The morbidity and mortality rates due to COVID-19 are increasing gradually. The current number of COVID-19 cases worldwide is approximately 140 million and the number of deaths is about 3 million (26). In Turkey, the current number of cases is approximately 4 million and the number of deaths about 35.000 (27). Due to the inability to control the pandemic, these numbers are increasing even more. These high number of cases show the fatality and severity of the pandemic as a global health problem. On the other hand, the psychosocial problems experienced by COVID-19 survivors are also increasing. According to official data in our country, 49% of COVID-19 cases are women and 51% are men (39). Studies conducted in China and Italy have also found that COVID-19 cases are more common in men (40, 41). However, no study has been found in the literature demonstrating that statistically significant relationship between the gender factor and COVID-19. Contrary to these results, in our study, COVID-19 cases was found more common in female (54.9%). On the other hand, percentage of female was also higher in participants (53.3%) who have notCOVID-19. There was no relationship between gender and COVID-19. Another important result of study was that COVID-19 cases were found to be significantly lower in people who are married and have a regular income. This result was interpreted as a regular personal and business life style could be more protective for COVID-19.
There are studies reporting that generalized anxiety levels are high in the general population due to COVID-19 outbreak (6, 28). Consistent with these results, also in our study generalized anxiety levels were found to be high. Especially in COVID-19 survivors, anxiety levels were found to be higher. In addition, the severity of anxiety symptoms was higher also in this group. A significant relationship has been found between COVID-19 disease and generalized anxiety. This result was interpreted as the psychosocial and economic problems experienced due to COVID-19, caused anxiety in people's private and social life.
Post-traumatic stress symptoms are manifested with ‘avoidance’ (the tendency to avoid thoughts or reminders about the event), ‘intrusion’ (difficulty in staying asleep, dissociative experiencing, similar to flashbacks) and ‘hyperarousal’ (irritated feeling, angry, difficulty in sleep onset) (18). Studies conducted during the COVID-19 pandemic found that PTSS increased (8, 29, 30). Additionally, in other study, PTSS were reported to be higher in COVID-19 patients (5). PTSS were found to be higher in the both groups in our study. On the other hand, there was no significant difference between the groups. This result indicate that people who have not had COVID-19 experienced post-traumatic stress as much as COVID-19 survivors. Furthermore, it was found that ' hyperarousal’ was higher in COVID-19 survivors. This result may be due to increased irritability in COVID-19 survivors due to the negative psychological effects experienced during the illness.
Coronavirus anxiety refers to the dysfunctional anxiety associated with the COVID-19 outbreak (9). In a study conducted in normal population, the rate of coronavirus anxiety was found to be 54.8% and in a study conducted with a group of healthcare workers consisting of nurses, it was found to be 37.8% (31, 32). In our study, the rates of coronavirus anxiety were found to be 21.2% in COVID-19 survivors and 34.5% in people who have not had COVID-19. The corona anxiety, which we expect to be higher in COVID-19 survivors, but lower in our results, may be the thought that they are immune to the disease and therefore will not have COVID-19.
Studies have shown that there is a positive relationship between stress caused by the COVID-19 pandemic and psychological disorders (33, 34). The ability to cope with stress effectively can be defined as reducing or eliminating psychological distress associated with stressors (11). It has been found that individuals who can effectively cope with stress use active/effective coping styles more (14). There are studies in which positive relationships have been found between passive/ineffective coping style and psychopathology (35, 36). In our study, it was found that COVID-19 survivors more used 'seeking of social support' from effective coping styles, and 'helpless' style from ineffective coping styles, compared to people who have not COVID-19. This result was evaluated as the COVID-19 survivors had personal difficulties in coping with stress, experienced helplessness and preferred social support to cope with problems.
During COVID-19 outbreak, governments of many countries implemented several preventive restrictions to controlling the spread of the infection, including careful infection control, contact tracing, social distancing, isolation, confinement and quarantine. The quality of life of people has affected due to the negative psychosocial and economic consequences caused by these restrictions. In limited studies during current outbreak, it has been found that the COVID-19 pandemic has influenced the QOL of individuals in various aspects (37, 38). In the study, the QOL levels of the participants were found to be low in all domains. Furthermore, COVID-19 survivors had poorer QOL, particularly in the social relationships and environmental-TR domains. Additionally, COVID-19 survivors had lower scores in the items of self-perception of overall QOL and self-perception overall health. This result can be evaluated as the result of the decrease in social and environmental interaction between people due to the restrictions related to the pandemic.
In the study it was evaluated that the relationship between corona anxiety, generalized anxiety and post-traumatic stress factors, which assessed separately and in detail in the study groups, a negative relationship was found between generalized anxiety and corona anxiety in both groups. This was a conclusion consistent with our findings, that is COVID-19 survivors had higher level of generalized anxiety and lower level of corona anxiety, while those who have not had COVID-19 had higher level of corona anxiety and lower level of generalized anxiety. This result was interpreted as corona anxiety is a specific anxiety and it is perceived in a different pattern from generalized anxiety. On the other hand, a positive relationship was found between post-traumatic stress with corona anxiety and generalized anxiety. This result can be evaluated as a reflection of the positive interaction between anxiety and stress factors.
This study had some limitations. First, because of the cross-sectional design of our study, the results shown the psychological impact within limited period of pandemic. The extent of these psychological impacts can be revealed more clearly with a longitudinal study. Second, because the study was conducted at a single center and in limited population, therefore the power of the study was lower. The results of a multi-center study with a larger samples will reflect the general population at a higher rate. Third, due to the design of the study, the temporal variation of psychosocial effects could not be evaluated. Studies in prospective or case-control design will reduce this limitation. Despite some limitations, our study is one of the limited studies in the literature and our findings will provide useful information for future study.
The COVID-19 pandemic has caused serious threats to people’s physical and mental health. Considering that the pandemic is still uncontrollable and the number of cases is increasing every day. The number of COVID-19 survivors, suffering from the psychosocial impacts of the pandemic, will increase even more. In parallel with this, in the study was found that COVID-19 survivors had higher levels of anxiety and stress and lower QOL. Having effective coping strategies for stressful events can prevent experiences that lead to possible psychiatric disorders. The results in our study show that people need more competence in coping with stress. Another important result of our study is that COVID-19 survivors need more social and environmental support. Our findings can be used to construct a psychosocial intervention directed toward COVID-19 survivors and to implement public mental health strategies. Psychosocial support and guidance services should be provided in cooperation with health administrators, public health officials, psychiatrists, psychologists, social workers, psychological support units and social support teams.