We investigated which factors in psychological changes positively or negatively affect the quality of life to suggest desirable directions in the period of the COVID-19 pandemic.
Online survey was conducted with 1,011 adults more than 19 years old in Busan, South Korea. Quality of life was measured using the World Health Organization Quality of Life-BREF. Questions regarding the psychological changes were about COVID-19-related concerns, distress in complying with quarantine guidelines, and interest in seeking something to do alone.
Quality of life was perceived to be below average (mean±SD, 2.86±0.53). The more economic worries there were, the lower the quality of life in psychological, social relationships and environmental domains. The more distress one experienced when maintaining their personal hygiene, the higher the quality of life related to their physical health. Likewise, the more difficult it was to maintain social distances, the higher the quality of life associated with psychological and social relationships. The more interested someone was in how to spend time alone, the higher the quality of life in all domains significantly.
We can minimize the negative impacts of COVID-19 by maintaining economic stability, maintaining prosocial behaviors related to personal hygiene and making good use of personal time.
On March 11, 2020, the WHO declared the new coronavirus to be a pandemic, and the risk of infection is still ongoing. In South Korea, starting with the first COVID-19 confirmed on January 22, 2020, coronavirus infections soared at the end of February 2020 due to group gatherings. In order to prevent the spread of infection, the Korean government postponed school openings for students starting in March and launched a high-intensity “social distancing” campaign until May. Social distancing was a recommended part of the public quarantine implemented for the purpose of minimizing contact between people, and it included complying with personal hygiene rules, delaying or canceling events or meetings, refraining from going out unnecessarily, keeping more than 2 meters between people, and not shaking hands.
Infectious diseases such as large-scale outbreaks (e.g., Ebola virus disease epidemic from 2014 to 2016) have wide influences that impact the majority of the general public because of no defined places or over a limited time, which makes the boundaries of their impacts relatively clear [
A cross-sectional online survey was conducted in the metropolitan city of Busan, South Korea. We conducted this study from 28 April until 12 May, 2020. This was a period of the coronavirus pandemic where the infection rate rose to its peak and stabilized to some degree, and the high-intensity social distancing policy was continued for several months. The participants in this study consisted of 1,011 adults more than 19 years old. The sample was selected using proportional stratified sampling between panels from the Gallup Korea Cooperation research agency. The sample consisted of group of people from Busan that was representative in terms of gender, age, and residential area. Informed consent was obtained from all of the participants included in the study. The study protocol was approved by the Institutional Review Board of Dong-A University Hospital (IRB No. DAUHIRB-20-104).
Quality of life was measured using the World Health Organization Quality of Life-BREF (WHOQOL-BREF). The WHOQOL-BREF is a self-report questionnaire comprising 26 items that assess 4 domains of the quality of life: physical health, psychological health, social relationships, and environment. The time frame was set to 1 month. We calculated the scores for each domain according to the scoring guidelines in the WHOQOL-BREF manual [
Three psychiatrists, one infectious medicine specialist and four mental health professionals (one clinical psychologist and three social workers) developed the questionnaire for this study. Our questionnaire was developed based on the literature review and expert opinions about infectious disease outbreaks. The questionnaire comprised 6 questions about responses related with psychological responses due to lifestyle changes after COVID-19, including the following: COVID-19 related concerns, difficulties complying with the quarantine guidelines, and interest in alternative coping behavior (Korean version in
We selected sociodemographic variables that have been known to be associated with quality of life in previous studies [
The SPSS statistical computer package (version 22.0; IBM Corp., Armonk, NY, USA) was used for all statistical analyses. The descriptive statistics, such as the frequency, mean and standard deviations, were computed to describe the characteristics of the study population. The questionnaire’s reliability was examined using Cronbach’s alpha coefficient. Multiple linear regression analysis was performed to ascertain the predictors of quality of life. Before the regression analyses, the autocorrelation (Durbin–Watson) and multicollinearity (variance inflation factor and tolerance) were checked. In our regression model, the dependent variable was the summed score of the 4 domains of WHOQOL-BREFF, and the independent variables were the scores of the COIVD 19-related concerns, the feeling difficulties in complying with quarantine guidelines, and interest in seeking something to do alone. The covariates considered in the analytic models were sex, age, educational level, occupational status, marital status, religion, number of family members, and monthly household income. The statistical significance was evaluated using a two-sided design with alpha set to 0.05.
Of the 1,011 participants who completed the questionnaire, the proportion of sex was similar with 526 males (52%) and 485 females (48%) (
Individuals’ overall perception of their quality of life score was 2.86±0.53, reflecting an average quality state (
When the relationship between each of the four domains regarding quality of life and the psychological responses related with lifestyle changes was investigated (
During the COVID-19 pandemic period, we investigated how people feel about their quality of life and various psychological changes that occurred in a metropolitan city in South Korea. Quality of life was perceived to be below average, and psychological health was evaluated as the lowest compared to other parts (physical, social, and environment). Overall distress from the psychological changes that were reported was also moderate. There was anxiety about infection, financial difficulties, and interpersonal relationships, distress regarding keeping personal hygiene and following social distancing guidelines, and increasing interest in how to spend time alone. When we examined the associations between quality of life and psychological changes, the more economic worries one experienced, the lower their quality of life in the psychological, social relationships and environmental domains excluding physical health. Interestingly, the more distress one experienced when maintaining their personal hygiene, the higher their quality of life related to physical health. Likewise, the more difficult it was to maintain social distancing, the higher the quality of life associated with psychological and social relationships. The more interested one was in in how to spend time alone, the better their assessed quality of life in all domains.
Quality of life was reported as an average of 2.9 points in May 2020, which is a reduced score compared to the 3.7 points reported when the same survey was conducted in 2019 in Busan [
It is easily predictable that worries about financial difficulties will lower the quality of life. The COVID-19 pandemic has curtailed the distribution and trade between many people and resulted in economic activities related to production and consumption coming to a standstill. This economic recession can cause common mental disorders and substance disorders, and economic recessions are known to be a major risk factor for suicide [
In this study, the more difficult it is to observe personal hygiene practices including hand washing to prevent the spread of COVID-19, the higher the quality of physical life is evaluated. This result seems to be contrary to the results of previous studies, which complains of stress due to pandemic and mental health problems such as anxiety and depression, resulting in poor quality of life [
While the amount or frequency of social activities has decreased, the time one spends alone has increased in the period of the COVID-19 pandemic. Loneliness is reported as a risk factor for a variety of psychological conditions [
There are several limitations in interpreting the results of this study. First, when measuring the quality of life due to the coronavirus epidemic, the timing and location of the investigation have decisive influences. This study was conducted on a community sample in the city of Busan and relatively early when the coronavirus epidemic spread nationwide. Thus, the results may differ from studies in other regions in South Korea or when coronavirus transmission was prolonged. Second, the psychological changes that affect quality of life have low explanatory power according to the statistical analyses. This is resulted from conduction of analysis using each of the 6 items separately, not as a whole. Third, our 6 items did not have an acquisition process of validity and could not capture important predictors of quality of life. Quality of life can be affected by various factors that we have not been able to measure, including an individual’s characteristics (personality, resilience and alexithymia) and environmental aspects (inadequate supplies or information and social support) [
COVID-19 has brought many life style and psychological changes to people around the world. Despite the occurrence of various negative impacts, we can minimize the impact by maintaining economic stability, keeping prosocial behaviors related to personal hygiene and making good use of personal time. Additionally, it may be possible to alleviate the mental tension prevailing in society by increasing social and family support and awareness of the importance of mental health [
The online-only Data Supplement is available with this article at
The Korean version questionnaire comprised 6 questions about psychological responses related with lifestyle changes in COVID-19
Psychological responses impacted on personal quality of life in COVID-19 pandemic
This work was supported by the Mental Health Research Project funded by the Government of Busan Metropolitan City.
The authors have no potential conflicts of interest to disclose.
Conceptualization: Seon-Cheol Park, Ok-Jin Jang, Joon Hee Kim, Jae Hong Park. Data curation: Joon Hee Kim, Eun Ok Kim. Formal analysis: Joon Hee Kim, Eun Ok Kim. Funding acquisition: Jae Hong Park. Investigation: Joon Hee Kim, Eun Ok Kim, Seong Hwan Kim. Methodology: Joon Hee Kim, Jae Hong Park, Yong Rong Bang. Project administration: Joon Hee Kim, Eun Ok Kim. Supervision: Jae Hong Park. Validation: Seong Hwan Kim. Writing—original draft: Young Rong Bang. Writing—review&editing: Jae Hong Park, Seong Hwan Kim, Seon-Cheol Park, Ok-Jin Jang.
Sociodemographic characteristics of participants (All=1,011)
Variables | N (%) |
---|---|
Age (mean±SD) | 46.8±15.1 (range 19–88) |
Sex | |
Male | 526 (52.0) |
Female | 485 (48.0) |
Education | |
12 years and under | 325 (32.1) |
Above 12 years | 686 (67.9) |
Occupational status | |
Unemployed or retired | 147 (14.5) |
Employed or self-employed | 626 (62.0) |
Housemaker | 167 (16.5) |
Student | 71 (7.0) |
Marital status | |
Never married | 366 (36.2) |
Married | 589 (58.3) |
Divorced | 33 (3.3) |
Widowed | 23 (2.3) |
Religion | |
Yes | 428 (42.3) |
No | 583 (57.7) |
Number of family members (including participants) | |
Alone | 124 (12.3) |
2 members | 242 (23.9) |
3 members | 266 (26.3) |
4 members | 316 (31.3) |
5 members and above | 63 (6.2) |
Monthly income (KRW) | |
Below 2 million | 205 (20.3) |
<3 million | 181 (17.9) |
<4 million | 169 (16.7) |
<5 million | 175 (17.3) |
<6 million | 105 (10.4) |
Above 6 million | 176 (17.4) |
Variables are presented as N(%) or mean±standard deviation (SD).
One US dollars is equivalent to about 1,200 KRW
The scores of questionnaires related to quality of life and psychological responses related with lifestyle changes after COVID-19
Min | Max | Mean | SD | |
---|---|---|---|---|
WHOQOL_BREF | ||||
Overall | 1 | 5 | 2.86 | 0.53 |
Physical health | 4 | 20 | 11.14 | 2.18 |
Psychological health | 4 | 20 | 10.70 | 2.49 |
Social relationships | 4 | 20 | 12.23 | 3.03 |
Environment | 4 | 20 | 11.84 | 2.55 |
Psychological responses related with lifestyle changes | ||||
Worry about getting infected | 1 | 5 | 3.22 | 1.21 |
Concern about financial difficulties | 1 | 5 | 3.10 | 1.30 |
Concern about interpersonal relationship | 1 | 5 | 2.48 | 1.23 |
Difficulty in complying personal hygiene | 1 | 5 | 2.48 | 0.97 |
Difficulty in keeping social distancing | 1 | 5 | 2.63 | 1.13 |
Seeking something to do alone | 1 | 5 | 2.96 | 1.15 |
WHOQOL_BREF: World Health Organization Quality of Life–BREF, SD: standard deviation
Psychological responses related with lifestyle changes impacted on personal quality of life in COVID-19 pandemic
Physical health |
Psychological health |
Social relationships |
Environment |
|||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
B | SE | Beta | p | B | SE | Beta | p | B | SE | Beta | p | B | SE | Beta | p | |
Worry about getting infected | 0.038 | 0.072 | 0.021 | 0.600 | 0.031 | 0.080 | 0.015 | 0.697 | -0.082 | 0.100 | -0.032 | 0.411 | 0.054 | 0.083 | 0.025 | 0.514 |
Concern about financial difficulties | -0.041 | 0.064 | -0.024 | 0.522 | -0.179 | 0.072 | -0.093 | 0.013 | -0.324 | 0.090 | -0.137 | <0.001 | -0.275 | 0.075 | -0.139 | <0.001 |
Concern about interpersonal relationship | 0.055 | 0.075 | 0.031 | 0.461 | -0.020 | 0.083 | -0.010 | 0.814 | 0.122 | 0.104 | 0.049 | 0.240 | -0.083 | 0.086 | -0.040 | 0.335 |
Difficulty in complying personal hygiene | 0.185 | 0.078 | 0.093 | 0.018 | 0.174 | 0.087 | 0.077 | 0.056 | -0.049 | 0.109 | -0.018 | 0.652 | -0.024 | 0.090 | -0.010 | 0.794 |
Difficulty in keeping social distancing | 0.060 | 0.063 | 0.036 | 0.338 | 0.185 | 0.070 | 0.096 | 0.008 | 0.168 | 0.087 | 0.071 | 0.046 | 0.111 | 0.073 | 0.056 | 0.127 |
Seeking something to do alone | 0.237 | 0.071 | 0.125 | 0.001 | 0.450 | 0.079 | 0.208 | 0.000 | 0.228 | 0.098 | 0.087 | 0.020 | 0.383 | 0.082 | 0.173 | <0.001 |
aR2 | 0.141 | 0.145 | 0.152 | 0.181 |
The covariates considered in analytic models were sex, age, educational level, occupational status, marital status, religion, number of family members, and monthly household income. B: unstandardized regression coefficient, SE: standard error, Beta: standardized regression coefficient, aR2: adjusted R-squared