Quantitative phase results
This study was a cross-sectional online survey conducted among 1,407 participants in Israel. The majority of the respondents were female (80%). The mean age of the participants was 41 years old (range 18–97) and they had an average of about 16.5 years of education (range 9–30). Most were married (63%) and had an average of two children. About 85% reported having no health problems and about 80% reported their health status as good. Only 5% were isolated in their homes since the COVID-19 outbreak. Moreover, participants indicated that working from home was their preferred resource in coping with COVID-19.
Table 2
Participants’ characteristics (N = 1,407)
Characteristic | N (%) |
Gender (%) | |
Male | 282 (20.1) |
Female | 1119 (79.9) |
Mean age (SD), range | 40.97 (14.66), 18–97 |
Mean number of years of education (SD), range | 16.44 (3.66), 9–30 |
Marital status (%) | |
Married | 879 (62.7) |
Divorced | 81 (5.8) |
Widow | 24 (1.7) |
Single | 380 (27.1) |
Other | 37 (2.6) |
Mean number of children (SD), range | 2.18 (1.39), 0–9 |
Health problems (%) | |
Yes | 214 (15.3) |
No | 1186 (84.7) |
Health status (%) | |
Poor | 19 (1.4) |
Fair | 276 (19.6) |
Good | 1108 (79.0) |
Home isolation since the outbreak of the Covid-19 (%) | |
Yes | 70 (5.0) |
No | 1333 (95.0) |
Resources that can make it easier to cope with COVID-19 (%) | |
More information regarding COVID-19 | 260 (19.4) |
Professional support | 172 (12.8) |
Layman support | 143 (10.7) |
Working from home | 529 (39.4) |
Other | 237 (17.7) |
Table 3 summarizes the means, SDs, ranges and correlates of the study variables. As can be seen, the mean scores for emotional reactions (M = 2.72, SD = 0.93, range 1–5) and perceived susceptibility were high (M = 3.25, SD = 1.14, range 1–5). Positive associations were found between perceived susceptibility and emotional reactions to COVID-19 (r = 0.31, p < 0.001). Moreover, perceived susceptibility exhibited a negative association with age, preexisting conditions and sex, indicating that those who were older, had more preexisting medical conditions and were male reported higher perceived susceptibility. Emotional responses exhibited a positive association to age and marital status and a negative association to sex, preexisting medical conditions and subjective perception of health status. Figure 1 shows that the participants reported the following emotional reactions: worry (48.5%), fear (38.6%), stress (37.7%) and feeling they were likely to contract the disease (16.6%).
Table 3
Correlates, Means, SDs, and ranges of study variables (n = 1,407)
Variables | 1 | 2 | 3 | 4 | 5 | 6 | 7 |
1.Age | - | | | | | | |
2.Gender | 1.19*** | - | | | | | |
3. Marital Status | − .34** | .06* | - | | | | |
4. Preexisting conditions | − .24** | .04 | − .02 | - | | | |
5. Perceived health status | − .12** | − .02 | .43** | | - | | |
6. Perceived susceptibility | − .08** | − .19** | − .003 | − .06* | − .18** | - | |
7. Emotional reactions | 1.21** | − .22** | .09** | − .07** | − .12** | 0.31*** | - |
Mean | 40.84 | 1.8 | 1.77 | 1.85 | 2.78 | 2.72 | 3.25 |
SD | 14.78 | 0.40 | 1.08 | 0.36 | 0.45 | 0.93 | 1.14 |
Possible range | - | - | - | - | 1–3 | 1–5 | 1–5 |
Actual range | 18–97 | - | - | - | 1–3 | 1–5 | 1–5 |
***p < 0.001 |
Preexisting conditions: yes/no |
Perceived health status: good/fair/poor |
Marital status: single/married/divorced/widowed |
Theme 1 - “I’m losing control”: Sense of shock and chaos
The research participants described how their lives changed overnight. The change was drastic, surprising, powerful and difficult to contain. When the COVID-19 epidemic broke out in China, the participants felt the virus was far away and that they were immune from it. As the epidemic got closer, reaching European countries and Israel as well, the respondents’ sense of shock and serious concern rose. People got their information from diverse media sources. Some of these sources were reliable, such as the Israeli Ministry of Health. Other less reliable sources spoke of conspiracy theories and a feeling that the world was coming to an end. Moreover, the guidelines provided by the Ministry of Health were not always clear to everyone, leading to confusion, information chaos and inner upheaval.
COVID-19 made its surprising debut on the world stage only a few months ago, a short period that now feels like an eternity. Initially we asked, “What is this? How should we respond to this event?” We were confused, uncertain, aware that this is a major event, something new that we’ve never experienced. I felt a tremendous need to follow the news and learn what was happening in the world in order to dispel my sense of uncertainty, to understand the repercussions, to learn how this will affect us and understand how to behave. (47-year-old married man, 2 children).
Some of the participants indicated that their feelings ranged from a sense of indifference to denial of the situation and continuing their ordinary behavior. They then began to internalize the difficult situation as it filtered down to them. They were overcome by a sense of lack of control and helplessness that necessitated changes in their behavior.
I was overcome by tremendous fear due to COVID-19, fear of contracting the disease, fear of the new reality. I felt helpless and it’s hard for me to function in this new reality that has been forced upon me. . .. I thought the situation would pass quickly and I never thought it would reach such great proportions that the entire country would be shut down (26-year-old single woman).
Some of the participants described being shocked and confused. They searched for a direction to follow, wondered how they should behave and what they should do. The situation generated feelings of frustration and of being stuck.
Since the COVID-19 outbreak, I have been feeling very frustrated and overwhelmed. The spread of the virus put me in a state of shock, I didn’t know how to digest this new reality that until now I’ve never had to face, how to respond to the situation as it is, how I should act. I didn’t know how to divide up my time and what I should do. The virus put everything on hold for me. (53-year-old divorced woman, 3 children).
Theme 2 - “Recalculating the route”: Gradual adjustment to the new reality
The participants indicated that after their initial feelings of shock, they found themselves gradually adjusting to the new reality that had been forced upon them by COVID-19 and the Ministry of Health guidelines. Adjustment difficulties stemmed from having to remain within their own household, limit their movements and, for some, stop working. The participants described how they internalized these guidelines and made changes in their familiar lifestyle.
As the situation developed and the virus began to spread, I saw how everything around me began to close and shut down... I began to think differently, to conduct myself differently, to leave the house less frequently, to pay much more attention to maintaining hygiene than usual, to keep my distance from people, to refrain from touching, even my own family. My life routine has changed. I leave the house only if I need something, groceries or the pharmacy or other urgent necessities (32-year-old married man, 1 child).
The main issue that emerged among all the research participants who had children focused on how to maintain a daily routine. Before this happened, the children were at school, attended afterschool activities, met with friends. Now parents are charged with the difficult task of mediating this new situation for their children while at the same time maintaining a routine without any clear or defined framework.
One day, out of the blue, without any advanced warning or chance to prepare, I found myself in a new reality that forced me to recalculate my route, and fast. I found myself at home with my family and I had to be their anchor at a time when everything around us is unknown and uncertain. How can I manage under these circumstances? How can I explain this strange new reality to my children? How can I maintain some sort of sane schedule when everything is so unclear? Yet despite all these complexities, I understood that this is a good time and wonderful opportunity for a mother with a family. (42-year-old married woman, 3 children).
Some of the parents described how they are adjusting to the new situation by setting up a regular routine that includes chores, arts and crafts, cooking activities, home workouts and cleaning. Most of the children study via distance learning and many of the parents work from home. Many parents told about being exhausted by these diverse roles and by the physical and emotional burden they entail.
I found that the easiest way for us to cope with the isolation was to set up a regular daily routine. When this first began, we tidied up the house, set up an arts and crafts space on a large table and began designing a lovely family album with all the photos we developed from our last family vacation. This took us three whole days and we enjoyed working together on this project (31-year-old married woman, 2 children).
An important element in adjusting to this new situation is coping together as a couple. Members of a couple who are accustomed to working outside the home and seeing each other only several hours a day find themselves together for many hours. If one partner is not working, he or she may feel unneeded and useless. Such situations can lead to frustration and conflict between the partners and within the family. The family as a unit must adjust to the new reality.
It wasn’t easy for me to see my husband at home, not working, depressed, incapable of doing the simplest everyday tasks. Unlike him, I gathered all my strength and tried to keep things running smoothly at home and not disrupt the normal routine (43-year-old married woman, 4 children).
The research participants also included young single people who were forced by the situation to return to their parents’ home. These participants described how difficult this was, citing their feelings of having regressed by returning to live with their parents and siblings, a sense of having been robbed of their freedom. Yet the situation also provided an opportunity to renew their acquaintance and draw closer to their families.
Over the last two days the situation began to get worse. The entire family at home all the time is challenging and really difficult. We are all at different ages and stages, and each of us wants to do what we feel like doing. It’s especially tough for me because before COVID-19 I was usually not at home. I was studying or at work or out with my girlfriends and suddenly I can’t even leave the house. It drives me crazy (23-year-old single woman).
Theme 3 - “It’s hard to fall asleep and even harder to get up in the morning”: Fears and concerns for self and family
The research participants described their concerns about their own health and the health of their loved ones. Some mentioned that people close to them were under quarantine or tested positive for COVID-19, increasing their stress and sense of helplessness. They are flooded by worry due to the uncertainty about when this will end and what will happen to them and their loved ones.
There are moments of crisis. Especially at night. Sometimes I feel I’m on the brink of losing hope. I have trouble coping with the ambiguity and uncertainty about how long this crisis will last. There’s no definitive time limit, and I wonder how long I’ll be able to be strong. How will things be when this is all over? What about the children? How long can they hang on? What about my parents? When I finish my daily routine I am flooded with worries and have trouble falling asleep (43-year-old divorced woman, 4 children).
Many of the participants expressed concerns about older family members or those at risk due to preexisting medical conditions. They worried about their elderly parents and grandparents. These worries led to a sense of uncertainty about the future, anxiety and lack of control over the situation.
My grandmother is in a high-risk group. She must not leave the house and the grandchildren, including me, cannot visit her. At first I found it very difficult to discuss the situation with her. She continued going to the grocery store and following her regular routine. When all her activities closed down she understood that the situation is really problematic and dangerous for her. I try to speak to her as frequently as possible by phone and video calls with the other grandchildren. The situation is very worrisome and makes me sad, both the physical risk of the virus and the emotional toll, because she now feels more lonely than ever before. Not only will she feel alone, she’ll also feel she’s getting old, something she has always feared (24-year-old single woman).
Some of the participants described how their concerns and fears affect their behavior and emotions. They mentioned sleep disturbances, restlessness, irritability and difficulty performing tasks. They felt depressed, anxious, sad and lonely as well as nervous, uncertain and helpless.
During this period I have practically stopped functioning. I constantly worry about what the situation will be in a few more days and where I’ll be and how I should behave during this period. Since the outbreak of the virus, every day I am more worried and concerned about my family, my friends, the entire world. I’m always anxious and am not functioning like I used to. I’m more irritable and I don’t feel like talking to anyone. I’m a student and I can’t concentrate on my studies or work from home. I am not functioning (28-year-old single woman).
Table 4
Classification of main categories and subcategories
Main categories | Subcategories |
Sense of shock and chaos | • Information search • Sense of shock, confusion, frustration • Sense of lack of control and helplessness regarding the need for behavioral changes |
Gradual adjustment to the new reality | • Internalizing the guidelines and changing one’s customary lifestyle • Changes in the family – the children are at home • Changes in the couple relationship – the members of the couple are together all the time; one or both may be unemployed |
Fears and concerns for self and family | • Concerns for own health and health of those close to them • Many described concerns for older relatives or those with illnesses in high-risk groups • Concerns affect behavior: sleep disruptions, restlessness, irritability, difficulty performing tasks • Depression, anxiety, sadness, loneliness alongside anxiety, uncertainty and helplessness |