Influence of Intolerance of Uncertainty on Preoccupation With Coronavirus Disease 2019 Among Frontline Nursing Professionals: Mediating Role of Reassurance-Seeking Behavior and Adherence to Physical Distancing

Eulah Cho; Jihoon Hong; Harin Kim; C. Hyung Keun Park; Youjin Hong; Jangho Park; Jin Yong Jun; Seockhoon Chung

doi:10.3346/jkms.2023.38.e282

Journal List > J Korean Med Sci > v.38(36) > 1516083847

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Cho, Hong, Kim, Park, Hong, Park, Jun, and Chung: Influence of Intolerance of Uncertainty on Preoccupation With Coronavirus Disease 2019 Among Frontline Nursing Professionals: Mediating Role of Reassurance-Seeking Behavior and Adherence to Physical Distancing

Original Article

Psychiatry & Psychology

Journal of Korean Medical Science 2023; 38(36): e282.

Published online: 18 August 2023

DOI: https://doi.org/10.3346/jkms.2023.38.e282

Influence of Intolerance of Uncertainty on Preoccupation With Coronavirus Disease 2019 Among Frontline Nursing Professionals: Mediating Role of Reassurance-Seeking Behavior and Adherence to Physical Distancing

Eulah Cho^1,^*

, Jihoon Hong^2,^*

, Harin Kim²

, C. Hyung Keun Park¹

, Youjin Hong³

, Jangho Park⁴

, Jin Yong Jun⁴

, Seockhoon Chung¹

¹Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

²University of Ulsan College of Medicine, Seoul, Korea.

³Department of Psychiatry, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.

⁴Department of Psychiatry, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea.

Address for Correspondence: Seockhoon Chung, MD, PhD. Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, 86 Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Republic of Korea. schung@amc.seoul.kr

Address for Correspondence: Jin Yong Jun, MD. Department of Psychiatry, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan 44033, Republic of Korea. jyjun826@gmail.com

Equal contributor:

^*Eulah Cho and Jihoon Hong contributed equally to this work.

Received 21 February 2023 Accepted 25 June 2023

The Korean Academy of Medical Sciences

https://creativecommons.org/licenses/by-nc/4.0/

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

This study investigated the relationship between preoccupation with coronavirus disease 2019 (COVID-19), reassurance-seeking behavior, viral anxiety, intolerance of uncertainty, and adherence to physical distancing among frontline nursing professionals working in COVID-19 inpatient wards. Additionally, the study aimed to determine whether the commitment to physical distancing mediates the influence of intolerance of uncertainty on viral anxiety.

Methods

Frontline healthcare professionals working in the COVID-19 inpatient wards at three tertiary-level affiliated hospitals in Korea were surveyed between April 7 and 26, 2022. The survey included scales—such as the Obsession with COVID-19 Scale, Coronavirus Reassurance-Seeking Behaviors Scale, Fear of COVID-19 Scale, and Intolerance of Uncertainty Scale-12 and a questionnaire on adherence to physical distancing. A total of 256 responses were analyzed after excluding inappropriate or incomplete responses.

Results

Pearson’s correlation analysis found that age was significantly associated with the Obsession with COVID-19 Scale (r = −0.12, P < 0.05) and adherence to physical distancing (r = 0.27, P < 0.01). Linear regression analysis ascertained that age (β = −0.07, P = 0.002), Coronavirus Reassurance-Seeking Behaviors Scale (β = 0.35, P < 0.001), and Fear of COVID-19 Scale (β = 0.24, P < 0.001) were predictors of obsession with COVID-19 (Adjusted R² = 0.60, F = 78.1, P < 0.001). The indirect pathway by mediation analysis showed that reassurance-seeking and viral anxiety mediated the effect of intolerance of uncertainty on the preoccupation with COVID-19.

Conclusion

During the pandemic, there may be a strong association between reassurance-seeking behavior, viral anxiety, and a heightened preoccupation with COVID-19 among frontline healthcare workers. Thus, from the early stages of infectious disease, a psychological support team for medical staff responding to the disease should be established, and periodic evaluations should be conducted to identify high-risk groups.

Go to :

Graphical Abstract

Go to :

Keywords: Reassurance-Seeking Behavior, Intolerance, Preoccupation, Coronavirus Disease 2019, Frontline Nurses

INTRODUCTION

Frontline healthcare workers are vital in delivering primary medical care and safeguarding the population against the coronavirus disease 2019 (COVID-19). Due to their critical role in various medical fields that induces a sense of responsibility, they may experience significant psychological stress.1 2 Nurses, particularly, are exposed to multiple tasks, such as administering tests and caring for infected patients. Their risk of contracting COVID-19 is significantly higher compared to other healthcare workers, which may lead to exposure to traumatic deaths, resulting in severe psychological issues.3

Hypochondriasis, also known as illness anxiety disorder, is a condition in which an excessive fear of being sick leads to anxiety, prompting an individual to avoid the perceived problem or repeatedly seek reassurances. Although seeking reassurance may temporarily reduce anxiety, the repetitive cycle of seeking reassurance and experiencing anxiety can lead to an excessive preoccupation with the perceived illness.4 5 6 The COVID-19 pandemic induced a fear of infections that prompted individuals to engage in reassurance-seeking behaviors such as constantly checking their bodily sensations, maintaining strict hand hygiene, or regularly monitoring news. However, excessively seeking reassurance can paradoxically increase anxiety. These reassurance-seeking behaviors can indicate an excessive preoccupation with illness in individuals concerned about their health or highly anxious about the virus. Most of these symptoms result from constant checking and the fear of contamination related to the COVID-19 pandemic. Additionally, measures such as wearing a mask and washing hands while effectively reducing the spread of infection may also increase preoccupation with the virus.

Previously, we observed that insomnia mediated the vicious cycle of viral anxiety, reassurance-seeking behavior, and hypochondriacal preoccupation with COVID-19 among the general population.7 Among the medical students, the influence of depression or viral anxiety on their preoccupation with COVID-19 was partially mediated by their reassurance-seeking behavior.8

In its simplest form, intolerance of uncertainty is the inability to tolerate the adverse response triggered by an absence of salient, pertinent, or sufficient information sustained by the associated perception of uncertainty. Intolerance of uncertainty has been associated with anxiety symptoms because of the way people respond to information when they are uncertain. Anxiety disorder development and maintenance are generally related to intolerance of uncertainty as a risk factor or cognitive vulnerability. Therefore, we hypothesize that intolerance of uncertainty and viral anxiety impact a vicious cycle of reassurance-seeking behaviors. COVID-19 pandemic researchers found that extreme intolerance of uncertainty induces anxiety, sleep problems, and depression, as well as behavior changes such as procrastination or emotional eating. Previously, we reported that intolerance of uncertainty among healthcare workers directly influenced their viral anxiety, and reassurance-seeking behavior and preoccupation with COVID-19 mediated this association.9 Reduced intolerance of uncertainty will, therefore, reduce viral anxiety by making it easier to predict and control.

Physical distancing also helps prevent viral transmission in this pandemic,10 which can be a double-edged sword. Psychological distress can occur if people adhere to physical distancing.11 However, as a healthcare worker, it can be an effective way to prevent the spread of infectious diseases.12 Consequently, healthcare professionals are forced to maintain physical distancing, which can also be stressful. Their adherence to physical distancing can be affected by intolerance of uncertainty,13 but little research has been done on how adherence to physical distancing affects or is affected by the preoccupation with COVID-19.

Intolerance of uncertainty or adherence to physical distancing during the pandemic may have contributed to more significant psychological distress among healthcare workers, especially frontline nursing professionals in the COVID-19 inpatient ward. Unlike other disasters, the victims of viral disasters transfer the infection to the healthcare workers at the hospital. Frontline nurses are equipped to care for patients despite poor protective equipment, overload, inadequate infection control, and pre-existing medical conditions. Consequently, they must prepare for risk, tolerate uncertainty, and adhere to physical distancing. It was previously reported that high-risk healthcare workers experienced more difficulty tolerating uncertainty than those in the low-burnout group and that could increase the healthcare workers’ ruminative thinking style.14 15 16

The present study investigated whether preoccupation with COVID-19 was associated with reassurance-seeking behavior, viral anxiety, intolerance of uncertainty, or adherence to physical distancing, especially among frontline nursing professionals who worked in the COVID-19 inpatient ward. Furthermore, we tested whether adherence to physical distancing mediated the influence of intolerance of uncertainty on the vicious cycles of viral anxiety. We hypothesized that 1) reassurance-seeking behavior; 2) viral anxiety; 3) intolerance of uncertainty; and 4) adherence to physical distancing were positively associated with a preoccupation with COVID-19. We also hypothesized that adherence to physical distancing would, at least partially, mediate the relationship between intolerance of uncertainty and preoccupation with COVID-19 among the nursing professionals working in COVID-19 inpatients ward.

Go to :

METHODS

Participants and procedure

The survey was conducted from April 7 to 26, 2022, among frontline healthcare professionals working in the COVID-19 inpatient wards at three tertiary-level affiliated hospitals of the University of Ulsan, including Asan Medical Center in Seoul, Ulsan University Hospital in Ulsan, and Gangneung Asan Hospital in Gangneung, South Korea. Participant age, sex, and marital status were obtained, but no identifiable personal information was collected. Furthermore, we collected information related to COVID-19, including “Did you witness any deaths due to COVID-19 while working on COVID-19 inpatient wards?”, “Were you quarantined due to COVID-19 infection?” “Did you get infected with COVID-19?” and “Did you get vaccinated?” Their past psychiatric history and current psychiatric distress were also examined. Additionally, to construct the e-survey form following the Checklist for Reporting Results of Internet e-Surveys (CHERRIES) guidelines, investigators verified the usability and technical functionality of the survey before implementation. A total of 339 nursing professionals (239 at Asan Medical Center, 150 at Ulsan University Hospital, and 50 at GangNeung Asan Hospital) work in COVID-19 inpatient wards in the three hospitals. Therefore, we aimed to obtain responses from 60% (N = 203) of the eligible population. A total of 266 responses (143 in Asan Medical Center, 94 in Ulsan University Hospital, and 29 in GangNeung Asan Hospital) were collected, and 256 responses (136, 93, and 28, respectively) were analyzed after excluding inappropriate or incomplete responses.

Measures

Obsession with COVID-19 Scale (OCS)

The OCS is a rating scale that measures an individual’s persistent disturbed thinking about coronavirus.17 Four items in the OCS are scored on a five-point scale (0: not at all; 4: nearly every day). A high total score means a high level of preoccupation with coronavirus. We used the Korean version of the OCS in this study.18 The Cronbach’s alpha for this sample was 0.846.

Coronavirus Reassurance-Seeking Behaviors Scale (CRBS)

The CRBS is a rating scale that measures an individual’s coronavirus-related reassurance-seeking behavior.19 Five items of the CRBS are scored on a five-point scale (0: not at all; 4: nearly every day). A high total score reflects a high level of reassurance-seeking tendency. We applied the Korean version of the CRBS, which was then validated.20 The Cronbach’s alpha for this sample was 0.890.

Fear of COVID-19 scale (FCV-19S)

The FCV-19S is a self-rating scale that measures one’s viral anxiety during this pandemic.21 Seven items of the FCV-19S are scored on a five-point Likert scale (1: strongly disagree; 5: strongly agree). A high total score means a high level of viral anxiety. We applied the Korean version in this study. The Cronbach’s alpha for this sample was 0.879.22

Intolerance of Uncertainty Scale-12 (IUS-12)

The IUS-12 is a self-rating scale that measures an individual’s level of tolerance of uncertainty. This is a shortened version of the original 27-items.23 Each of the 12 items of the IUS-12 is scored on a four-point Likert scale (1: not at all characteristic of me; 5: entirely characteristic of me), and a high total score reflects a high level of intolerance of uncertainty. We applied the Korean version of the IUS-12.24 The Cronbach’s alpha for this sample was 0.902.

Questionnaire on adherence to physical distancing

This self-rating questionnaire measures adherence to the physical distancing policy during the pandemic.25 It comprises seven items, which ask about an individual’s adherence to physical distancing behavior such as “minimize contact with other individuals,” “avoid social gatherings with several individuals,” or “wear a face mask in indoor public spaces.” Each of the seven items is scored on a five-point Likert scale (1: never; 5: almost always). A high total score reflects a high level of adherence. The Korean version, validated among healthcare workers,13 was applied in this study. The Cronbach’s alpha for this sample was 0.873.

Statistical analysis

Continuous variables of demographic characteristics and rating scales scores were summarized as mean ± standard deviation. Pearson’s correlation coefficients were examined to explore the correlations between age and rating scale scores. The significance level was defined as two-tailed at values of P < 0.05. A linear regression analysis explored the variables predicting preoccupation with COVID-19 among frontline nursing professionals. The study employed the bootstrap method with 2,000 resamples to investigate whether viral anxiety, COVID-19-related reassurance-seeking behavior, or adherence to physical distancing policy mediated the relationship between intolerance of uncertainty and preoccupation with COVID-19. The SPSS software version 21.0, AMOS version 27 for Windows, and Jamovi 1.6.23 were used for the statistical analyses.

Ethics statement

All three Institutional Review Boards (IRBs) approved the study protocol, and the written informed consent was waived by each IRB (Asan Medical Center: 2022-0323; Ulsan University Hospital: UUH 2022-02-016-003; and GangNeung Asan Hospital: 2022-03-003-001).

Go to :

RESULTS

A total of 256 participants were included in this study, which consisted over 90% female (N = 240, 93.8%) participants, who worked for an average of 6.7 ± 5.9 years. Almost all of the participants (N = 245, 96.5%) were on a working time shift. 42.2% were quarantined for COVID-19 infection and all of them experienced patient deaths associated with COVID-19 infection. Less than 15% (N = 38, 14.9%) reported psychiatric difficulties. Table 1 lists the mean scores of the rating scales used in this study.

Table 1

Clinical characteristics of participants (N = 256)

Variables		Values
Sex (female)		240 (93.8)
Age		29.8 ± 6.2
Years of employment		6.7 ± 5.9
Marital status^a
	Single	198 (78.0)
	Married, without kids	17 (6.7)
	Married, with kids	39 (15.4)
Are you a shift worker?		245 (96.5)
Questions on COVID-19
	Are you taking care of COVID-19-infected patients? (Yes)	256 (100.0)
	Did you experience being quarantined due to infection with COVID-19? (Yes)	108 (42.2)
	Did you experience being infected with COVID-19? (Yes)	98 (38.4)
	Did you get vaccinated? (Yes)	229 (89.5)
	Did you experience deaths of COVID-19-infected patients? (Yes)	256 (100.0)
Psychiatric history
	Did you experience or treat depression, anxiety, or insomnia? (Yes)	38 (14.9)
	Now, do you think you are depressed or anxious, or do you need help with your mood state? (Yes)	34 (13.3)
Scores of rating scales
	Obsession with COVID-19	4.8 ± 3.5
	Coronavirus Reassurance-seeking Behavior Scale	6.6 ± 4.5
	Fear of COVID-19 scale	16.7 ± 5.5
	Intolerance of uncertainty-12 items	31.4 ± 6.0
	Adherence to physical distancing	29.5 ± 5.0

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

COVID-19 = coronavirus disease 2019.

^aThere are two missing values.

Significant correlations were observed in Pearson’s correlation analysis. Age was associated with OCS (r = −0.12, P < 0.05) and adherence to physical distancing (r = 0.27, P < 0.01). The OCS score was significantly correlated with CRBS (r = 0.70, P < 0.01), FCV-19S (r = 0.65, P < 0.01), IUS-12 (r = 0.30, P < 0.01), and adherence to physical distancing (r = 0.28, P < 0.01). CRBS was significantly correlated with FCV-19S, IUS-12, and adherence to physical distancing (P < 0.01). FCV-19S was related to IUS-12 and adherence to physical distancing (r = 0.26, P < 0.01 in both scales). Adherence to physical distancing only correlated with IUS-12 (r = 0.21, P < 0.01; Table 2).

Table 2

Correlation coefficients of each variable among nursing professionals working in COVID-19 inpatients ward

Variables	Age	OCS	CRBS	FCV-19S	IUS-12
OCS	−0.12^*	-	-	-	-
CRBS	−0.08	0.70^**	-	-	-
FCV-19S	0.05	0.65^**	0.56^**	-	-
IUS-12	−0.02	0.30^**	0.28^**	0.26^**	-
Adherence to physical distancing	0.27^**	0.28^**	0.28^**	0.26^**	0.21^**

COVID-19 = coronavirus disease 2019, OCS = Obsession with COVID-19 Scale, CRBS = Coronavirus Reassurance-Seeking Behaviors Scale, FCV-19S = Fear of CoronaVirus-19 Scale, IUS-12 = Intolerance of Uncertainty-12 items.

*P < 0.05, **P < 0.01.

To explore the parameters that could predict the obsession with COVID-19, linear regression analysis was performed. Age (β = −0.07, P = 0.002), CRBS (β = 0.35, P < 0.001), and FCV-19S (β = 0.24, P < 0.001) could predict obsession with COVID-19 (Adjusted R² = 0.60, F = 78.1, P < 0.001; Table 3).

Table 3

Results of linear regression analysis among nursing professionals working in COVID-19 inpatients ward

Dependent variables	Included parameters	Beta	P value	Adjusted R²	F, P value
OCS	Age	−0.07	0.002	0.60	F = 78.1
	CRBS	0.35	< 0.001		P < 0.001
	FCV-19S	0.24	< 0.001
	IUS-12	0.03	0.167
	Adherence to physical distancing	0.06	0.058

Mediation analysis showed that the indirect pathway from intolerance of uncertainty to (independent variable) reassurance seeking or viral anxiety (mediator) to preoccupation with COVID-19 (dependent variable) was significant but mediated by adherence to physical distancing in the indirect pathway, which was not significant (Table 4). This pathway found that reassurance-seeking and viral anxiety would mediate the effect of intolerance of uncertainty on the preoccupation with COVID-19 (Fig. 1).

Fig. 1

Mediation model of the effect of intolerance of uncertainty (independent variables) on the preoccupation with coronavirus (outcome) is mediated by reassurance-seeking behavior and viral anxiety (mediator).

**P < 0.01.

Table 4

The results of direct, indirect, and total effects on mediation analysis

Effects		Standardized estimator	SE	Z-value	P value	95% CI
Direct effect
	IUS-12 → OCS	0.07	0.03	1.48	0.140	−0.01 to 0.09
Indirect effect
	IUS-12 → CRBS → OCS	0.14	0.02	4.33	< 0.001	0.04 to 0.11
	IUS-12 → FCV-19S → OCS	0.11	0.01	3.88	< 0.001	0.03 to 0.08
	IUS-12 → Distancing → OCS	0.01	0.01	1.01	0.313	−0.01 to 0.02
Component
	IUS-12 → CRBS	0.28	0.04	4.69	< 0.001	0.12 to 0.30
	CRBS → OCS	0.51	0.03	11.20	< 0.001	0.30 to 0.43
	IUS-12 → FCV-19S	0.26	0.06	4.32	< 0.001	0.13 to 0.35
	FCV-19S → OCS	0.40	0.03	8.86	< 0.001	0.18 to 0.29
	IUS-12 → Distancing	0.21	0.05	3.41	< 0.001	0.07 to 0.21
	Distancing → OCS	0.09	0.03	1.06	0.291	−0.03 to 0.09
Total effect
	IUS-12 → OCS	0.30	0.03	5.01	< 0.001	0.11 to 0.25

SE = standard error, CI = confidence interval, OCS = Obsession with COVID-19 Scale, CRBS = Coronavirus Reassurance-Seeking Behaviors Scale, FCV-19S = Fear of CoronaVirus-19 Scale, IUS-12 = Intolerance of Uncertainty-12 items.

Go to :

DISCUSSION

In this study, we found that our hypotheses were supported, as we observed positive correlations between preoccupation with COVID-19 among frontline nursing professionals and 1) coronavirus-related reassurance-seeking behavior (Hypothesis 1); 2) viral anxiety (Hypothesis 2); 3) intolerance of uncertainty (Hypothesis 3); and 4) adherence to physical distancing (Hypothesis 4). However, our hypothesis that adherence to physical distancing mediated the association between intolerance of uncertainty and preoccupation with COVID-19 (Hypothesis 5) was not supported. Instead, the association was found to be mediated by viral anxiety and reassurance-seeking behavior.

Existing literature have found evidence that intolerance of uncertainty relates to other psychological problems. Intolerance of uncertainty could be related to obsessions or compulsions, and understanding this would help manage anxiety disorder.26 Additionally, intolerance of uncertainty plays a role in individuals experiencing anxiety disorders such as hypochondriacal issues. In our previous study, conducted among healthcare workers during the COVID-19 pandemic, we observed that the intolerance of uncertainty was significantly correlated with an obsession with COVID-19.27 The present study observed the association between the intolerance of uncertainty and obsession with COVID-19 among nursing professionals who work in COVID-19 inpatient units.

A high proportion of participants in this study experienced being quarantined (42.2%) or infected (38.4%). Isolation ward nurses’ frequency of exposure to COVID-19 is much higher than that of the general population owing to the nature of the job. Nurses caring for infected patients in isolation wards are more concerned about infection. Research on coronavirus is still ongoing, and there is uncertainty about its mutation. The uncertainty of the new virus can cause more fear among people with higher anxiety.28 29 This uncertainty of the new virus provokes more anxiety for frontline medical workers and makes them act more obsessively toward COVID-19. Previous research has shown that anxiety in infectious diseases negatively correlates with performance.30 Therefore, intervention regarding frontline nurses’ anxiety is vital for effective patient management.

In this study, viral anxiety and reassurance-seeking behavior mediated the influence of adherence to physical distancing on obsession with COVID-19. Our previous study observed that intolerance of uncertainty directly influenced their viral anxiety, and reassurance-seeking behavior and obsession with COVID-19 mediated this association.27 We confirmed that intolerance of uncertainty might influence the vicious cycle of viral anxiety, reassurance-seeking behavior, and hypochondriacal preoccupation with COVID-19, even among nursing professionals working in COVID-19 inpatient units. As shown in this study, intolerance of uncertainty has direct and indirect effects through mediation on psychological distress in many ways on COVID-19 healthcare workers.31 32 According to a prior study, it can also influence adherence to physical distancing. Moreover, intolerance of uncertainty is reported to have a mediation effect on the fear of COVID-19 toward positivity.33

However, in this study, we observe that adherence to physical distancing did not mediate the influence of intolerance of uncertainty on obsession with COVID-19, contrary to our expectations. Consistent with our previous study conducted among healthcare workers,13 we observed that intolerance of uncertainty directly influenced adherence to physical distancing. However, compliance with physical distancing did not mediate the influence of intolerance of uncertainty on the preoccupation with COVID-19. First, due to the peculiarity of a group of nurses working in the COVID-19 ward, the mediation effect on obsession with COVID-19 may have been insignificant. If the intolerance of uncertainty is more prominent, there is a higher possibility that physical distancing is better followed. However, nurses in the COVID-19 ward are likely to observe social distancing appropriately. This may be related to their professionalism or their working guidelines, or they simply may be overwhelmed with fear and anxiety during the pandemic.34

Second, distancing phobia is a double-edged sword.35 It may be a result of the ambivalence of physical distancing. Thus, it is necessary to distinguish between physical distancing and social distancing phobia. Physical distancing reflects various situations; in this context, physical distancing is a double-edged sword.35 Maintaining good physical distancing can reduce the probability of viral infection, thereby reducing anxiety about viral infection. However, maintaining physical distance can also cause considerable anxiety about virus infection. Previous research on nursing students revealed that those who felt anxious about being infected with COVID-19 tended to adhere to physical distancing.36 Additionally, since the social connection due to physical distancing is weakened and isolated, depression or anxiety may increase. People may also be anxious about social distancing phobia, fear of getting close to others. The mediating effect may not have been well revealed as various attributes are mixed. The COVID-19 pandemic forced many healthcare workers to work in a COVID-19 inpatient ward without adequate training to cope with the pressures. When stressed by environmental factors, they may use negative psychological coping strategies such as hypochondriasis, which can negatively affect their jobs and social lives.37 38

The limitations of this study include the potential for bias in the responses collected through a self-reported, web-based questionnaire. The decision to collect participants’ responses online was made due to the ongoing pandemic and the desire to prevent the transmission of the virus. However, this data collection method may have introduced bias into the results. Further, this study was conducted only at one hospital located in Seoul, implying that the findings cannot be generalized to other locations or populations. The study also did not classify the participants as patient-facing, contact, or frontline healthcare workers, which could have provided valuable information about how the pandemic affected these groups. Furthermore, the study participants were considered clinically vulnerable or living with family or friends who would be regarded as clinically vulnerable, which might have influenced the results. Therefore, the results may not represent the general population or be generalizable to other groups. Given that this study was conducted approximately 2 years after the onset of the pandemic, it may be challenging to accurately capture the participants’ psychological state during the acute phase of the pandemic. This limitation could have affected the ability to confirm the mediating effect definitively.

In conclusion, the study found that preoccupation with COVID-19 among frontline nursing professionals was positively correlated with reassurance-seeking behavior, viral anxiety, intolerance of uncertainty, and adherence to physical distancing. However, the data did not support the hypothesis that compliance with physical distancing would mediate the association between intolerance of uncertainty and preoccupation with COVID-19. Instead, the association was found to be mediated by viral anxiety and reassurance-seeking behavior. These findings provide important insights into the psychological effects of the COVID-19 pandemic on frontline nursing professionals and can inform interventions to support their well-being. It can help reduce anxiety if accurate information is quickly delivered to frontline medical staff as a top priority and can prevent excessive immersion. Additionally, it is essential to deploy medical staff who can cope with infectious diseases on-site and sufficiently train and educate them before deployment to avoid exhaustion. This is also an important aspect that should be considered. The study also highlights the need for organizations to provide resources and support to help mitigate the psychological stress of working during a pandemic on their employees. From the early stages of infectious disease, a psychological support team for medical staff responding to the disease should be established, and periodic evaluations should be conducted to identify high-risk groups. Additionally, sufficient rest time should be provided to prevent excessive distress, and methods for promoting physical and psychological recovery should be taught.

Go to :

Notes

Disclosure: The authors have no potential conflicts of interest to disclose.

Author Contributions:

Conceptualization: Chung SH, Jun JY, Cho EA.
Data curation: Hong JH.
Formal analysis: Kim HR, Park HK.
Investigation: Hong YJ.
Methodology: Park JH.
Software: Hong YJ, Park JH Validation.
Visualization: Kim HR, Park HK.
Writing - original draft: Cho EA, Hong JH, Kim HR, Park HK.
Writing - review & editing: Hong YJ, Park JH, Jun JY, Chung SH.

Go to :

References

1. Gupta S, Sahoo S. Pandemic and mental health of the front-line healthcare workers: a review and implications in the Indian context amidst COVID-19. Gen Psychiatr. 2020; 33(5):e100284. PMID: 34192235.

2. Xu H, Stjernswärd S, Glasdam S. Psychosocial experiences of frontline nurses working in hospital-based settings during the COVID-19 pandemic - a qualitative systematic review. Int J Nurs Stud Adv. 2021; 3:100037. PMID: 34308373.

3. Murat M, Köse S, Savaşer S. Determination of stress, depression and burnout levels of front-line nurses during the COVID-19 pandemic. Int J Ment Health Nurs. 2021; 30(2):533–543. PMID: 33222350.

4. Hernandez JM, Munyan K, Kennedy E, Kennedy P, Shakoor K, Wisser J. Traumatic stress among frontline American nurses during the COVID-19 pandemic: a survey study. Traumatology. 2021; 27(4):413–418.

5. Rector NA, Kamkar K, Cassin SE, Ayearst LE, Laposa JM. Assessing excessive reassurance seeking in the anxiety disorders. J Anxiety Disord. 2011; 25(7):911–917. PMID: 21641764.

6. Warwick HM. A cognitive-behavioural approach to hypochondriasis and health anxiety. J Psychosom Res. 1989; 33(6):705–711. PMID: 2621674.

7. Parrish CL, Radomsky AS. Why do people seek reassurance and check repeatedly? An investigation of factors involved in compulsive behavior in OCD and depression. J Anxiety Disord. 2010; 24(2):211–222. PMID: 19939622.

8. Cho E, Lee D, Cho IK, Lee J, Ahn J, Bang YR. Insomnia mediate the influence of reassurance-seeking behavior and viral anxiety on preoccupation with COVID-19 among the general population. Sleep Med Rev. 2022; 13(2):68–74.

9. Kim HS, Ahn J, Lee J, Hong Y, Kim C, Park J, et al. The mediating effect of reassurance-seeking behavior on the influence of viral anxiety and depression on COVID-19 obsession among medical students. Front Psychiatry. 2022; 13:899266. PMID: 35770057.

10. Lee J, Cho IK, Lee D, Kim K, Ahn MH, Chung S. Mediating effects of reassurance-seeking behavior or obsession with COVID-19 on the association between intolerance of uncertainty and viral anxiety among healthcare workers in Korea. J Korean Med Sci. 2022; 37(21):e157. PMID: 35638193.

11. Jo Y, Shrestha S, Radnaabaatar M, Park H, Jung J. Optimal social distancing policy for COVID-19 control in Korea: a model-based analysis. J Korean Med Sci. 2022; 37(23):e189. PMID: 35698839.

12. Chen L, Wang D, Xia Y, Zhou R. The association between quarantine duration and psychological outcomes, social distancing, and vaccination intention during the second outbreak of COVID-19 in China. Int J Public Health. 2022; 67:1604096. PMID: 35321049.

13. Chung S, Lee T, Hong Y, Ahmed O, Silva WA, Gouin JP. Viral anxiety mediates the influence of intolerance of uncertainty on adherence to physical distancing among healthcare workers in COVID-19 pandemic. Front Psychiatry. 2022; 13:839656. PMID: 35733798.

14. Di Trani M, Mariani R, Ferri R, De Berardinis D, Frigo MG. From resilience to burnout in healthcare workers during the COVID-19 emergency: the role of the ability to tolerate uncertainty. Front Psychol. 2021; 12:646435. PMID: 33935905.

15. Hacimusalar Y, Kahve AC, Yasar AB, Aydin MS. Anxiety and hopelessness levels in COVID-19 pandemic: a comparative study of healthcare professionals and other community sample in Turkey. J Psychiatr Res. 2020; 129:181–188. PMID: 32758711.

16. Chan-Yeung M. Severe acute respiratory syndrome (SARS) and healthcare workers. Int J Occup Environ Health. 2004; 10(4):421–427. PMID: 15702757.

17. Lee SA. How much “Thinking” about COVID-19 is clinically dysfunctional? Brain Behav Immun. 2020; 87:97–98. PMID: 32353520.

18. Choi E, Lee J, Lee SA. Validation of the Korean version of the obsession with COVID-19 scale and the coronavirus anxiety scale. Death Stud. 2022; 46(3):608–614. PMID: 34030606.

19. Lee SA, Jobe MC, Mathis AA, Gibbons JA. Incremental validity of coronaphobia: coronavirus anxiety explains depression, generalized anxiety, and death anxiety. J Anxiety Disord. 2020; 74:102268. PMID: 32650221.

20. Kim C, Ahmed O, Park CH, Chung S. Validation of the Korean version of the coronavirus reassurance-seeking behaviors scale during the COVID-19 pandemic. Psychiatry Investig. 2022; 19(6):411–417.

21. Ahorsu DK, Lin CY, Imani V, Saffari M, Griffiths MD, Pakpour AH. The Fear of COVID-19 Scale: development and initial validation. Int J Ment Health Addict. 2022; 20(3):1537–1545. PMID: 32226353.

22. Hwang KS, Choi HJ, Yang CM, Hong J, Lee HJ, Park MC, et al. The Korean version of Fear of COVID-19 Scale: psychometric validation in the Korean population. Psychiatry Investig. 2021; 18(4):332–339.

23. Freeston MH, Rhéaume J, Letarte H, Dugas MJ, Ladouceur R. Why do people worry? Pers Individ Dif. 1994; 17(6):791–802.

24. Kim S. The relationship of fear of negative and positive evaluation, intolerance of uncertainty, and social anxiety [Unpublished master’s thesis]. Seoul, Korea: Ewha Womans University;2010. p. 26.

25. Gouin JP, MacNeil S, Switzer A, Carrese-Chacra E, Durif F, Knäuper B. Socio-demographic, social, cognitive, and emotional correlates of adherence to physical distancing during the COVID-19 pandemic: a cross-sectional study. Can J Public Health. 2021; 112(1):17–28. PMID: 33464556.

26. Dugas MJ, Gosselin P, Ladouceur R. Intolerance of uncertainty and worry: Investigating specificity in a nonclinical sample. Cognit Ther Res. 2001; 25(5):551–558.

27. Lee J, Cho IK, Lee D, Kim K, Ahn MH, Chung S. Mediating effects of reassurance-seeking behavior or obsession with COVID-19 on the association between intolerance of uncertainty and viral anxiety among healthcare workers in Korea. J Korean Med Sci. 2022; 37(21):e157. PMID: 35638193.

28. Carleton RN, Mulvogue MK, Thibodeau MA, McCabe RE, Antony MM, Asmundson GJ. Increasingly certain about uncertainty: Intolerance of uncertainty across anxiety and depression. J Anxiety Disord. 2012; 26(3):468–479. PMID: 22366534.

29. Millroth P, Frey R. Fear and anxiety in the face of COVID-19: Negative dispositions towards risk and uncertainty as vulnerability factors. J Anxiety Disord. 2021; 83:102454. PMID: 34298237.

30. Lee MH, Kim MY, Go YJ, Kim DR, Lim HN, Lee KH, et al. Factors influencing in the infection control performance of COVID-19 in nurses. J Digit Converg. 2021; 19(3):253–261.

31. Beck E, Daniels J. Intolerance of uncertainty, fear of contamination and perceived social support as predictors of psychological distress in NHS healthcare workers during the COVID-19 pandemic. Psychol Health Med. 2023; 28(2):447–459. PMID: 35792750.

32. Kartal N, Arıkan G, Seyhan F, Aydan S. Mediator roles of resilience and intolerance of uncertainty in the effect of healthcare professionals’ coronavirus stigma on stress. Int J Healthc Manag. 2023; 16(1):120–127.

33. 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 Health Addict. 2021; 19(6):2369–2382. PMID: 32837421.

34. Apisarnthanarak A, Apisarnthanarak P, Siripraparat C, Saengaram P, Leeprechanon N, Weber DJ. Impact of anxiety and fear for COVID-19 toward infection control practices among Thai healthcare workers. Infect Control Hosp Epidemiol. 2020; 41(9):1093–1094. PMID: 32507115.

35. Cho IK, Ahmed O, Lee D, Cho E, Chung S, Günlü A. Intolerance of uncertainty mediates the influence of viral anxiety on social distancing phobia among the general Korean population during the coronavirus disease 2019 pandemic. Psychiatry Investig. 2022; 19(9):712–721.

36. Kim JH, Seo MS, Chung S. The influence of physical distancing, sense of belonging, and resilience of nursing students on their viral anxiety during the COVID-19 era. Psychiatry Investig. 2022; 19(5):386–393.

37. Yusefi AR, Daneshi S, Davarani ER, Nikmanesh P, Mehralian G, Bastani P. Resilience level and its relationship with hypochondriasis in nurses working in COVID-19 reference hospitals. BMC Nurs. 2021; 20(1):219. PMID: 34727947.

38. Jihn CH, Kim B, Kim KS. Predictors of burnout in hospital health workers during the COVID-19 outbreak in South Korea. Int J Environ Res Public Health. 2021; 18(21):11720. PMID: 34770231.

Go to :

TOOLS

Similar articles