Resilience and Spirituality as Moderators between Several Concerns and Psychological Distress during the COVID-19 Pandemic

Main Article Content

Ankica Kosic Corine Stella Kana Kenfack Amy L. Ai

Abstract

The COVID-19 pandemic has led to psychological stress caused by several threats such as concerns for health, economic problems, and several others. This study aims at exploring if inner resilience and belief in spiritual support may moderate the relationship between the concerns, on one side, and distress and the attitudes towards anti-COVID-19 vaccines, on the other side. We conducted a study involving 235 participants through an online survey from March to April 2021 in Italy, immediately after the last lockdown that took place in March 2021. Several scales were used to measure various difficulties and concerns, resilience, beliefs about spiritual support, conspiracy beliefs about COVID-19, psychological distress, and acceptance of the anti-COVID-19 vaccines. We found that resilience moderates the relationship between several concerns and psychological distress during the COVID-19 pandemic, especially among the participants who have strong beliefs in spiritual support.

Article Details

How to Cite
KOSIC, Ankica; KENFACK, Corine Stella Kana; AI, Amy L.. Resilience and Spirituality as Moderators between Several Concerns and Psychological Distress during the COVID-19 Pandemic. Medical Research Archives, [S.l.], v. 11, n. 2, feb. 2023. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/3517>. Date accessed: 27 apr. 2024. doi: https://doi.org/10.18103/mra.v11i2.3517.
Section
Research Articles

References

1. https://covid19.who.int/
2. https://coronavirus.jhu.edu/map.html
3. Lorant V, Smith P, Van den Broeck K, Nicaise P. Psychological distress associated with the COVID-19 pandemic and suppression measures during the first wave in Belgium. BMC Psychiatry. 2021;21. doi:10.1186/s12888-021-03109-1
4. Patel K, Robertson E, Kwong ASF, et al. Psychological Distress Before and During the COVID-19 Pandemic Among Adults in the United Kingdom Based on Coordinated Analyses of 11 Longitudinal Studies. JAMA Netw Open. 2022;5(4):e227629. doi:10.1001/jamanetworkopen.2022.7629
5. Eurobarometer. Attitudes on vaccination against COVID-19. conducted by Ipsos European Public Affairs at the request of the European Commission, Directorate-General for Directorate-General for Communication. ISBN: 978-92-76-49631-1. 2022. doi:10.2775/0254. Available online: https://europa.eu/eurobarometer/surveys/detail/2692 (Accessed on May 15, 2022)
6. Neumann-Böhme S, Varghese N E, Sabat I, et al. Once we have it, will we use it? A European survey on willingness to be vaccinated against COVID-19. The European Journal of Health Economics. 2020;21(7): 977-982.
7. Hammen C, Kim EY, Eberhart NK, Brennan PA. Chronic and acute stress and the prediction of major depression in women. Depression and Anxiety. 2009;26(8):718-723. doi:10.1002/da.20571
8. Marin M-F, Lord C, Andrews J, et al. Chronic stress, cognitive functioning and mental health. Neurobiology of Learning and Memory. 2011;96(4):583-595. doi:10.1016/j.nlm.2011.02.016
9. McEwen, Bruce S, Eliot Stellar. Stress and the individual: Mechanisms leading to disease. Archives of internal medicine. 1993;153(18): 2093-2101. https://doi.org/10.1001/archinte.1993.00410180039004
10. Brakemeier EL, Wirkner J, Knaevelsrud C, Wurm S, Christiansen H, Lueken U, Schneider, S.Die COVID-19-Pandemie als Herausforderung für die psychische Gesundheit [The COVID-19 pandemic as a challenge to mental health. Findings and implications for research and practice from the perspective of clinical psychology and psychotherapy]. ZeitschriftfürKlinischePsychologie und Psychotherapie.2020;49: 1–31. https://doi.org/10.1026/1616-3443/a000574
11. Gruber J, Prinstein MJ, Clark LA, et al. Mental health and clinical psychological science in the time of COVID-19: Challenges, opportunities, and a call to action. American Psychologist. 2021;76(3):409-426. doi:10.1037/amp0000707
12. Vindegaard N, Benros ME. COVID-19 pandemic and mental health consequences: Systematic review of the current evidence. Brain, Behavior, and Immunity. 2020;89:531-542. doi:10.1016/j.bbi.2020.05.048
13. Bäuerle A, Teufel M, Musche V, et al. Increased generalized anxiety, depression and distress during the COVID-19 pandemic: a cross-sectional study in Germany. J Public Health (Oxf). 2020;42(4):672-678. doi:10.1093/pubmed/fdaa106
14. Bartoszek A, Walkowiak D, Bartoszek A, Kardas G. Mental Well-Being (Depression, Loneliness, Insomnia, Daily Life Fatigue) during COVID-19 Related Home-Confinement—A Study from Poland. International Journal of Environmental Research and Public Health. 2020; 17(20):7417. https://doi.org/10.3390/ijerph17207417
15. Wang C, Pan R, Wan X, et al. A longitudinal study on the mental health of general population during the COVID-19 epidemic in China. Brain, Behavior, and Immunity. 2020;87:40-48. doi:10.1016/j.bbi.2020.04.028
16. Cullen W, Gulati G, Kelly B D. Mental health in the COVID-19 pandemic. QJM: An International Journal of Medicine. 2020; 113(5): 311–312. doi:10.1093/qjmed/hcaa110.
17. Salari, N.; Hosseinian-Far, A.; Jalali, R.; Vaisi-Raygani, A.; Rasoulpoor, S.; Mohammadi, M.; Rasoulpoor, S.; Khaledi-Paveh, B. Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: A systematic review and meta-analysis. Glob. Health 2020, 16, 57, doi:10.1186/s12992-020-00589-w.
18. Torales J, O’Higgins M, Castaldelli-Maia JM, Ventriglio A. The outbreak of COVID-19 coronavirus and its impact on global mental health. International Journal of Social Psychiatry. 2020;66(4):317-320. doi:10.1177/0020764020915212
19. Kosic A, DžamonjaIgnjatović T, Petrović N. A Cross-Cultural Study of Distress during COVID-19 Pandemic: Some Protective and Risk Factors. International Journal of Environmental Research and Public Health. 2021; 18(14):7261.https://doi.org/10.3390/ijerph18147261
20. Castellini G, Rossi E, Cassioli E, Sanfilippo G, Innocenti M, Gironi V, Silvestri C, Voller F, Ricca V. A longitudinal observation of general psychopathology before the COVID-19 outbreak and during lockdown in Italy.Journal of Psychosomatic Research. (2021);141: 110328. https://doi.org/10.1016/j.jpsychores.2020.1103
21. Deng J, Zhou F, Hou W, Silver Z, Wong C Y, Chang O, et al. The prevalence of depression, anxiety, and sleep disturbances in COVID-19 patients: a meta-analysis. Annals of the New York Academy of Sciences. 2020;1486(1): 90-111.doi: 10.1111/nyas. 14506
22. Galea S, Merchant RM, Lurie N. The Mental Health Consequences of COVID-19 and Physical Distancing: The Need for Prevention and Early Intervention. JAMA InternMed. 2020;180(6):817–818. doi:10.1001/jamainternmed.2020.1562
23. Huang Y, Zhao N. Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 outbreak in China: A web-based cross-sectional survey. Psychiatry Research. 2020;288. doi:10.1016/j.psychres.2020.112954
24. Hyland P, Shevlin M, McBride O, et al. Anxiety and depression in the republic of ireland during the covid‐19 pandemic. Acta Psychiatrica Scandinavica. August 2020. doi:10.1111/acps.13219
25. Lakhan R, Agrawal A, Sharma M. Prevalence of depression, anxiety, and stress during COVID-19 pandemic. Journal of neurosciences in rural practice. 2020; 11(04):519-525. doi: 10.1055/s-0040-1716442
26. Niedzwiedz C L, Green M J, Benzeval M, Campbell D, Craig P, Demou E, Leyland A, Pearce A, Thomson R, Whitley E, Katikireddi S V.Mental health and health behaviours before and during the initial phase of the COVID-19 lockdown: Longitudinal analyses of the UK Household Longitudinal Study. Journal of Epidemiology and Community Health. 2021;75(3): 224–231. https://doi.org/10.1136/jech-2020-215060
27. Osofsky J D, Osofsky H J, Mamon LY. Psychological and social impact of COVID-19. Psychological Trauma: Theory, Research, Practice, and Policy. 2020;12(5): 468–469. https://doi.org/10.1037/tra0000656
28. Pfefferbaum B, North C S. Mental Health and the Covid-19 Pandemic. The New England Journal of Medicine. 2020; 383(6): 510-512. doi: 10.1056/NEJMp2008017
29. Pierce M, Hope H, Ford T, et al. Mental health before and during the COVID-19 pandemic: A longitudinal probability sample survey of the UK population. The Lancet Psychiatry. 2020;7(10):883-892. doi:10.1016/S2215-0366(20)30308-4
30. Qiu J, Shen B, Zhao M, Wang Z, Xie B, Yifeng X. A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: implications and policy recommendations. General Psychiatry. 2020;33: e1002013. doi:10.1136/gpsych-2020-100213
31. Saladino V, Algeri D, Auriemma V. The psychological and social impact of COVID-19: New perspectives of well-being. Frontiers in Psychology. 2020;11. doi:10.3389/fpsyg.2020.577684
32. Shevlin M, McBride O, Murphy J, et al. Anxiety, depression, traumatic stress and COVID-19-related anxiety in the UK general population during the COVID-19 pandemic. BJPsych Open. 2020;6. doi:10.1192/bjo.2020.109
33. 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. European Psychologist. 2021;26(4):310-322. doi:10.1027/1016-9040/a000465
34. Yamada Y, Ćepulić D B, Coll-Martín T, et al. COVIDiSTRESS Global Survey dataset on psychological and behavioural consequences of the COVID-19 outbreak. Scientific data. 2021;8(1): 1-23. doi.org/10.1038/s41597-020-00784-9
35. Lieberoth A, Lin S Y, Stöckli S, et al. Stress and worry in the 2020 coronavirus pandemic: Relationships to trust and compliance with preventive measures across 48 countries in the COVIDiSTRESS global survey. Royal Society Open Science. 2021;8(2): 200589.
36. COVIDiSTRESS Consortium. COVIDiSTRESS global survey. Open Science Framework. 2020. https://doi.org/10.17605/OSF.IO/Z39US
37. Blackburn A M, Vestergren S, & the COVIDiSTRESS II Consortium. COVIDiSTRESS diverse dataset on psychological and behavioural outcomes one year into the COVID-19 pandemic. Scientific data. 2022;9: 331. https://doi.org/10.1038/s41597-022-01383-6
38. Browning MHEM, Larson LR, Sharaievska I, et al. Psychological impacts from COVID-19 among university students: Risk factors across seven states in the United States. PLoS ONE. 2021;16(1). doi:10.1371/journal.pone.0245327
39. Guo J, Feng X L, Wang X H, & van IJzendoorn M H. Coping with COVID-19: exposure to COVID-19 and negative impact on livelihood predict elevated mental health problems in Chinese adults. International journal of environmental research and public health. 2020;17(11): 3857. doi: 10.1016/j.jadohealth.2020.08.001
40. Wang C, Pan R, Wan X, Tan Y, Xu L, Ho C S, Ho R C. Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. International journal of environmental research and public health. 2020;17(5): 1729. https://doi.org/10.3390/ijerph17051729
41. Zhang W, Wang K, Yin L, et al. Mental health and psychosocial problems of medical health workers during the COVID-19 epidemic in China. Psychotherapy and Psychosomatics. 2020;89(4):242-250. doi:10.1159/000507639
42. Bendau A, Kunas SL, Wyka S, et al. Longitudinal changes of anxiety and depressive symptoms during the COVID-19 pandemic in Germany: The role of pre-existing anxiety, depressive, and other mental disorders. Journal of Anxiety Disorders. 2021;79. doi:10.1016/j.janxdis.2021.102377
43. Okely J A, Corley J, Welstead M, et al.Change in physical activity, sleep quality, and psychosocial variables during COVID-19 lockdown: Evidence from the Lothian Birth Cohort 1936. International Journal of Environmental Research and Public Health.2020;18(1):210. https://doi.org/10.3390/ijerph18010210
44. Pan K Y, Kok AAL, Eikelenboom M, et al. The mental health impact of the COVID-19 pandemic on people with and without depressive, anxiety, or obsessive-compulsive disorders: A longitudinal study of three Dutch case-control cohorts. The Lancet Psychiatry. 2021;8(2):121-129. doi:10.1016/S2215-0366(20)30491-0
45. Ramiz L, Contrand B, Rojas Castro M Y, et al. A longitudinal study of mental health before and during COVID-19 lockdown in the French population. Globalization and Health.2021;17(1): 29. https://doi.org/10.1186/s12992-021-00682-8
46. Varga T V, Bu F, Dissing A S, et al. Loneliness, worries, anxiety, and precautionary behaviours in response to the COVID-19 pandemic: A longitudinal analysis of 200, 000 Western and Northern Europeans. The Lancet Regional Health – Europe. 2021; 2: 100020. https://doi.org/10.1016/j.lanepe.2020.100020
47. Fancourt D, Steptoe A, Bu F. Trajectories of anxiety and depressive symptoms during enforced isolation due to COVID-19 in England: A longitudinal observational study. The Lancet Psychiatry. 2021;8(2): 141–149. https://doi.org/10.1016/S2215-0366(20)30482-X
48. Maslakçı A, & Sürücü L. Gender Effects on Depression, Anxiety, and Stress Regarding the Fear of COVID-19. Trends in Psychology. 2022; 1-13. https://doi.org/10.1007/s43076-022-00227-x
49. Proto E, Quintana-Domeque C. COVID-19 and mental health deterioration by ethnicity and gender in the UK. PloS One. 2021;16(1): e0244419. https://doi.org/10.1371/journal.pone.0244419
50. Salfi F, D’Atri A, Tempesta D, Ferrara M. Sleeping under the waves: A longitudinal study across the contagion peaks of the COVID-19 pandemic in Italy. Journal of Sleep Research. 2021;30(5). doi:10.1111/jsr.13313
51. Bu F, Steptoe A, Fancourt D. Who is lonely in lockdown? Cross-cohort analyses of predictors of loneliness before and during the COVID-19 pandemic. Public Health. 2020;186:31-34. doi:10.1016/j.puhe.2020.06.036
52. Savage MJ, Hennis PJ, Magistro D, Donaldson J, Healy LC, James RM. Nine Months into the COVID-19 Pandemic: A Longitudinal Study Showing Mental Health and Movement Behaviours Are Impaired in UK Students. International Journal of Environmental Research and Public Health. 2021; 18(6):2930. https://doi.org/10.3390/ijerph18062930
53. Groarke JM, McGlinchey E, McKenna-Plumley PE, Berry E, Graham-Wisener L, Armour C. Examining temporal interactions between loneliness and depressive symptoms and the mediating role of emotion regulation difficulties among UK residents during the COVID-19 lockdown: Longitudinal results from the COVID-19 psychological wellbeing study. Journal of Affective Disorders. 2021;285:1-9. doi:10.1016/j.jad.2021.02.033
54. Ezpeleta L, Navarro J.B, de la Osa N, et al. Life conditions during COVID-19 lockdown and mental health in Spanish adolescents. International Journal of Environmental Research and Public Health. 2020; 17(19): 1–13. https://doi.org/10.3390/ijerph17197327
55. Bendau A, Plag J, Kunas S, et al. Longitudinal changes in anxiety and psychological distress, and associated risk and protective factors during the first three months of the COVID-19 pandemic in Germany. Brain and Behavior. 2021b;11(2): e01964. https://doi.org/10.1002/brb3.1964
56. Janssen LHC, Kullberg M-LJ, Verkuil B, et al. Does the COVID-19 pandemic impact parents’ and adolescents’ well-being? An EMA-study on daily affect and parenting. PLoS ONE. 2020;15(10). doi:10.1371/journal.pone.0240962
57. Elmer T, Mepham K, Stadtfeld C. Students under lockdown: Comparisons of students’ social networks and mental health before and during the COVID-19 crisis in Switzerland. PLoS ONE. 2020;15(7). doi:10.1371/journal.pone.0236337
58. Davidson B, Schmidt E, Mallar C, et al. Risk and resilience of well-being in caregivers of young children in response to the COVID-19 pandemic. Translational Behavioral Medicine. 2021;11(2):305-313. doi:10.1093/tbm/ibaa124
59. Matiz A, Fabbro F, Paschetto A, et al. Positive impact of mindfulness meditation on mental health of female teachers during the COVID-19 outbreak in Italy. International Journal of Environmental Research and Public Health.2020;17(18): 1–22. https://doi.org/10.3390/ijerph17186450
60. Prime H, Wade M, Browne DT. Risk and resilience in family well-being during the COVID-19 pandemic. American Psychologist. 2020;75(5):631-643. doi:10.1037/amp0000660
61. González-Sanguino C, Ausín B, Castellanos MA, Saiz J, Muñoz M. Mental health consequences of the Covid-19 outbreak in Spain A longitudinal study of the alarm situation and return to the new normality. Progress in Neuro-Psychopharmacology & Biological Psychiatry. 2021;107. doi:10.1016/j.pnpbp.2020.110219
62. Kimhi S, Eshel Y, Marciano H, Adini B. Impact of societal resilience on vaccine hesitancy and uptake: Lessons learned from the Israeli experience. International Journal of Disaster Risk Reduction. 2022;79: 103181. doi.org/10.1016/j.ijdrr.2022.103181
63. Li J B, Dou K, Liu Z H. Profiles of positive changes in life outcomes over the COVID-19 pandemic in Chinese adolescents: the role of resilience and mental health consequence. Child and Adolescent Psychiatry and Mental Health. 2022;16(1): 1-11. doi.org/10.1186/s13034-022-00451-4
64. Luthar SS, Cicchetti D, Becker B. The construct of resilience: A critical evaluation and guidelines for future work. Child Development. 2000;71(3):543-562. doi:10.1111/1467-8624.00164
65. Ong AD, Bergeman CS, Bisconti TL, Wallace KA. Psychological resilience, positive emotions, and successful adaptation to stress in later life. Journal of Personality and Social Psychology. 2006;91(4):730-749. doi:10.1037/0022-3514.91.4.730
66. 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. Current Psychology: A Journal for Diverse Perspectives on Diverse Psychological Issues. 2022;41(8):5712-5722. doi:10.1007/s12144-020-01177-2
67. Kimhi S, Marciano H, Eshel Y, Adini B. Resilience and demographic characteristics predicting distress during the COVID-19 crisis. Social Science & Medicine. 2020;265. doi:10.1016/j.socscimed.2020.113389
68. Resilience Research Centre (undated) ‘What is resilience?’ available at https://resilienceresearch.org/about-resilience/
69. Bonanno GA. Loss, trauma, and human resilience: Have we underestimated the human capacity to thrive after extremely aversive events? Psychological Trauma: Theory, Research, Practice, and Policy. 2008;S(1):101-113. doi:10.1037/1942-9681.S.1.101
70. Bonanno GA, Romero SA, Klein SI. The temporal elements of psychological resilience: An integrative framework for the study of individuals, families, and communities. Psychological Inquiry. 2015;26(2):139-169. doi:10.1080/1047840X.2015.992677
71. Cacioppo JT, Reis HT, Zautra AJ. Social resilience: The value of social fitness with an application to the military. American Psychologist. 2011;66(1):43-51. doi:10.1037/a0021419
72. Ben-Dor G, Pedahzur A, Canetti-Nisim D, Zaidise E. The role of public opinion in Israel’s national security. American Jewish Congress: Congress Monthly. 2002;69 (5), 13–15.
73. Kimhi S, Eshel Y. Measuring national resilience: A new short version of the scale (NR-13). Journal of Community Psychology. 2019;47(3):517-528. doi:10.1002/jcop.22135
74. Kimhi S. Levels of resilience: Associations among individual, community, and national resilience. Journal of Health Psychology. 2016;21(2):164-170. doi:10.1177/1359105314524009
75. Abolghasemi A, Varaniyab ST. Resilience and perceived stress: predictors of life satisfaction in the students of success and failure. Procedia-Social and Behavioral Sciences. 2010; 5:748-752.
76. Yildirim M. Mediating Role of Resilience in the Relationships Between Fear of Happiness and Affect Balance, Satisfaction With Life, and Flourishing. Europe's Journal of Psychology. 2019;15(2):183-198. doi:10.5964/ejop.v15i2.1640
77. Burns RA, Anstey KJ, Windsor TD. Subjective Well-Being Mediates the Effects of Resilience and Mastery on Depression and Anxiety in a Large Community Sample of Young and Middle-Aged Adults. Australian & New Zealand Journal of Psychiatry. 2011;45(3):240-248. doi:10.3109/00048674.2010.529604
78. McCanlies EC, Mnatsakanova A, Andrew ME, Burchfiel CM, Violanti JM. Positive psychological factors are associated with lower PTSD symptoms among police officers: Post Hurricane Katrina. Stress and Health: Journal of the International Society for the Investigation of Stress. 2014;30(5):405-415. doi:10.1002/smi.2615
79. Wind TR, Rijkeboer M, Andersson G, Riper H. The COVID-19 pandemic: The 'black swan' for mental health care and a turning point for e-health. Internet Interv. 2020;20:100317. doi:10.1016/j.invent.2020.100317
80. Stănculescu E. Fear of covid-19 in romania: Validation of the romanian version of the fear of covid-19 scale using graded response model analysis. International Journal of Mental Health and Addiction. January 2021. doi:10.1007/s11469-020-00428-4
81. Coulombe S, Pacheco T, Cox E, et al. Risk and resilience factors during the COVID-19 pandemic: A snapshot of the experiences of Canadian workers early on in the crisis. Frontiers in Psychology. 2020;11. doi:10.3389/fpsyg.2020.580702
82. Seaborn K, Henderson K, Gwizdka J, et al. A meta-review of psychological resilience during COVID-19. npj Mental Health Research. 2022;1(1): 1-9. https://doi.org/10.1038/s44184-022-00005-8
83. Chan ACY, Piehler TF, Ho GWK. Resilience and mental health during the COVID-19 pandemic: Findings from Minnesota and Hong Kong. Journal of Affective Disorders. 2021;295:771-780. doi:10.1016/j.jad.2021.08.144
84. Kavčič T, Avsec A, Zager Kocjan G. Psychological functioning of slovene adults during the covid-19 pandemic: Does resilience matter? Psychiatric Quarterly. June 2020. doi:10.1007/s11126-020-09789-4
85. Killgore WDS, Taylor EC, Cloonan SA, Dailey NS. Psychological resilience during the COVID-19 lockdown. Psychiatry Research. 2020;291. doi:10.1016/j.psychres.2020.113216
86. Knowles C, Shannon S, Prentice G, Breslin G. Comparing mental health of athletes and non-athletes as they emerge from a COVID-19 pandemic lockdown. Frontiers in sports and active living. 2021;3: 612532. doi.org/10.3389/fspor.2021.612532
87. Zager Kocjan G, Kavčič T, Avsec A. Resilience matters: Explaining the association between personality and psychological functioning during the COVID-19 pandemic. International Journal of Clinical and Health Psychology. 2021;21(1). doi:10.1016/j.ijchp. 2020.08.002
88. Manchia M, Gathier AW, Yapici-Eser H, et al. The impact of the prolonged COVID-19 pandemic on stress resilience and mental health: A critical review across waves. European Neuropsychopharmacology. 2022;55:22-83. doi:10.1016/j.euroneuro.2021.10.864
89. Paredes MR, Apaolaza V, Fernandez-Robin C, Hartmann P, Yañez-Martinez D. The impact of the COVID-19 pandemic on subjective mental well-being: The interplay of perceived threat, future anxiety and resilience. Personality and Individual Differences. 2021;170. doi:10.1016/j.paid.2020.110455
90. Shah S S, Memon F A, Qureshi F, et al. Mental well-being during COVID-19 pandemic: the role of fear, social isolation and psychological resilience. Cogent Psychology. 2022;9(1): 2006993.doi: 10.1080/23311908.2021.2006993
91. Aten JD, Smith WR, Davis EB, et al. The psychological study of religion and spirituality in a disaster context: A systematic review. Psychological Trauma: Theory, Research, Practice, and Policy. 2019;11(6):597-613. doi:10.1037/tra0000431
92. Ai AL, Cascio T, Santangelo LK, Evans-Campbell T. Hope, Meaning, and Growth Following the September 11, 2001, Terrorist Attacks. Journal of Interpersonal Violence. 2005;20(5):523-548. doi:10.1177/0886260504272896
93. Ai AL, Raney AA, Paloutzian RF. Perceived spiritual support counteracts the traumatic impact of extreme disasters: Exploration of moderators. Psychological Trauma: Theory, Research, Practice, and Policy. October 2021. doi:10.1037/tra0001133.supp (Supplemental)
94. Dubey N, Podder P, Pandey D. Knowledge of COVID-19 and its influence on mindfulness, cognitive emotion regulation and psychological flexibility in the indian community. Frontiers in Psychology. 2020;11. doi:10.3389/fpsyg.2020.589365
95. Peterson C, Seligman MEP. Character strengths before and after September 11. Psychological Science. 2003;14(4):381-384. doi:10.1111/1467-9280.24482
96. Hai AH, Franklin C, Park S, DiNitto DM, Aurelio N. The efficacy of spiritual/religious interventions for substance use problems: A systematic review and meta-analysis of randomized controlled trials. Drug and Alcohol Dependence. 2019;202:134-148. doi:10.1016/j.drugalcdep.2019.04.045
97. Gonçalves JPB, Lucchetti G, Menezes PR, Vallada H. Religious and spiritual interventions in mental health care: A systematic review and meta-analysis of randomized controlled clinical trials. Psychological Medicine. 2015;45(14):2937-2949. doi:10.1017/S0033291715001166
98. Koenig HG. Maintaining health and well-being by putting faith into action during the COVID-19 pandemic. Journal of Religion and Health. 2020;59(5):2205-2214. doi:10.1007/s10943-020-01035-2
99. Pellebon DA, Anderson SC. Understanding the life issues of spiritually-based clients. Families in Society. 1999;80(3):229-238. doi:10.1606/1044-3894.676
100. Carroll MM. Social work’s conceptualization of spirituality. Social Thought. 1998;18(2):1-13.
101. Gray AJ. Resilience, spirituality and health. Psyche en Geloof. 2017;28(1):31-39.
102. Cascio T.Religion and spirituality: Diversity issues for the future. Journal of Multicultural Social Work.1999;7(3/4): 129-145
103. Anderson DA, Worthen D. Exploring a fourth dimension: Spirituality as a resource for the couple therapist. Journal of Marital and Family Therapy. 1997;23(1):3-12. doi:10.1111/j.1752-0606.1997.tb00227.x
104. Pargament KI, Magyar-Russell GM, Murray-Swank NA. The sacred and the search for significance: Religion as a unique process. Journal of Social Issues. 2005;61(4):665-687. doi:10.1111/j.1540-4560.2005.00426.x
105. Ai AL, Huang B, Bjorck J, Appel HB. Religious attendance and major depression among Asian Americans from a national database: The mediation of social support. Psychology of Religion and Spirituality. 2013;5(2):78-89. doi:10.1037/a0030625
106. Chatters LM, Taylor RJ, Jackson JS, Lincoln KD. Religious coping among African Americans, Caribbean Blacks and non-Hispanic Whites. Journal of Community Psychology. 2008;36(3):371-386. doi:10.1002/jcop.20202
107. Ano GG, Vasconcelles EB. Religious Coping and Psychological Adjustment to Stress: A Meta-Analysis. Journal of Clinical Psychology. 2005;61(4):461-480. doi:10.1002/jclp.20049
108. Sinding Bentzen J. Acts of God? Religiosity and natural disasters across subnational world districts. The Economic Journal. 2019;129(622): 2295-2321.
109. Rosmarin DH, Leidl B. Spirituality, religion, and anxiety disorders. In: Rosmarin DH, Koenig HG, eds. Handbook of Spirituality, Religion, and Mental Health., 2nd Ed. Elsevier Academic Press; 2020:41-60. doi:10.1016/B978-0-12-816766-3.00003-3
110. Bovero A, Tosi C, Botto R, Opezzo M, Giono-Calvetto F, Torta R. The spirituality in end-of-life cancer patients, in relation to anxiety, depression, coping strategies and the daily spiritual experiences: A cross-sectional study. Journal of Religion and Health. 2019;58(6):2144-2160. doi:10.1007/s10943-019-00849
111. Johnson KS, Tulsky JA, Hays JC, et al. Which domains of spirituality are associated with anxiety and depression in patients with advanced illness? Journal of General Internal Medicine. 2011;26(7):751-758. doi:10.1007/s11606-011-1656-2
112. González-Sanguino C, Ausín B, Castellanos MÁ, et al. Mental health consequences during the initial stage of the 2020 Coronavirus pandemic (COVID-19) in Spain. Brain, Behavior, and Immunity. 2020;87:172-176. doi:10.1016/j.bbi.2020.05.040
113. Tolentino JC, Gjorup ALT, Mello CR, et al. Spirituality as a protective factor for chronic and acute anxiety in Brazilian healthcare workers during the COVID-19 outbreak. PLoS ONE. 2022;17(5). doi:10.1371/journal.pone.0267556
114. Rias YA, Rosyad YS, Chipojola R, Wiratama BS, Safitri CI, Weng SF, Yang CY, Tsai HT. Effects of Spirituality, Knowledge, Attitudes, and Practices toward Anxiety Regarding COVID-19 among the General Population in INDONESIA: A Cross-Sectional Study. Journal of Clinical Medicine. 2020;9(12): 3798. doi: 10.3390/jcm9123798.
115. Gayatri D, Efremov L, Kantelhardt EJ, Mikolajczyk R. Quality of life of cancer patients at palliative care units in developing countries: Systematic review of the publishedliterature. Quality of Life Research: An International Journal of Quality of Life Aspects of Treatment, Care & Rehabilitation. 2021;30(2):315-343. doi:10.1007/s11136-020-02633-z
116. Hall J. Spirituality at the beginning of life. Journal of Clinical Nursing. 2006;15: 804- 810.
117. Schuster MA, Stein BD, Jaycox LH, et al. A national survey of stress reactions after the September 11, 2001, terrorist attacks. The New England Journal of Medicine. 2001;345(20):1507-1512. doi:10.1056/NEJM200111153452024
118. EsmaeiliDarmianM, Javadi SV. Study the role of spiritual health and resilience in pandemic COVID-19 on psychological vulnerability. Journal of Fundamentals of Mental Health. 2022;24(5), 349-354.doi: 10.22038/jfmh.2022.21014
119. Kosarkova A, Malinakova K, van Dijk J P, Tavel P. Vaccine refusal in the czech republic is associated with being spiritual but not religiously affiliated. Vaccines. 2021;9(10): 1157.doi: 10.3390/vaccines9101157
120. Lindeman M, Svedholm-Häkkinen A M, Riekki T J. Searching for the cognitive basis of anti-vaccination attitudes. Thinking & Reasoning. 2022: 1-26. doi: 10.1080/13546783.2022.2046158
121. Rutjens B T, Zarzeczna N, van der Lee R. Science rejection in Greece: Spirituality predicts vaccine scepticism and low faith in science in a Greek sample. Public Understanding of Science. 2022 ;31(4): 428-436.doi.org/10.1177/096366252110615
122. Ai AL, Tice TN, Lemieux CM, Huang B. Modeling the post-9/11 meaning-laden paradox: From deep connection and deep struggle to posttraumatic stress and growth. Archiv für Religions psychologie / Archive for the Psychology of Religion. 2011;33(2):173-204. doi:10.1163/157361211X575736
123. Ryff C, Singer B. From social structure to biology. Handbook of positive psychology. 2002;63: 73.
124. Ai AL, Hopp F, Tice TN, Koenig H. Existential relatedness in light of eudemonic well-being and religious coping among middle-aged and older cardiac patients. Journal of Health Psychology. 2013;18(3):368-382. doi:10.1177/1359105311434754
125. Ai AL, Huang B, Bjorck J, Appel HB. Religious attendance and major depression among Asian Americans from a national database: The mediation of social support. Psychology of Religion and Spirituality. 2013;5(2):78-89. doi:10.1037/a0030625
126. Ai AL, Tice TN, Peterson C, Paloutzian RF, Croney-Clark P. The Perceived Spiritual Support Scale (PSSS): Measuring support from the deep connection with diverse sacred entities. In: Ai AL, Wink P, Paloutzian RF, Harris KA, eds. Assessing Spirituality in a Diverse World. Springer Nature Switzerland AG; 2021:493-520. doi:10.1007/978-3-030-52140-0_20
127. Li F, Luo S, Mu W, et al. Effects of sources of social support and resilience on the mental health of different age groups during the COVID-19 pandemic. BMC Psychiatry. 2021;21. doi:10.1186/s12888-020-03012-1
128. Szkody E, Stearns M, Stanhope L, McKinney C. Stress‐buffering role of social support during covid‐19. Family Process. November 2020. doi:10.1111/famp.12618
129. Douglas K M. COVID-19 conspiracy theories. Group Processes & Intergroup Relations. 2021;24(2): 270-275. https://doi.org/10.1177/1368430220982068
130. Hogg, M. A., & Vaughan, G. M. Social psychology (5th ed). London: Prentice Hall.2008
131. Allington, D., &Dhavan, N. (2020). The relationship between conspiracy beliefs and compliance with public health guidance with regard to COVID-19. Available online: https://kclpure.kcl.ac.uk/portal/files/127048253/Allington_and_Dhavan_2020.pdf
132. Allington D, Duffy B, Wessely S, Dhavan N, Rubin J. Health-protective behaviour, social media usage and conspiracy belief during the COVID-19 public health emergency. Psychological Medicine. 2021;51(10):1763-1769. doi:10.1017/S003329172000224X
133. Earnshaw VA, Eaton LA, Kalichman SC, Brousseau NM, Hill EC, Fox AB. COVID-19 conspiracy beliefs, health behaviors, and policy support. Translational Behavioral Medicine. 2020;10(4):850-856. doi:10.1093/tbm/ibaa090
134. Bertin P, Nera K, Delouvée S. Conspiracy beliefs, rejection of vaccination, and support for hydroxychloroquine: A conceptual replication-extension in the COVID-19 pandemic context. Frontiers in Psychology. 2020;11. doi:10.3389/fpsyg.2020.565128
135. Malik A A, McFadden S M, Elharake J, Omer S B. Determinants of COVID-19 vaccine acceptance in the US. Clinical Medicine. 2020;26: 100495. https://doi.org/10.1016/j.eclinm.2020.100495
136. Hartman T K, Marshall M, Stocks T V, et al. Different conspiracy theories have different psychological and social determinants: Comparison of three theories about the origins of the COVID-19 virus in a representative sample of the UK population. Frontiers in Political Science. 2021;3: 642510.doi.org/10.3389/fpos.2021.642510
137. Stasielowicz L. A continuous time meta-analysis of the relationship between conspiracy beliefs and individual preventive behavior during the COVID-19 pandemic. Scientific Reports. 2022;12(1): 1-10.doi.org/10.1038/s41598-022-15769-4
138. Smith BW, Dalen J, Wiggins K, Tooley E, Christopher P, Bernard J. The Brief Resilience Scale: Assessing the ability to bounce back. International Journal of Behavioral Medicine. 2008;15(3):194-200. doi:10.1080/10705500802222972
139. Cohen J, Cohen P, West SG, Aiken LS. Applied Multiple Regression/Correlation Analysis for the Behavioral Sciences, 3rd Ed. Lawrence Erlbaum Associates Publishers; 2003.
140. Dawson JF, Richter AW. Probing three-way interactions in moderated multiple regression: Development and application of a slope difference test. Journal of Applied Psychology. 2006;91(4):917-926. doi:10.1037/0021-9010.91.4.917
141. Davis EB, McElroy-Heltzel SE, Lemke AW, et al. Psychological and spiritual outcomes during the COVID-19 pandemic: A prospective longitudinal study of adults with chronic disease. Health Psychology. 2021;40(6):347-356. doi:10.1037/hea0001079.
142. Ursu A, Măirean C. Cognitive Emotion Regulation Strategies as Mediators between Resilience and Stress during COVID-19 Pandemic. International Journal of Environmental Research and Public Health. 2022;19(19): 12631.
143. Birditt KS, Turkelson A, Fingerman KL, Polenick CA, Oya A. Age differences in stress, life changes, and social ties during the COVID-19 pandemic: Implications for psychological well-being. The Gerontologist. 2021;61(2):205-216. doi:10.1093/geront/gnaa204
144. Cunningham TJ, Fields EC, Garcia SM, Kensinger EA. The relation between age and experienced stress, worry, affect, and depression during the spring 2020 phase of the COVID-19 pandemic in the United States. Emotion. 2021;21(8):1660-1670. doi:10.1037/emo0000982.supp (Supplemental)