Fear of COVID-19 and emotional dysfunction problems: Intrusive, avoidance and hyperarousal stress as key mediators

Abstract

BACKGROUND There is mounting empirical evidence of the detrimental effects of the coronavirus disease 2019 (COVID-19) outbreak on mental health. Previous research has underscored the effects of similar destabilizing situations such as war, natural disasters or other pandemics on acute stress levels which have been shown to exacerbate current and future psychopathological symptoms. AIM To explore the role of acute stress responses (intrusive, avoidance and hyperarousal) as mediators in the association between fear of COVID-19 and emotional dysfunction-related problems: Depression, agoraphobia, panic, obsessive-compulsive, generalized anxiety, social anxiety and health anxiety symptoms. METHODS A sample of 439 participants from a university community in Spain (age: mean ± SD: 36.64 ± 13.37; 73.1% females) completed several measures assessing their fear of COVID-19, acute stress responses and emotional dysfunction syndromes through an online survey. Data collection was carried out from the start of home confinement in Spain until May 4, 2020, coinciding with initial de-escalation measures. Processing of the dataset included descriptive and frequency analyses, Mann-Whitney U Test of intergroup comparisons and path analysis for direct and indirect effects. This is an observational, descriptive-correlational and cross-sectional study. RESULTS The prevalence of clinical symptoms in our sample, reported since the beginning of the pandemic, reached 31.44%. The female group presented higher scores although the effect size was small. Overall, the participants who exceeded the clinical cut-off points in emotional problems showed higher levels of fear of COVID-19 and of cognitive, motor and psychophysiological responses of acute stress, unlike the group with normative scores. In addition, the results show significant mediated effects of hyperarousal stress among fear of COVID-19 and emotional dysfunction psychopathology. However, the clinical syndromes most related to the consequences of the pandemic ( e.g. , social contact avoidance or frequent hand washing), such as agoraphobia and obsessive-compulsive symptoms, were in fact predicted directly by fear of COVID-19 and/or the acute stress response associated with the pandemic and had a greater predictive power. CONCLUSION The present study illustrates a clearer picture of the role of acute stress on several forms of psychopathology during the COVID-19 crisis and home confinement.

The Influence of the COVID-19 Pandemic on Social Anxiety: A Systematic Review

“…Moreover, SAD individuals scored higher (d = 1.02, p < 0.001) for fears associated with social distancing (e.g., "I am afraid I will lose my friends because of a bad illness or virus") and higher (d = 1.19, p < 0.01) for how much these fears impacted the participant's life (e.g., "being afraid of an illness or virus has caused me to feel experience strong emotions"). Consistent with these results, Falco et al [52], using a DSM-5-based self-report questionnaire, conducted a path mediation and found intrusive stress (e.g., repeated thoughts about the stressful event) to be related to social anxiety (β = 0.21, 99% CI > 0.0). Additionally, hyperarousal stress, such as anger and irritability, difficulty concentrating and hypervigilance, was related to social anxiety (β = 0.17, 99% CI > 0.0).…”

“…Additionally, Blasco-Belled et al [46] found that social anxiety correlated significantly with a COVID-19 threat item. In Falco et al [52], scores on fear of COVID-19 were large for a high social anxiety group compared to a low social anxiety group, reaching an almost moderate effect size (Hedge's g = 0.47, p = 0.003). In Moran [68], fear of COVID-19 had a positive but non-significant correlation with social anxiety (r = 0.12, p = 0.52), although this was possibly due to the small sample size (n = 32).…”

“…In Zhu et al [43], female students reported significantly higher social anxiety compared to male students (p < 0.001). Finally, Falco et al [52] found that women had increased social anxiety during a lockdown, with a small effect size (Hedge's g = 0.33, p = 0.001).…”

Binge eating as an emotional response to the Covid-19 pandemic: A sequential mediation model via the impact of events and social anxiety

“…Additionally, [39] found a signi cant correlation between intrusive pandemic-related stress, conceptualized as repetitive negative thoughts about the COVID-19 pandemic, and social anxiety. Speci cally, the pandemic-related stress was assessed as PTS symptoms, including avoidance of awareness, intrusive thinking, and hyperarousal, with the last two resulting positively related to social anxiety [39]. The pandemic might have caused indeed life-threating events (e.g.…”