COVID-19–Related Functional Impairment in a Community Sample of Korean Adults: Associations With Depression, COVID-19 Infection Fear, and Resilience

Article information

Psychiatry Investig. 2022;19(11):919-926
Publication date (electronic) : 2022 November 23
doi : https://doi.org/10.30773/pi.2022.0138
1Department of Psychiatry, Jeju National University Hospital, Jeju, Republic of Korea
2Department of Psychiatry, Jeju National University School of Medicine, Jeju, Republic of Korea
3Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
Correspondence: Young-Eun Jung, MD, PhD Department of Psychiatry, Jeju National University School of Medicine, 15 Aran 13-gil, Jeju 63241, Republic of Korea Tel: +82-64-754-8150, Fax: +82-64-717-1861, E-mail: jyejye77@daum.net
Correspondence: Moon-Doo Kim, MD, PhD Department of Psychiatry, Jeju National University School of Medicine, 15 Aran 13-gil, Jeju 63241, Republic of Korea Tel: +82-64-754-8180, Fax: +82-64-717-1861, E-mail: mdkim0721@gmail.com
Received 2022 May 25; Revised 2022 August 25; Accepted 2022 August 29.

Abstract

Objective

We aimed to determine the effects of depression, COVID-19 infection fear, and resilience on COVID-19–related functional impairment.

Methods

We obtained data from 476 community-dwelling adults aged 20–69 years living in Jeju, South Korea, and evaluated the relationships between COVID-19–related functional impairment (work/school, social, and home life) and sociodemographic and healthrelated characteristics, COVID-19–related life changes (financial difficulties since the pandemic, employment change, interpersonal conflict), and clinical characteristics, including depression, COVID-19 infection fear, and resilience.

Results

Functional impairment in the home life domain was associated with marital status and monthly income. Greater work/school, social, and home life functional impairment was significantly associated with all COVID-19–related life changes. Regression analysis indicated that resilience modulated the positive associations of COVID-19–related functional impairment with symptoms of depression and COVID-19 infection fear when relevant factors were controlled for.

Conclusion

Our results suggest the importance of clinical characteristics, including depression, COVID-19 infection fear, and resilience for understanding functional impairment related to COVID-19. These results have important implications for interventions aimed at reducing depression and COVID-19 infection fear, and enhancing resilience.

INTRODUCTION

COVID-19 was declared a pandemic in March 2020 by the WHO. The prolonged pandemic spread worldwide; to date, about 510 million confirmed cases of COVID-19 have been reported, including 6 million deaths [1]. In Korea, there have been more than 17 million cases and 23,000 deaths [2]. The lockdown policy implemented in response to this novel coronavirus disease, and the associated social distancing and isolation, severely limited interpersonal and community interactions [3,4]. Many countries imposed strict border rules and quarantine measures because of the alarming spread and severity of the coronavirus [5,6]. About 60 governments announced or implemented containment measures, and more than 39 countries closed schools and universities [7].

The purpose of social distancing and quarantine is to prevent infection and viral spread [8-10]. People had to adapt to a completely new way of life; daily lives changed instantaneously. Social distancing measures are important for reducing the spread of infectious disease, but reduce the social support needed to manage psychological problems and loneliness [11-13].

Quarantine forced people to work and learn from home, reduced contact with friends and colleagues, and reduced quality of life [14,15]. Many people lost their jobs or experienced a decrease in income [16]. Financial difficulties caused by COVID-19, and the isolation associated with quarantine, had psychological problems such as anxiety, fear, and depression [17,18]. In fact, this psychological pain has become a public health crisis [19,20]. Many studies reported that the mental health of the general population deteriorated over the past 2 years, i.e., during the COVID-19 pandemic [21-26]. The pandemic has led to depression and anxiety disorders, irrational fear and anger, impulsiveness, sleep disturbances, post-traumatic stress disorder (PTSD), and suicide [27-29].

The association between COVID-19 and functional impairment has not been widely studied. COVID-19 affects quality of life, and the association between the severity of symptoms and dysfunction (disability and functional impairment) depends greatly on an individual’s psychiatric condition [30-33]. We hypothesize that psychiatric problems due to COVID-19, such as depression and anxiety disorders, are highly related to disability and functional impairment.

Previous studies focused on the relationship between coping ability and mental health [34,35]. Negative coping styles are associated with severe psychiatric problems, while positive coping styles are negatively related to anxiety and depression. In this respect, psychological resilience has emerged as an important concept. Resilience is a term mainly used in positive psychology studies of subjective well-being and mental health. Resilience refers to the ability to willingly accept serious life changes or challenges and overcome a crisis without becoming frustrated [36-39].

The current study was conducted to identify sociodemographic and psychiatric factors associated with COVID-19–related functional impairment, including depression, COVID-19 infection fear, and psychological resilience. We have also made some suggestions for improving mental health at the individual level.

METHODS

Study participants and procedure

A cross-sectional survey was performed of 500 community-dwelling adults aged 20–69 years living in Jeju, Korea. A quota sampling strategy was utilized to collect data from June to July 2021, and a random sample of adults was obtained from the target population, stratified based on geographic region, gender, and age. The purpose of the study, confidentiality, and voluntary nature of participation were fully explained to the participants in oral and written forms. Questionnaires with no responses to any of the sociodemographic questions, or with no responses for over half of all items, were not included in the analysis. As a result, there were 476 respondents in the final analysis. The study protocol was approved by the Institutional Review Board of Jeju National University Hospital, Korea (IRB No. JEJUNUH 2021-12-010).

Assessments

The survey included various self-report questionnaires administered by interviewers during in-person interviews. Data on sociodemographic and health-related characteristics were collected, including age, gender, marital status, education level, monthly income, employment status, living arrangements, and pre-existing mental health conditions. COVID-19–related life changes were assessed by asking questions (yes or no) about financial difficulties since the pandemic, any change in employment (leaving or losing a job), and more interpersonal conflict more than before.

The Sheehan Disability Scale (SDS) was administered to assess COVID-19–related functional impairment [40]. The SDS assesses functional impairment in the domains of work/school life, social life, and home life on a visual analog scale (0, not at all; 1–3, mild; 4–6, moderate; 7–9, marked; 10, extreme).

To screen for depression, we employed the Patient Health Questionnaire-9 (PHQ-9) [41,42], which is a reliable and valid tool for measuring depression severity over the previous 2 weeks. The PHQ-9 is composed of nine items, each rated from 0 (not at all) to 3 (symptoms nearly every day); the scores for all items are summed to produce a total depression severity score (range: 0–27). The COVID-19 Infection Fear Scale (CIFS) was developed by the Korean Society for Traumatic Stress Studies and assesses the level of fear of COVID-19 infection [43]. This questionnaire consists of nine items scored on a 4-point Likert type scale ranging from 0 (strongly disagree) to 3 (strongly agree). The Cronbach’s alpha value of the CIFS is 0.91, reflecting very high reliability. Psychological resilience was assessed using the 25-item Connor-Davidson Resilience Scale (CD-RISC) [44,45]. Items are rated on a 5-point Likert scale ranging from 0 (not true at all) to 4 (true nearly all the time). Higher total scores indicate higher resilience.

Statistical analysis

We used the independent t-test to compare the mean SDS scores. Pearson’s correlation analysis was performed to identify the relationships between SDS scores and participant characteristics. Hierarchical regression analyses were conducted to test the hypothesis that resilience modulates the associations of COVID-19–related functional impairment with depressive symptoms and COVID-19 infection fear levels, after adjusting for factors significantly associated with the SDS score. Depressive symptoms (PHQ-9) and COVID-19 infection fear levels (CIFS) were included as predictors in step 1 of the hierarchical linear regression analysis. Resilience (CD-RISC) was entered in step 2. All statistical analyses were performed using SPSS software (version 25.0; IBM Corp., Armonk, NY, USA), and a p-value<0.05 was considered significant.

RESULTS

Table 1 shows the sociodemographic and clinical characteristics. Of the 476 participants included in the analysis; 236 (49.6%) were men, 240 (50.4%) were women, and 251 (52.7%) were 20–49 years old, and 225 (47.3%) were 50 years old or more. The overall score of SDS was 13.4 (standard deviation [SD]: 7.4), while the work/school life domain score was 4.8 (SD: 3.0), the social life domain score was 5.3 (SD: 3.0), and the home life domain score was 3.3 (SD: 2.7). Numerically, the social life functional impairment was greatest.

Characteristics of the study population

Table 2 presents the associations between sociodemographic characteristics and SDS scores. The results revealed no significant group differences in COVID-19–related functional impairment according to age, gender, education, living arrangements, employment status, or pre-existing mental health conditions in any SDS domain. The home life functional impairment domain score was associated with marital status (p=0.002) and monthly income (p=0.016). Higher scores in all SDS domains were significantly associated with COVID-19–related life changes, including financial difficulties since the pandemic, employment changes such as leaving or losing a job, and interpersonal conflict.

Sociodemographic characteristics associated with COVID-19–related functional impairment

Table 3 also shows that higher scores on all SDS domains were associated with more severe symptoms (higher scores on the PHQ-9 and CIFS) (all p<0.001). In contrast, greater resilience was significantly associated with lower scores for all SDS domains (overall score, p=0.001; work/school life, p=0.001; work-life, p=0.041; home life, p<0.001).

Clinical characteristics associated with COVID-19–related functional impairment

The results of hierarchical regression analyses are presented in Table 4. After controlling for relevant factors (gender, age group, marital status, monthly income, and COVID-19–related life changes), depressive symptoms (PHQ-9) and COVID-19 infection fear (CIFS) were entered simultaneously into the SDS regression model (step 1). Depressive symptoms and COVID-19 infection fear were positively associated with all SDS domain scores. Depression and COVID-19 infection fear together accounted for 22.4% of the variance in overall functional impairment, 13.1% of the variance in work/school life functional impairment, 14.9% of the variance in social life functional impairment, and 21.4% of the variance in home life functional impairment. When entered in the final regression analysis after the covariates of demographic characteristics, symptoms of depression, and CD-RISC (step 2), resilience was negatively associated with the scores for all SDS domains, except social life functional impairment. This model (step 2) explained an additional 2.0% of the variance in overall functional impairment, 2.1% of the variance in work/school life functional impairment, 0.5% of the variance in social life functional impairment, and 1.4% of the variance in home life functional impairment, indicating that resilience modulated the associations of COVID-19–related functional impairment with symptoms of depression, and COVID-19 infection fear.

Hierarchical regression analysis of factors associated with COVID-19–related functional impairment

DISCUSSION

The present study sought to assess the impact of depression, COVID-19 infection fear, resilience, and various sociodemographic characteristics on COVID-19–related functional impairment.

The sociodemographic characteristics were not associated with COVID-19–related functional impairment, except marital status (p=0.002) and monthly income (p=0.016). We found that married individuals, and those with a high income, had high SDS domain scores. This result was not in line with the expectation that people with a higher standard of living and more family support have less functional impairment [46,47]. Stress and disability due to COVID-19 may increase concern regarding the physical and psychological condition of families (children and spouses) of married people. And people who earn are more likely to have concerns about decreased wages due to changes in external circumstances [48]. Further research to test this hypothesis is needed.

Severe financial difficulties (all p-values<0.001), an employment change (all p-values<0.01), and interpersonal conflict (all p-values<0.01) were all associated with higher scores for home, social, and work-life functional impairment. In other words, social and economic conditions exert an important influence on the sense of psychological safety. Psychiatric fac tors, such as depression, COVID-19 infection fear, and resilience, were strongly associated with SDS scores. Depressed people are likely to experience a decrease in productivity, lack of interpersonal communication, and social disconnectedness. COVID-19 infection fear is related to psychological, social, and financial threats [49]. Fear of infection and psychological contraction can reduce the quality of life as not only individual psychological pain but also problems with family and financial difficulties intensify [50]. In particular, social stigma caused by infection also negatively affects an individual’s quality of life. Fear of infection and psychological contraction can be greater because there is a strong tendency to regard responsibility for the disease as an individual’s problem [51]. If someone becomes infected with COVID-19, permanent health impairment or death are concerns, as is the possibility that family, friends, relatives, and colleagues could become infected (which may lead to social ostracism or stigma for violating social rules) [52]. Long-term isolation can lead to unemployment or loss of income. In contrast, people with a higher level of resilience are more able to cope with stress, depression, and anxiety, which protects against functional impairment [39]. Therefore, detecting and treating depression and COVID-19 infection fear, as well as enhancing resilience, is very important to reduce COVID-19–related functional impairment.

Among the sociodemographic variables, high income and financial difficulties are associated with high SDS scores. It can seem like conflicting results at the same time in one study. The association between high SDS domain scores and a high income can be explained as the functional impairment of people with a lot of losses more severely declined, which means that income levels have been directly damaged by COVID-19. On the other side, the response to financial difficulties is based on the self-report evaluation. Since it is about the perceived economic difficulties of the participants, it seems more deeply related to the situation in which the individual interprets the current situation regardless of whether it is real or not. For this reason, it is presumed that conflicting results came out. Putting the two results together, we can expect that people with more to lose and those who perceive that they are currently experiencing more difficulties, can experience more functional impairment.

This study had some limitations. First, the data were from a community sample; other areas would need to be surveyed to allow generalization of the findings. Second, the PHQ-9, CIFS, and CD-RISC are self-report measures, so may lack precision. Despite these limitations, this study revealed that psychological resilience modulates COVID-19–related functional impairments in the work and home life domains. Psychological resilience was most strongly associated with the functional impairment related to COVID-19. When all significant variables, including sociodemographic factors, depression, and COVID-19 infection fear, were included in the final stepwise regression model, resilience modulated the negative relationships of functional impairment with the symptoms of depression and COVID-19 infection fear. This result was consistent with previous studies on healthcare professionals [53,54]. Buheji et al. [55] reported that resilience moderated the impact of a pandemic on patients in Bahrain. Additionally, resilience can lessen the harmful effects of COVID-19, such as stress and burnout [56,57].

Several serious infectious disease outbreaks occurred before COVID-19, including severe acute respiratory syndrome (SARS-CoV) and Middle East respiratory syndrome (MERS-CoV). A study of SARS survivors in Hong Kong reported that 25.6% and 15.6% of people were diagnosed with PTSD and depressive disorder 30 months after the SARS outbreak [58]. In total, 25% and 30%–40% of people were diagnosed with depressive disorder and PTSD 18 months after the MERS outbreak, respectively [59]. Similarly, COVID-19 could have long-term psychological consequences [60]. Although COVID-19 has become endemic, studies on reducing and recovering from the psychological damage caused by the disease have received less attention than studies on physical and economic difficulties.

The present study emphasizes the importance of developing a mental health service system to address the long-term psychiatric problems caused by COVID-19. COVID-19 has become a crisis in various areas of life for our society and individuals, but at the same time, we have the resilience to overcome it [61]. In particular, a good understanding of the modulatory role of resilience in the relationships among depression, COVID-19 infection fear, and functional impairment will help identify ways to enhance well-being during the epidemic. Due to COVID-19, the vulnerability and resilience of infectious diseases have become an issue in our society. In the early days of COVID-19, understanding the infection rate, fatality rate, and the causes that affect it were emphasized. However, now facing the endemic, various studies and discussions are needed on how to recover and how to make efforts to increase the resilience of individuals and society. Therefore, more research is needed on how resilience specifically modulates mental health.

Notes

Availability of Data and Material

The datasets generated or analyzed during the study are available from the corresponding author on reasonable request.

Conflicts of Interest

The authors have no potential conflicts of interest to disclose.

Author Contributions

Conceptualization: Moon-Doo Kim. Data curation: Young-Eun Jung, Moon-Doo Kim. Formal analysis: Yun-ju Park, Young-Eun Jung. Writing—original draft: Yun-ju Park, Young-Eun Jung. Writing—review & editing: all authors.

Funding Statement

None

References

1. WHO coronavirus (COVID-19) dashboard. Available at: https://covid19.who.int/. Accessed May 14, 2022.
2. Coronavirus (COVID-19), Republic of Korea. Available at: http://ncov.mohw.go.kr/. Accessed May 14, 2022.
3. Benke C, Autenrieth LK, Asselmann E, Pané-Farré CA. Lockdown, quarantine measures, and social distancing: associations with depression, anxiety and distress at the beginning of the COVID-19 pandemic among adults from Germany. Psychiatry Res 2020;293:113462.
4. Armitage R, Nellums LB. COVID-19 and the consequences of isolating the elderly. Lancet Public Health 2020;5:e256.
5. Shah JN, Shah J, Shah J. Quarantine, isolation and lockdown: in context of COVID-19. J Patan Academy Health Sci 2020;7:48–57.
6. Güner R, Hasanoğlu I, Aktaş F. COVID-19: prevention and control measures in community. Turk J Med Sci 2020;50:571–577.
7. Haldane V, De Foo C, Abdalla SM, Jung AS, Tan M, Wu S, et al. Health systems resilience in managing the COVID-19 pandemic: lessons from 28 countries. Nat Med 2021;27:964–980.
8. Singh J, Singh J. COVID-19 and its impact on society. Electron Res J Soc Sci Humanities 2020;2:168–172.
9. Aquino EML, Silveira IH, Pescarini JM, Aquino R, Souza-Filho JA, Rocha AS, et al. Social distancing measures to control the COVID-19 pandemic: potential impacts and challenges in Brazil. Cien Saude Colet 2020;25(suppl 1):2423–2446.
10. Qian M, Jiang J. COVID-19 and social distancing. J Public Health (Berl) 2022;30:259–261.
11. Venkatesh A, Edirappuli S. Social distancing in covid-19: what are the mental health implications? BMJ 2020;369:m1379.
12. Pietrabissa G, Simpson SG. Psychological consequences of social isolation during COVID-19 outbreak. Front Psychol 2020;11:2201.
13. Oral T, Gunlu A. Adaptation of the social distancing scale in the covid-19 era: its association with depression, anxiety, stress, and resilience in Turkey. Int J Ment Health Addict 2022;20:1336–1353.
14. Ferreira LN, Pereira LN, da Fé Brás M, Ilchuk K. Quality of life under the COVID-19 quarantine. Qual Life Res 2021;30:1389–1405.
15. Malik P, Patel K, Pinto C, Jaiswal R, Tirupathi R, Pillai S, et al. Postacute COVID-19 syndrome (PCS) and health-related quality of life (HRQoL)—A systematic review and meta-analysis. J Med Virol 2022;94:253–262.
16. Blustein DL, Duffy R, Ferreira JA, Cohen-Scali V, Cinamon RG, Allan BA. Unemployment in the time of COVID-19: a research agenda. J Vocat Behav 2020;119:103436.
17. Paul KI, Moser K. Unemployment impairs mental health: meta-analyses. J Vocat Behav 2009;74:264–282.
18. Witteveen D, Velthorst E. Economic hardship and mental health complaints during COVID-19. Proc Natl Acad Sci U S A 2020;117:27277–27284.
19. Sher L. The impact of the COVID-19 pandemic on suicide rates. QJM 2020;113:707–712.
20. Wang Z, Wang D. The influence and enlightenment of five public health emergencies on public psychology since new century: a systematic review. Int J Soc Psychiatry 2021;67:878–891.
21. Pieh C, Budimir S, Delgadillo J, Barkham M, Fontaine JRJ, Probst T. Mental health during COVID-19 lockdown in the United Kingdom. Psychosom Med 2021;83:328–337.
22. Cullen W, Gulati G, Kelly BD. Mental health in the COVID-19 pandemic. QJM 2020;113:311–312.
23. Kumar A, Nayar KR. COVID 19 and its mental health consequences. J Ment Health 2021;30:1–2.
24. Usher K, Durkin J, Bhullar N. The COVID-19 pandemic and mental health impacts. Int J Ment Health Nurs 2020;29:315–318.
25. Hoffart A, Johnson SU, Ebrahimi OV. The network of stress-related states and depression and anxiety symptoms during the COVID-19 lockdown. J Affect Disord 2021;294:671–678.
26. Satici B, Gocet-Tekin E, Deniz ME, Satici SA. Adaptation of the fear of COVID-19 scale: its association with psychological distress and life satisfaction in Turkey. Int J Ment Health Addict 2021;19:1980–1988.
27. Hossain MM, Tasnim S, Sultana A, Faizah F, Mazumder H, Zou L, et al. Epidemiology of mental health problems in COVID-19: a review. F1000Res 2020;9:636.
28. Tzur Bitan D, Grossman-Giron A, Bloch Y, Mayer Y, Shiffman N, Mendlovic S. Fear of COVID-19 scale: psychometric characteristics, reliability and validity in the Israeli population. Psychiatry Res 2020;289:113100.
29. Guo Q, Zheng Y, Shi J, Wang J, Li G, Li C, et al. Immediate psychological distress in quarantined patients with COVID-19 and its association with peripheral inflammation: a mixed-method study. Brain Behav Immun 2020;88:17–27.
30. Gallagher MW, Zvolensky MJ, Long LJ, Rogers AH, Garey L. The impact of Covid-19 experiences and associated stress on anxiety, depression, and functional impairment in American adults. Cognit Ther Res 2020;44:1043–1051.
31. Havervall S, Rosell A, Phillipson M, Mangsbo SM, Nilsson P, Hober S, et al. Symptoms and functional impairment assessed 8 months after mild COVID-19 among health care workers. JAMA 2021;325:2015–2016.
32. Goggin G, Ellis K. Disability, communication, and life itself in the COVID-19 pandemic. Health Sociol Rev 2020;29:168–176.
33. Norrefalk JR, Borg K, Bileviciute-Ljungar I. Self-scored impairments in functioning and disability in post-COVID syndrome following mild COVID-19 infection. J Rehabil Med 2021;53:jrm00239.
34. Dawson DL, Golijani-Moghaddam N. COVID-19: psychological flexibility, coping, mental health, and wellbeing in the UK during the pandemic. J Contextual Behav Sci 2020;17:126–134.
35. Mahmoud JS, Staten R, Hall LA, Lennie TA. The relationship among young adult college students’ depression, anxiety, stress, demographics, life satisfaction, and coping styles. Issues Ment Health Nurs 2012;33:149–156.
36. Herrman H, Stewart DE, Diaz-Granados N, Berger EL, Jackson B, Yuen T. What is resilience? Can J Psychiatry 2011;56:258–265.
37. PeConga EK, Gauthier GM, Holloway A, Walker RSW, Rosencrans PL, Zoellner LA, et al. Resilience is spreading: mental health within the COVID-19 pandemic. Psychol Trauma 2020;12(S1):S47–S48.
38. Bryce C, Ring P, Ashby S, Wardman JK. Resilience in the face of uncertainty: early lessons from the COVID-19 pandemic. J Risk Res 2020;23:880–887.
39. Hooberman J, Rosenfeld B, Rasmussen A, Keller A. Resilience in trauma-exposed refugees: the moderating effect of coping style on resilience variables. Am J Orthopsychiatry 2010;80:557–563.
40. Sheehan KH, Sheehan DV. Assessing treatment effects in clinical trials with the discan metric of the Sheehan Disability Scale. Int Clin Psychopharmacol 2008;23:70–83.
41. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001;16:606–613.
42. Han C, Jo SA, Kwak JH, Pae CU, Steffens D, Jo I, et al. Validation of the Patient Health Questionnaire-9 Korean version in the elderly population: the Ansan Geriatric study. Compr Psychiatry 2008;49:218–223.
43. Korean Society for Traumatic Stress Studies (KSTSS). COVID-19-mental health survey. 2020; Available at: http://kstss.kr/?p=1370/. Accessed May 14, 2022.
44. Connor KM, Davidson JR. Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depress Anxiety 2003;18:76–82.
45. Jung YE, Min JA, Shin AY, Han SY, Lee KU, Kim TS, et al. The Korean version of the Connor-Davidson Resilience Scale: an extended validation. Stress Health 2012;28:319–326.
46. Nguyen HC, Nguyen MH, Do BN, Tran CQ, Nguyen TTP, Pham KM, et al. People with suspected COVID-19 symptoms were more likely depressed and had lower health-related quality of life: the potential benefit of health literacy. J Clin Med 2020;9:965.
47. Nguyen LH, Tran BX, Hoang Le QN, Tran TT, Latkin CA. Quality of life profile of general Vietnamese population using EQ-5D-5L. Health Qual Life Outcomes 2017;15:199.
48. Terrier C, Chen DL, Sutter M. COVID-19 within families amplifies the prosociality gap between adolescents of high and low socioeconomic status. Proc Natl Acad Sci U S A 2021;118:e2110891118.
49. Lee DH, Kim YJ, Lee DH, Hwang HH, Nam SK, Kim JY. The influence of public fear, and psycho-social experiences during the coronavirus disease 2019 (COVID-19) pandemic on depression and anxiety in South Korea. Korean J Counsel Psychotherapy 2020;32:2119–2156.
50. Dubey S, Biswas P, Ghosh R, Chatterjee S, Dubey MJ, Chatterjee S, et al. Psychosocial impact of COVID-19. Diabetes Metab Syndr 2020;14:779–788.
51. Jang KE, Baek YM. How did MERS outbreak become a political matter?: how political ideology moderates the effect of multidimensional health locus of control beliefs on citizens’ attribution process of MERS outbreak. Korean J Commun Stud 2016;60:36–65.
52. Park HJ, Kim MS, Kim SH, Song KR. The relationship between fear of social stigma according to adult’s COVID-19 infection, change in quality of life, and COVID-19 anxiety: the mediating effects of perceived situational control. J Korean Assoc Psychother 2021;13:39–62.
53. Bozdağ F, Ergün N. Psychological resilience of healthcare professionals during COVID-19 pandemic. Psychol Rep 2021;124:2567–2586.
54. Yıldırım M, Arslan G, Özaslan A. Perceived risk and mental health problems among healthcare professionals during COVID-19 pandemic: exploring the mediating effects of resilience and coronavirus fear. Int J Ment Health Addict 2022;20:1035–1045.
55. Buheji M, Jahrami H, Dhahi A. Minimising stress exposure during pandemics similar to COVID-19. Int J Psychol Behav Sci 2020;10:9–16.
56. Yıldırım M, Arslan G. Exploring the associations between resilience, dispositional hope, preventive behaviours, subjective well-being, and psychological health among adults during early stage of COVID-19. Curr Psychol 2022;41:5712–5722.
57. Yıldırım M, Solmaz F. COVID-19 burnout, COVID-19 stress and resilience: initial psychometric properties of COVID-19 Burnout Scale. Death Stud 2022;46:524–532.
58. Lee AM, Wong JG, McAlonan GM, Cheung V, Cheung C, Sham PC, et al. Stress and psychological distress among SARS survivors 1 year after the outbreak. Can J Psychiatry 2007;52:233–240.
59. Batawi S, Tarazan N, Al-Raddadi R, Al Qasim E, Sindi A, Al Johni S, et al. Quality of life reported by survivors after hospitalization for Middle East Respiratory Syndrome (MERS). Health Qual Life Outcomes 2019;17:101.
60. Sommer IE, Bakker PR. What can psychiatrists learn from SARS and MERS outbreaks? Lancet Psychiatry 2020;7:565–566.
61. Kimhi S, Marciano H, Eshel Y, Adini B. Recovery from the COVID-19 pandemic: distress and resilience. Int J Disaster Risk Reduct 2020;50:101843.

Article information Continued

Table 1.

Characteristics of the study population

Variables Value
Age (yr)
 20–49 251 (52.7)
 ≥50 225 (47.3)
Women 240 (50.4)
Marital status
 Married 331 (69.5)
 Single or other 145 (30.5)
Education
 High school and below 213 (44.7)
 College and above 263 (55.3)
Monthly income (US$) (N=432)
 <1,000 150 (34.7)
 ≥1,000 282 (65.3)
Live alone 48 (10.1)
Unemployed 130 (27.3)
Pre-existing psychiatric condition, yes 17 (3.6)
COVID-19–related life change, yes
 Financial difficulties since the pandemic 230 (48.3)
 Employment change (leaving or losing a job) 79 (16.6)
 More interpersonal conflict more than before 69 (14.5)
Depression (PHQ-9) 3.8±4.9
COVID-19 fear of infection (CIFS) 17.7±5.5
Resilience (CD-RISC) 57.5±16.2
COVID-19–related functional impairment (SDS)
 Overall 13.4±7.4
 Work/school life 4.8±3.0
 Social life 5.3±3.0
 Home life 3.3±2.7

Values are presented as number (%) or mean±standard deviation.

PHQ-9, Patient Health Questionnaire-9; CIFS, COVID-19 Infection Fear Scale; CD-RISC, Connor-Davidson Resilience Scale; SDS, Sheehan Disability Scale

Table 2.

Sociodemographic characteristics associated with COVID-19–related functional impairment

Demographics Sheehan Disability Scale
Overall Domains

Work life
Social life
Home life
Mean±SD p Mean±SD p Mean±SD p Mean±SD p
Age (yr) 0.921 0.506 0.583 0.115
20–49 13.4±7.5 4.9±3.0 5.4±3.0 3.1±2.7
≥50 13.4±7.3 4.7±2.9 5.2±2.8 3.5±2.7
Gender 0.519 0.941 0.400 0.428
Men 13.2±7.8 4.8±3.1 5.2±3.0 3.2±2.7
Women 13.6±7.0 4.8±2.9 5.4±2.8 3.4±2.7
Marital status 0.634 0.373 0.479 0.002
Married 13.5±7.3 4.7±3.0 5.3±2.8 3.5±2.7
Single or other 13.1±7.6 5.0±2.9 5.5±3.2 2.7±2.7
Education 0.394 0.598 0.256 0.615
High school and below 13.7±7.3 4.9±3.0 5.5±3.0 3.3±2.7
College and above 13.1±7.5 4.7±2.9 5.2±2.9 3.2±2.8
Monthly income (US$) 0.342 0.985 0.848 0.016
<1,000 12.8±7.1 4.8±2.9 5.2±2.9 2.8±2.6
≥1,000 13.5±7.5 4.7±3.0 5.3±3.0 3.5±2.7
Living arrangement 0.769 0.778 0.546 0.871
Alone 13.1±8.3 4.7±3.3 5.1±3.3 3.3±3.0
With partner 13.4±7.3 4.8±3.0 5.3±2.9 3.3±2.7
Employment status 0.887 0.328 0.214 0.925
Employed 13.4±6.5 4.9±3.0 5.2±3.0 3.3±2.7
Unemployed 13.5±7.2 4.6±3.1 5.6±3.0 3.3±2.8
Pre-existing psychiatric condition 0.294 0.657 0.244 0.261
Yes 15.2±7.5 5.1±2.8 6.1±2.6 4.0±2.4
No 13.4±7.3 4.8±3.0 5.3±3.0 3.3±2.7
Financial difficulties since the pandemic <0.001 <0.001 <0.001 <0.001
Yes 16.0±7.0 5.7±2.8 6.1±2.7 4.2±2.8
No 11.0±7.1 4.0±2.9 5.0±3.0 2.4±2.4
Employment change (leaving or losing a job) <0.001 <0.001 0.007 <0.001
Yes 16.5±7.1 6.1±3.0 6.1±2.8 4.3±2.8
No 12.8±7.3 4.6±2.9 5.1±2.9 3.1±2.6
Interpersonal conflict 0.001 0.017 0.120 <0.001
Yes 16.2±7.0 6.0±2.7 5.8±2.7 4.8±2.4
No 13.0±7.4 4.7±3.0 5.2±3.0 3.0±2.7

SD, standard deviation

Table 3.

Clinical characteristics associated with COVID-19–related functional impairment

Clinical variables Sheehan Disability Scale
Overall Domains

Work life
Social life
Home life
r p r p r p r p
PHQ-9 0.361 <0.001 0.276 <0.001 0.293 <0.001 0.365 <0.001
CIFS 0.297 <0.001 0.210 <0.001 0.273 <0.001 0.286 <0.001
CD-RISC -0.159 0.001 -0.156 0.001 -0.094 0.041 -0.163 <0.001

PHQ-9, Patient Health Questionnaire-9; CIFS, COVID-19 Infection Fear Scale; CD-RISC, Connor-Davidson Resilience Scale

Table 4.

Hierarchical regression analysis of factors associated with COVID-19–related functional impairment

SDS Step 1
Step 2
B β t B β t
Overall
PHQ-9 0.333 0.220 4.702*** 0.294 0.194 4.136***
CIFS 0.258 0.193 4.211*** 0.279 0.209 4.575***
CD-RISC -0.067 -0.148 -3.300**
Adjusted R2 0.224 0.244
Adjusted R2 change 0.020
F 12.173*** 12.317***
Work/school life
PHQ-9 0.096 0.157 2.977** 0.079 0.129 2.637**
CIFS 0.077 0.143 2.977** 0.086 0.129 3.343**
CD-RISC -0.029 -0.158 -3.375**
Adjusted R2 0.131 0.152
Adjusted R2 change 0.021
F 7.512*** 8.033***
Social life functional impairment
PHQ-9 0.109 0.180 3.724*** 0.099 0.164 3.356**
CIFS 0.115 0.216 4.553*** 0.120 0.226 4.744***
CD-RISC -0.017 -0.091 -1.956
Adjusted R2 0.149 0.154
Adjusted R2 change 0.005
F 8.523*** 8.148***
Home life functional impairment
PHQ-9 0.128 0.231 4.979*** -0.039 -0.245 -6.560***
CIFS 0.066 0.135 2.950** 0.072 0.149 3.263**
CD-RISC -0.022 -0.132 -2.952**
Adjusted R2 0.214 0.228
Adjusted R2 change 0.014
F 12.714*** 12.562***
**

p<0.01;

***

p<0.001;

adjustment for gender, age group, marital status, monthly income, and COVID-19–related life changes (financial difficulty, employment change, and interpersonal conflict).

SDS, Sheehan Disability Scale; PHQ-9, Patient Health Questionnaire-9; CIFS, COVID-19 Infection Fear Scale; CD-RISC, Connor-Davidson Resilience Scale