When altruists cannot help: The influence of altruism on mental health during COVID-19 pandemic

doi:10.21203/rs.3.rs-25715/v1

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When altruists cannot help: The influence of altruism on mental health during COVID-19 pandemic

https://doi.org/10.21203/rs.3.rs-25715/v1

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published 10 Jul, 2020

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Background The positive predictive effect of altruism on physical and psychological well-being has been extensively demonstrated in previous studies, but few studies have examined the effect of altruism on negative mental health outcomes when altruists cannot perform altruistic behaviors. This study explored the influence of altruism on negative affect and mental health (anxiety and depression) during the outbreak of the COVID-19 pandemic, when people self-isolated at home in China.

Method: College students were recruited via a cross-sectional online survey during the outbreak of COVID-19 in China. Self-reported perceived risk, altruism, negative affect, anxiety and depressive symptoms were measured using the Self-Report Altruism Scale (SRA), the Positive and Negative Affect Schedule (PANAS), the 7-item Generalized Anxiety Disorder Scale (GAD-7) and the 9-item PHQ depression scale (PHQ-9). A structural equation model was used to analyze the mediating and moderating effects on mental health.

Results The final sample comprised 1346 Chinese participants (Mage = 19.76 ± 2.23 years, 73% female). Overall, the higher risk people perceived, the more negative affect they exhibited (β = 0.16, p < .001); thus, the more anxious and depressed they felt (β = 0.134, p < .001), but this relationship between risk perception and negative affect was moderated by altruism. Paradoxical to previous studies, the increase in negative affect associated with increased perceived risk was pronounced among individuals with high altruism ( t = 7.68, p < .001).

Conclusions Individuals with high altruism exhibited more negative affect, indirectly increasing their anxiety and depressive symptoms. The findings enrich the theory of altruism and provide valuable insight into the influence of altruism on mental health during the COVID-19 outbreak.

Health Economics & Outcomes Research

Infectious Diseases

Psychology

Psychiatry

Altruism

Mental health

Negative affect

Perceived risk

COVID-19

Coined as a “once-in-a-century pandemic”, COVID-19 has been an ongoing global emergency due to its high mortality rate and widespread contagion [1]. In the face of the health threat of COVID-19, people have predictable threat responses, including fear, anxiety, depression, panic shopping, and xenophobic tendencies [2]. However, not everyone responses in the same way. A number of psychological factors shape people’s different threat reactions, including risk perception, personality traits, and social support [3].

Risk perception and mental health

Stress-appraisal theory (Lazarus and Folkman, 1984) proposed that the perceived threat of a health risk depends on perceived vulnerability to that risk and the ability to cope with it [4]. COVID-19 has evoked a widespread and worldwide threat to health due to vulnerability to the virus or difficulty coping with it. Research on risk perception and mental health in cases of emerging infectious disease is still relatively limited. Although perceived risk is not the same as actual risk in most cases, it leads to negative emotions and mental health outcomes, such as anxiety and depression [5, 6]. It is urgent to investigate the influence of risk perception on negative emotion and public mental health during the COVID-19 pandemic.

Altruism and mental health

As an important concept in social psychology, altruism is highly valued for its significant importance to human evolution and the development of human civilization [7]. Altruism was first defined by Comte as “an unselfish regard for the welfare of others” [8], which contained two core concepts: empathy (altruistic attitude) and prosocial behavior (altruistic behavior). To date, a dominant perspective for understanding altruism has suggested that altruists receive instant or long-term physical and psychological benefits from engaging in altruistic activities [9]. Altruistic behavior is associated with reduced aggression, better physical and mental health, longevity, and improved well-being [10–12].

Empathy is widely considered an essential premise for altruistic behavior [13]. Nonetheless, few studies have explored the psychological outcomes if altruists with empathy cannot perform altruistic behaviors under specific circumstances. The outbreak of COVID-19 provides the context that most people in China self-isolated at home under the policy of social distancing. All altruists could do was remain at home and access COVID-19-related information on social media instead of going out to perform direct altruistic behaviors during the pandemic. A neglected possibility is that altruism may not serve as a protective factor for mental health against the threat of COVID-19 during the self-isolation period. We predicted that compared to individuals with low altruism, those with high altruism may feel more anxious due to their empathy towards infected patients and more depressed due to their helplessness towards others. However, to our knowledge, current research provides no guidance on altruists’ psychological responses in this situation.

Underlying mechanism of altruism on mental health

These is no consensus among researchers on the underlying mechanisms behind the association of altruism and mental health. A theoretical distinction is that altruism affects mental health through increased positive mood or decreased negative mood. Some studies propose that altruism serves as an accelerator of elevated positive mood [14, 15], whereas other studies argue that altruism serves as a buffer against negative mood [16]. The outbreak of COVID-19 provided a natural research context for this controversy. As we assume above, people with high altruism may have more negative mental health outcomes (anxiety and depression) in the self-isolation period, which could verity the mediating mechanism of positive or negative emotion.

Aims of this study

This article focuses on health psychology to formulate a theoretical model of psychological responses to the COVID-19 threat. First, we examine the effect of individual perceived risk on public mental health outcomes, including anxiety and depressive symptoms. Second, we attempt to extend altruistic norms from a different perspective by examining the effect of altruism on emotional outcomes with a focus on conditions in which altruistic behavior cannot occur. Finally, we clarify the underlying mechanism of altruism on mental health through an examination of the mediating effect of positive and negative emotion on mental health.

Participants and sampling

The study was a cross-sectional design conducted during the outbreak of COVID-19 (February 8–28, 2020). Simple cluster sampling was used to construct the sample. College students from a Beijing university were recruited to complete an online questionnaire when they self-isolated at home in any city in China under the policy of social distancing. Participants who met the following criteria were included: (1) Chinese students; (2) able to understand Chinese; and (3) the participant or family members were not infected by COVID-19.

Ethical approval and consent

Participants were informed about the purpose and procedures of this study via an online WeChat leaflet before the investigation. Informed written consent was provided at the beginning of the questionnaire for all participants. The research protocol was approved by the Research Ethics Review Committee of Beijing Normal University, China.

Measures

Participants clicked their consent to complete an online survey on “College Students’ psychological responses to COVID-19”. The survey consisted of a series of scales and demographic information. Demographic measures included age, gender, ethnic group, and location.

Perceived risk of COVID-19

Individual perceived risk was assessed by three items. Two items were related to perceived vulnerability to COVID-19 (e.g., “How likely do you think it is that you will be infected by COVID-19?” and “How likely do you think it is that your family members/relatives/friends will be infected by COVID-19?”) with an 11-point scale from 0–100%. The other item was related to the ability to cope with this pandemic through the question “How long do you think it will take to go back to normal life in your area?” Participants were given five choices (1 = within 1 month; 2 = 2–3 months; 3 = 4–6 months; 4 = 7–12 months; 5 = more than 1 year). Responses to these items formed the composite score for perceived risk (α = .70), with higher scores indicating greater perceived risk.

Altruism

The self-reported altruism scale was adapted from Rushton, Chrisjohn and Fekken with 20 items about altruistic behaviors (e.g., “I have helped push a stranger’s car out of the snow.”) [17]. Participants clicked the option that best conformed to their past acts using a 5-point scale (1 = never; 2 = once, 3 = more than once; 4 = often; 5 = very often). We created an altruism composite (α = .89), with higher scores indicating higher altruism.

Positive and negative affect

The Positive and Negative Affect Scale (PANAS) with 20 items was used to measure emotional outcomes [18]. It comprised two scales, a 10-item positive affect scale (e.g., enthusiastic, excited, inspired) and a 10-item negative affect scale (e.g., afraid, upset, distressed). Previous studies regarded positive and negative affect as two dominant and relatively independent dimensions, rather than as two poles on the same continuous scale [18, 19]. Participants were asked to answer the question “How did you feel over the past two weeks?” on a 5-point scale (1 = very slightly or not at all; 2 = a little, 3 = moderately; 4 = quite a bit; 5 = extremely). Positive (α = .92) and negative (α = .94) affect composites were created separately, with higher scores indicating higher positive or negative emotions.

Mental health

The latent variable “mental health” was constructed as an outcome variable through anxiety and depressive symptoms, which are widely used indicators to assess individual mental health. The 7-item Generalized Anxiety Disorder Scale (GAD-7) was used to assess anxiety symptoms [20]. Participants were asked about the frequency of occurrence of anxiety symptoms over the past two weeks on a 4-point Likert scale (1 = not at all; 2 = several days, 3 = more than half the days; 4 = nearly every day). The anxiety composite was created (α = .92), with higher scores indicating greater severity of anxiety symptoms. Similar to the measure of anxiety symptoms, depressive symptoms were measured through the 9-item PHQ depression scale (PHQ-9) [21]. Each item assessed the frequency of occurrence of depressive symptoms over the past two weeks on a 4-point scale from 1 (not at all) to 4 (nearly every day). We computed the depression composite (α = .89). Higher scores indicated more severe depressive symptoms.

Data analysis

We used the Shapiro-Wilk test to examine the normality of continuous variables. The comparisons of demographic characteristics between participants with and without anxiety symptoms as well as those with and without depressive symptoms were appropriately performed by t-test and chi-square test. Spearman correlations between the variables measured above were calculated. Hypothesized moderating and mediating effects were examined by structural equation modeling (SEM) using Mplus software, version 8.0.

Background characteristics and Covariates

A total of 1,493 questionnaires were distributed, and 1,346 participants completed the survey. The response rate was 90.15%. The final sample comprised 1,346 participants: 364 (27%) were male (mean age = 19.69, SD = 2.30), 982 (73%) were female (mean age = 19.79, SD = 2.21); 1143 (84.9%) were Han nationality (mean age = 19.81, SD = 2.32), and 203 (15.1%) were other ethic groups (mean age = 19.48, SD = 1.66). Table 1 shows summary statistics for the background characteristics.

-------------Insert Table 1 around here----------------

Correlations between mental health and other variables

Table 2 shows the results of Spearman correlations between perceived risk, altruism, positive affect, negative affect, anxiety and depressive symptoms. Significant correlations were found between anxiety symptoms and perceived risk (r = 0.17, p < .01), positive affect (r = -0.27, p < .01) and negative affect (r = 0.57, p < .01); depressive symptoms significantly correlated with perceived risk (r = 0.18, p < .01), positive affect (r = -0.42, p < .01), negative affect (r = 0.54, p < .01) and anxiety symptoms (r = 0.67, p < .01).

----------------Insert Table 2 around here---------------

Moderation of altruism

We ran a SEM and path analysis method to test our moderation hypothesis, with perceived risk as a predictor and altruism as a moderator. Gender, age and ethnicity were controlled as covariates in the SEM. We separately examined the moderating effect on positive affect, negative affect and the mental health latent variable.

First, we report the results for positive affect. We found that there was no interaction effect of altruism and perceived risk on positive affect (β = 0.05, 95% CI = [-0.11, 0.11], p > .05).

Second, we report the results for negative affect. There was no main effect of altruism on negative affect (β = 0.02, 95% CI = [-0.02, 0.07], p > .05). We found a main effect of perceived risk on negative affect (β = 0.17, 95% CI = [0.12, 0.21], p < .001). However, altruism moderated this main effect, as indicated by a significant interaction of altruism and perceived risk on negative affect (β = 0.10, 95% CI = [0.03, 0.16], p < .05). Figure 1 shows the results of the moderating effect of altruism on negative affect. As illustrated in Fig. 1, at high levels of altruism (1 SD above the mean), greater perceived risk predicted greater negative affect (t = 7.68, 95% CI = [0.55, 0.94], p < .001). However, at low levels of altruism (1 SD below the mean), the relationship between perceived risk and negative affect was attenuated (t = 2.41, 95% CI = [0.05, 0.50], p < .001). In addition, the moderating role of altruism on negative affect is mainly driven by individuals who perceived high risk of COVID-19. Among people who perceived low risk of COVID-19, those with high altruism demonstrated the same level of negative affect (M = -2.16, SD = 6.70) as those with low altruism (M = − .99, SD = 6.88), t = -0.934, p > .05. However, among people who perceived high risk of COVID-19, those with high altruism exhibited significantly greater negative affect (M = 5.80, SD = 9.36) than those with low altruism (M = -2.09, SD = 5.85), t = 3.2, p < .01.

Finally, we report the results for the latent mental health variable. The main effect of perceived risk on mental health was significant (β = 0.25, 95% CI = [0.17, 0.32], p < .001). Nevertheless, we found no main effect of altruism on mental health (β = -0.00, 95% CI = [-0.06, 0.02], p > .05) but a significant interaction effect of altruism and perceived risk on mental health (β = 0.13, 95% CI = [0.05, 0.21], p < .001).

----------------Insert Fig. 1 around here---------------

Mediation of negative affect

We conducted a SEM to test our mediation hypothesis regarding whether the interaction of perceived risk and altruism on mental health was mediated by negative affect. We have tested that there was no interaction of perceived risk and positive affect above, so we regarded negative affect as the only mediator in the model.

In summary, the moderating effect of altruism was completely mediated by negative affect, which suggests that when people perceive high risk of COVID-19, those with high altruism may show worse mental health outcomes because they may experience greater negative affect.

----------------Insert Fig. 2 around here---------------

This study investigated the moderating role of altruism and the mediating role of negative affect on mental health during the outbreak of COVID-19 in China. Our results showed that altruism was associated with increased anxiety and depressive symptoms, particularly when people perceived higher risk of the virus. Negative affect provided an indirect path for altruism on mental health, which suggested that altruism played a moderating role in worse mental health through the increase of negative affect.

Implications

The COVID-19 pandemic has presented a global health risk to humans. Most people perceive the threat of the virus in both frontline and low-risk areas, which leads to generalized fear and fear-induced behavior. In addition, people who perceive high risk are more likely to show anxiety and depressive symptoms [22]. Our results verify the positive association of perceived risk and worse mental health. We provide empirical evidence for psychological inventions in public health during the pandemic.

Altruism has been understood as an important protective factor for mental health in previous studies [9, 23–25], while few studies have found a negative effect on mental health under specific circumstances. Our study presents a paradox in which altruism is associated with negative emotion and worse mental health outcomes when altruistic norms exist in the condition that altruistic behavior cannot occur. This result is consistent with the theory that altruism contains two core concepts: attitude and behavior [8]. There are two possible explanations for this phenomenon. On the one hand, COVID-19 first emerged in Wuhan, Hubei Province, China, and thousands of citizens were infected. The severity of this disease was much higher than that of SARS in 2003 or H1N1 in 2009. The Chinese government called for self-isolation and social distancing during the outbreak of the pandemic. Altruists who perceived the high risk of this pandemic could not go out to help others who were in dilemma, which might reduce their self-efficacy and increase their feelings of helplessness and other negative emotions. On the other hand, altruists generally feel empathy; thus, if they perceived that the risk was very high, they might feel sorry and sad for those infected by the virus, which might increase their negative emotions. Briefly, the strong benefits of altruism are based on the premise that altruistic behavior exists.

There has been debate about the mechanism of altruism on mental health via the path of increased positive emotion, decreased negative emotion or both [15]. Our study provides evidence for either or both paths by examining altruism as a moderator. There was a significant interaction of altruism and perceived risk on negative affect, whereas there was no interaction on positive affect. In addition, the effect of altruism and perceived risk on mental health was completely mediated by negative affect. This result suggested that the influence of altruism on mental health was entirely through the effect of altruism on negative affect. Although our study does not provide a direct explanation of the mechanism of altruism on better mental health, we provide evidence for the mechanism of altruism on worse mental health by increasing negative emotions.

In addition to theoretical implications, this study provides practical insights into public health management. First, we tested the influence of social distancing policy on altruists. The results offers a reflection on regulations for social isolation in the future. Second, altruistic behavior can be realized in indirect ways, such as online donations. Engaging in indirect altruistic activities may also relieve altruists’ anxiety and depression. Third, effective psychological prevention strategies for the COVID-19 crisis can be developed to reduce risk perception, such as lower exposure to COVID-19-related news on social media and more physical exercise.

Limitations and future direction

This study is limited in several aspects. First, the sample size was not sufficient and may not provide sufficient power to detect some effects. The participants mostly came from Chinese low-risk areas of China rather than from Wuhan, the city most affected by the COVID-19 pandemic. We assume that participants from Wuhan may perceive more risk and that the mechanism of perceived risk on mental health would be more complicated. Future research could test and refine our model for participants in Wuhan. Second, we clarified that the mechanism of altruism on worse mental health during the outbreak of COVID-19 relied on the path of increased negative affect, but we did not determine the mechanism of altruism on negative affect during this specific period. We assume that empathy or self-efficacy may mediate the role of altruism in negative affect. Future research could focus on exploring this underlying mechanism to better understand the influence of altruism on mental health. Finally, our model was limited to revealing the causality of variables of interest. Future research could strengthen causal explanations by manipulating the variable of perceived risk in lab experiments.

Our study focused on health psychology to understand how people respond to the threat of COVID-19. Using representative data during the outbreak of COVID-19 in China, this paper provides a unique opportunity to investigate the relationship between altruism and perceived risk on emotion and mental health. The negative influence of the perceived risk of COVID-19 and altruism on mental health suggests that the protective effect of altruism requires specific premise. The underlying mechanism of altruism on mental health was also examined. This study provides valuable insights into the psychological mechanism of altruism and a reference for public mental health during the pandemic. Future analyses will more deeply explore this mechanism and other factors that disturb people’s emotions and mental health.

Ethics approval and consent to participate

Consent for publication

Not applicable. The survey was anonymous for all participants.

Availability of data and materials

The datasets used during the current study are available from the corresponding author on reasonable request.

Competing interests

The authors declare that they have no competing interests.

Funding

This study was funded by the Beijing Higher Education "Undergraduate Teaching Reform and Innovation Project 2019" (Grant No. 2019-552-N137), which was granted by Beijing Municipal Education Commission.

Author’s contributions

All authors contributed significantly to the concept of this study. YF and ZHQ designed the study; YF, MZ, and ZZY collected data; YF and DD conducted analysis and interpreted data; YF drafted the manuscript and all author contributed to revise it. All authors read and approved the final manuscript.

Acknowledgements

Not applicable.

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Table 1. Demographic characteristics of the study sample

	Without anxiety symptoms (N=992)	With anxiety symptoms (N=354)	p value
	n,%	n,%
Gender (N=1346)			0.135
Male (N=364)	279（28.1%）	85（24%）
Female (N=982)	713（71.9%）	269（76%）
Ethnic group (N=1346)			0.781
Han (N=1143)	844（85.1%）	299（84.5%）
Others (N=203)	148（14.9%）	55（15.5%）
	*Mean (SD)*	*Mean (SD)*
Age (years) (N=1346)	19.63（2.154）	20.13（2.40）	0.000
	Without depression symptoms (N=917)	With depression symptoms (N=429)	p value
	n,%	n,%
Gender (N=1346)			0.890
Male (N=364)	247（26.9%）	117（27.3%）
Female (N=982)	670（73.15%）	312（72.7%）
Ethnic group (N=1346)			0.386
Han (N=1143)	784（85.5%）	359（83.7%）
Others (N=203)	133（14.5%）	70（16.3%）
	*Mean(SD)*	*Mean(SD)*
Age(years) (N=1346)	19.63（2.13）	20.04（2.41）	0.003

p value: T-test and chi-square test.

Table 2. Spearman’s correlation coefficients between main variables and covariates

	Gender	Age	Ethnicity	Perceived risk	Altruism	Negative affect	Positive affect	Anxiety
Gender	1
Age	0.03	1
Ethnicity	0.00	-0.03	1
Perceived risk	0.08**	-0.11**	0.01	1
Altruism	-0.07**	0.11**	0.02	-0.02	1
Negative affect	0.09*	0.15**	0.06*	0.16**	0.05	1
Positive affect	-0.06*	-0.08**	-0.03	-0.13**	0.28**	-0.24**	1
Anxiety	0.12*	0.13**	0.00	0.17**	0.02	0.57**	-0.27**	1
Depression	0.03	0.07*	0.03	0.18**	-0.05	0.54**	-0.42**	0.67**

*p < .05, **p < .01. The gender variable was coded as “1 = male, 2 = female”.

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published 10 Jul, 2020

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Editorial decision: Major Revision
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When altruists cannot help: The influence of altruism on mental health during COVID-19 pandemic

Status:

Journal Publication

Version 1

Abstract

Figures

Background

Risk perception and mental health

Altruism and mental health

Underlying mechanism of altruism on mental health

Aims of this study

Methods

Participants and sampling

Measures

Perceived risk of COVID-19

Altruism

Positive and negative affect

Mental health

Data analysis

Results

Background characteristics and Covariates

-------------Insert Table 1 around here----------------

Correlations between mental health and other variables

----------------Insert Table 2 around here---------------

Moderation of altruism

----------------Insert Fig. 1 around here---------------

Mediation of negative affect

----------------Insert Fig. 2 around here---------------

Discussion

Implications

Limitations and future direction

Conclusions

Declarations

References

Tables

Status:

Journal Publication

Version 1