Mediation Effect of Perceived Symptom Change on the Association between COVID-19 Perceptions and Well-Being Controlling for the Effect of Relationship Quality

Year 2024, Volume: 11 Issue: 2, 271 - 291, 31.05.2024

S. Burcu Özgülük Üçok , Kürşad Demirutku , Çiğdem Topcu , Claudia Chiarolanza , Ashley K. Randall

https://doi.org/10.31682/ayna.1323531

Abstract

Most people had a perception of COVID-19 as an illness throughout the COVID-19 pandemic, and this inevitably resulted in developing psychological symptoms which in the end yielded to lower levels of well-being. These experiences affected the people who were in a relationship during the pandemic, hence the quality of their relationship was influenced by all these individual feelings. Regarding this context, the current study aimed to explore the mediation role of perceived symptom change in the association between well-being and COVID-19 perceptions, controlling for the effect of relationship quality. To achieve this goal, 174 (N = 124 women, N = 49 men) participants were recruited. Results of the study put forth that (1) there was a positive association between COVID-19 illness perception and symptom change, (2) there was a negative association between perceived symptom change and well-being, (3) there was a negative association between COVID-19 illness perception and well-being, (4) relationship quality was positively associated with well-being, and (5) the symptom change mediated the association between COVID-19 illness perception and well-being in the case relationship quality was considered as a covariate. Limitations and recommendations for further research are presented.

Keywords

COVID-19, depression, anxiety, stress, illness perception, relationship quality, well-being

Thanks

The author(s) disclosed receipt of the following financial support for the research, authorship, and/ or publication of this article: This research was supported by funding from American Psychological Association’s Office of International Affairs (PI: Randall).

Algılanan Semptom Değişiminin, İlişki Kalitesinin Etkisi Kontrol Edildiğinde, İyi Oluş ve COVID-19 Algısı Arasındaki Aracı Rolü

Abstract

COVID-19 pandemi döneminde, birçok kişi COVID-19’un bir hastalık olduğuna dair bir algıya sahip olmuş ve bu da kaçınılmaz olarak kişilerin depresyon, kaygı ve stres gibi birçok psikolojik belirti geliştirmesine, sonuç olarak da iyi oluşlarının azalmasına yol açmıştır. Pandemi döneminde bir romantik ilişki içinde olan kişilerin ilişkilerinin kalitesi de bu bireysel belirtiler ve duygulardan etkilenmiştir. Bu bağlam içinde, bu çalışma, COVID-19’a yönelik algı ile iyi oluş arasındaki ilişkide algılanan semptom değişiminin aracı rolünü, ilişki kalitesinin bu ilişkideki etkisini kontrol ederek incelemeyi amaçlamıştır. Bu amaca ulaşmak için, romantik bir ilişkide olan, 124’ü kadın ve 49’u erkek toplam 174 katılımcıya ulaşılmıştır. Çalışmanın sonuçları: (1) COVID-19 hastalık algısı ile semptom değişimi arasında olumlu ve anlamlı bir ilişki olduğunu, (2) algılanan semptom değişimi ile iyi oluş arasında olumsuz ve anlamlı bir ilişki olduğunu, (3) COVID-19 hastalık algısı ile iyi oluş arasında olumsuz ve anlamlı bir ilişki olduğunu, (4) ilişki kalitesinin iyi oluş ile olumlu ve anlamlı olarak ilişkili olduğunu ve (5) algılanan semptom değişiminin COVID-19 hastalık algısı ile iyi oluş arasındaki ilişkide, ilişki kalitesi ortak değişken (covariate) olarak ele alındığında, anlamlı bir aracı rolünün olduğunu ortaya çıkarmıştır. Çalışmanın sınırlıkları ve gelecek araştırmalar için öneriler de ayrıca belirtilmiştir.

Keywords

COVID-19, depresyon, kaygı, stres, hastalık algısı, ilişki kalitesi, iyi oluş

References

• Ahmed, W., Bertsch, P. M., Bivins, A., Bibby, K., Farkas, K., Gathercole, A., Haramoto, E., Gyawali, P., Korajkic, A., McMinn, B. R., Mueller, J. F., Simpson, S. L., Smith, W. J. M., Symonds, E. M., Thomas, K. V., Verhagen, R., & Kitajima, M. (2020). Comparison of virus concentration methods for the RT-qPCR-based recovery of murine hepatitis virus, a surrogate for SARS-CoV-2 from untreated wastewater. Science of the Total Environment, 739, 139960. https://doi.org/10.1016/j.scitotenv.2020.139960
• Arbuckle, J. L. (2012). Amos (Version 21.0) [Computer Program]. IBM SPSS.
• Aqeel, M. , Abbas, J. , Shuja, KH , Rehna, T. , Ziapour, A. , Yousaf, I. & Karamat, T. (2022). The influence of illness perception, anxiety and depression disorders on students mental health during COVID-19 outbreak in Pakistan: A web-based cross-sectional survey. International Journal of Human Rights in Healthcare, 15(1), 17-30. https://doi.org/0.1108/IJHRH-10-2020-0095
• Broadbent, E., Petrie, K. J., Main, J., & Weinman, J. (2006). The brief illness perception questionnaire. Journal of Psychosomatic Research, 60(6), 631-637. https://doi.org/10.1016/j.jpsychores.2005.10.020
• Brose, A., Neubauer, A. B., & Schmiedek, F. (2021). Integrating state dynamics and trait change: A tutorial using the example of stress reactivity and change in well-being. European Journal of Personality, 36(2), 180-199. https://doi.org/10.1177/08902070211014055
• Choi I., Kim J.H., Kim N., Choi E., Choi J., & Suk H.W. (2021). How COVID-19 affected mental well-being: An 11- week trajectories of daily wellbeing of Koreans amidst COVID-19 by age, gender and region. Plos One, 16(4). https://doi.org/10.1371/journal.pone.0250252
• Chua, G. T., Wong, J. S. C., Lam, I., Ho, P. P. K., Chan, W. H., Yau, F. Y. S., ... & Kwan, M. Y. W. (2021). Clinical characteristics and transmission of COVID-19 in children and youths during 3 waves of outbreaks in Hong Kong. JAMA Network Open, 4(5), e218824-e218824.
• Demir, M., Haynes, A., Orthel-Clark, H., & Özen, A. (2017). Volunteer bias in research on friendship among emerging adults. Emerging Adulthood, 5(1), 53-68. https://doi.org/10.1177/2167696816641542
• Dickinson, E. R., Adelson, J. L., & Owen, J. (2012). Gender balance, representativeness, and statistical power in sexuality research using undergraduate student samples. Archives of Sexual Behavior, 41, 325-327. https://doi.org/10.1007/s10508-011-9887-1
• Fletcher, G. J. O., Simpson, J. A., & Thomas, G. (2000). The measurement of perceived relationship quality components: A confirmatory factor analytic approach. Personality and Social Psychology Bulletin, 26, 340-354. https://doi/org/10.1177/0146167200265007
• Fraenkel, J. R., Wallen, N. E., & Hyun, H. H. (2012). How to design and evaluate research in education (8th ed.). McGraw-Hill.
• Fritz, M. S., & MacKinnon, D. P. (2007). Required sample size to detect the mediated effect. Psychological Science, 18(3), 233-239. https://doi.org/10.1111/j.1467-9280.2007.01882.x
• Galvin K. T. & Todres L. (2011). Kinds of well-being: A conceptual framework that provides direction for caring. International Journal of Qualitative Studies on Health and Well-being, 6(10362). http://doi.org/10.3402/qhw.v6i4.10362
• Genç, E., Su, Y., & Turhan, Z. (2023). The mediating role of dyadic coping on the effects of COVID-19 and relationship satisfaction among Turkish Couples. The American Journal of Family Therapy, 51(4), 421-439.
• González-Sanguino C., Ausín B., Castellanos M. Á., Saiz J., López Gómez A., Ugidos C., & Muñoz, M. (2020). Mental health consequences during the initial stage of the 2020 Coronavirus pandemic (COVID-19) in Spain. Brain, Behavior, & Immunity, 87, 172-176. https://doi.org/10.1016/j.bbi.2020.05.040
• Grover, S., Sahoo, S., Mehra, A., Avasthi, A., Tripathi, A., Subramanyan, A., Pattojoshi, G., Rao, P., Saha, G., Mishra, K. K., Chakraborty, K., Rao, N. P.,Vaishnav, M., Singh, O. P., Dalal, P. K., Chadda, R. K., Gupta, R., Gautam, S., Sarkar, S., …, Reddy, Y. C. J. (2020). Psychological impact of COVID-19 lockdown: An online survey from India. Indian Journal of Psychiatry, 62(4), 354-362. 10.4103/psychiatry.IndianJPsychiatry_427_20
• Guo, Z. D., Wang, Z. Y., Zhang, S. F., Li, X., Li, L., Li, C., Cui, Y., Fu, R. B., Dong, Y. Z., Chi, X. Y., Zhang, M. Y., Liu, K., Cao, C., Liu, B., Zhang, K., Gao, Y. W., Lu, B., & Chen, W. (2020). Aerosol and surface distribution of severe acute respiratory syndrome coronavirus 2 in hospital wards, Wuhan, China, 2020. Emerging Infectious Diseases, 26(7), 1586-1591. https://doi.org/10.3201/eid2607.200885
• Hayes, A. F. (2018). Partial, conditional, and moderated mediation: Quantification, inference, and interpretation. Communication Monographs, 85(1), 4-40.
• Holt-Lunstad, J., Smith, T. B., & Layton, J. B. (2010). Social relationships and mortality risk: A meta-analytic review. PLoS Medicine, 7(7). https://doi/org/10.1371/journal.pmed.1000316
• Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6, 1-55. https://doi.org/10.1080/10705519909540118
• Huang H., Ullah F., Zhou D.X., Yi, M. & Zhao Y. (2019). Mechanisms of ROS regulation of plant development and stress responses. Frontiers in Plant Science, 10(800) https://doi.org/10.3389/fpls.2019.00800
• Huang, Y. & Zhao, N. (2020). Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 outbreak in China: A web-based cross-sectional survey. Psychiatry Research, 288. https://doi.org/10.1016/j.psychres.2020.112954
• Hurt, C. S., Burn, D. J., Hindle, J., Samuel, M., Wilson, K., & Brown, R. G. (2014). Thinking positively about chronic illness: An exploration of optimism, illness perceptions and well‐being in patients with Parkinson's disease. British Journal of Health Psychology, 19(2), 363-379. https://doi.org/10.1111/bjhp.12043
• Karataş, T., Özen, Ş., & Kutlutürkan, S. (2017). Factor structure and psychometric properties of the Brief Illness Perception Questionnaire in Turkish cancer patients. Asia Pacific Journal of Oncology Nursing, 4, 77-83. https://doi.org/10.4103/2347-5625.199080
• Keldal, G. (2015). Warwick-Edinburg Mental İyi Oluş Ölçeği’nin Türkçe Formu: Geçerlik ve güvenirlik çalışması [Turkish version of the Warwick-Edinburg Mental Well-being Scale: A validity and reliability study]. The Journal of Happiness & Well-Being, 3(1), 103-115.
• Kendler, K. S., Karkowski, L. M., & Prescott, C. A. (1999). Causal relationship between stressful life events and the onset of major depression. Am J Psychiatry, 156(6), 837-841. https://doi.org/10.1176/ajp.156.6.837
• Khodavirdipour, A., & Samadi, M. (2022). Pandemic consequences: An increase in divorce rate, domestic violence, and extramarital affairs at the time of COVID-19 pandemic: A sad Persian story. Frontiers in Public Health, 10, 1100149. https://doi.org/10.3389/fpubh.2022.1100149
• Kirby, L. D., Qian, W., Adiguzel, Z., Afshar Jahanshahi, A., Bakracheva, M., Orejarena Ballestas, M. C., ... & Smith, C. A. (2022). Appraisal and coping predict health and well‐being during the COVID‐19 pandemic: An international approach. International Journal of Psychology, 57(1), 49-62. https://doi.org/10.1002/ijop.12770
• Kline, R. B. (2011). Principles and practice of structural equation modeling (3rd ed.). Guilford Press.
• Laux, L., Glanzmann, P., Schaffner, P., & Spielberger, C. (1981). Das State-Trait-Angstinventar. Theoretische Grundlagen und Handanweisung. Weinheim: Beltz Test GmbH.
• Lee, Y., Baek, J. M., Jeon, Y. W., & Im, E. O. (2019). Illness perception and sense of well-being in breast cancer patients. Patient Preference and Adherence, 1557-1567. https://doi.org/10.2147/PPA.S225561
• Lei, L., Huang, X., Zhang, S., Yang, J., Yang, L., & Xu, M. (2020). Comparison of prevalence and associated factors of anxiety and depression among people affected by versus people unaffected by quarantine during the covıd-19 epidemic in southwestern China. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research, 26, e924609. https://doi.org/10.12659/MSM.924609
• Leventhal, H., Nerenz, D. R. & Steele, D. J. (1984). Illness representations and coping with health threats. In: A. Baum., S. E. Taylor, & J. E. Singer, (Eds.), Handbook of psychology and health; Volume IV: Social Psychological Aspects of Health (pp. 219-252). Erlbaum.
• Lim, L., Mi, D., Liorca, A., & Marı´n, O. (2018). Development and functional diversification of cortical interneurons. Neuron, 100(2), 294-313. https://doi.org/10.1016/j.neuron.2018.10.009
• Lovibond, P. F. & Lovibond, S.H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33(3), 335-343. https://doi.org/10.1016/0005-7967(94)00075-U
• Lubrano, R., Villani, A., Berrettini, S., Caione, P., Chiara, A., Costantino, A., ... & Bloise, S. (2020). Point of view of the Italians pediatric scientific societies about the pediatric care during the COVID-19 lockdown: what has changed and future prospects for restarting. Italian Journal of Pediatrics, 46, 1-5. https://doi.org/10.1186/s13052-020-00907-3
• Mazza, M., Marano, G., Lai, C., Janiri, L., & Sani, G. (2020). Danger in danger: Interpersonal violence during COVID-19 quarantine. Psychiatry Research, 289. https://doi.org/10.1016/j.psychres.2020.113046
• Moghanibashi-Mansourieh, A. (2020). Assessing the anxiety level of Iranian general population during COVID-19 outbreak. Asian Journal of Psychiatry, 51. https://doi.org/10.1016/j.ajp.2020.102076
• Neff, L. A. & Karney, B. R. (2004). How does context affect intimate relationships? Linking external stress and cognitive processes within marriage. Personality and Social Psychology Bulletin, 30(2), 134–148. https://doi.org/10.1177/0146167203255984
• Neto, R. M. S., Benjamim, C. J. R., Carvalho, P. M. M., & Neto, M. L. R. (2021). Psychological effects caused by the COVID-19 pandemic in health professionals: A systematic review with meta-analysis. Progress in Neuropsychopharmacology and Biological Psychiatry, 104. https://doi.org/10.1016/j.pnpbp.2020.110062
• Oducado, R. M., & Estoque, H. (2021). Online learning in nursing education during the COVID-19 pandemic: Stress, satisfaction, and academic performance. Journal of Nursing Practice, 4(2), 143-153.
• Özdin, S. & Bayrak Özdin, Ş. (2020). Levels and predictors of anxiety, depression and health anxiety during COVID-19 pandemic in Turkish society: The importance of gender. International Journal of Social Psychiatry, 66(5), 504–511. https://doi.org/10.1177/0020764020927051
• Pellert, M., Lasser, J., Metzler, H., & Garcia, D. (2020). Dashboard of sentiment in Austrian social media during COVID-19. Frontiers in Big Data, 3, 32. https://doi.org/10.3389/fdata.2020.00032
• Pieh, C., O´Rourke, T., Budimir, S., & Probst, T. (2020). Relationship quality and mental health during COVID-19 lockdown. Plos One, 15(9). https://doi.org/10.1371/journal.pone.0238906
• Randall, A. K., Leon, G., Basili, E., Martos, T., Boiger, M., Baldi, M., Hocker, L., Kline, K., Masturzi, A., Aryeetey, R., Bar-Kalifa, E., Boon, S. D., Botella, L., Burke, T., Carnelley, K. B., Carr, A., Dash, A., Fitriana, M., Gaines, S. O., … Chiarolanza, C. (2022). Coping with global uncertainty: Perceptions of COVID-19 psychological distress, relationship quality, and dyadic coping for romantic partners across 27 countries. Journal of Social and Personal Relationships, 39(1), 3-33. https://doi.org/10.1177/02654075211034236
• Rodriguez Espinosa, P., Chen, Y. C., Sun, C. A., You, S. L., Lin, J. T., Chen, K. H., Hsing, A. W., & Heaney, C. A. (2020). Exploring health and well-being in Taiwan: What we can learn from individuals’ narratives. BMC Public Health, 20, 159. https://doi.org/10.1186/s12889-020-8201-3
• Samadarshi, S. C. A., Sharma, S., & Bhatta, J. (2020). An online survey of factors associated with self-perceived stress during the initial stage of the COVID-19 outbreak in Nepal. Ethiopian Journal of Health Development, 34(2), 84-89.
• Santabárbara, J., Lasheras, I., Lipnicki, D.M., Bueno-Notivol, J., Pérez-Moreno, M., López-Antón, R., De la Cámara, C., Lobo, A., Gracia-García, P. (2021). Prevalence of anxiety in the COVID-19 pandemic: An updated meta-analysis of community-based studies. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 109, 1-14. https://doi: 10.1016/j.pnpbp.2020.110207
• Serim-Yıldız, B., Özgülük Üçok, S. B., Topcu-Uzer, C., Chiarolanza, C., & Randall, A. K. (2024). A qualitative investigation of perceived stress in the COVID-19 pandemic. Gümüşhane Sağlık Bilimleri Dergisi, 13(1), 216-230.
• Shi, D., Lee, T., & Maydeu-Olivares, A. (2019). Understanding the model size effect on SEM fit indices. Educational and Psychological Measurement, 79(2), 310-334. https://doi.org/10.1177/0013164418783530
• Signorella, M. L., & Vegega, M. E. (1984). A note on gender stereotyping of research topics. Personality and Social Psychology Bulletin, 10(1), 107-109. https://doi.org/10.1177/0146167284101012
• Spinelli, M., Lionetti, F., Setti, A., & Fasolo, M. (2021). Parenting stress during the COVID‐19 outbreak: Socioeconomic and environmental risk factors and implications for children emotion regulation. Family Process, 60(2), 639-653. https://doi.org/10.1111/famp.12601
• Stafford, O., Berry, A., Taylor, L. K., Wearen, S., Prendergast, C., Murphy, E., ... & Burke, T. (2021). Comorbidity and COVID-19: Investigating the relationship between medical and psychological well-being. Irish Journal of Psychological Medicine, 38(4), 272-277.
• Tennant, R., Hiller, L., Fishwick, R., Platt, S., Joseph, S., Weich, S., Parkinson, J., Secker, J., & Stewart-Brown, S. (2007). The Warwick-Edinburgh Mental Well-being Scale (WEMWBS): Development and UK validation. Health and quality of Life Outcomes, 5(63). https://doi.org/10.1186/1477-7525-5-63
• Thombs, B. D., Kwakkenbos, L., Henry, R. S., Carrier, M. E., Patten, S., Harb, S., Bourgeault, A., Tao, L., Bartlett, S. J., Mouthon, L., Varga, J., Benedetti, A. (2020). Changes in mental health symptoms from pre-COVID-19 to COVID-19 among participants with systemic sclerosis from four countries: A Scleroderma Patient-centered Intervention Network (SPIN) Cohort study. Journal of Psychosomatic Research, 139. https://doi.org/10.1016/j.jpsychores.2020.110262
• Wang, X., Tan, L., Wang, X., Liu, W., Lu, Y., Cheng, L., & Sun, Z. (2020). Comparison of nasopharyngeal and oropharyngeal swabs for SARS-CoV-2 detection in 353 patients received tests with both specimens simultaneously. International Journal of Infectious Diseases, 94, 107-109. https://doi.org/10.1016/j.ijid.2020.04.023
• Wierenga, K. L., Moore, S. E., Pressler, S. J., Hacker, E. D., & Perkins, S. M. (2021). Associations between COVID-19 perceptions, anxiety, and depressive symptoms among adults living in the United States. Nursing Outlook, 69(5), 755-766.
• Williamson, B. (2021). Making markets through digital platforms: Pearson, edu-business, and the (e)valuation of higher education. Critical Studies in Education, 62, 50-66. https://doi.org/10.1080/17508487.2020.1737556
• World Health Organization. (2020). WHO Director-General’s opening remarks at the media briefing on COVID-19. Retrieved August 2023, from https://www.who.int/dg/ speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19— 11-march-2020.
• Yıldırım, A., Boysan, M., & Kefeli, M. C. (2018). Psychometric properties of the Turkish version of the Depression Anxiety Stress Scale-21 (DASS-21). British Journal of Guidance & Counselling, 46, 582-595. https://doi.org/10.1080/03069885.2018.1442558
• Young, K. S., Purves, K.L., Hübel, C., Davies, M. R., Thompson, K. N., Bristow, S., Krebs, G., Danese, A., Hirsch, C., Parsons, C. E., Vassos, E., Adey, B. N., Bright, S., Hegemann, L., Lee, Y. T., Kalsi, G., Monssen, D., Mundy, J., Peel, A. J., … Breen, G. (2023). Depression, anxiety and PTSD symptoms before and during the COVID-19 pandemic in the UK. Psychological Medicine, 12, 5428-5441. https://doi.org/10.1017/S0033291722002501