Resilience, COVID-19-related stress, anxiety and depression during the pandemic in a large population enriched for healthcare providers
Open accessAbstract
Abstract COVID-19 pandemic is a global calamity posing an unprecedented opportunity to study resilience. We developed a brief resilience survey probing self-reliance, emotion-regulation, interpersonal-relationship patterns and neighborhood-environment, and applied it online during the acute COVID-19 outbreak (April 6–15, 2020), on a crowdsourcing research website ( www.covid19resilience.org ) advertised through social media. We evaluated level of stress (worries) regarding COVID-19: (1) contracting, (2) dying from, (3) currently having, (4) family member contracting, (5) unknowingly infecting others with (6) experiencing significant financial burden following. Anxiety (GAD7) and depression (PHQ2) were measured. Totally, 3042 participants (n = 1964 females, age range 18–79, mean age = 39) completed the resilience and COVID-19-related stress survey and 1350 of them (mean age = 41, SD = 13; n = 997 females) completed GAD7 and PHQ2. Participants significantly endorsed more distress about family contracting COVID-19 (48.5%) and unknowingly infecting others (36%), than getting COVID-19 themselves (19.9%), p < 0.0005 covarying for demographics and proxy COVID-19 exposures like getting tested and knowing infected individuals. Patterns of COVID-19 related worries, rates of anxiety (GAD7 > 10, 22.2%) and depression (PHQ2 > 2, 16.1%) did not differ between healthcare providers and non-healthcare providers. Higher resilience scores were associated with lower COVID-19 related worries (main effect F1,3054 = 134.9; p < 0.00001, covarying for confounders). Increase in 1 SD on resilience score was associated with reduced rate of anxiety (65%) and depression (69%), across healthcare and non-healthcare professionals. Findings provide empirical evidence on mental health associated with COVID-19 outbreak in a large convenience sample, setting a stage for longitudinal studies evaluating mental health trajectories following COVID-19 pandemic.
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Stressful events are inherently highly emotional and can increase vulnerability to psychopathology; the ability to regulate emotions may be a critically important factor in determining stress resilience and mental wellbeing.
“As stressful events are inherently highly emotional (Southwick et al., 2011) and can increase vulnerability to psychopathology (Grueschow et al., 2021), the ability to regulate emotions may be a critically important factor in determining stress resilience (Barzilay et al., 2020; Kaldewaij et al., 2021) and mental wellbeing (Satchit et al., 2011; Silton et al., 2020).”
From Mindfulness-Based Stress Reduction Increases Mental Wellbeing and Emotion Regulation During the First Wave of the COVID-19 Pandemic: A Synchronous Online Intervention Study (2021) · cites this paper as Barzilay et al., 2020
The Resilience survey section (page not available) includes emotion regulation among five components of the resilience score. The Results section (page not available) links the composite score to fewer COVID-19 worries, but does not test whether emotion regulation itself determines stress resilience or establish a causal role. (LLM, conf=0.83)
Experimental — accuracy not yet measuredTrait optimism and trait resilience may serve as buffers against the effects of pandemic-related distress.
“Research further suggests that trait optimism and trait resilience may serve as buffers against the effects of pandemic-related distress (Taylor, 2019; Barzilay et al., 2020; Paredes et al., 2021).”
From Predicting the Severity of Symptoms of the COVID Stress Syndrome From Personality Traits: A Prospective Network Analysis (2021) · cites this paper as Barzilay et al., 2020
The Results report that higher resilience scores were associated with fewer COVID-19 worries and lower anxiety and depression; the Discussion describes a possible buffering effect. The paper does not report measuring trait optimism or show that optimism has a buffering effect. (LLM, conf=0.89)
Experimental — accuracy not yet measuredEven fewer studies have focused on resilience during the 2020 pandemic.
“To our knowledge, to date, few studies focused on positive outcomes during the 2020 pandemic [25, 26] and even fewer on resilience [27, 28].”
From Factors impacting resilience as a result of exposure to COVID-19: The ecological resilience model (2021) · cites this paper as [27]
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“As a result, the pandemic has created not only the “perfect storm” for an augmentation of anxiety and depression (Barzilay et al., 2020; Lakhan et al., 2020; Prete et al., 2020; Salari et al., 2020; Boden et al., 2021), which increased through the two lockdown periods (Lu et al.”
Background
- Authors
- Barzilay, R., Moore, T. M., Greenberg, D. M., DiDomenico, G. E., Brown, L. A., White, L. K., Gur, R. C., & Gur, R. E.
- Affiliations
- Children's Hospital of Philadelphia (US)
- Bar-Ilan University (IL)
- University of Pennsylvania (US)
- Corresponding author
- Barzilay, Ran
- ORCID
- Venue
- Translational Psychiatry
- Published
- 2020-08-20
- Volume
- 10
- Issue
- 1
- Pages
- 291-291
- ISSN
- 2158-3188 (ISSN-L)
- PMC
- PMC7439246
- OpenAlex
- W3062617766
- Cited by
- 634
- References
- 30
- Citations by year
- 2026: 13 · 2025: 31 · 2024: 52 · 2023: 114 · 2022: 195 · 2021: 206 · 2020: 22 · 2013: 1
- FWCI
- 53.74
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Translational Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Health & Human Services | NIH | National Institute of Mental Health (K23-MH120437, R01-MH117014, R01-MH119219)
- Topics
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Social Sciences › Psychology › Clinical Psychology › Resilience and Mental Health
- Keywords
- COVID-19 pandemic, resilience, COVID-19 stress, anxiety, depression, healthcare workers, self-reliance, emotion regulation, interpersonal relationships, neighborhood environment, financial burden, mental health
- MeSH terms
- Betacoronavirus, COVID-19, SARS-CoV-2, Adolescent, Adult, Aged, Anxiety, Depression, Female, Health Personnel, Humans, Male, Middle Aged, Pneumonia, Viral, Surveys and Questionnaires, Regression Analysis, Stress, Psychological, Coronavirus Infections, Resilience, Psychological, Young Adult, Pandemics, Social Media
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