Fear of Covid-19, anxiety, and depression during the pandemic: A network analysis
Miedo al COVID-19, ansiedad y depresión durante la pandemia: un análisis de redes
Andre Faro , Julian Tejada , Walter Lisboa , Diogo Conque Seco Ferreira
Suma Psicológica, (2023), 30(1), pp. 58-67.
Received 1 December 2022
Accept 17 May 2023
Introducción: El COVID-19 generó varios impactos psicológicos en la vida de las personas imponiendo nuevos desafíos para confrontar la pandemia. Objetivo: Analizar la relación entre los síntomas de miedo al COVID-19, ansiedad y depresión utilizando diferentes muestras extraídas durante tres períodos de tiempo distintos. Fueron analizadas redes del miedo y los síntomas de ansiedad y depresión usando datos recolectados durante la pandemia de COVID-19. Método: Tres encuestas transversales anuales basadas en muestras independientes (2020-2022) de adultos brasileños (punto temporal 1, punto temporal 2 y punto temporal 3 con 1520, 1523 y 1517 participantes, respectivamente). Se aplicaron la Escala de Miedo al COVID-19, la Escala de Trastorno de Ansiedad Generalizada (7 ítems) y el Cuestionario de Salud del Paciente (9 ítems). Se compararon la invariancia de la estructura de la red, la invariancia de la fuerza global y la fuerza del índice de centralidad entre los tres puntos temporales. Resultados: Los ítems de los tres instrumentos tuvieron valores altos (> 70 %) en todos los puntos temporales (excluyendo el miedo al COVID-19 en el punto temporal 3). A lo largo de los tres puntos temporales, los síntomas de depresión y ansiedad aumentaron, mientras que el miedo disminuyó. Las redes se volvieron progresivamente más parsimoniosas y pocas aristas conectaron diferentes escalas, con estructuras similares. Conclusiones: La pandemia tuvo un mayor impacto desorganizador en su inicio, con un aumento continuo de la sintomatología de salud mental y una disminución de la relación entre miedo y ansiedad o depresión.
Palabras clave:
Miedo al COVID-19, ansiedad, depresión, COVID-19, análisis de redes
Introduction: Covid-19 has generated several psychological impacts on people’s lives and brought new challenges for dealing with the pandemic’s repercussions. Objective: The objective was to analyse the relationship between the symptoms of fear of Covid-19, anxiety, and depression using different samples extracted at three distinct time-points. This study performed a network analysis of the fear of Covid-19 and anxiety- and depression -related symptoms based on data collected during the Covid-19 pandemic. Method: Three yearly cross-sectional surveys were conducted based on independent samples (2020–2022) of Brazilian adults (Time-point 1, Time-point 2, and Time-point 3 with 1,520, 1,523, and 1,517 participants, respectively). The Fear of Covid-19 Scale, the Generalised Anxiety Disorder Scale (7 items), and the Patient Health Questionnaire (9 items) were applied. The network structure invariance, the global strength invariance, and the strength of centrality index between the samples were compared. Results: Items from the three instruments had high values (> 70%) in all samples (excluding the fear of Covid-19 at Time-point 3). Depression and anxiety symptoms increased, while fear-related behaviours decreased. Network analysis indicates that networks became progressively more parsimonious, and few edges connected different scales. Network comparisons revealed similar structures, but key differences were found: Time-point 1 showed significantly higher global connectivity, and changes in edge weights were observed only within the scales. Conclusions: Our findings suggest that the pandemic had a greater disorganising impact at its beginning, with a continuous increase in the mental health symptomatology and a reduction in the ratio between fear and anxiety and/or depression.
Keywords:
Fear of Covid-19, anxiety, depression, Covid-19, network analysis
Ahorsu, D. K., Lin, C. Y., Imani, V., Saffari, M., Griffiths, M. D., & Pakpour, A. H. (2020). The Fear of COVID-19 Scale: Development and initial validation. International Journal of Mental Health and Addiction, 20(3), 1537-1545. https://doi.org/10.1007/s11469-020-00270-8
Alimoradi, Z., Ohayon M. M., Griffiths M. D., Lin, C-Y., & Pakpour, A. H. (2022). Fear of COVID-19 and its association with mental health-related factors: Systematic review and meta-analysis. BJPsych Open, 8(2), e73. https://doi.org/10.1192/bjo.2022.26
Borsboom, D. (2017). A network theory of mental disorders. World Psychiatry: Official Journal of the World Psychiatric Association (WPA), 16(1), 5-13. https://doi.org/10.1002/wps.20375
Borsboom, D., & Cramer A. O. J. (2013). Network analysis: An integrative approach to the structure of psychopathology. Annual Review of Clinical Psychology, 9(1), 91-121. https://doi.org/10.1146/annurev-clinpsy-050212-185608
Budimir, S., Probst, T., & Pieh C. (2021). Coping strategies and mental health during COVID-19 lockdown. Journal of Mental Health, 30(2), 156-163. https://doi.org/10.1080/09638237.20211875412
Buneviciene, I., Bunevicius, R., Bagdonas, S., & Bunevicius, A. (2022). The impact of pre-existing conditions and perceived health status on mental health during the COVID-19 pandemic. Journal of Public Health (Oxford, England), 44(1), e88-e95. https://doi.org/10.1093/pubmed/fdab248
Castro, M. C., Gurzenda, S., Turra, C. M., Kim, S., Andrasfay, T., & Goldman, N. (2021). Reduction in life expectancy in Brazil after COVID-19. Nature Medicine, 27(9), 1629-1635. https://doi.org/10.1038/s41591-021-01437-z
Contreras, A., Nieto, I., Valiente, C., Espinosa, R., & Vazquez, C. (2019). The study of psychopathology from the network analysis perspective: A systematic review. Psychotherapy and Psychosomatics, 88(2), 71-83. https://doi.org/10.1159/000497425
Epskamp, S., Borsboom, D., & Fried, E. I. (2018). Estimating psychological networks and their accuracy: A tutorial paper. Behavior Research Methods, 50(1), 195-212. https://doi.org/10.3758/s13428-017-0862-1
Ettman, C. K., Cohen, G. H., Abdalla, S. M., Sampson, L., Trinquart, L., Castrucci, B. C., Bork, R. H., Clark., M. A., Wilson, I., Vivier, P. M., & Galea, S. (2022). Persistent depressive symptoms during COVID-19: A national, population-representative, longitudinal study of U.S. adults. The Lancet, 5, 100091. https://doi.org/10.1016/j.lana.2021.100091
Faro, A., Lisboa, W., Silva-Santos, L.C., & Falcão-Lima, G. O. (2022). Non-suicidal self-injury and suicidal behavior during the COVID-19 pandemic in Brazil. Death Studies 46(10), 2498-2506. https://doi.org/10.1080/07481187.2021.1978116
Faro, A., Silva, L. S., Santos, D. N., & Feitosa, A. L. B. (2022). The Fear of COVID-19 Scale adaptation and validation. Estudos de Psicologia (Campinas), 39, e2000121. https://doi.org/10.1590/1982-0275202239e200121
Feter, N., Caputo, E.L., Doring, I. R., Leite, J. S., Cassuriaga, J., Reichert, F. F., da Silva, M. C., Coomber, J. S., & Rombaldi, A. J. (2021). Sharp increase in depression and anxiety among Brazilian adults during the COVID-19 pandemic: Findings from the PAMPA cohort. Public Health, 190, 101-107. https://doi.org/10.1016/j.puhe.2020.11.013
Fiocruz (2022, April 30). Boletim observatório Covid-19 – Semanas epidemiológicas 15 e 16 de 10 a 23 de abril de 2022. Portal FIOCRUZ. https://portal.fiocruz.br/sites/portal.fiocruz.br/files/documentos_2/boletim_covid_2022-se14-16-red.pdf
Fluharty, M., Bu, F., Steptoe, A., & Fancourt, D. (2021). Coping strategies and mental health trajectories during the first 21 weeks of COVID-19 lockdown in the United Kingdom. Social Science and Medicine, 279, 113958. https://doi.org/10.1016/j.socscimed.2021.113958
Freire, N. P., Cunha, I. C. K. O., Ximenes Neto, F. R. G., Machado, M. H., & Minayo, M. C. S. (2021). The infodemic transcends the pandemic. Ciencia & Saude Coletiva, 26(9), 4065-4068. https://doi.org/10.1590/1413-81232021269.12822021
Giordani, R. C. F., Zanoni da Silva, M., Muhl, C., & Giolo, S. R. (2022). Fear of COVID-19 scale: Assessing fear of the coronavirus pandemic in Brazil. Journal of Health Psychology, 27(4), 901-912. https://doi.org/10.1177/1359105320982035
Hornstein, E. A., Fanselow, M. S., & Eisenberger, N. I. (2022). Warm hands, warm hearts: An investigation of physical warmth as a prepared safety stimulus. Emotion, 22(7), 1517-1528. https://doi.org/10.1037/emo0000925
Isvoranu, A. M., & Epskamp, S. (2023). Which estimation method to choose in network psychometrics? Deriving guidelines for applied researchers. Psychological Methods, 28(4), 925-946. https://doi.org/10.1037/met0000439
Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606-613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
Luo, F., Ghanei Gheshlagh, R., Dalvand, S., Saedmoucheschi, S., & Li, Q. (2021). Systematic review and meta-analysis of fear of COVID-19. Frontiers in Psychology, 12, 661078. https://doi.org/10.3389/fpsyg.2021.661078
Moreno, A. L., DeSousa, D. A., Souza, A. M. F. L. P., Manfro, G. G., Salum, G. A., Koller, S. H., Osório, F. L., & Crippa, J. A. S. (2016). Factor structure, reliability, and item parameters of the Brazilian-Portuguese version of the GAD-7 questionnaire. Trends in Psychology, 24, 367-376.
Osório, F. L., Mendes, A.V., Crippa, J. A. S., & Loureiro, S. R. (2009). Study of the discriminative validity of the PHQ-9 and PHQ-2 in a sample of Brazilian women in the context of primary health care. Perspectives in Psychiatric Care, 45, 216-227. https://doi.org/10.1111/j.1744-6163.2009.00224.x
Pan American Health Organization [PAHO] (2020, September 16). Understanding the Infodemic and misinformation in the fight against COVID-19. https://iris.paho.org/handle/10665.2/52052
Pfeifer, L. S., Heyers, K., Ocklenburg, S., & Wolf, O. T. (2021). Stress research during the COVID-19 pandemic and beyond. Neuroscience and Biobehavioral Reviews, 131, 581-596. https://doi.org/10.1016/j.neubiorev.2021.09.045
Seco Ferreira, D. C., Oliveira, W. L., Costa Delabrida, Z. N., Faro, A., & Cerqueira-Santos, E. (2020). Intolerance of uncertainty and mental health in Brazil during the Covid-19 pandemic. Suma Psicológica, 27, 62-69. https://doi.org/10.14349/sumapsi.2020.v27.n1.8
Shamblaw, A. L., Rumas, R. L., & Best, M. W. (2021). Coping during the COVID-19 pandemic: Relations with mental health and quality of life. Canadian Psychology / Psychologie canadienne, 62(1), 92-100. https://doi.org/10.1037/cap0000263
Silva, S. J. R., & Pena, L. (2021). Collapse of the public health system and the emergence of new variants during the second wave of the COVID-19 pandemic in Brazil. One Health, 13, 100287. https://doi.org/10.1016/j.onehlt.2021.100287
Souza, W. M., Buss, L. F., Candido, D., Carrera, J-P., Li, S., Zarebski, A. E., Pereira, R. H. M., Prete Júnior, C. A., Souza-Santos, A. A., Parag, K.V., Belotti, M. C. T. D., Vicenti-Gonzalez, M. F., Messina, J., Sales, F. C. S., Andrade, P. S., Nascimento, V. H., Ghilardi, F., Abade, L., Gutierrez, B.,. . . Faria, N. R. (2020). Epidemiological and clinical characteristics of the Covid-19 epidemic in Brazil. Nature Human Behaviour, 4(8), 856-865. https://doi.org/10.1038/s41562-020-0928-4
Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Lowe, B. (2006). A brief measure for assessing generalized anxiety disorder the GAD-7. Archives of Internal Medicine, 166, 1092-1097. https://doi.org/10.1001/archinte.166.10.1092
Tentolouris, A., Ntanasis-Stathopoulos, I., Vlachakis, P. K., Tsilimigras, D.I., Gavriatopoulou, M., & Dimopoulos, M. A. (2021). COVID-19: Time to flatten the Infodemic curve. Clinical and Experimental Medicine, 21(2), 161-165. https://doi.org/10.1007/s10238-020-00680-x
Van Borkulo, C., Van Bork, R., Boschloo, L., Kossakowski, J. J., Tio, P., Schoevers, R. A., Borsboom, D., & Waldorp, L. J. (2022). Comparing network structures on three aspects: A permutation test. Psychological Methods. https://doi.org/10.1037/met0000476
Wang, C., Pan, R., Wan, X., Tan, W., Xu, L., McIntyre, R.S., Choo, F. N., Tran, B., Ho, R., Sharma, V. K., & Ho, C. (2020). A longitudinal study on the mental health of general population during the COVID-19 epidemic in China. Brain, Behavior, and Immunity 87, 40-48. https://doi.org/10.1016%2Fj.bbi.2020.04.028
Wang, H., Paulson, K. R., Pease, S.A., Watson, S., Comfort, H., Zheng, P., Aravkin, A.Y., Bisignano, C., Barber, R. M., Alam, T., Fuller, J. E., May, E. A., Jones, D. P., Frisch, M. E., Abbafati, C., Adolph, C., Allorant, A., Amlag, J. O., Bang-Jensen, B., . . . Murray, C. J. L. (2022). Estimating excess mortality due to the COVID-19 pandemic: A systematic analysis of COVID-19-related mortality, 2020–21. The Lancet, 399, 10334, 1513-1536. https://doi.org/10.1016/S0140-6736(21)02796-3
World Health Organization [WHO] (2022a, April 2020). Mental Health and COVID-19: Early evidence of the pandemic’s impact: Scientific brief. https://www.who.int/publications/i/item/WHO-2019-nCoV-Sci_Brief-Mental_health-2022.1
World Health Organization [WHO] (2022b, July 2022). WHO Coronavirus (COVID-19) Dashboard. https://covid19.who.int/
Yarrington, J. S., Lasser, J., Garcia, D., Vargas, J. H., Couto, D. D., Marafon, T., Craske, M. G., & Niles, A. N. (2021). Impact of the COVID-19 pandemic on mental health among 157,213 Americans. Journal of Affective Disorders, 286, 64-70. https://doi.org/10.1016/j.jad.2021.02.056
