On March 4, 2020, the first cases of the coronavirus disease were announced in Hungary. One week later, the World Health Organization (WHO) declared COVID-19 as a global pandemic . The Hungarian government ordered a ban on outdoor public events with more than 500 people and indoor events with more than 100 participants to reduce contact between people . On March 27, the government imposed a nationwide lockdown for two weeks effective from March 28, to mitigate the spread of the pandemic. Except for food stores, drug stores, pharmacies, and petrol stations, all other shops and educational institutions remained closed. On April 16, a week-long extension was further announced .
The COVID-19 pandemic with its high morbidity and mortality has already afflicted the psychological and physical wellbeing of humans worldwide [4–9]. During major life changes, people may have to deal with more stress. Stress can negatively affect the population’s well-being or function when they construe the situation as stressful and they cannot handle the environmental stimuli . Health anxiety is one of the most common types of anxiety. It occurs -to a certain degree- in almost everyone’s life and can be rather deleterious when it is excessive. Health anxiety is alarming when someone’s life is affected in more aspects or when it interferes with daily life by making people misinterpret somatic sensations, leading them to think that they have an underlying condition .
Illness anxiety disorder is described as a preoccupation with acquiring or having a serious illness. Somatic symptoms are not present or if they are, then only mild in intensity. The preoccupation is disproportionate or excessive if there is a high risk of developing a medical condition (e.g., family history) or the patient has another medical condition. Excessive health-related behaviors can be observed (e.g., checking body for signs of illness) and individuals can show maladaptive avoidance as well by avoiding hospitals and doctor appointments .
Health anxiety is indeed an important topic as both its increase and decrease can progress to problems . Looking at health anxiety as a wide spectrum, it can be high or low . While people with a higher degree of worry and checking behaviors may cause some burden on healthcare facilities by visiting them too many times (e.g., frequent unnecessary visits), other individuals may not seek medical help at healthcare units in order to avoid catching up infections for instance. A lower degree of health anxiety can lead to low compliance with imposed regulations made to control a pandemic .
The COVID-19 pandemic as a major event in almost everyone’s life has posed a great impact on the population’s perceived stress level. Several studies about the relation between coping and response to epidemics in recent and previous outbreaks found higher perceived stress levels among people. Being a woman, low income, and living with other people related to higher stress levels. Protective factors like being emotionally more stable, having self-control, adaptive coping mechanisms, and internal locus of control were also addressed. The findings indicated that the COVID-19 crisis is perceived as a stressful event. The perceived stress was higher amongst people than it was in situations with no emergency. According to the Perceived Stress Scale (PSS) mean values, nervousness, stress, and the loss of control of one’s life are the factors that are most connected to perceived stress levels which leads to the suggestion that unpredictability and uncontrollability take an important part in perceived stress during a crisis. Certain coping styles (e.g., having a positive attitude) were associated with less psychological distress experiences but avoidance strategies were more likely to cause higher levels of stress [15–18].
According to Lazarus (1999), individuals differ in their perception of stress if the stress response is viewed as the interaction between the environment and humans . An Individual can experience two kinds of evaluation processes, one to appraise the external stressors and personal stake, and the other one to appraise personal resources that can be used to cope with stressors [19, 20]. If there is an imbalance between these two evaluation processes, then stress occurs, because the personal resources are not enough to cope with the stressor’s demands . Perceived stress can be also affected by personality traits.
A recent study in Hunan province in China found that the most effective factor in coping with stress among medical staff was the knowledge of their family’s well-being . Although there have been several studies about the mental health of hospital workers during the COVID-19 pandemic or other epidemics (e.g., SARS, MERS) [22–25], only a few studies from recent literature assessed the general population’s coping mechanisms. According to Gerhold (2020) , older people perceived lower risk of COVID-19 than younger people. Also, women have expressed more worries about the disease than men did. Coping strategies were highly problem-focused and most of the participants reported that they listen to professionals’ advice and tried to remain calm . In the same study, most responders perceived the COVID-19 pandemic as a global catastrophe that will severely affect a lot of people. On the other hand, they perceived the pandemic as a controllable risk that can be reduced. Dealing with macrosocial stressors takes faith in politics and in those people, who work with COVID-19 on the frontline.
According to the Centers for Disease Control and Prevention (CDC) recommendation, the ways to cope with stress in this current crisis of COVID-19 is to take breaks from watching, reading, or listening to news stories, including social media, as hearing about the pandemic repeatedly can be upsetting . Taking care of the body, taking deep breaths, stretching, and meditating, eating healthy, regularly exercising, getting plenty of sleep, and avoiding alcohol and drugs can also reduce stress .
In our present study, we aimed at assessing levels of health anxiety, perceived stress, and coping style among university students, amid the COVID-19 crisis and lockdown in Hungary. We hypothesized the following: (i) Students who use problem-focused coping styles are more resilient to psychosocial stressors than those who use emotion-focused ways to cope with stress, (ii) Emotion-focused strategies would be more frequently used by women than men. And (iii) we assumed that the results would be independent of the country of origin (Hungarian vs International).