![[ Visit Client Website ]](images/banner.gif)
The spread of COVID-19 increased stress related to COVID-19 (hereafter stress) and negative psychological consequences. As a result, many people suffered from mental health issues such as anxiety during the COVID-19 (Havnen et al., 2020; Yoon & Choi, 2022). They also suffered from loneliness, which is known to have negative effects on mental, cognitive, and physical health during challenging times. However, previous studies have shown that protective factors such as resilience may help people move forward despite stressful conditions (PeConga et al., 2020). Recent research has also found that during COVID-19, resilience and family cohesion acted as protective factors against negative psychological outcomes for middle-aged and older adults (Yoon & Choi, 2022). However, despite the negative impact of loneliness, to date, little research has examined the moderating effects of loneliness on the association between stress and anxiety. This study investigated the direct and indirect effects of stress on anxiety through resilience and family cohesion as well as the moderating effects of loneliness in this association during COVID-19. This study aimed to investigate (1) the impact of stress on anxiety, (2) protective factors against anxiety, and (3) the moderating effects of loneliness on the association between stress and anxiety.
Methods
Data were collected from 873 adults (ages 31 to 76) living in areas that were severely impacted by the COVID-19 in South Korea from July to August 2020. The dependent variable, anxiety (α = .922), was measured by GAD-7 (Spitzer et al., 2006). Resilience (α=.832) was measured using the Brief Resilience Scale (Smith et al., 2008), and family cohesion (α=.890) was measured using four items of the Brief Family Relationship Scale (Timg Fok et al., 2014). Loneliness (α = .858) was measured by three items (Hughes et al., 2004). The higher loneliness group with a higher-than-average score was coded as “1” (n= 415) and the lower loneliness group was coded as “0” (n= 458) (Kim et al., 2021). Covariates were physical health, annual income, age, and gender. Missing values were imputed by employing a Maximum Likelihood estimation using SPSS 26 (Enders, 2010). A multi-group path analysis using Amos 25 was employed and maximum likelihood (ML) estimation was used for data analysis. Measurement invariance was examined by comparing unconstrained and fully constrained models. Both models were a good fit. For the direct and indirect effects, 95% confidence intervals were estimated using bootstrapping (a bootstrap sample of 1,000).
Results
Stress was positively associated with anxiety for both the higher and lower loneliness groups. For both groups, resilience and family cohesion reduced anxiety. In the lower loneliness group, stress was indirectly associated with anxiety through resilience. The path coefficient between stress and anxiety was significantly greater for the higher loneliness group than for the lower loneliness group.
Conclusions and Implications
Programs and services to decrease loneliness and anxiety are important for adults during stressful times. Efforts to increase protective factors such as family cohesion and resilience may help reduce the negative mental health outcomes associated with health crises such as COVID-19.