Resilience, COVID-19-related stress, anxiety and depression during the pandemic in a large population enriched for healthcare providers

Abstract

COVID-19 pandemic is a global calamity posing an unprecedented opportunity to study resilience. We developed a brief resilience survey probing self-reliance, emotion-regulation, interpersonal-relationship patterns and neighborhood-environment, and applied it online during the acute COVID-19 outbreak (April 6-15, 2020), on a crowdsourcing research website ( www.covid19resilience.org ) advertised through social media. We evaluated level of stress (worries) regarding COVID-19: (1) contracting, (2) dying from, (3) currently having, (4) family member contracting, (5) unknowingly infecting others with (6) experiencing significant financial burden following. Anxiety (GAD7) and depression (PHQ2) were measured. Totally, 3042 participants (n = 1964 females, age range 18-79, mean age = 39) completed the resilience and COVID-19-related stress survey and 1350 of them (mean age = 41, SD = 13; n = 997 females) completed GAD7 and PHQ2. Participants significantly endorsed more distress about family contracting COVID-19 (48.5%) and unknowingly infecting others (36%), than getting COVID-19 themselves (19.9%), p < 0.0005 covarying for demographics and proxy COVID-19 exposures like getting tested and knowing infected individuals. Patterns of COVID-19 related worries, rates of anxiety (GAD7 > 10, 22.2%) and depression (PHQ2 > 2, 16.1%) did not differ between healthcare providers and non-healthcare providers. Higher resilience scores were associated with lower COVID-19 related worries (main effect F_1,3054 = 134.9; p < 0.00001, covarying for confounders). Increase in 1 SD on resilience score was associated with reduced rate of anxiety (65%) and depression (69%), across healthcare and non-healthcare professionals. Findings provide empirical evidence on mental health associated with COVID-19 outbreak in a large convenience sample, setting a stage for longitudinal studies evaluating mental health trajectories following COVID-19 pandemic.

Fig. 1. COVID-19-related stress in study participants (A) with gender (B) and age (C) comparison.

a Patterns of COVID-19-related worry in the entire sample; b gender differences; c age differences. y-axis represents the rate of responders endorsing significant worry (a lot/a great deal, items 4/5 on a 5 option Likert scale). Error bars represent 95% confidence intervals.

Fig. 2. Gender differences in anxiety and depression.

A positive GAD screen was considered for in GAD7 score > 10. Positive depression screen was considered for PHQ2 score > 2. GAD generalized anxiety disorder.

Fig. 3. Resilience profile association with (A) COVID-19-related worries and with (B) anxiety and depression rates.

a Y-axis represents the rate of responders endorsing significant worry (a lot/a great deal, items 4/5 on a 5 option Likert scale). Error bars represent 95% confidence intervals. b A positive-GAD screen was considered for in GAD7 score > 10. Positive depression screen was considered for PHQ2 score > 2. GAD generalized anxiety disorder.