Published online Aug 19, 2022. doi: 10.5498/wjp.v12.i8.1088
Peer-review started: March 20, 2022
First decision: May 30, 2022
Revised: June 13, 2022
Accepted: July 16, 2022
Article in press: July 16, 2022
Published online: August 19, 2022
Processing time: 150 Days and 21.9 Hours
The coronavirus disease 2019 (COVID-19) pandemic and initial home confinement stage have had an indisputable psychological impact on society. Previous studies show that similar destabilizing events of a traumatic nature have resulted in the origin and exacerbation of current and future psychopathological symptoms in which fear plays a key role. In this sense, scientific literature underlines the importance of early reduction of the initial acute stress response to that fear since its continuity over time could be the prelude to more severe clinical conditions (e.g., post-traumatic stress disorder).
This study sought to elucidate a threefold question: (1) Does fear of COVID-19 produce emotional dysfunction problems? (2) Does the level of acute stress play a mediating role between fear of COVID-19 and psychopathological symptoms? and (3) If affirmative, do the 3 core symptoms of acute stress (i.e. intrusive re-experiencing, motor and cognitive avoidance strategies and psychophysiological activation) equally modulate this relation? Knowing the answer to these questions would allow us to identify the pandemic risk factors that contribute to the manifestation and chronicity of associated psychopathology.
The main purpose of this study is 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 problems: Depression, agoraphobia, panic, obsessive-compulsive, generalized anxiety, social anxiety and health anxiety symptoms. As secondary objectives: (1) To examine the clinical prevalence and sex differences; (2) To compare levels of COVID-19 fear and acute stress among groups of participants with normative vs clinical scores on the psychopathological syndromes; and (3) To examine the associations between the study variables.
This is an observational, descriptive-correlational and cross-sectional study. Data collection was conducted through an online survey since the beginning of the pandemic and during the home confinement stage in Spain. It was disseminated among the members of the university community (n = 439; age: mean ± SD = 36.64 ± 13.37; 73.1% females). Processing of the dataset included descriptive and frequency analyses, Mann-Whitney U Test of intergroup comparisons and path analysis using the double software: IBM® SPSS® Statistics 27 and Mplus 8.4.
The main findings indicate that the hyperarousal stress assume mediator role among fear of COVID-19 and emotional dysfunction. However, the clinical syndromes most related to the consequences of the pandemic (i.e. agoraphobia and obsessive-compulsive symptoms) were predicted directly by fear of COVID-19 and/or the acute stress response associated with the pandemic. In addition, the prevalence of clinical symptoms 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 acute stress.
Our findings highlight the mediator role of hyperarousal response to explain indirect effects from the fear of COVID-19 on the origin, development and exacerbation of psychopathological syndromes. These results provide an empirical basis for reducing the psychological impact of the pandemic through selection of more targeted intervention techniques and application in future similar social and health conditions.
We consider it relevant to longitudinally test whether the persistence of high levels of acute stress, especially in its hyperarousal manifestation, predicts a worse prognosis of the reported psychopathology. It would also be appropriate to consider the use of different representative samples and even analyze whether this psychological component of fear and acute stress influences the manifestation, course and prognosis of COVID-19 disease as previous studies in the field of Health Psychology have shown (for instance, in cancer patients).