Psychological Determinants and Consequences of COVID-19 Anxiety: A Web-Based Study in Iran

Pandemic illnesses such as COVID-19 can provoke negative emotions, including anxiety and depression, in addition to compulsive behaviors. Clarifying the psychosocial antecedents and consequences of COVID-19 anxiety can inform successful psychological support and treatment. This study investigated psychological predictors and consequences of COVID-19 anxiety during the outbreak of COVID-19 in Iran. University students (N = 398) completed a web-based survey measuring COVID-19 anxiety, general health anxiety, uncertainty intolerance, interpersonal trust, depression, and COVID-19-related panic shopping. The participants also responded to two additional questions: “Do you personally know of anyone who was suspected of having been infected with COVID-19?” and "Did you get sick in the past year?” Exploratory factor analysis, confirmatory factor analysis, Pearson correlation, multiple regression analysis, multivariate regression analysis, and 2 × 2 factorial ANOVA were used to analyze data. Health anxiety, uncertainty intolerance, and interpersonal trust were significantly associated with COVID-19 anxiety. COVID-19 anxiety was a significant predictor of depression and panic shopping. Participants who knew someone with COVID-19 and those who reported being sick in the past year experienced more COVID-19 anxiety. COVID-19 anxiety appears to be more severe among people with a low tolerance for uncertainty and low interpersonal trust. Understanding these risk factors can inform individualized therapeutic approaches to address the maladaptive outcomes of depression and false safety behaviors, such as panic buying.
1. Salari N, Hosseinian-Far A, Jalali R,et al. Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: A systematic review and meta-analysis. Global Health. 2020;16(1):57. doi:10.1186/s12992-020-00589-w
2. Xiang YT, Yang Y, Li W,et al. Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. The Lancet Psychiatry. 2020;7(3):228-229. doi:10.1016/s2215-0366(20)30046-8
3. Cao W, Fang Z, Hou G,et al. The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry Research. 2020;287:112934. doi:10.1016/j.psychres.2020.112934
4. Wang C, Pan R, Wan X,et al. Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. IJERPH. 2020;17(5):1729. doi:10.3390/ijerph 17051729
5. Li S, Wang Y, Xue J, Zhao N, Zhu T. The impact of COVID-19 Epidemic Declaration on psychological consequences: A study on active Weibo users. IJERPH. 2020;17(6):2032. doi:10.3390/ijerph17062032
6. Taylor S, Asmundson GJG. Understanding and Treating Health Anxiety: A Cognitive-Behavioral Approach. Guilford; 2004. doi:10.1016/s1077-7229(04)80015-4
7. Asmundson GJG, Taylor S. How health anxiety influences responses to viral outbreaks like COVID-19: What all decision-makers, health authorities, and health care professionals need to know. Journal of Anxiety Disorders. 2020;71:102211. doi:10.1016/j.janxdis.2020.102211
8. Leventhal H, Diefenbach M, Leventhal EA. Illness cognition: Using common sense to understand treatment adherence and affect cognition interactions. Cogn Ther Res. 1992;16(2):143-163. doi:10.1007/bf01173486
9. Marcus DK, Hughes KT, Arnau RC. Health anxiety, rumination, and negative affect: A mediational analysis. Journal of Psychosomatic Research. 2008;64(5):495-501. doi:10.1016/j.jpsychores.2008.02.004
10. Noyes R Jr, Kathol RG, Fisher MM, Phillips BM, Suelzer MT, Woodman CL. Psychiatric comorbidity among patients with hypochondriasis. General Hospital Psychiatry. 1994;16(2):78-87. doi:10.1016/0163-8343(94)90049-3
11. Wolfradt U, Oemler M, Braun K, Klement A. Health anxiety and habitual rumination: The mediating effect of serenity. Personality and Individual Differences. 2014;71(December 2014):130-134. doi:10.1016/j.paid.2014.07.030
12. Dugas MJ, Gagnon F, Ladouceur R, Freeston MH. Generalized anxiety disorder: A preliminary test of a conceptual model. Behaviour Research and Therapy. 1998;36(2):215-226. doi:10.1016/s0005-7967(97)00070-3
13. Zandifar A, Badrfam R. Iranian mental health during the COVID-19 epidemic. Asian Journal of Psychiatry. 2020;51:101990. doi:10.1016/j.ajp.2020.101990
14. Fergus TA, Bardeen JR. Anxiety sensitivity and intolerance of uncertainty: Evidence of incremental specificity in relation to health anxiety. Personality and Individual Differences. 2013;55(6):640-644. doi:10.1016/j.paid.2013.05.016
15. Carleton RN, Norton PJ, Asmundson GJG. Fearing the unknown: A short version of the Intolerance of Uncertainty Scale. Journal of Anxiety Disorders. 2007;21(1):105-117. doi:10.1016/j.janxdis.2006.03.014
16. Taylor C. Here's why people are panic buying and stockpiling toilet paper to cope with coronavirus fears. CNBC. Published online March 11, 2020. https://www.cnbc.com/2020/03/11/heres-why-people-are-panic-buying-and-stockpiling-toilet-paper.html
17. Rotter JB. A new scale for the measurement of interpersonal trust. J Personality. 1967;35(4):651-665. doi:10.1111/j.1467-6494.1967.tb 01454.x
18. Schneider IK, Koninn EA, Righetti F, Rusbult CE. A healthy dose of trust: The relationship between interpersonal trust and health. Personal Relationships. 2011;18(4):668-676. doi:10.1111/j.1475-6811.2010.01338.x
19. Fabrigar LR, Wegener DT, MacCallum RC, Strahan EJ. Evaluating the use of exploratory factor analysis in psychological research. Psychological Methods. 1999;4(3):272-299. doi:10.1037/1082-989x.4.3.272
20. Comrey AL, Lee HB. A First Course in Factor Analysis. Lawrence Eribaum Associates; 1992.
21. Wheaton MG, Abramowitz JS, Berman NC, Fabricant LE, Olatunji BO. Psychological predictors of anxiety in response to the H1N1 (swine flu) pandemic. Cogn Ther Res. 2012;36(3):210-218. doi:10.1007/s10608-011-9353-3
22. Shabahang R, Aruguete M, McCutcheon L. Online health information utilization and online news exposure as predictor of COVID-19 anxiety. North American Journal of Psychology. 2020;22(3):469-482.
23. Shabahang R, Aruguete MS, McCutcheon L. Video-based cognitive-behavioral intervention for COVID-19 anxiety: A randomized controlled trial. Trends Psychiatry Psychother. Published online 2020. doi:10.47626/2237-6089-2020-0056
24. Nourisaeid A, Shabahang R, Bagheri Sheykhangafshe F, Saeedi M, Mousavi M. Comparison of online health information utilization, online shared identity, and online shared information usage in different levels of COVID-19 anxiety. Journal of Research in Psychological Health. 2020;14(1):28-39.
25. Salkovskis PM, Rimes KA, Warwick HMC, Clark DM. The Health Anxiety Inventory: Development and validation of scales for the measurement of health anxiety and hypochondriasis. Psychol Med. 2002;32(5):843-853. doi:10.1017/s0033291702005822
26. Abramowitz JS, Deacon BJ, Valentiner DP. The Short Health Anxiety Inventory: Psychometric properties and construct validity in a non-clinical sample. Cogn Ther Res. 2007;31(6):871-883. doi:10.1007/s10608-006-9058-1
27. Alberts NM, Hadjistavropoulos HD, Jones SL, Sharpe D. The Short Health Anxiety Inventory: A systematic review and meta-analysis. Journal of Anxiety Disorders. 2013;27(1):68-78. doi:10.1016/j.jan xdis.2012.10.009
28. Freeston MH, Rhéaume J, Letarte H, Dugas MJ, Ladouceur R. Why do people worry? Personality and Individual Differences. 1994;17(6):791-802. doi:10.1016/0191-8869(94)90048-5
29. Khawaja NG, Yu LNH. A comparison of the 27-item and 12-item intolerance of uncertainty scales. Clinical Psychologist. 2010;14(3):97-106. doi:10.1080/13284207.2010.502542
30. Chun KT, Campbell JB. The dimensionality of the Rotter Interpersonal Trust Scale. Psychol Rep. 1974;35(3):1059-1070. doi:10.2466/pr0.1974.35.3.1059
31. Beck AT, Steer RA, Carbin MG. Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation. Clinical Psychology Review. 1988;8(1):77-100. doi:10.1016/0272-7358(88)90050-5
32. Beck AT, Steer RA, Brown GK. Manual for the Beck Depression Inventory-II. Psychological Corporation; 1996.
33. Dere J, Watters CA, Yu SCM, Bagby RM, Ryder AG, Harkness KL. Cross-cultural examination of measurement invariance of the Beck Depression Inventory-II. Psychological Assessment. 2015;27(1):68-81. doi:10.1037/pas0000026
34. Erford BT, Johnson E, Bardoshi G. Meta-Analysis of the English Version of the Beck Depression Inventory-Second Edition. Measurement and Evaluation in Counseling and Development. 2016;49(1):3-33. doi:10.1177/0748175615596783
35. Wang YP, Gorenstein C. Psychometric properties of the Beck Depression Inventory-II: A comprehensive review. Rev Bras Psiquiatr. 2013;35(4):416-431. doi:10.1590/1516-4446-2012-1048
36. Rook DW. The buying impulse. J Consum Res. 1987;14(2):189-199. doi:10.1086/209105
37. Badgaiyan AJ, Verma A, Dixit S. Impulsive buying tendency: Measuring important relationships with a new perspective and an indigenous scale. IIMB Management Review. 2016;28(4):186-199. doi:10.1016/j.iimb.2016.08.009
38. Verplanken B, Herabadi AG. Individual differences in impulse buying tendency: Feeling and no thinking. Eur J Pers. 2001;15(S1):S71-S83. doi:10.1002/per.423
39. Nunnally JC, Bernstein IH. Psychometric Theory. McGraw-Hill; 1994.
40. Mueller RO. Basic Principles of Structural Equation Modeling: An Introduction to LISREL and EQS. Springer Science & Business Media; 1999.
41. Kline RB. Principles and Practice of Structural Equation Modeling. 5th ed. The Guilford Press; 2011:3-427.
42. Hair JF Jr, Black WC, Babin BJ, Anderson RE. Multivariate Data Analysis: A Global Perspective. 7th ed. Pearson Education; 2010.
43. Abramowitz JS, Braddock AE. Psychological Treatment of Health Anxiety and Hypochondriasis: A Biopsychosocial Approach. Hogrefe; 2008.
44. Fetzner MG, Asmundson GJG, Carey C, et al. How do elements of a reduced capacity to withstand uncertainty relate to the severity of health anxiety? Cognitive Behaviour Therapy. 2014;43(3):262-274. doi:10.1080/16506073.2014.929170
45. Wright KD, Lebell MANA, Carleton RN. Intolerance of uncertainty, anxiety sensitivity, health anxiety, and anxiety disorder symptoms in youth. Journal of Anxiety Disorders. 2016;41(June 2016):35-42. doi:10.1016/j.janxdis.2016.04.011
46. Hong RY, Lee SSM. Further clarifying prospective and inhibitory intolerance of uncertainty: Factorial and construct validity of test scores from the Intolerance of Uncertainty Scale. Psychological Assessment. 2015;27(2):605-620. doi:10.1037/pas0000074
47. Craske MG, Waters AM. Panic disorder, phobias, and generalized anxiety disorder. Annu Rev Clin Psychol. 2005;1(1):197-225. doi:10.1146/annurev.clin psy.1.102803.143857
48. Feng Z, Vlachantoni A, Liu X, Jones K. Social trust, interpersonal trust and self-rated health in China: A multi-level study. Int J Equity Health. 2016;15(1):180. doi:10.1186/s12939-016-0469-7
49. Douglas PK, Douglas DB, Harrigan DC, Douglas KM. Preparing for pandemic influenza and its aftermath: Mental health issues considered. International journal of emergency mental health. 2009;11(3):137-144.
50. Telch MJ, Lancaster CL. Is there room for safety behaviors in exposure therapy for anxiety disorders? In: Neudeck P, Wittchen HU, eds. Exposure Therapy: Rethinking the Mode-Refining the Method. Springer; 2012:313-334. https://doi.org/10.1007/978-1-4614-3342-2 18
51. Helbig-Lang S, Petermann F. Tolerate or eliminate? A systematic review on the effects of safety behavior across anxiety disorders. Clinical Psychology: Science and Practice. 2010;17(3):218-233. doi:10.1111/j.1468-2850.2010.01213.x
52. Okajima I, Kanai Y, Chen J, Sakano Y. Effects of safety behaviour on the maintenance of anxiety and negative belief social anxiety disorder. Int J Soc Psychiatry. 2009;55(1):71-81. doi:10.1177/0020764008092191
53. Abramowitz JS, Moore EL. An experimental analysis of hypochondriasis. Behaviour Research and Therapy. 2007;45(3):413-424. doi:10.1016/j.brat.2006.04.005
54. Olatunji BO, Etzel EN, Tomarken AJ, Ciesielski BG, Deacon B. The effects of safety behaviors on health anxiety: An experimental investigation. Behaviour Research and Therapy. 2011;49(11):719-728. doi:10.1016/j.brat.2011.07.008