PSYCHOLOGICAL DISTRESS, COVID-19 FEAR, QUALITY OF LIFE, AND COPING STRATEGIES AMONG GENERAL POPULATION DURING THE POST- LOCKDOWN PERIOD OF THE COVID-19 PANDEMIC IN MALAYSIA
Keywords:post COVID-19; mental health; fear of COVID- 19; quality of life; coping; general population
This study examined the prevalence and predictors of psychological distress among the general population of Malaysia after nationwide lockdown restrictions were lifted, querying if psychosocial factors including quality of life, COVID-19 fears, and coping strategies affected levels of psychological distress beyond sociodemographic predictors. A total of 4,904 (male = 798, female = 4106) Malaysian adults participated in an online survey conducted in August- December 2021, just after the gradual release of lockdown restrictions. Psychological distress was assessed using the General Health Questionnaire-12; quality of life was measured by the WHOQOL-BREF. The Fear of COVID-19 scale and Brief COPE tool measured the level of COVID-19 fear and coping mechanisms, respectively. The prevalence of psychological distress among respondents was 37.6%, 95% confidence interval (36%—39%). Results suggested demographic indicators of higher psychological distress, specifically younger adults, childless adults, and adults with lower income. Prior medical diagnoses and COVID-19-related stressful events increased psychological distress. Results demonstrated an association between lower quality of life across all domains and higher psychological distress. Fear of COVID-19 and avoidant coping amplified distress while problem-focused and emotional coping mechanisms played protective roles. Pronounced and prolonged mental health deterioration was observed after the nationwide lockdown was relaxed; cost-effective interventions are needed to prevent new mental health issues and promote well-being and resilience.
Wirkner J, Christiansen H, Knaevelsrud C, et al. Mental health in times of the COVID-19 pandemic: Current knowledge and implications from a European perspective. Eur Psychol. 2021;26(4):310-322
Chandola T, Kumari M, Booker CL, et al. The mental health impact of COVID-19 and lockdown related stressors among adults in the UK. Psychol Med. 2020;1-10.
Xiong J, Lipsitz O, Nasri F, et al. Impact of COVID-19 pandemic on mental health in the general population: A systematic review. J Affect Disord. 2020;277:55-64.
Pappa S, Chen J, Barnett J, et al. A systematic review and meta-analysis of the mental health symptoms during the Covid-19 pandemic in Southeast Asia. Psychiatry Clin Neurosci. 2022;76(2):41-50.
Wheaton B. The twain meet: distress, disorder and the continuing conundrum of categories (comment on Horwitz). Health 2007;11(3):303-19.
Ping W, Zheng J, Niu X, et al. Evaluation of health-related quality of life using EQ-5D in China during the COVID-19 pandemic. PLoS One. 2020;15(6):e0234850.
Melo-Oliveira ME, Sá-Caputo D, Bachur JA, et al. Reported quality of life in countries with cases of COVID19: a systematic review. Expert Rev Respir Med. 2021;15(2):213-220.
Panayiotou G, Panteli M, Leonidou C. Coping with the invisible enemy: The role of emotion regulation and awareness in quality of life during the COVID-19 pandemic. J Context Behav Sci. 2021;19:17-27.
Hansel TC, Saltzman LY, Bordnick PS. Behavioral Health and Response for COVID-19. Disaster Med Public Health Prep. 2020;14(5):670-676.
Baumeister H, Balke K, Härter M. Psychiatric and somatic comorbidities are negatively associated with quality of life in physically ill patients. J Clin Epidemiol. 2005;58(11):1090-1100.
Connell J, Brazier J, O’Cathain A, et al. Quality of life of people with mental health problems: a synthesis of qualitative research. Health Qual Life Outcomes. 2012;10(1):138.
Serafini G, Parmigiani B, Amerio A, et al. The psychological impact of COVID-19 on the mental health in the general population. QJM An Int J Med. 2020;113(8):531-537.
Pakpour AH, Griffiths MD. The fear of COVID-19 and its role in preventive behaviors. Journal of concurrent disorders. 2020;2(1):58-63.
Mertens G, Gerritsen L, Duijndam S, et al. Fear of the coronavirus (COVID-19): Predictors in an online study conducted in March 2020. J Anxiety Disord. 2020;74:102258.
Sloan MM, Haner M, Graham A, et al. Pandemic emotions: the extent, correlates, and mental health consequences of fear of COVID-19. Sociol Spectr. 2021;41(5):369-386.
Dsouza DD, Quadros S, Hyderabadwala ZJ, et al. Aggregated COVID-19 suicide incidences in India: Fear of COVID-19 infection is the prominent causative factor. Psychiatry Res. 2020;290:113145.
Kontodimopoulos N, Poulaki E, Fanourgiakis J, Talias MA. The Association between Fear of COVID-19 and Health-Related Quality of Life: A Cross-Sectional Study in the Greek General Population. Journal of Personalized Medicine 2022 ;12(11):1891.
Siddique RF, Ahmed O, Hossain KN. Relationship between the fear of COVID-19 disease and sleep quality: the mediating role of stress. Heliyon 2021 ;7(5):e07033.
?im?ir Z, Koç H, Seki T, et al. The relationship between fear of COVID-19 and mental health problems: A meta-analysis. Death Stud. 2022;46(3):515-523.
Lazarus RS, Folkman S. Stress, Appraisal, and Coping. Springer; 1984.
Folkman S, Lazarus RS. An analysis of coping in a middle-aged community sample. J Health Soc Behav.1980; 21(3):219-239.
García FE, Barraza-Peña CG, Wlodarczyk A, et al. Psychometric properties of the Brief-COPE for the evaluation of coping strategies in the Chilean population. Psicol Reflexão e Crítica. 2018;31:22
Margeti? B, Peraica T, Stojanovi? K, et al. Predictors of emotional distress during the COVID-19 pandemic; a Croatian study. Pers Individ Dif. 2021;175:110691.
Fluharty M, Fancourt D. How have people been coping during the COVID-19 pandemic? Patterns and predictors of coping strategies amongst 26,016 UK adults. BMC Psychol. 2021;9(1):1-12.
Fluharty M, Bu F, Steptoe A, et al. Coping strategies and mental health trajectories during the first 21 weeks of COVID-19 lockdown in the United Kingdom. Soc Sci Med. 2021;279:113958.
Wong LP, Alias H, Md Fuzi AA, et al. Escalating progression of mental health disorders during the COVID-19 pandemic: Evidence from a nationwide survey. PLoS One. 2021;16(3):e0248916.
Yee A, Hodori N ‘Aqilah M, et al. Depression level and coping responses toward the movement control order and its impact on quality of life in the Malaysian community during the COVID-19 pandemic: a web-based cross-sectional study. Ann Gen Psychiatry. 2021;20(1):31.
Daniel, W. Biostatistics: A Foundation For Analysis in the Health Sciences, New York: Wiley 1999:141-142.
Institute for Public Health. National Health and Morbidity Survey (NHMS 2015): Methodology and General Findings, Ministry of Health, 2015.
Department of Statistics Malaysian, 2019. Household income and basic amenities survey report 2019. https://www.dosm.gov.my/v1/index.php?r=column/pdfPrev&id=TU00TmRhQ1N5TUxHVWN0T2VjbXJYZz09 (accessed 20 May 2022)
Goldberg D, Williams P. A User’s guide to the General Health Questionnaire (GHQ). Berks: NFER-Nelson. Published online 1988.
Quek KF, Low WY, Razack AH, et al. Reliability and validity of the General Health Questionnaire (GHQ-12) among urological patients: A Malaysian study. Psychiatry Clin Neurosci. 2001;55(5):509-513.
Skevington SM, Lotfy M, O’Connell KA. The World Health Organization’s WHOQOL-BREF quality of life assessment: Psychometric properties and results of the international field trial. A Report from the WHOQOL Group. Qual Life Res. 2004;13(2):299-310.
Hasanah CI, Naing L, Rahman ARA. World Health Organization quality of life assessment: brief version in Bahasa Malaysia. Med J Malaysia. 2003;58(1):79-88.
Ahorsu DK, Lin C-Y, Imani V, et al. The Fear of COVID-19 Scale: Development and Initial Validation. Int J Ment Health Addict. 2020;20: 1537-1545
Pang NTP, Kamu A, Hambali NLB, et al. Malay Version of the Fear of COVID-19 Scale: Validity and Reliability. Int J Ment Health Addict. 2022;20(1):263-272.
Carver CS. You want to measure coping but your protocol’ too long: Consider the brief cope. Int J Behav Med. 1997;4(1):92.
Yusoff MSB. The validity of the Malay Brief COPE in identifying coping strategies among adolescents in secondary school. Int Med J. 2011;18(1):29-33.
Kathirvel N. Post COVID-19 pandemic mental health challenges. Asian J Psychiatr. 2020;53:102430.
Orfei MD, Bossi F, D’Arcangelo S, et al. Mental health in the post-lockdown pandemic phase: Relief or exacerbation of psychological distress? A cross-sectional study in the general population in Italy. Acta Psychol (Amst). 2022;225:103555.
Meda N, Pardini S, Slongo I, et al. Students’ mental health problems before, during, and after COVID-19 lockdown in Italy. J Psychiatr Res. 2021;134:69-77.
Serrano-Alarcón M, Kentikelenis A, Mckee M, et al. Impact of COVID-19 lockdowns on mental health: Evidence from a quasi-natural experiment in England and Scotland. Health Econ. 2022;31(2):284-296.
Kola L, Kohrt BA, Hanlon C, et al. COVID-19 mental health impact and responses in low-income and middle-income countries: reimagining global mental health. The Lancet Psychiatry. 2021;8(6):535-550.
Vigo D, Thornicroft G, Gureje O. The differential outcomes of coronavirus disease 2019 in low-and middle-income countries vs high-income countries. JAMA psychiatry. 2020;77(12):1207-1208.
Beckstein A, Rathakrishnan B, Hutchings PB, Mohamed NH. The covid-19 pandemic and mental health in Malaysia: current treatment and future recommendations. Malays J. Public Health Med. 2021 24;21(1):260-7.
Mir IA, Ng SK, Mohd Jamali MN, Jabbar MA, Humayra S. Determinants and predictors of mental health during and after COVID-19 lockdown among university students in Malaysia. PloS one 2023 20;18(1):e0280562.
Varma P, Junge M, Meaklim H, et al. Younger people are more vulnerable to stress, anxiety and depression during COVID-19 pandemic: A global cross-sectional survey. Prog Neuro-Psychopharmacology Biol Psychiatry. 2021;109:110236.
Wang Y, Kala MP, Jafar TH. Factors associated with psychological distress during the coronavirus disease 2019 (COVID-19) pandemic on the predominantly general population: A systematic review and meta-analysis. PLoS One. 2021;15(12):e0244630.
Yu Y, Yu Y, Hu J. COVID-19 among Chinese high school graduates: Psychological distress, growth, meaning in life and resilience. J Health Psychol. 2021;27(5):1057-1069.
Silva M, Loureiro A, Cardoso G. Social determinants of mental health: a review of the evidence. Eur J Psychiatry. 2016;30(4):259-292.
Ettman CK, Abdalla SM, Cohen GH, et al. Low assets and financial stressors associated with higher depression during COVID-19 in a nationally representative sample of US adults. J Epidemiol Community Heal. 2021;75(6):501-508.
Mazza C, Ricci E, Biondi S, et al. A nationwide survey of psychological distress among Italian people during the COVID-19 pandemic: immediate psychological responses and associated factors. Int J Environ Res Public Health. 2020;17(9):3165.
Stafford O, Berry A, Taylor LK, et al. Comorbidity and COVID-19: investigating the relationship between medical and psychological well-being. Ir J Psychol Med. 2021;38(4):272-277.
Bui E, Ander I, Jaussaud C. Grief in the time of COVID-19: An editorial. Int J Ment Health. 2021 2;50(1):1-3.
Rossi R, Socci V, Jannini TB, D'Aurizio G, Mensi S, Pacitti F, Rossi A, Di Lorenzo G. Changes in mental health outcomes in the general population 14 months into the COVID-19 pandemic in Italy. J Affect Disord. 2023 325: 35-40.
Leong Bin Abdullah MFI, Ahmad Yusof H, Mohd Shariff N, Hami R, et al. Depression and anxiety in the Malaysian urban population and their association with demographic characteristics, quality of life, and the emergence of the COVID-19 pandemic. Curr Psychol. 2021;40(12):6259-6270.
Woon LS-C, Mansor NS, Mohamad MA, et al. Quality of life and its predictive factors among healthcare workers after the end of a movement lockdown: The salient roles of COVID-19 stressors, psychological experience, and social support. Front Psychol. 2021;12: 652326
Ahmad A, Shahril MR, Wan-Arfah N, Mohd Abu Bakar WA, Bakar A, Piernas C, Lua PL. Changes in health-related lifestyles and food insecurity and its association with quality of life during the COVID-19 lockdown in Malaysia. BMC public health. 2022 Dec;22(1):1-9.
Di Blasi M, Gullo S, Mancinelli E, et al. Psychological distress associated with the COVID-19 lockdown: A two-wave network analysis. J Affect Disord. 2021;284:18-26.
Luo M, Guo L, Yu M, et al. The psychological and mental impact of coronavirus disease 2019 (COVID-19) on medical staff and general public – A systematic review and meta-analysis. Psychiatry Res. 2020;291:113190.
Bahar Moni AS, Abdullah S, Bin Abdullah MFIL, et al. Psychological distress, fear and coping among Malaysians during the COVID-19 pandemic. PLoS One. 2021;16(9):e0257304.
Gerace A, Rigney G, Anderson JR. Predicting attitudes towards easing COVID-19 restrictions in the United States of America: The role of health concerns, demographic, political, and individual difference factors. PLoS One. 2022;17(2):e0263128.
Coelho CM, Suttiwan P, Arato N, Zsido AN. On the nature of fear and anxiety triggered by COVID-19. Front Psychol. 2020;11:581314.
Yang F. Coping strategies, cyberbullying behaviors, and depression among Chinese netizens during the COVID-19 pandemic: a web-based nationwide survey. J Affect Disord. 2021;281:138-144.
Agha S. Mental well-being and association of the four factors coping structure model: A perspective of people living in lockdown during COVID-19. Ethics, Med Public Heal. 2021;16:100605.
McFadden P, Ross J, Moriarty J, et al. The role of coping in the wellbeing and work-related quality of life of uk health and social care workers during COVID-19. Int J Environ Res Public Heal . 2021;18(2).
Dumas TM, Ellis W, Litt DM. What does adolescent substance use look like during the COVID-19 pandemic? examining changes in frequency, social contexts, and pandemic-related predictors. J Adolesc Heal. 2020;67(3):354-361.
Xu S, Park M, Kang UG, Choi J-S, et al. Problematic use of alcohol and online gaming as coping strategies during the COVID-19 pandemic: A Mini Review. Front psychiatry. 2021;12:685964.
Avena NM, Simkus J, Lewandowski A, et al. Substance use disorders and behavioral addictions during the COVID-19 pandemic and COVID-19-related restrictions. Front Psychiatry. 2021;12: 653674.
Godor BP, Van der Hallen R. Investigating the susceptibility to change of coping and resiliency during COVID-19. Scand J Psychol. 2022;63(3):238-245.
Department of Statistic Malaysia, 2021. Household income estimates and incidence of poverty report, Malaysia 2020. https://www.dosm.gov.my/v1/index.php?r=column/pdfPrev&id=VTNHRkdiZkFzenBNd1Y1dmg2UUlrZz09 (accessed 15 June 2022)
Rossi R, Socci V, Pacitti F, et al. Mental health outcomes among frontline and second-line health care workers during the coronavirus disease 2019 (COVID-19) pandemic in Italy. JAMA Netw open. 2020;3(5):e2010185-e2010185.