From the Journals

Worry over family, friends the main driver of COVID-19 stress


Individuals are more worried about family members becoming ill with COVID-19 or about unknowingly transmitting the disease to family members than they are about contracting it themselves, results of a new survey show.

Investigators surveyed over 3,000 adults, using an online questionnaire. Of the respondents, about 20% were health care workers, and most were living in locations with active stay-at-home orders at the time of the survey.

Dr. Ran Barzilay

Close to half of participants were worried about family members contracting the virus, one third were worried about unknowingly infecting others, and 20% were worried about contracting the virus themselves.

“We were a little surprised to see that people were more concerned about others than about themselves, specifically worrying about whether a family member would contract COVID-19 and whether they might unintentionally infect others,” lead author Ran Barzilay, MD, PhD, child and adolescent psychiatrist at the Children’s Hospital of Philadelphia (CHOP), told Medscape Medical News.

The study was published online August 20 in Translational Psychiatry.

Interactive platform

“The pandemic has provided a unique opportunity to study resilience in healthcare professionals and others,” said Barzilay, assistant professor at the Lifespan Brain Institute, a collaboration between CHOP and the University of Pennsylvania, under the directorship of Raquel Gur, MD, PhD.

“After the pandemic broke out in March, we launched a website in early April where we surveyed people for levels of resilience, mental health, and well-being during the outbreak,” he added.

Dr. Raquel Gur

The researchers used a “snowball recruitment” approach, in which teams sent out information about the online survey to their social networks and mailing lists. Survey participants then shared it with their contacts.

“To date, over 7000 people have completed it – mostly from the US but also from Israel,” Barzilay said.

The survey was anonymous, but participants could choose to have follow-up contact. The survey included an interactive 21-item resilience questionnaire and an assessment of COVID-19-related items related to worries concerning the following: contracting, dying from, or currently having the illness; having a family member contract the illness; unknowingly infecting others; and experiencing significant financial burden.

A total of 1350 participants took a second survey on anxiety and depression that utilized the Generalized Anxiety Disorder–7 and the Patient Health Questionnaire–2.

“What makes the survey unique is that it’s not just a means of collecting data but also an interactive platform that gives participants immediate personalized feedback, based on their responses to the resilience and well-being surveys, with practical tips and recommendations for stress management and ways of boosting resilience,” Barzilay said.

Tend and befriend

Ten days into the survey, data were available on 3,042 participants (64% women, 54% with advanced education, 20.5% health care providers), who ranged in age from 18 to 70 years (mean [SD], 38.9 [11.9] years).

After accounting for covariates, the researchers found that participants reported more distress about family members contracting COVID-19 and about unknowingly infecting others than about getting COVID-19 themselves (48.5% and 36% vs. 19.9%, respectively; P < .0005).

Increased COVID-19-related worries were associated with 22% higher anxiety and 16.1% higher depression scores; women had higher scores than men on both.

Each 1-SD increase in the composite score of COVID-19 worries was associated with over twice the increased probability of generalized anxiety and depression (odds ratio, 2.23; 95% confidence interval, 1.88-2.65; and OR, 1.67; 95% CI, 1.41-1.98, respectively; for both, P < .001).

On the other hand, for every 1-SD increase in the resilience score, there was a 64.9% decrease in the possibility of screening positive for generalized anxiety disorder and a 69.3% decrease in the possibility of screening positive for depression (for both, P < .0001).

Compared to participants from Israel, US participants were “more stressed” about contracting, dying from, and currently having COVID-19 themselves. Overall, Israeli participants scored higher than US participants on the resilience scale.

Rates of anxiety and depression did not differ significantly between healthcare providers and others. Health care providers worried more about contracting COVID-19 themselves and worried less about finances after COVID-19.

The authors propose that survey participants were more worried about others than about themselves because of “prosocial behavior under stress” and “tend-and-befriend,” whereby, “in response to threat, humans tend to protect their close ones (tending) and seek out their social group for mutual defense (befriending).”

This type of altruistic behavior has been “described in acute situations throughout history” and has been “linked to mechanisms of resilience for overcoming adversity,” the authors indicate.


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