As a result of this cross-sectional, controlled study, coronaphobia was determined at a statistically significantly higher level in the FMS patients than in the control group. The combination of FMS and anxiety disorders is well known. Previous studies have shown that FMS patients are affected more than healthy individuals by concerns and anxiety triggered by stress factors.16
Several studies have shown that the majority of patients with FMS have various psychosocial problems and psychiatric disorders including depression, anxiety, somatization and phobias.17 It has been stated in literature that 19.4%-34.8% of FMS patients have emotional disorders, and 11.6 %-32.2% have anxiety and anxiety disorders. Uğuz et al. reported that specific phobias are seen more frequently in FMS patients but there are insufficient studies that have investigated specific phobia types in FMS.18 To the best of our knowledge, this is the first study to have examined coronaphobia in FMS patients. In addition to the physical threat and destruction caused by COVID-19, it has led to stress reaction and trauma created by what has been experienced related to the disease, making it necessary to consider the process and its aftermath from a psychological aspect. When the WHO declared the disease a pandemic, precautions started to be taken globally. Preventative measures such as mandatory isolation, quarantine and temporary closures of schools and businesses implemented by governments and health authorities, although necessary to prevent the spread of infections and reduce the effects on healthcare systems, gave rise to and fed fear and anxiety. These precautions are known to have negative psychological, psychosomatic, social, and economic results. Especially as the debates related to the treatment process, an effective vaccine and the routes of virus transmission have not reached a clear conclusion, this pandemic has created fear, anxiety and desperation in people and this has been reported to have negative effects on behavior.19 In addition to environmental conditions, specific phobias may emerge associated with the existing psychological status, diseases, temperament, genetic and physiological precursors.10 It is thought that the psychological status, temperament, and personal characteristics of FMS patients facilitate the development of specific phobias.20-23 The difficulties experienced by FMS patients because of the COVID-19 pandemic in many activities, exercise, and accessing regular medical treatment are thought to have increased anxiety and phobic reactions.
In a study by Haktanir et al,24 there was reported to be no difference between patients with and without chronic disease in respect of fear of COVID-19. In that study, the Fear of COVID-19 Scale was used in the evaluation of the fear of COVID-19, but individuals previously diagnosed with anxiety were excluded from the evaluation. Therefore, it cannot be said to reflect the general population. In the current study, the results demonstrated that the presence of FMS as a chronic disease increased the risk of coronaphobia.
It has been reported from several countries that the COVID-19 pandemic has significant psychological, social and economic negative effects. The negative psychological effects of COVID-19 started to be investigated first in China where the pandemic first occurred and then in countries such as Italy and Spain where severe effects of the pandemic were seen.25-27 In a study conducted on 7143 university students in China after the COVID-19 outbreak, symptoms of anxiety were reported to have been experienced by 0.9% of the students at an intense level, at a moderate level by 2.7%, and at a mild level by 21.3%.25 Similarly in another study in China of 1210 individuals, the psychological effects of the pandemic were examined and it was reported that 16.5% of the participants showed symptoms of depression from a moderate to severe level, 28.8% had moderate to severe level anxiety symptoms, and 8.1% showed moderate to severe level stress symptoms.28 A study of 3550 adults conducted over the internet in Spain determined anxiety disorder in 32.4% of the respondents, depression in 44.1%, and stress disorder in 37%.29 To examine the effect of the pandemic and quarantine period on psychological health, Rossi et al27 conducted an online questionnaire with 18147 respondents in Italy, and reported that post-traumatic stress symptoms were seen in 37%, anxiety symptoms in 20.8%, depression symptoms in 17.3%, sleep problems in 7.3%, and perceived high levels of stress in 21.8%.27 In the current study, a significant difference was found in the psychological and psychosomatic phobia parameters in the FMS patient group. The anxiety and fear created by the nature of the pandemic can also affect interpersonal relationships in daily life. For example, more than half of the people who quarantined with the suspicion that they had been in contact with a SARS-infected person reported that weeks later they tried to distance themselves from anybody who sneezed or coughed, 26% stayed away from crowded or indoor places, and 21% avoided all areas open to the public.30,31 In the current study, the social phobia parameters were found to be high in the FMS patient group. The economic parameters in the current study were also found to be high in the FMS patients of the current study for reasons such as having to continue with existing work, not going to work because of social isolation, being made redundant, and difficulties finding new work.
For the evaluation of specific phobias, it is recommended to use evaluation questionnaires specific to that fear. Thus, a need arose for evaluation of the fear of COVID-19 and different scales have been developed for this.32 In the current study, the C19P-S questionnaire was used, which was developed to evaluate coronoaphobia. The C19P-S has been tested for validity and reliability in a Turkish population. A previous review showed that the C19P-S is one of the few scales that attempts to comprehensively evaluate mental health problems related to COVID-19.33 In a study by Celenay et al. using the C19P-S, the levels of coronaphobia were compared in subjects who stayed at home during the pandemic and those who continued to work. However, apart from those with severe psychological problems, other health problems were not taken into consideration.34 It is possible that the presence of additional diseases has an effect on coronaphobia. A substantial amount of evidence has been shown that the COVID-19 pandemic has deep psychological and social effects. The psychological sequelae of the pandemic will probably continue for months and years in the future.35 Therefore, in this extraordinary situation in which we find ourselves, it is vital that individuals with a predisposition to psychological disorders are identified from different groups, and thus with the implementation of appropriate psychological strategies, techniques and interventions, the mental health of the general population can be protected and improved.36 The determination of COVID-19 phobia, and the provision of timely psychological support are important to be able to keep FMS disease under control.37,38
The most important limitations of this study were the cross-sectional design and limited number of cases. Therefore, it is not possible to provide information about why coronaphobia is seen more often in FMS patients or what causes the development of coronaphobia in FMS. Consequently, there is a need for further studies to show the cause and effect relationships.