Fear of COVID-19 and emotional dysfunction problems: Intrusive, avoidance and hyperarousal stress as key mediators

Abstract

BACKGROUND There is mounting empirical evidence of the detrimental effects of the coronavirusdisease 2019 (COVID-19) outbreak on mental health. Previous research hasunderscored the effects of similar destabilizing situations such as war, naturaldisasters or other pandemics on acute stress levels which have been shown toexacerbate current and future psychopathological symptoms.AIM To explore the role of acute stress responses (intrusive, avoidance and hyper-arousal) as mediators in the association between fear of COVID-19 and emotionaldysfunction-related problems: Depression, agoraphobia, panic, obsessive-compulsive, generalized anxiety, social anxiety and health anxiety symptoms. METHODS A sample of 439 participants from a university community in Spain (age: mean ±SD: 36.64 ± 13.37; 73.1% females) completed several measures assessing their fearof COVID-19, acute stress responses and emotional dysfunction syndromesthrough an online survey. Data collection was carried out from the start of homeconfinement in Spain until May 4, 2020, coinciding with initial de-escalationmeasures. Processing of the dataset included descriptive and frequency analyses,Mann-Whitney U Test of intergroup comparisons and path analysis for direct andindirect effects. This is an observational, descriptive-correlational and cross-sectional study.RESULTS The prevalence of clinical symptoms in our sample, reported since the beginning of the pandemic,reached 31.44%. The female group presented higher scores although the effect size was small.Overall, the participants who exceeded the clinical cut-off points in emotional problems showedhigher levels of fear of COVID-19 and of cognitive, motor and psychophysiological responses ofacute stress, unlike the group with normative scores. In addition, the results show significantmediated effects of hyperarousal stress among fear of COVID-19 and emotional dysfunctionpsychopathology. However, the clinical syndromes most related to the consequences of thepandemic (e.g., social contact avoidance or frequent hand washing), such as agoraphobia andobsessive-compulsive symptoms, were in fact predicted directly by fear of COVID-19 and/or theacute stress response associated with the pandemic and had a greater predictive power.CONCLUSION The present study illustrates a clearer picture of the role of acute stress on several forms of psycho-pathology during the COVID-19 crisis and home confinement.