. Participants were Jewish and Arab pregnant women (n = 403) aged 20-47, who completed a set of structured self-report questionnaires from 18 March to 9 April 2020. Findings indicated that Arab women reported higher level of COVID-19-related childbirth anxiety and COVID-19-related fears of being infected and concern for the foetus. In addition, poorer health, being an Arab woman, being in the third trimester, lower self-compassion, and higher COVID-19-related fears contributed significantly to greater COVID-19-related childbirth anxiety. Furthermore, poorer health, being primiparous, at-risk pregnancy, lower self-compassion and higher fear of being infected contributed significantly to greater FOC. Importantly, social support was found to moderate the association between self-compassion and FOC. The results highlight the need to be attentive to pregnant women in times of crisis, and in particular to especially vulnerable subgroups, such as cultural minorities. They also highlight the importance of personal resources that may be applied in targeted interventions to reduce distress in vulnerable populations.

Traumatic Distress of COVID-19 and Depression in the General Population: Exploring the Role of Resilience, Anxiety, and Hope

International evidence published so far shows that the COVID-19 pandemic has negatively impacted on global mental health. Specifically, there is some research suggesting that the psychological distress related to depression, anxiety and posttraumatic stress has impacted on the psychological well-being of the general population. Yet, there is limited evidence on the relational paths between COVID-19 traumatic distress and depression. Participants of this cross-sectional study were 456 adults 18 years old or older from the general population (Mean age = 41.2 years, SD = 11.7) who completed an online questionnaire including measures assessing depression, anxiety, resilience, hope and traumatic distress related to COVID-19. Structural equation modelling was applied to examine the proposed mediation model. The results confirmed the proposed model, with traumatic distress of COVID-19, resilience, anxiety and hope explaining a considerable amount of variance (59%) in depression scores. Traumatic distress of COVID-19 was a strong positive predictor of depression, while anxiety, hope and resilience were both joint and unique mediators of this relationship. Exposure to the COVID-19 pandemic is strongly associated with depression in adults of the general population. The co-occurrence of anxiety may negatively contribute to experiencing higher levels of depression, while resilience and hope may act as buffers against depression associated with the impact of this pandemic. Our findings suggest that wide community-based interventions designed to promote resilience, build hope and reduce anxiety may help mitigate depression associated with exposure to the COVID-19 pandemic.

"Stay at Home" in Italy during the COVID-19 Outbreak: A Longitudinal Study on Individual Well-Being among Different Age Groups

The restrictions imposed by the Italian government because of the coronavirus outbreak have been shown to be demanding on the Italian population. Data were collected at four different time points from 29 March 2020 to 3 May 2020 and during the final follow-up survey on 12 October 2020. In the present study, we provided longitudinal evidence on the relationship between the lockdown and mental health dimensions, such as emotional state, perceived stress, and time perspective, for three age groups. The results allowed us to observe their psychological status from different perspectives at five different time points. Notably, a negative effect of the lockdown individual well-beings emerged as a trend, and differences in individual adaptation strategies to a prolonged stressful situation were observed at the follow-up. Indeed, pairwise comparisons between age groups showed that the young adult group (18-23 years old) seemed to be the most psychologically affected by the lockdown. The findings are discussed according to the most recent literature on the topic. To the best of our knowledge, this is one of the first longitudinal studies carried out in Italy concerning the general psychological effects of the coronavirus lockdown.

From Isolation to Containment: Perceived Fear of Infectivity and Protective Behavioral Changes during the COVID-19 Vaccination Campaign

In the ongoing COVID-19 pandemic, maintenance of protective behavior is a continued challenge in the effort to contain the spread of the virus. A cross-sectional study via an internet questionnaire was utilized to elucidate changes in compliance to protective behavior among the Israeli population (n = 1120), after the beginning of the vaccination campaign. Comparison was made between individuals who were previously infected with the virus, those who received one dose of inoculation with the vaccine, and individuals that were neither infected or vaccinated. The study results indicate that those who were previously infected with the COVID-19 virus were less careful about mask wearing (18.8%) and social distancing (29.7%), as compared to the other examined groups (regarding mask wearing, 8.2% and 11.6% respectively, and with regard to social distancing 12.8% and 19.2%), and may require targeted risk communication campaigns to address this population. Furthermore, the study revealed that those that were non-Jewish (as compared to Jewish study counterparts) or that were older (19+) were more vigilant in their protective behavior (29.6% vs. 11.2% respectively for social distancing and 29.6% vs. 11.1% respectively for mask wearing). Despite a successful initial vaccination campaign in Israel, public health officials need to engage all members of the public to unremittingly observe compliance to directed health guidelines, to ensure that the results of previous governmental efforts in fighting the pandemic (such as lockdowns) will be effectively sustained, and the road to containment will be hastened.

Fluctuations in National Resilience during the COVID-19 Pandemic

The current study measured national resilience (NR) in three different time frames during the coronavirus disease 2019 (COVID-19) pandemic in Israel (N = 804). We investigated two main issues: first, the direction and extent of NR changes during the crisis, and second, the predictors of NR. The results show the following: (a) the average NR score declined significantly across the three repeated measures, with a medium-size effect. (b) Three of the four identified NR factors declined significantly across the three measurements: belief in the government and the prime minister (large effect size); belief in civil society; and patriotism (medium effect size); while trust in Israeli national institutions was the lowest and did not weaken significantly. (c) Analyzing the prediction of NR factors indicated that the levels of the three NR factors mainly reflected one's political attitudes, sense of political and economic threats, rather than health threats. One conclusion concerns the importance of trust in leadership as the most sensitive component in the decline of national resilience following a crisis.

Socio-ecological determinants of distress in Filipino adults during COVID-19 crisis

The present study examined the socio-ecological factors that influenced psychological distress (combined index of depression and anxiety symptoms) among Filipino adults during the COVID-19 crisis. The study involved 401 adult participants currently residing in the Philippines. Data were collected using a self-reported online questionnaire administered to the participants. Findings revealed that one individual level factor, such as individual resilience, and two family level factors, such as safety at home and being a parent, negatively influenced psychological distress. On the other hand, a family level factor, family’s financial difficulties, positively predicted psychological distress. Societal level factor such as national resilience, but not the community level factor, community resilience, positively predicted psychological distress in Filipino adults. Findings identified individual resilience, national resilience, and financial difficulties as the strongest predictors of psychological distress among Filipino adults during the COVID-19 crisis. Implications, limitations, and future directions are discussed.

Jewish and Arab pregnant women's psychological distress during the COVID-19 pandemic: the contribution of personal resources

OBJECTIVE

The study sought to examine the psychological distress of Israeli pregnant women during the worldwide spread of COVID-19. As Israel has a diverse cultural-religious population, the sample included both Jewish and Arab women, allowing us to explore the differences between them. Furthermore, we examined the contribution of personal resources, both internal (self-mastery and resilience) and external (perceived social support), as well as the level of infection-related anxiety to the women's psychological distress.

METHOD

A convenience sample of 403 Israeli women (233 Jewish and 170 Arab) was recruited through social media.

RESULTS

Arab women reported significantly higher infection-related anxiety and psychological distress than Jewish women. In addition, Jewish women reported significantly higher self-mastery than Arab pregnant women. Finally, poorer health, being an Arab woman, and lower levels of self-mastery, resilience, and perceived social support, as well as a higher level of infection-related anxiety, contributed significantly to greater psychological distress.

CONCLUSIONS

The findings show that pregnant women in general may be at risk of psychological distress in times of crisis, and that minority populations in particular may be at greater risk than others. Moreover, the results highlight the contribution of women's personal and environmental resources in the face of crisis, an understanding that may be used in targeted interventions to reduce distress in vulnerable populations.

Recovery from the COVID-19 pandemic: Distress and resilience

The current study analyzed repeated responses to the coronavirus. Data for the first phase was gathered during the peak of the COVID-19 pandemic crisis in Israel (T1), which included the overall lock-down of the Israeli society. The repeated measurement was conducted approximately two months later, on the initial phase of lifting the lock-down (T2). The sample size was 300 people. Results indicated four significant differences between the first and the second measurements: Sense of danger, distress symptoms, and national resilience significantly decreased, while perceived well-being increased at T2. No significant differences were noted between the two measurements regarding individual and community resilience and economic difficulties. The data indicated that the highest decrease in national resilience was accounted for by low respondent trust in governmental decisions during the COVID-19 crisis. The negative impact of the COVID-19 pandemic on the participants was determined by two indicators: level of distress symptoms and sense of danger. Path analyses showed that five variables significantly predicted these two indicators. Their best predictor at T1 and T2 was well-being followed by individual resilience, economic difficulties due to the pandemic crisis, community resilience, and gender. It was concluded that psychological attributes may help in decreasing the impact of the threats of the COVID-19 pandemic.

Recovery from the COVID-19 pandemic: Distress and resilience

The current study analyzed repeated responses to the coronavirus. Data for the first phase was gathered during the peak of the COVID-19 pandemic crisis in Israel (T1), which included the overall lock-down of the Israeli society. The repeated measurement was conducted approximately two months later, on the initial phase of lifting the lock-down (T2). The sample size was 300 people. Results indicated four significant differences between the first and the second measurements: Sense of danger, distress symptoms, and national resilience significantly decreased, while perceived well-being increased at T2. No significant differences were noted between the two measurements regarding individual and community resilience and economic difficulties. The data indicated that the highest decrease in national resilience was accounted for by low respondent trust in governmental decisions during the COVID-19 crisis. The negative impact of the COVID-19 pandemic on the participants was determined by two indicators: level of distress symptoms and sense of danger. Path analyses showed that five variables significantly predicted these two indicators. Their best predictor at T1 and T2 was well-being followed by individual resilience, economic difficulties due to the pandemic crisis, community resilience, and gender. It was concluded that psychological attributes may help in decreasing the impact of the threats of the COVID-19 pandemic.

Health-Care Services as a Platform for Building Community Resilience among Minority Communities: An Israeli Pilot Study during the COVID-19 Outbreak

Background: Previous studies of minority groups in times of emergency have tended to focus on risk reduction or on individual resilience, overlooking the community factors that could be bolstered to promote better health and safety outcomes. The current study aimed to examine the role of health-care services in the perceived community resilience of urban and suburban Arab communities in Israel during the COVID-19 outbreak. Method: The study included 196 adults age 17–76 years, who filled out on-line questionnaires in May 2020; 112 participants lived in an urban community and 84 lived in a suburban community. Community resilience was evaluated using the Conjoint Community Resiliency Assessment Measure (CCRAM), a validated five-factor multidimensional instrument. Results: Residents of the suburban community reported higher community resilience than residents of the urban community. This difference was related to increased preparedness levels and strength of place attachment in the suburban community. Residents of suburban communities were also more satisfied and confident in health-care services than those of urban communities. Regression analysis showed that the satisfaction with primary health-care services, and not community type, significantly predicted community resilience. Conclusions: Our results support the pivotal role of primary health care in building community resilience of minority communities in times of emergency and routine.

Information on COVID-19 and Psychological Distress in a Sample of Non-Health Workers during the Pandemic Period

Methods by which the population should be informed when going through a pandemic such as COVID-19 have been questioned because of its influence on the adoption of preventive measures and its effects on mental health. Non-health workers are at risk of psychological distress from exposure to contaminated people or materials or by having to stay at home and adapt their activity to telework. The objective of the study is to analyze information the public receives about COVID-19 and its influence on their level of distress. For this, 1089 questionnaires from non-health workers were collected online between 26 March and 26 April 2020 in Spain, and analysed and distributed by snowball effect. 492 participants carried out essential activities away from home, and 597 did so from home. They were surveyed about information received about COVID-19 regarding its source, time, assessment, or the beliefs expressed in it. Mental health was also measured with Goldberg’s General Health Questionnaire (GHQ-12). The classification and regression tree (CART) method was used to design a binary tree with sample cases. It has been found that the time spent learning about COVID-19 and the level of knowledge about symptoms, pathways, prevention, treatment, or prognosis are associated with the level of distress, where 25% of participants were found to have spent more than 3 h daily on this activity. Social media and television are the most widely used sources, but they are considered to be of lower quality and usefulness than official sources. There is greater confidence in healthcare professionals than in the health system, and the main concern of those working away from home is spreading the virus to family members. It has been concluded that there is a need to enhance quality and truthful information on the Internet for non-health workers due to its accessibility, which should be constantly updated, a fact which international and national public bodies, research centers, and journal publishers have begun to understand during the current pandemic. Such quality information is needed to combat distress.

The Role of Resilience and Gender in Relation to Infectious-Disease-Specific Health Literacy and Anxiety During the COVID-19 Pandemic

BACKGROUND

Anxiety is one of the psychological problems being experienced by the general population during the current coronavirus disease 2019 (COVID-19) pandemic. Health literacy, such as infectious-disease-specific health literacy, is associated with anxiety, but the mechanism of such association is not clear. This study explored the relationship between infectious-disease-specific health literacy and anxiety.

METHODS

We conducted an online survey in Hubei province, the early epicenter of the COVID-19 pandemic. A total of 1038 COVID-19-negative participants accomplished a battery of online survey tools determining their sociodemographic characteristics, perceived risk of acquiring COVID-19, infectious-disease-specific health literacy, resilience, and anxiety symptoms. We examined the moderated mediation models, in which the mediator was resilience and the moderator was gender.

RESULTS

Most (63%) of the study participants experienced at least mild anxiety. The indirect effect of infectious-disease-specific health literacy on anxiety through resilience was -0.282 (95% confidence interval [CI] = [-0.511, -0.083]), contributing to 32.7% of the total effect of health literacy on anxiety. Resilience fully mediated the association. The mediation effect of resilience tended to be stronger for the male participants than for the female participants as the moderation effect of gender remained until we included perceived risk of acquiring COVID-19 in the model.

CONCLUSION

Resilience was found to mediate the association between infectious-disease-specific health literacy and anxiety. Individuals with good infectious-disease-specific health literacy are more likely to acquire higher resilience, which may in turn decrease their anxiety level. Males may benefit more from the mediation effect of resilience during the current pandemic. Infectious-disease-specific health literacy programs may help reduce the anxiety of the program participants by enhancing their resilience during a pandemic.