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Open Access 01-12-2021 | Insomnia | Research article

Mental health and its association with coping strategies and intolerance of uncertainty during the COVID-19 pandemic among the general population in Saudi Arabia: cross-sectional study

Authors: Ahmad N. AlHadi, Mohammed A. Alarabi, Khulood M. AlMansoor

Published in: BMC Psychiatry | Issue 1/2021

Abstract

Background

The COVID-19 pandemic has had a major impact on people’s lives globally. The outbreak in Saudi Arabia worsened when the number of cases and deaths rose in March and April of 2020, leading to a national lockdown. This study aimed to assess the factors associated with mental health symptoms in a sample of people residing in Saudi Arabia during the COVID-19 pandemic.

Methods

We conducted an observational cross-sectional study using an online survey distributed via social media, completed by 3032 respondents from all Saudi regions. We collected demographic data, illness history, and scores of validated self-report scales to assess mental health symptoms, intolerance of uncertainty, and coping strategies.

Results

In total, respondents indicated moderate to very severe symptoms during the pandemic as follows: 20.9% for depression, 17.5% for anxiety, and 12.6% for stress. Younger age, female gender, and history of mental illness were associated with higher levels of depression, anxiety, stress, and insomnia. Intolerance of uncertainty and certain coping strategies (such as denial or self-blame) were associated with more severe symptoms.

Conclusions

Mental health is a key concern during the COVID-19 pandemic, especially for the identified vulnerable groups. Agencies concerned with mental health during crises may use the studied associated factors of mental health symptoms to generate targeted policies or interventions.

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WHO. Coronavirus Disease 2019 Situation Report – 94. A A Pract. 2020;14:e01218.CrossRef

Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern. Lancet. 2020;395(10223):470–3. https://doi.org/10.1016/S0140-6736(20)30185-9.CrossRefPubMedPubMedCentral

Chong M-Y, Wang W-C, Hsieh W-C, Lee C-Y, Chiu N-M, Yeh W-C, et al. Psychological impact of severe acute respiratory syndrome on health workers in a tertiary hospital. Br J Psychiatry. 2004;185(2):127–33. https://doi.org/10.1192/bjp.185.2.127.CrossRefPubMed

Sim K, Huak Chan Y, Chong PN, Chua HC, Wen SS. Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease. J Psychosom Res. 2010;68(2):195–202. https://doi.org/10.1016/j.jpsychores.2009.04.004.CrossRefPubMed

Peng EY-C, Lee M-B, Tsai S-T, Yang C-C, Morisky DE, Tsai L-T, et al. Population-based post-crisis psychological distress: an example from the SARS outbreak in Taiwan. J Formos Med Assoc. 2010;109(7):524–32. https://doi.org/10.1016/S0929-6646(10)60087-3.CrossRefPubMedPubMedCentral

Lee S-H, Juang Y-Y, Su Y-J, Lee H-L, Lin Y-H, Chao C-C. Facing SARS: psychological impacts on SARS team nurses and psychiatric services in a Taiwan general hospital. Gen Hosp Psychiatry. 2005;27(5):352–8. https://doi.org/10.1016/j.genhosppsych.2005.04.007.CrossRefPubMedPubMedCentral

Maunder R, Hunter J, Vincent L, Bennett J, Peladeau N, Leszcz M, et al. The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital. CMAJ. 2003;168(10):1245–51. http://www.ncbi.nlm.nih.gov/pubmed/12743065.PubMedPubMedCentral

Jeong H, Yim HW, Song YJ, Ki M, Min JA, Cho J, et al. Mental health status of people isolated due to Middle East respiratory syndrome. Epidemiol Health. 2016;38:e2016048. https://doi.org/10.4178/epih.e2016048.CrossRefPubMedPubMedCentral

Ro JS, Lee JS, Kang SC, Jung HM. Worry experienced during the 2015 Middle East respiratory syndrome (MERS) pandemic in Korea. PLoS One. 2017;12(3):e0173234. https://doi.org/10.1371/journal.pone.0173234.

10.

Al-Rabiaah A, Temsah M-HH, Al-Eyadhy AA, Hasan GM, Al-Zamil F, Al-Subaie S, et al. Middle East respiratory syndrome-Corona virus (MERS-CoV) associated stress among medical students at a university teaching hospital in Saudi Arabia. J Infect Public Health. 2020;13(5):687–91. https://doi.org/10.1016/j.jiph.2020.01.005.CrossRefPubMedPubMedCentral

11.

Khalid I, Khalid TJ, Qabajah MR, Barnard AG, Qushmaq IA. Healthcare workers emotions, perceived stressors and coping strategies during a MERS-CoV outbreak. Clin Med Res. 2016;14(1):7–14. https://doi.org/10.3121/cmr.2016.1303.CrossRefPubMedPubMedCentral

12.

CDC. Mental Health and Coping During COVID-19. Coronavirus Dis. 2019. 2020.

13.

Kabir M, Afzal MS, Khan A, Ahmed H. COVID-19 pandemic and economic cost; impact on forcibly displaced people. Travel Med Infect Dis. 2020;35:101661. https://doi.org/10.1016/j.tmaid.2020.101661.CrossRefPubMedPubMedCentral

14.

Rundle AG, Park Y, Herbstman JB, Kinsey EW, Wang YC. COVID-19–related school closings and risk of weight gain among children. Obesity. 2020;28(6):1008–9. https://doi.org/10.1002/oby.22813.CrossRefPubMed

15.

O’Connor RC, Wetherall K, Cleare S, McClelland H, Melson AJ, Niedzwiedz CL, et al. Mental health and well-being during the COVID-19 pandemic: longitudinal analyses of adults in the UK COVID-19 Mental Health & Wellbeing study. Br J Psychiatry. 2021;218(6):326–33. https://doi.org/10.1192/bjp.2020.212.

16.

Rajkumar RP. COVID-19 and mental health: a review of the existing literature. Asian J Psychiatr. 2020;52:102066. https://doi.org/10.1016/j.ajp.2020.102066.CrossRefPubMedPubMedCentral

17.

Vindegaard N, Benros ME. COVID-19 pandemic and mental health consequences: systematic review of the current evidence. Brain Behav Immun. 2020;89:531–42. https://doi.org/10.1016/j.bbi.2020.05.048.CrossRefPubMedPubMedCentral

18.

Shigemura J, Ursano RJ, Morganstein JC, Kurosawa M, Benedek DM. Public responses to the novel 2019 coronavirus (2019-nCoV) in Japan: mental health consequences and target populations. Psychiatry Clin Neurosci. 2020;74(4):281–2. https://doi.org/10.1111/pcn.12988.CrossRefPubMedPubMedCentral

19.

Freeston MH, Rhéaume J, Letarte H, Dugas MJ, Ladouceur R. Why do people worry? Personal Individ Differ. 1994;17(6):791–802. https://doi.org/10.1016/0191-8869(94)90048-5.CrossRef

20.

Dugas MJ, Gagnon F, Ladouceur R, Freeston MH. Generalized anxiety disorder: a preliminary test of a conceptual model. Behav Res Ther. 1998;36(2):215–26. https://doi.org/10.1016/S0005-7967(97)00070-3.CrossRefPubMed

21.

Ladouceur R, Dugas MJ, Freeston M. Intolerance of uncertainty in normal and excessive worry. In: Recent developments in research on worry and the treatment of Generalized Anxiety Disorder. Copenhagen: Symposium presented at the World Congress of behavioral and cognitive therapies; 1995.

22.

Carleton RN, Weeks JW, Howell AN, Asmundson GJG, Antony MM, McCabe RE. Assessing the latent structure of the intolerance of uncertainty construct: an initial taxometric analysis. J Anxiety Disord. 2012;26(1):150–7. https://doi.org/10.1016/j.janxdis.2011.10.006.CrossRefPubMed

23.

Greco V, Roger D. Coping with uncertainty: the construction and validation of a new measure. Personal Individ Differ. 2001;31(4):519–34. https://doi.org/10.1016/S0191-8869(00)00156-2.CrossRef

24.

Taha S, Matheson K, Cronin T, Anisman H. Intolerance of uncertainty, appraisals, coping, and anxiety: the case of the 2009 H1N1 pandemic. Br J Health Psychol. 2014;19(3):592–605. https://doi.org/10.1111/bjhp.12058.CrossRefPubMed

25.

Heffer T, Willoughby T. A count of coping strategies: a longitudinal study investigating an alternative method to understanding coping and adjustment. PLoS One. 2017;12(10):e0186057. https://doi.org/10.1371/journal.pone.0186057.CrossRefPubMedPubMedCentral

26.

Orzechowska A, Zajączkowska M, Talarowska M, Gałecki P. Depression and ways of coping with stress: A preliminary study. Med Sci Monit. 2013;19:1050–6. https://doi.org/10.12659/MSM.889778.CrossRefPubMedPubMedCentral

27.

Arab News. King Salman imposes curfew across Saudi Arabia to contain COVID-19. 2020. https://www.arabnews.com/node/1645526/saudi-arabia.

28.

U.S. Embassy & Consulates in Saudi Arabia. COVID-19 Information. 2020. https://sa.usembassy.gov/u-s-citizen-services/covid-19-information/. Accessed 7 Apr 2020.

29.

Saudi Ministry of Health (MOH). MOH Publications - COVID-19 Guidelines. 2020. https://www.moh.gov.sa/en/Ministry/MediaCenter/Publications/Pages/covid19.aspx. Accessed 8 Apr 2020.

30.

Lovibond PF, Lovibond SH. The structure of negative emotional states: comparison of the depression anxiety stress scales (DASS) with the Beck depression and anxiety inventories. Behav Res Ther. 1995;33(3):335–43. https://doi.org/10.1016/0005-7967(94)00075-U.CrossRefPubMed

31.

Antony MM, Cox BJ, Enns MW, Bieling PJ, Swinson RP. Psychometric properties of the 42-item and 21-item versions of the depression anxiety stress scales in clinical groups and a community sample. Psychol Assess. 1998;10(2):176–81. https://doi.org/10.1037/1040-3590.10.2.176.CrossRef

32.

Henry JD, Crawford JR. The short-form version of the depression anxiety stress scales (DASS-21): construct validity and normative data in a large non-clinical sample. Br J Clin Psychol. 2005;44(2):227–39. https://doi.org/10.1348/014466505X29657.CrossRefPubMed

33.

Han KS, Kim L, Shim I. Stress and Sleep Disorder. Exp Neurobiol. 2012;21(4):141–50. https://doi.org/10.5607/en.2012.21.4.141.CrossRefPubMedPubMedCentral

34.

Kalmbach DA, Anderson JR, Drake CL. The impact of stress on sleep: pathogenic sleep reactivity as a vulnerability to insomnia and circadian disorders. J Sleep Res. 2018;27(6):e12710. https://doi.org/10.1111/jsr.12710.CrossRefPubMedPubMedCentral

35.

Xiao H, Zhang Y, Kong D, Li S, Yang N. The Effects of Social Support on Sleep Quality of Medical Staff Treating Patients with Coronavirus Disease 2019 (COVID-19) in January and February 2020 in China. Med Sci Monit. 2020;26:e923549. https://doi.org/10.12659/MSM.923549.CrossRefPubMedPubMedCentral

36.

Morin CM, Belleville G, Bélanger L, Ivers H. The insomnia severity index: psychometric indicators to detect insomnia cases and evaluate treatment response. Sleep. 2011;34(5):601–8. https://doi.org/10.1093/sleep/34.5.601.CrossRefPubMedPubMedCentral

37.

Gagnon C, Belanger L, Ivers H, Morin CM. Validation of the insomnia severity index in primary care. J Am Board Fam Med. 2013;26(6):701–10. https://doi.org/10.3122/jabfm.2013.06.130064.CrossRefPubMed

38.

Thorndike FP, Ritterband LM, Saylor DK, Magee JC, Gonder-Frederick LA, Morin CM. Validation of the insomnia severity index as a web-based measure. Behav Sleep Med. 2011;9(4):216–23. https://doi.org/10.1080/15402002.2011.606766.CrossRefPubMed

39.

Suleiman KH, Yates BC. Translating the insomnia severity index into Arabic. J Nurs Scholarsh. 2011;43(1):49–53. https://doi.org/10.1111/j.1547-5069.2010.01374.x.CrossRefPubMed

40.

Buhr K, Dugas MJ. The intolerance of uncertainty scale: psychometric properties of the English version. Behav Res Ther. 2002;40(8):931–45. https://doi.org/10.1016/s0005-7967(01)00092-4.CrossRefPubMed

41.

Carleton RN, Norton MAPJ, Asmundson GJG. Fearing the unknown: a short version of the intolerance of uncertainty scale. J Anxiety Disord. 2007;21(1):105–17. https://doi.org/10.1016/j.janxdis.2006.03.014.CrossRefPubMed

42.

Almansoor K, Freeston M, Alhadi A, Rosenkranz P. Intolerance of uncertainty, worry and Generalized Anxiety Disorder in Saudi Arabia. (Unpublished Work); 2019.

43.

Carver CS. You want to measure coping but your protocol’ too long: consider the brief cope. Int J Behav Med. 1997;4(1):92–100. https://doi.org/10.1207/s15327558ijbm0401_6.CrossRefPubMed

44.

Hamdan- Mansour A, Badawi T, Haourani E, Marmash L. Depression, psychological distress and coping skills among patients diagnosed with type-II Diabetes Mellitus. Life Sci J. 2013;10(4):3044-48.

45.

IBM SPSS Inc. SPSS Statistics for Windows: IBM Corp Released 2012; 2012. Version 20:1–8

46.

Felt JM, Castaneda R, Tiemensma J, Depaoli S. Using person fit statistics to detect outliers in survey research. Front Psychol. 2017;8:863. https://doi.org/10.3389/fpsyg.2017.00863.CrossRefPubMedPubMedCentral

47.

Niessen ASM, Meijer RR, Tendeiro JN. Detecting careless respondents in web-based questionnaires: which method to use? J Res Pers. 2016;63:1–11. https://doi.org/10.1016/j.jrp.2016.04.010.CrossRef

48.

General Authority for Statistics. Population Estimates | General Authority for Statistics. https://www.stats.gov.sa/en/43. Accessed 19 May 2020.

49.

General Authority for Statistics. Population and Housing Atlas | General Authority for Statistics. https://www.stats.gov.sa/en/391. Accessed 19 May 2020.

50.

Altwaijri YA, Al-Subaie AS, Al-Habeeb A, Bilal L, Al-Desouki M, Aradati M, et al. Lifetime prevalence and age-of-onset distributions of mental disorders in the Saudi National Mental Health Survey. Int J Methods Psychiatr Res. 2020;29(3):e1836. https://doi.org/10.1002/mpr.1836.CrossRefPubMedPubMedCentral

51.

Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al. Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. Int J Environ Res Public Health. 2020;17(5):1729. https://doi.org/10.3390/ijerph17051729.CrossRefPubMedCentral

52.

Mazza C, Ricci E, Biondi S, Colasanti M, Ferracuti S, Napoli C, 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. https://doi.org/10.3390/ijerph17093165.CrossRefPubMedCentral

53.

González-Sanguino C, Ausín B, Castellanos MÁ, Saiz J, López-Gómez A, Ugidos C, et al. Mental health consequences during the initial stage of the 2020 coronavirus pandemic (COVID-19) in Spain. Brain Behav Immun. 2020;87:172–6. https://doi.org/10.1016/j.bbi.2020.05.040.CrossRefPubMedPubMedCentral

54.

American Psychiatric Association. New Poll: COVID-19 Impacting Mental Well-Being: Americans Feeling Anxious, Especially for Loved Ones; Older Adults are Less Anxious. 2020. https://www.psychiatry.org/newsroom/news-releases/new-poll-covid-19-impacting-mental-well-being-americans-feeling-anxious-especially-for-loved-ones-older-adults-are-less-anxious. Accessed 14 Jun 2020.

55.

American Psychological Association. Stress in America™ 2020: Stress in the Time of COVID-19, Volume One. https://www.apa.org/news/press/releases/stress/2020/report. Accessed 14 Jun 2020.

56.

KFF. Brief Examines the COVID-19 Crisis’ Implications for Americans’ Mental Health | KFF. 2020. https://www.kff.org/health-reform/press-release/brief-examines-the-covid-19-crisis-implications-for-americans-mental-health/. Accessed 14 Jun 2020.

57.

Voitsidis P, Gliatas I, Bairachtari V, Papadopoulou K, Papageorgiou G, Parlapani E, et al. Insomnia during the COVID-19 pandemic in a Greek population. Psychiatry Res. 2020;289:113076. https://doi.org/10.1016/j.psychres.2020.113076.CrossRefPubMedPubMedCentral

58.

Satici B, Saricali M, Satici SA, Griffiths MD. Intolerance of Uncertainty and Mental Wellbeing: Serial Mediation by Rumination and Fear of COVID-19. Int J Ment Heal Addict. 2020:1-12. https://doi.org/10.1007/s11469-020-00305-0.

59.

Bakioğlu F, Korkmaz O, Ercan H. Fear of COVID-19 and positivity: mediating role of intolerance of uncertainty, depression, anxiety, and stress. Int J Ment Heal Addict. 2020. p. 1-14. https://doi.org/10.1007/s11469-020-00331-y.

60.

Bottesi G, Carraro E, Martignon A, Cerea S, Ghisi M. “I’m uncertain: what should I do?”: an investigation of behavioral responses to everyday life uncertain situations. Int J Cogn Ther. 2019;12(1):55–72. https://doi.org/10.1007/s41811-019-00040-y.CrossRef

61.

Hayward LE, Vartanian LR, Kwok C, Newby JM. How might childhood adversity predict adult psychological distress? Applying the identity disruption model to understanding depression and anxiety disorders. J Affect Disord. 2020;265:112–9. https://doi.org/10.1016/j.jad.2020.01.036.CrossRefPubMed

62.

Jensen D, Cohen JN, Mennin DS, Fresco DM, Heimberg RG. Clarifying the unique associations among intolerance of uncertainty, anxiety, and depression *. Cogn Behav Ther. 2016;45(6):431–44. https://doi.org/10.1080/16506073.2016.1197308.CrossRefPubMedPubMedCentral

63.

Lauriola M, Carleton RN, Tempesta D, Calanna P, Socci V, Mosca O, et al. A correlational analysis of the relationships among intolerance of uncertainty, anxiety sensitivity, subjective sleep quality, and insomnia symptoms. Int J Environ Res Public Health. 2019;16(18):3253. https://doi.org/10.3390/ijerph16183253.CrossRefPubMedCentral

64.

Lin R-M, Xie S-S, Yan Y-W, Yan W-J. Intolerance of uncertainty and adolescent sleep quality: the mediating role of worry. Personal Individ Differ. 2017;108:168–73. https://doi.org/10.1016/j.paid.2016.12.025.CrossRef

65.

Nekić M, Mamić S. Intolerance of Uncertainty and Mindfulness as Determinants of Anxiety and Depression in Female Students. Behav Sci (Basel). 2019;9:135. https://doi.org/10.3390/bs9120135.CrossRef

66.

Sabouri S, Gerber M, Lemola S, Becker SP, Shamsi M, Shakouri Z, et al. Examining dark triad traits in relation to sleep disturbances, anxiety sensitivity and intolerance of uncertainty in young adults. Compr Psychiatry. 2016;68:103–10. https://doi.org/10.1016/j.comppsych.2016.03.012.CrossRefPubMed

67.

Swee MB, Olino TM, Heimberg RG. Worry and anxiety account for unique variance in the relationship between intolerance of uncertainty and depression. Cogn Behav Ther. 2019;48(3):253–64. https://doi.org/10.1080/16506073.2018.1533579.CrossRefPubMed

68.

Gentes EL, Ruscio AM. A meta-analysis of the relation of intolerance of uncertainty to symptoms of generalized anxiety disorder, major depressive disorder, and obsessive–compulsive disorder. Clin Psychol Rev. 2011;31(6):923–33. https://doi.org/10.1016/j.cpr.2011.05.001.CrossRefPubMed

69.

McEvoy PM, Hyett MP, Shihata S, Price JE, Strachan L. The impact of methodological and measurement factors on transdiagnostic associations with intolerance of uncertainty: a meta-analysis. Clin Psychol Rev. 2019;73:101778. https://doi.org/10.1016/j.cpr.2019.101778.CrossRefPubMed

70.

McEvoy PM, Mahoney AEJ. Achieving certainty about the structure of intolerance of uncertainty in a treatment-seeking sample with anxiety and depression. J Anxiety Disord. 2011;25(1):112–22. https://doi.org/10.1016/j.janxdis.2010.08.010.CrossRefPubMed

71.

Rosser BA. Intolerance of uncertainty as a Transdiagnostic mechanism of psychological difficulties: a systematic review of evidence pertaining to causality and temporal precedence. Cognit Ther Res. 2019;43(2):438–63. https://doi.org/10.1007/s10608-018-9964-z.CrossRef

72.

Huang L, Lei W, Xu F, Liu H, Yu L. Emotional responses and coping strategies in nurses and nursing students during Covid-19 outbreak: a comparative study. PLoS One. 2020;15(8):e0237303. https://doi.org/10.1371/journal.pone.0237303.CrossRefPubMedPubMedCentral

Title: Mental health and its association with coping strategies and intolerance of uncertainty during the COVID-19 pandemic among the general population in Saudi Arabia: cross-sectional study
Authors: Ahmad N. AlHadi
Mohammed A. Alarabi
Khulood M. AlMansoor
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Insomnia
Mood Disorders
Affective Disorder
COVID-19
Anxiety
Published in: BMC Psychiatry / Issue 1/2021
Electronic ISSN: 1471-244X
DOI: https://doi.org/10.1186/s12888-021-03370-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Mental health and its association with coping strategies and intolerance of uncertainty during the COVID-19 pandemic among the general population in Saudi Arabia: cross-sectional study

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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