The Causal Model of Coronavirus Anxiety in the Elderly Based on Perceived Stress and Sense of Cohesion: The Mediating Role of Perceived Social Support

Document Type : Original Article

Authors

1 Department of Psychology, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili , Ardabil, Iran

2 ., Department of Psychology, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardebil, Iran

Abstract

The spread of the Coronavirus is a challenge for healthcare systems all around the world. The elderly are at high risk for complications from Coronavirus due to low immune system function and underlying diseases. Therefore, the aim of this study was to investigate the causal modeling of Corona anxiety in the elderly based on perceived stress and sense of cohesion with the mediating role of perceived social support. The research method was descriptive, of structural equations type. The statistical population included all the elderly living in nursing homes in Ardabil in 2020, from which 160 were selected using purposive sampling. Used to collect data were Alipour et al.'s Corona Anxiety Scale, Sense of Coherence- 13 scale of Antonovsky, Calhoun et al.'s Perceived Stress Scale, and Zimet et al.'s Multidimensional Scale of Perceived Social Support. Data were analyzed by structural equation modeling using SPSS-23 and Lisrel 8.8 software. Based on the obtained results, the causal model confirmed the relationship between perceived stress, sense of cohesion, perceived social support and corona anxiety in the elderly based on different fitness indices (P<0.05). Perceived stress, sense of cohesion, and perceived social support had a direct effect on corona anxiety in the elderly. Besides, perceived stress and sense of cohesion had an indirect effect on corona anxiety in the elderly through perceived social support (P<0.05). Thus, in the context of the Covid-19 epidemic, it is possible to play an important role in reducing coronary anxiety in the elderly by informing and applying measures to empower the elderly in the areas of perceived stress, sense of cohesion, and perceived social support.
 

References
Aldwin, C. M., Molitor, N. T., Avron, S., Levenson, M. R., Molitor, J., & Igarashi, H. (2011). Do stress trajectories predict mortality in older men? Longitudinal findings from the VA normative aging study. Journal of Aging Research, 896109.
Alipour, A., Ghadami, A., Alipour, Z., & Abdollahzadeh, H. (2020). Preliminary validation of the Corona Disease Anxiety Scale (CDAS) in the Iranian sample. Health Psychology, 8(32), 163-175. [Persian]
Alizadeh Fard, S., & Saffarinia, M. (2020). The prediction of mental health based on the anxiety and the social cohesion that caused by Coronavirus. Quarterly Social Psychology Research, 9(36), 129-141. [Persian]
Antonovsky, A. (1993). The structure and properties of the sense of coherence scale. Social Science & Medicine, 36(6), 725-733.
Antonovsky, A. (2014). Intergenerational networks and transmitting the sense of coherence. Life-span Developmental Psychology Intergenerational Relations, 211.
Bahramnia, M., Ramak, N., & Sangani, A. (2020). The role of perceived mental stress in the health of suspected cases of COVID-19. Journal of Military Medicine, 22(2), 115-121. [Persian]
Banjongrewadee, M., Wongpakaran, N., Wongpakaran, T., Pipanmekaporn, T., Punjasawadwong, Y., & Mueankwan, S. (2020). The role of perceived stress and cognitive function on the relationship between neuroticism and depression among the elderly: a structural equation model approach. BMC Psychiatry, 20(1), 1-8.
Barni, D., Danioni, F., Canzi, E., Ferrari, L., Ranierr, S., Lanz, M., Iafrate, R., Regalia, C., & Rosnati, R. (2020). Facing the COVID-19 Pandemic: The role of sense of coherence. Frontiers in Psychology, 11, 578440.
Behroozi, N., Shahani Yeylaq, M., & Purseyed, S. M. (2013). Relationship between perfectionism, perceived stress and social support with academic burnout. Rahborde Farhang, 5(20), 83-102. [Persian]
Calhoun, L.G., Cann, A., Tedeschi, R.G., & McMillan, J.A. (2000). A correlational test of the relationship between posttraumatic growth, religion and cognitive processing. Journal of Traumatic Stress, 13(3), 521-527.

Chadwick, K.A., & Collins, P.A (2015). Examining the relationship between social support availability, urban center size, and self-perceived mental health of recent immigrants to Canada: A mixed-methods analysis. Social Science & Medicine, 128, 220-230.
Chen, Y., Liang, Y., Zhang, W., Crawford, J. C., Sakel, K.L., & Dong, X. (2019). Perceived stress and cognitive decline in Chinese-American older adults. Journal of the American Geriatrics Society, 67(S3), S519-S524.
Chittem, M., Lindström, B., Byrapaneni, R., & Espnes, G. A. (2015). Sense of coherence and chronic illnesses: Scope for research in India. Journal of Social Health and Diabetes, 3(2), 79.
Del-Pino-Casado, R., Espinosa-Medina. A., López-Martínez, C., & Orgeta. V. (2019). Sense of coherence, burden and mental health in caregiving: A systematic review and meta-analysis. Journal of Affective Disorders, 242, 14–21.
Duan, L., & Zhu, G. (2020). Psychological interventions for people affected by the COVID-19 epidemic. Lancet Psychiatry, 7(4), 300-302.
Feldt, T (2014). Development of sense of coherence in adulthood. European Health Psychologist, 16(S), 389.
Flesia, L., Monaro, M., Mazza, C., Fietta, V., Colicino, E., Segatto, B., & Roma, P. (2020). Predicting perceived stress related to the Covid-19 outbreak through Stable psychological traits and machine learning models. Journal of Clinical Medicine, 9(10), 3350.
Grevenstein, D., & Bluemke, M. (2015). Can the Big Five explain the criterion validity of sense of coherence for mental health, life satisfaction, and personal distress? Personality and Individual Differences, 77, 106–111.
Hashemi, Z., & Eyni, S. (2020). Perceived Stress in the Elderly: The role of spiritual Intelligence, self-compassion, and psychological hardiness. Aging Psychology, 5(4), 289-299. [Persian]
Henry, A., Tourbah, A., Camus, G., Deschamps, R., Mailhan, L., Castex, C., Gout, O., & Montreuil, M. (2019). Anxiety and depression in patients with multiple sclerosis: The mediating effects of perceived social support. Multiple Sclerosis and Related Disorders, 27, 46–51.
Huang, J., Wang, X., Li, W., & An, Y. (2019). The relationship between conscientiousness and posttraumatic stress disorder among young Chinese firefighters: The mediating effect of perceived social support. Psychiatry Research, 273, 450-455.
Huremovi´c, D. (2019). Psychiatry of Pandemics: A Mental Health Response to Infection Outbreak; Huremovi´c, D., Ed.; Springer International Publishing.
Hutchinson, A.M.K., Suart, A. D., & Pretorius, H.G. (2011). The relationships between temperament, character strengths, and resilience. In The Human Pursuit of Well-Being: A Cultural Approach; Brdar, I., Ed., Springer: Dordrecht.
Jones-Bitton, A., Best, C., MacTavish, J., Fleming, S., & Hoy, S. (2020). Stress, anxiety, depression, and resilience in Canadian farmers. Social Psychiatry and Psychiatric Epidemiology, 55, 229-236.
Kaniasty, K. (2012). Predicting social psychological well-being following trauma: The role of post disaster social support. Psychological Trauma: Theory, Research, Practice, and Policy, 4(1), 22–33.
Khoshnami, M. S., Javadi, S. M. H., Noruzi, S., & Arian, M. (2020). The Elderly as the symbol of a generation’s experience through Covid-19 pandemic. Elderly Health Journal, 6(1), 1-2.
Krantz, G., & Ostergren, P.O. (2004). Does it make sense in a coherent way? Determinants of sense of coherence in Swedish women 40 to 50 years of age. International Journal of Behavioral Medicine, 11(1), 18-26.
Li, X., Wu, H., Meng, F., Li, L., Wang, Y., & Zhou, M. (2020). Relations of COVID-19-related stressors and social support with Chinese college students' psychological response during the COVID-19 pandemic. Frontiers in Psychiatry, 11, 551315.
Lindblad, C., Sandelin, K., Petersson, L. M., Rohani, C., & Langius-EKlӧf, A. (2016). Stability of item sense of coherence (SOC) scale: a longitudinal prospective study in women for breast cancer. Quality of Life Research, 25(3), 753-760.
Liu, K., Zhang, W., Yang, Y., Zhang, J., Li, Y., & Chen, Y. (2020). Respiratory rehabilitation in elderly patients with COVID-19: A randomized controlled study. Complementary Therapies in Clinical Practice, 39, 101166. 
Mahammadzadeh, A., Poursharifi, H., & Alipour, A. (2010). Validation of Sense of Coherence (SOC) 13-item scale in Iranian sample. Procedia Social and Behavioral Sciences, 5, 1451–1455.
Małgorzata Szcze´sniak, M., & Strochalska, K. (2020). Temperament and sense of coherence: emotional intelligence as a Mediator. International Journal of Environmental Research and Public Health, 17(1), 219.
Malta, M., Rimoin, A.W., & Strathdee, S. A. (2020). The coronavirus 2019-nCoV epidemic: Is hindsight 20/20? EClinical Medicine, 20, 100289.
Mehra, A., Rani, S., Sahoo, S., Parveen, S., Singh, A. P., Chakrabarti, S., & Grover, S. (2020). A crisis for elderly with mental disorders: Relapse of symptoms due to heightened anxiety due to COVID-19. Asian Journal of Psychiatry, 51, 102114.
Meng, H., Xu, Y., Dai, J., Zhang, Y., Liu, B., & Yang, H. (2020). Analyze the psychological impact of COVID-19 among the elderly population in China and make corresponding suggestions. Psychiatry Research, 289, 112983. 
Osmanovic-Thunstrom, A., Mossello, E., Akerstedt, T., Fratiglioni, L., &Wang, H. X. (2015). Do levels of perceived stress increase with increasing age after age 65? A population-based study. Age and Ageing, 44(5), 828-834.
Özmete, E., & Pak, M. (2020). The relationship between anxiety levels and perceived social support during the pandemic of COVID-19 in Turkey. Social Work in Public Health, 35(7), 603-616.
Paika, V., Ntountoulaki, E., Papaioannou, D., & Hyphantis, T. (2017). The Greek Version of the Sense of Coherence Scale (SOC-29): Psychometric properties and associations with mental illness, suicidal risk and quality of life. Journal of Psychology and Clinical Psychiatry, 7(4), 1-10.
Paules, C. I., Marston, H. D., & Fauci, A. S. (2020). Coronavirus infections-more than just the common cold. The Journal of the American Medical Association, 323(8), 707-708.
Pearman, A., Hughes, M. L., Smith, E. L., Neupert, S. D. (2020). Age Differences in Risk and Resilience Factors in COVID-19- Related Stress. Journal of Gerontology: Psychological Sciences, 1-7.
Rajkumar, R.P. (2020). COVID-19 and mental health: a review of the existing literature. Asian Journal of Psychiatry, 52, 102066.
Ralph, P., Magyar-Russell, G., Dilella, N., & Matter, S. (2014). Sense of coherence: big five correlates, spirituality, and incremental. Journal of Personality Psychology, 2(1), 1-9.
Rohani, C., Khanjari, S., Abedi, H.A., Oskouie, F., & Langius-Eklöf, A. (2010). Health index, sense of coherence scale, brief religious coping scale and spiritual perspective scale: Psychometric properties. Journal of Advanced Nursing, 66 (12), 2796-2806.
Ronnlund, M., Astrom, E., Adolfsson, R., & Carelli, M. G. (2018). Perceived stress in adults aged 65 to 90: Relations to facets of Time Perspective and COMT Val158Met Polymorphism. Frontiers in Psychology, 22(9), 378.
Salimi, A., Jokar, B., & Nikpour, R. (2009). Internet communication in life: Exploring the role of perception of social support and loneliness in internet use. Quarterly Journal of Psychological Studies, 5(3), 81-102. [Persian]
Schäfer, S. K., Sopp, M. R., Schanz, C. G., Staginnus, M., Göritz, A. S., & Michael, T. (2020). Impact of Covid-19 on public mental health and the buffering effect of sense of coherence. Psychotherapy and Psychosomatics, 89(6), 386–392.
Srensen, T., Klungsyr, O., Kleiner, R., & Klepp, O. M. (2011). Social support and sense of coherence: independent, shared and interaction relationships with life stress and mental health. International Journal of Mental Health Promotion, 13(1), 27-44.
Uchida, H., Tsujino, D., Muguruma, T., Hino, N., Sasaki, K., Miyoshi, M., Koyama, Y., & Hirao, K. (2018). Low sense of coherence is associated with anxiety among adults: Results based on data from all 47 prefectures of Japan. Comprehensive Psychiatry, 86, 131-136.
Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., Ho, C.S, & Ho, R. C. (2020). Immediate psychological responses and associated factors during the initial stage of the 2019 Coronavirus Disease (COVID-19) epidemic among the general population in China. International Journal of Environmental Research and Public Health, 17(5), 1729.
Xu, J., Ou, J., Luo, S., Wang, Z., Chang, E., Novak, C., Shen, J., Zheng, Sh., & Wang, Y. (2020). Perceived social support protects lonely people against COVID-19 anxiety: A three-wave longitudinal study in China. Frontiers in Psychology, 11, 566965.
Ye, B. J., Hu, X. Y., Yang, Q. & Hu, Z. J. (2014). The effect mechanism of perceived social support coping efficacy and stressful life events on adolescents’ academic achievement. Journal of Psychological Science, 37(2), 342-348.
Ye, Z., Yang, X., Zeng, Ch., Wang, Y., Shen, Z., Li, X., & Lin, D. (2020). Resilience, social support, and coping as mediators between COVID‐19‐related stressful experiences and acute stress disorder among college students in China. Applied Psychology. Health and Well-being, 10.1111/aphw.12211.
Zandifar, A., Badrfam, R., Yazdani, SH., Arzaghi, S. M., Rahimi, F., Ghasemi, S., Khamisabadi, S., Mohammadian Khonsari, N., & Qorbani, M. (2020). Prevalence and severity of depression, anxiety, stress and perceived stress in hospitalized patients with COVID-19. Journal Diabetes & Metabolic Disorders, 1-8.
Zhang, Y., & Ma, Z.F. (2020). Impact of the COVID-19 pandemic on mental health and quality of life among local residents in Liaoning Province, China: a cross-sectional study. International Journal of Environmental Research and Public Health, 17(7), 2381.
Zimet, G.D., Dahlem, N.W., Zimet, S.G., & Farley, G.K. (1988). The multidimensional scale of perceived social support. Journal of Personality Assessment, 52(1), 30-41.

Keywords

References

 
References
Aldwin, C. M., Molitor, N. T., Avron, S., Levenson, M. R., Molitor, J., & Igarashi, H. (2011). Do stress trajectories predict mortality in older men? Longitudinal findings from the VA normative aging study. Journal of Aging Research, 896109.
Alipour, A., Ghadami, A., Alipour, Z., & Abdollahzadeh, H. (2020). Preliminary validation of the Corona Disease Anxiety Scale (CDAS) in the Iranian sample. Health Psychology, 8(32), 163-175. [Persian]
Alizadeh Fard, S., & Saffarinia, M. (2020). The prediction of mental health based on the anxiety and the social cohesion that caused by Coronavirus. Quarterly Social Psychology Research, 9(36), 129-141. [Persian]
Antonovsky, A. (1993). The structure and properties of the sense of coherence scale. Social Science & Medicine, 36(6), 725-733.
Antonovsky, A. (2014). Intergenerational networks and transmitting the sense of coherence. Life-span Developmental Psychology Intergenerational Relations, 211.
Bahramnia, M., Ramak, N., & Sangani, A. (2020). The role of perceived mental stress in the health of suspected cases of COVID-19. Journal of Military Medicine, 22(2), 115-121. [Persian]
Banjongrewadee, M., Wongpakaran, N., Wongpakaran, T., Pipanmekaporn, T., Punjasawadwong, Y., & Mueankwan, S. (2020). The role of perceived stress and cognitive function on the relationship between neuroticism and depression among the elderly: a structural equation model approach. BMC Psychiatry, 20(1), 1-8.
Barni, D., Danioni, F., Canzi, E., Ferrari, L., Ranierr, S., Lanz, M., Iafrate, R., Regalia, C., & Rosnati, R. (2020). Facing the COVID-19 Pandemic: The role of sense of coherence. Frontiers in Psychology, 11, 578440.
Behroozi, N., Shahani Yeylaq, M., & Purseyed, S. M. (2013). Relationship between perfectionism, perceived stress and social support with academic burnout. Rahborde Farhang, 5(20), 83-102. [Persian]
Calhoun, L.G., Cann, A., Tedeschi, R.G., & McMillan, J.A. (2000). A correlational test of the relationship between posttraumatic growth, religion and cognitive processing. Journal of Traumatic Stress, 13(3), 521-527.
Chadwick, K.A., & Collins, P.A (2015). Examining the relationship between social support availability, urban center size, and self-perceived mental health of recent immigrants to Canada: A mixed-methods analysis. Social Science & Medicine, 128, 220-230.
Chen, Y., Liang, Y., Zhang, W., Crawford, J. C., Sakel, K.L., & Dong, X. (2019). Perceived stress and cognitive decline in Chinese-American older adults. Journal of the American Geriatrics Society, 67(S3), S519-S524.
Chittem, M., Lindström, B., Byrapaneni, R., & Espnes, G. A. (2015). Sense of coherence and chronic illnesses: Scope for research in India. Journal of Social Health and Diabetes, 3(2), 79.
Del-Pino-Casado, R., Espinosa-Medina. A., López-Martínez, C., & Orgeta. V. (2019). Sense of coherence, burden and mental health in caregiving: A systematic review and meta-analysis. Journal of Affective Disorders, 242, 14–21.
Duan, L., & Zhu, G. (2020). Psychological interventions for people affected by the COVID-19 epidemic. Lancet Psychiatry, 7(4), 300-302.
Feldt, T (2014). Development of sense of coherence in adulthood. European Health Psychologist, 16(S), 389.
Flesia, L., Monaro, M., Mazza, C., Fietta, V., Colicino, E., Segatto, B., & Roma, P. (2020). Predicting perceived stress related to the Covid-19 outbreak through Stable psychological traits and machine learning models. Journal of Clinical Medicine, 9(10), 3350.
Grevenstein, D., & Bluemke, M. (2015). Can the Big Five explain the criterion validity of sense of coherence for mental health, life satisfaction, and personal distress? Personality and Individual Differences, 77, 106–111.
Hashemi, Z., & Eyni, S. (2020). Perceived Stress in the Elderly: The role of spiritual Intelligence, self-compassion, and psychological hardiness. Aging Psychology, 5(4), 289-299. [Persian]
Henry, A., Tourbah, A., Camus, G., Deschamps, R., Mailhan, L., Castex, C., Gout, O., & Montreuil, M. (2019). Anxiety and depression in patients with multiple sclerosis: The mediating effects of perceived social support. Multiple Sclerosis and Related Disorders, 27, 46–51.
Huang, J., Wang, X., Li, W., & An, Y. (2019). The relationship between conscientiousness and posttraumatic stress disorder among young Chinese firefighters: The mediating effect of perceived social support. Psychiatry Research, 273, 450-455.
Huremovi´c, D. (2019). Psychiatry of Pandemics: A Mental Health Response to Infection Outbreak; Huremovi´c, D., Ed.; Springer International Publishing.
Hutchinson, A.M.K., Suart, A. D., & Pretorius, H.G. (2011). The relationships between temperament, character strengths, and resilience. In The Human Pursuit of Well-Being: A Cultural Approach; Brdar, I., Ed., Springer: Dordrecht.
Jones-Bitton, A., Best, C., MacTavish, J., Fleming, S., & Hoy, S. (2020). Stress, anxiety, depression, and resilience in Canadian farmers. Social Psychiatry and Psychiatric Epidemiology, 55, 229-236.
Kaniasty, K. (2012). Predicting social psychological well-being following trauma: The role of post disaster social support. Psychological Trauma: Theory, Research, Practice, and Policy, 4(1), 22–33.
Khoshnami, M. S., Javadi, S. M. H., Noruzi, S., & Arian, M. (2020). The Elderly as the symbol of a generation’s experience through Covid-19 pandemic. Elderly Health Journal, 6(1), 1-2.
Krantz, G., & Ostergren, P.O. (2004). Does it make sense in a coherent way? Determinants of sense of coherence in Swedish women 40 to 50 years of age. International Journal of Behavioral Medicine, 11(1), 18-26.
Li, X., Wu, H., Meng, F., Li, L., Wang, Y., & Zhou, M. (2020). Relations of COVID-19-related stressors and social support with Chinese college students' psychological response during the COVID-19 pandemic. Frontiers in Psychiatry, 11, 551315.
Lindblad, C., Sandelin, K., Petersson, L. M., Rohani, C., & Langius-EKlӧf, A. (2016). Stability of item sense of coherence (SOC) scale: a longitudinal prospective study in women for breast cancer. Quality of Life Research, 25(3), 753-760.
Liu, K., Zhang, W., Yang, Y., Zhang, J., Li, Y., & Chen, Y. (2020). Respiratory rehabilitation in elderly patients with COVID-19: A randomized controlled study. Complementary Therapies in Clinical Practice, 39, 101166. 
Mahammadzadeh, A., Poursharifi, H., & Alipour, A. (2010). Validation of Sense of Coherence (SOC) 13-item scale in Iranian sample. Procedia Social and Behavioral Sciences, 5, 1451–1455.
Małgorzata Szcze´sniak, M., & Strochalska, K. (2020). Temperament and sense of coherence: emotional intelligence as a Mediator. International Journal of Environmental Research and Public Health, 17(1), 219.
Malta, M., Rimoin, A.W., & Strathdee, S. A. (2020). The coronavirus 2019-nCoV epidemic: Is hindsight 20/20? EClinical Medicine, 20, 100289.
Mehra, A., Rani, S., Sahoo, S., Parveen, S., Singh, A. P., Chakrabarti, S., & Grover, S. (2020). A crisis for elderly with mental disorders: Relapse of symptoms due to heightened anxiety due to COVID-19. Asian Journal of Psychiatry, 51, 102114.
Meng, H., Xu, Y., Dai, J., Zhang, Y., Liu, B., & Yang, H. (2020). Analyze the psychological impact of COVID-19 among the elderly population in China and make corresponding suggestions. Psychiatry Research, 289, 112983. 
Osmanovic-Thunstrom, A., Mossello, E., Akerstedt, T., Fratiglioni, L., &Wang, H. X. (2015). Do levels of perceived stress increase with increasing age after age 65? A population-based study. Age and Ageing, 44(5), 828-834.
Özmete, E., & Pak, M. (2020). The relationship between anxiety levels and perceived social support during the pandemic of COVID-19 in Turkey. Social Work in Public Health, 35(7), 603-616.
Paika, V., Ntountoulaki, E., Papaioannou, D., & Hyphantis, T. (2017). The Greek Version of the Sense of Coherence Scale (SOC-29): Psychometric properties and associations with mental illness, suicidal risk and quality of life. Journal of Psychology and Clinical Psychiatry, 7(4), 1-10.
Paules, C. I., Marston, H. D., & Fauci, A. S. (2020). Coronavirus infections-more than just the common cold. The Journal of the American Medical Association, 323(8), 707-708.
Pearman, A., Hughes, M. L., Smith, E. L., Neupert, S. D. (2020). Age Differences in Risk and Resilience Factors in COVID-19- Related Stress. Journal of Gerontology: Psychological Sciences, 1-7.
Rajkumar, R.P. (2020). COVID-19 and mental health: a review of the existing literature. Asian Journal of Psychiatry, 52, 102066.
Ralph, P., Magyar-Russell, G., Dilella, N., & Matter, S. (2014). Sense of coherence: big five correlates, spirituality, and incremental. Journal of Personality Psychology, 2(1), 1-9.
Rohani, C., Khanjari, S., Abedi, H.A., Oskouie, F., & Langius-Eklöf, A. (2010). Health index, sense of coherence scale, brief religious coping scale and spiritual perspective scale: Psychometric properties. Journal of Advanced Nursing, 66 (12), 2796-2806.
Ronnlund, M., Astrom, E., Adolfsson, R., & Carelli, M. G. (2018). Perceived stress in adults aged 65 to 90: Relations to facets of Time Perspective and COMT Val158Met Polymorphism. Frontiers in Psychology, 22(9), 378.
Salimi, A., Jokar, B., & Nikpour, R. (2009). Internet communication in life: Exploring the role of perception of social support and loneliness in internet use. Quarterly Journal of Psychological Studies, 5(3), 81-102. [Persian]
Schäfer, S. K., Sopp, M. R., Schanz, C. G., Staginnus, M., Göritz, A. S., & Michael, T. (2020). Impact of Covid-19 on public mental health and the buffering effect of sense of coherence. Psychotherapy and Psychosomatics, 89(6), 386–392.
Srensen, T., Klungsyr, O., Kleiner, R., & Klepp, O. M. (2011). Social support and sense of coherence: independent, shared and interaction relationships with life stress and mental health. International Journal of Mental Health Promotion, 13(1), 27-44.
Uchida, H., Tsujino, D., Muguruma, T., Hino, N., Sasaki, K., Miyoshi, M., Koyama, Y., & Hirao, K. (2018). Low sense of coherence is associated with anxiety among adults: Results based on data from all 47 prefectures of Japan. Comprehensive Psychiatry, 86, 131-136.
Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., Ho, C.S, & Ho, R. C. (2020). Immediate psychological responses and associated factors during the initial stage of the 2019 Coronavirus Disease (COVID-19) epidemic among the general population in China. International Journal of Environmental Research and Public Health, 17(5), 1729.
Xu, J., Ou, J., Luo, S., Wang, Z., Chang, E., Novak, C., Shen, J., Zheng, Sh., & Wang, Y. (2020). Perceived social support protects lonely people against COVID-19 anxiety: A three-wave longitudinal study in China. Frontiers in Psychology, 11, 566965.
Ye, B. J., Hu, X. Y., Yang, Q. & Hu, Z. J. (2014). The effect mechanism of perceived social support coping efficacy and stressful life events on adolescents’ academic achievement. Journal of Psychological Science, 37(2), 342-348.
Ye, Z., Yang, X., Zeng, Ch., Wang, Y., Shen, Z., Li, X., & Lin, D. (2020). Resilience, social support, and coping as mediators between COVID‐19‐related stressful experiences and acute stress disorder among college students in China. Applied Psychology. Health and Well-being, 10.1111/aphw.12211.
Zandifar, A., Badrfam, R., Yazdani, SH., Arzaghi, S. M., Rahimi, F., Ghasemi, S., Khamisabadi, S., Mohammadian Khonsari, N., & Qorbani, M. (2020). Prevalence and severity of depression, anxiety, stress and perceived stress in hospitalized patients with COVID-19. Journal Diabetes & Metabolic Disorders, 1-8.
Zhang, Y., & Ma, Z.F. (2020). Impact of the COVID-19 pandemic on mental health and quality of life among local residents in Liaoning Province, China: a cross-sectional study. International Journal of Environmental Research and Public Health, 17(7), 2381.
Zimet, G.D., Dahlem, N.W., Zimet, S.G., & Farley, G.K. (1988). The multidimensional scale of perceived social support. Journal of Personality Assessment, 52(1), 30-41.

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  • Receive Date: 28 December 2020
  • Revise Date: 17 March 2021
  • Accept Date: 04 April 2021

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