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Working in a pandemic: Exploring the impact of COVID-19 health anxiety on work, family, and health outcomes

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The COVID-19 pandemic has unhinged the lives of employees across the globe, yet there is little understanding of how COVID-19 health anxiety (CovH anxiety)-that is, feelings of fear and apprehension about having or contracting COVID-19-impacts critical work, home, and health outcomes. In the current study, we integrate transactional stress theory (Lazarus & Folkman, 1984) with self-determination theory (Deci & Ryan, 2000) to advance and test a model predicting that CovH anxiety prompts individuals to suppress emotions, which has detrimental implications for their psychological need fulfillment. In turn, lack of psychological need fulfillment hinders employees' abilities to work effectively, engage with their family, and experience heightened well-being. Our model further predicts that handwashing frequency-a form of problem-focused coping-will mitigate the effects of CovH anxiety. We test our propositions using a longitudinal design that followed 503 employees across the first four weeks that stay-at-home and social distancing orders were enacted. Consistent with predictions, CovH anxiety was found to impair critical work (goal progress), home (family engagement) and health (somatic complaints) outcomes due to increased emotion suppression and lack of psychological need fulfillment. Further, individuals who frequently engage in handwashing behavior were buffered from the negative impact of CovH anxiety. Combined, our work integrates and extends existing theory and has a number of important practical implications. Our research represents a first step to understanding the work-, home-, and health-related implications of this unprecedented situation, highlighting the detrimental impact of the anxiety stemming from the COVID-19 pandemic. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Journal of Applied Psychology
Working in a Pandemic: Exploring the Impact of COVID-
19 Health Anxiety on Work, Family, and Health
Outcomes
John P. Trougakos, Nitya Chawla, and Julie M. McCarthy
Online First Publication, September 24, 2020. http://dx.doi.org/10.1037/apl0000739
CITATION
Trougakos, J. P., Chawla, N., & McCarthy, J. M. (2020, September 24). Working in a Pandemic:
Exploring the Impact of COVID-19 Health Anxiety on Work, Family, and Health Outcomes. Journal
of Applied Psychology. Advance online publication. http://dx.doi.org/10.1037/apl0000739
Working in a Pandemic: Exploring the Impact of COVID-19 Health
Anxiety on Work, Family, and Health Outcomes
John P. Trougakos
University of Toronto Scarborough
Nitya Chawla
Texas A&M University
Julie M. McCarthy
University of Toronto Scarborough
The COVID-19 pandemic has unhinged the lives of employees across the globe, yet there is little
understanding of how COVID-19 health anxiety (CovH anxiety)—that is, feelings of fear and appre-
hension about having or contracting COVID-19 —impacts critical work, home, and health outcomes. In
the current study, we integrate transactional stress theory (Lazarus & Folkman, 1984) with self-
determination theory (Deci & Ryan, 2000) to advance and test a model predicting that CovH anxiety
prompts individuals to suppress emotions, which has detrimental implications for their psychological
need fulfillment. In turn, lack of psychological need fulfillment hinders employees’ abilities to work
effectively, engage with their family, and experience heightened well-being. Our model further predicts
that handwashing frequency—a form of problem-focused coping—will mitigate the effects of CovH
anxiety. We test our propositions using a longitudinal design that followed 503 employees across the first
four weeks that stay-at-home and social distancing orders were enacted. Consistent with predictions,
CovH anxiety was found to impair critical work (goal progress), home (family engagement) and health
(somatic complaints) outcomes due to increased emotion suppression and lack of psychological need
fulfillment. Further, individuals who frequently engage in handwashing behavior were buffered from the
negative impact of CovH anxiety. Combined, our work integrates and extends existing theory and has a
number of important practical implications. Our research represents a first step to understanding the
work-, home-, and health-related implications of this unprecedented situation, highlighting the detrimen-
tal impact of the anxiety stemming from the COVID-19 pandemic.
Keywords: COVID-19, anxiety, emotion regulation, self-determination theory, employee well-being and
effectiveness
Supplemental materials: http://dx.doi.org/10.1037/apl0000739.supp
I am dealing with feelings of helplessness— usually I am one to plan
and control every aspect of my life, and in the face of adversity, I will
simply work harder and smarter. In this situation, I cannot outsmart
a virus, and the unknown, how it will impact the life of my loved ones,
and what impact it will have in my life, comes in waves of anxiety.
—Construction industry employee, March 2020
1
As illustrated in this powerful quote, the COVID-19 pandemic
has projected humanity into an unprecedented era characterized by
feelings of helplessness and loss of control. While it is too early to
robustly understand the impact of the virus on long-term psycho-
logical outcomes, several anecdotal reports by health care profes-
sionals note an increase in anxiety, particularly surrounding the
uncertainties brought by COVID-19 (e.g., Achenbach, 2020;
Kluger, 2020). However, our understanding of how employees’
COVID-19 health anxiety (CovH anxiety)—that is, feelings of fear
and apprehension about having or contracting COVID-19 (Afifi,
Shahnazi, & Harrison, 2018)—spills over to affect their work- and
home-related behaviors is nascent. In this study, we advance and
test a model that elucidates the mechanisms by which CovH
anxiety impacts critical work (goal progress), home (family en-
1
This quote was provided by one of the 503 employees included in the
current study and was captured during the week that Canada implemented
social distancing measures as a result of COVID-19.
XJohn P. Trougakos, Department of Management, Rotman School of
Management, University of Toronto Scarborough; Nitya Chawla, Depart-
ment of Management, Mays Business School, Texas A&M University;
Julie M. McCarthy, Department of Management, Rotman School of Man-
agement, University of Toronto Scarborough.
All authors contributed to this article equally; the author order was
determined randomly. This research was supported by research grants from
the Social Sciences and Humanities Research Council of Canada awarded
to John P. Trougakos (435-2014-0693) and Julie M. McCarthy (435-2015-
0220). We thank Aqsa Dutli, Michelle Harli, and Jai Yadav for their
outstanding work as research assistants. We would also like to thank Daniel
Beal, Stephane Côté, and Alicia Grandey, for their helpful insights. Finally,
we thank all frontline workers for their dedication and effort in helping us
all get through these challenging times.
Correspondence concerning this article should be addressed to John P.
Trougakos, Department of Management, Rotman School of Manage-
ment, University of Toronto Scarborough, 1095 Military Trail, Toronto,
ON M1C 1A4, Canada. E-mail: john.trougakos@utoronto.ca
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Journal of Applied Psychology
© 2020 American Psychological Association 2020, Vol. 2, No. 999, 000
ISSN: 0021-9010 http://dx.doi.org/10.1037/apl0000739
1
gagement), and health (somatic complaints) outcomes. Further, we
assess the role of problem-focused coping in the form of hand-
washing as a strategy to mitigate the potentially detrimental effects
of CovH anxiety.
We advance existing theory and research in at least three ways.
First, we integrate tenets from transactional stress theory (Lazarus
& Folkman, 1984) and self-determination theory (SDT; Deci &
Ryan, 2000) to develop a conceptual framework that delineates the
mechanisms by which CovH anxiety impacts critical outcomes
across both work and home domains. Consistent with this theoret-
ical lens, our work is situated within an environmental context—
the COVID-19 pandemic. Specifically, we theorize that in situa-
tions wherein the imminent threat is uncontrollable, as in the
current crisis, people are more likely to withdraw from the situa-
tion by suppressing their emotions (Gross, 2015). Thus, we ad-
vance scholarly understanding of the impact of anxiety on indi-
viduals’ self-regulation, particularly in situations characterized by
high levels of threat and lack of control (e.g., pandemics, wars,
natural disasters). Further, our examination of CovH anxiety as a
core determinant of suppression is a significant shift from past
work that has largely focused on the consequences of suppression.
Second, to understand the downstream effects of suppressing
one’s emotions during the COVID-19 pandemic, we draw from
research on emotion regulation and SDT (Deci & Ryan, 2000;
Roth et al., 2014) to highlight—for the first time—the negative
impact of emotion suppression on individuals’ psychological need
fulfillment in a work context. Since emotion suppression nega-
tively impacts factors linked to competence, relatedness, and au-
tonomy (Butler, Lee, & Gross, 2007; Gross, 2015; Gross & John,
2003; Roth et al., 2014), we expect emotion suppression to hinder
need fulfillment. We further consider the extent to which the three
psychological needs of SDT (competence, relatedness, and auton-
omy) align with domains of workers’ lives (work, family, and
health) that are likely to be influenced by the pandemic. Thus, in
line with SDT, we posit that need fulfillment will impact people’s
ability to effectively work, engage with their family, as well as
their personal well-being.
Third, we examine a core moderator of the negative impact of
CovH anxiety on emotion suppression—active coping in the form
of handwashing frequency. Drawing from the literature on
problem-focused coping (Lazarus & Folkman, 1984), as well as
work demonstrating that anxiety is often driven by a loss of control
(Bandura, 1988; Fiske, Morling, & Stevens, 1996), we position
washing one’s hands as a critical behavior that can help individuals
regain control of the situation, thereby alleviating the detrimental
effects of CovH anxiety.
Theoretical Background
The COVID-19 pandemic has impacted all aspects of people’s
lives, leading to changes in work behaviors, family experiences,
and personal well-being (e.g., Achenbach (2020); Brenner, 2020;
Thompson, 2020). In the sections that follow, we integrate core
ideas from the transactional model of stress (Lazarus, 1991) with
SDT (Deci & Ryan, 2000) to outline the mechanisms by which we
expect anxiety stemming from the COVID-19 situation to impact
these critical outcomes. Our overall conceptual model is depicted
in Figure 1.
The Impact of CovH Anxiety on Emotion Suppression
CovH anxiety reflects feelings of apprehension about having or
contracting COVID-19. Grounded in the literature on health anx-
iety (Afifi et al., 2018; Creed & Barsky, 2004), this construct is
aligned with Lazarus and Folkman’s (1984) transactional stress
framework, which holds that threatening events—such as a global
pandemic—trigger high levels of anxiety (Lazarus, 1991). This
conceptualization is also consistent with Cheng and McCarthy’s
(2018) theory of workplace anxiety, as well as Gross’ (1998)
process model of emotion regulation, both of which emphasize the
role of the situation in the experience of anxiety.
When threatened, individuals analyze their current resources in
order to enact a coping response (Lazarus & Folkman, 1984).
Prevailing theory and research indicate that feelings of anxiety will
trigger defense mechanisms in the form of a fight or flight re-
sponse that is aimed at escaping the threat (Cannon, 1927). The
fight response is triggered when the threat is deemed surmount-
able, while the flight response is triggered when it is believed that
the threat is difficult to overcome (Folkman & Lazarus, 1980;
Steimer, 2002). The COVID-19 pandemic is likely to prompt a
flight response, as it is an immediate threat, it is unclear how long
it will persist, and there are a multitude of unanswered questions
regarding its impact. Stress-based theories (Cannon, 1927;
Lazarus, 1991), combined with theories of emotion regulation
(Gross, 1998; Gross & John, 2003), provide critical insight on how
the flight response will surface with respect to emotion-focused
coping. Specifically, situations that elicit threat, such as the new
coronavirus, likely motivate people to reduce the expression of
their emotions through emotion suppression, a response-based
form of emotion-focused coping that is used to regulate emotions
after they have been generated (Gross, 1998; Gross, 2015; Gross &
John, 2003; Lazarus, 1991). Thus, we expect that the affective
reaction due to the worldwide pandemic (i.e., CovH anxiety)
triggers emotion-focused coping in the form of emotion suppres-
sion (Cutuli, 2014).
Research findings across several disciplines provide preliminary
support for this argument. For example, emotion regulation re-
search has found significant positive relations between measures
of stress (Mohiyeddini, Opacka-Juffry, & Gross, 2014), anxiety
(Lee et al., 2016), aggression (Grandey, Dickter, & Sin, 2004), and
negative affect (Talaei-Khoei et al., 2017) on the one hand, and
suppression-based regulation on the other. Further, cross-sectional
studies indicate that trait anxiety (Kashdan & Steger, 2006) and
negative affect predict subsequent emotion suppression (Brock-
man, Ciarrochi, Parker, & Kashdan, 2017). Additional support
comes from the realm of clinical psychology, wherein withdrawal
strategies are commonly observed among individuals with clinical
levels of anxiety, such as those suffering from generalized anxiety
and panic disorder (e.g., Baker, Holloway, Thomas, Thomas, &
Owens, 2004; Kennedy & Ehrenreich-May, 2017). Finally, there is
evidence for this proposition in scholarly work on chronic ill-
nesses, such as cancer. For instance, Conley, Bishop, and Ander-
sen (2016) found that breast cancer patients with high levels of
negative affect were more likely to use disengagement-focused
coping strategies. Combined, the above discussion suggests that
emotion suppression may be a form of coping with CovH anxiety.
Thus, we predict:
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2TROUGAKOS, CHAWLA, AND MCCARTHY
Hypothesis 1: CovH anxiety is positively related to emotion
suppression.
The Impact of Emotion Suppression on Need
Fulfillment
When individuals engage in response-focused coping in the
form of suppression, they are stifling the experience of their
emotions and denying an outlet to attend to their needs (Shahar,
Kalman-Halevi, & Roth, 2019). Thus, it is not surprising that this
type of regulation has been found to be maladaptive, particularly
when people are faced with challenging situations (Gross & Lev-
enson, 1993). Rather than aiding coping, emotion suppression
tends to undermine support, exacerbate distress, and lead to lower
physical and psychological well-being (Gross, 2015). Indeed, sup-
pression has been linked to a host of negative personal outcomes
that span a wide range of personal domains (e.g., Clohessy &
Ehlers, 1999; Gross, 2015).
We build on past work to theorize that emotion suppression is
detrimental to need fulfillment as outlined in SDT, which suggests
that people strive to meet needs of competence, relatedness, and
autonomy (Deci & Ryan, 2000; Roth et al., 2014). Fulfillment of
these needs leads to a number of positive professional, social, and
health-related outcomes (Gagné & Deci, 2005). However, emotion
suppression may undermine individuals’ psychological needs due
to its impact on cognitive functioning, reduced social effective-
ness, and sense of autonomy (e.g., Benita, Benish-Weisman, Ma-
tos, & Torres, 2019; Grandey, Rupp, & Brice, 2015; Gross, 2015).
Prior work has established the severely depleting and cogni-
tively taxing nature of suppression (e.g., Baumeister, Bratslavsky,
Muraven, & Tice, 1998), suggesting that it reduces feelings of
competence. Indeed, the effort required for suppression impedes
subsequent efforts to regulate behavior, limiting performance ef-
fectiveness (e.g., Beal, Weiss, Barros, & MacDermid, 2005;
Grandey, 2000). The depleting nature of suppression is largely
driven by the increased cognitive load resulting from trying to deal
with the underlying emotions being suppressed (Gross & John,
2003). This impairs constructive thought processes, problem solv-
ing, memory, and information recall, resulting in a reduction in
individuals’ efficacy beliefs about performing a variety of tasks
(e.g., Beal et al., 2005; Gross, 2015; Richards, Butler, & Gross,
2003).
Emotion suppression can also impact individuals’ relatedness
needs by inhibiting social functioning and positive interpersonal
experiences. For example, the use of emotion suppression has been
linked to diminished recall of social information, lower commu-
nication effectiveness and social functioning, and reduced rapport
between interaction partners (Butler et al., 2003; Gross & John,
2003). Suppression is also related to increased social avoidance
behaviors, negative partner perceptions, and increased hostility
(Butler et al., 2007; Trougakos, Jackson, & Beal, 2011). These
findings highlight a body of evidence linking emotion suppression
to reduced interpersonal functioning, which should interfere with
feelings of relatedness.
Finally, emotion suppression can lead to a decreased sense of
autonomy. Emotion suppression is an inhibitory state in which
people do not display their inner feelings (Richards & Gross,
1999), suggesting that suppression does not reflect autonomous
behavior. Supporting this logic, scholars have proposed that emo-
tion suppression impairs people’s sense of autonomy as they are
unable to express genuine emotions and thus experience a loss of
control (Grandey et al., 2015). Past research has also demonstrated
that greater use of surface acting—an emotional labor strategy that
relies on suppression—relates to decreased personal control
(Grandey, Fisk, & Steiner, 2005) and that use of these strategies is
opposed to autonomy (Goldberg & Grandey, 2007). Overall, emo-
tion suppression requires restraint, which is likely to reduce a
person’s sense that their autonomy needs are being met. Based on
the above discussion, we predict:
Hypothesis 2: Emotion suppression is negatively related to
psychological need fulfillment.
Impact of Need Fulfillment on Work, Home, and
Health Outcomes
In line with past work on SDT, we expect decreased psycho-
logical need fulfillment—stemming from emotion suppression as a
result of CovH anxiety—to be critical in influencing individuals’
work effectiveness, home experiences, and health outcomes (e.g.,
Gagné & Deci, 2005; Ryan & Deci, 2017). These domains capture
Figure 1. Conceptual model and path analysis results. N465 (after accounting for missing data). Analyses
include all possible direct effects from predictor to outcome variables. In addition, the residuals of our outcome
variables were allowed to covary. This model also controls for trait anxiety (assessed at Time 1) on all paths as
well as hours spent working at home and hours spent working outside home (e.g., at job site, traditional office
setting, etc.; assessed at Time 4) on the outcome variables. For parsimony, these variables are not presented in
the figure, but are reported in Table 2. Unstandardized coefficients reported in the figure.
p.05.
ⴱⴱ
p.01.
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3
IMPACT OF COVID-19 HEALTH ANXIETY
critical aspects of people’s lives impacted by the pandemic (work,
home, and health), and are conceptually aligned with the facets of
SDT.
With respect to the work domain, a lack of need fulfillment is
likely to impede employees’ job effectiveness, particularly with
regards to competence needs. Competence “concerns succeeding
at optimally challenging tasks and being able to attain desired
outcomes” (Baard, Deci, & Ryan, 2004, p. 2046). Not surprisingly,
when people experience greater need fulfillment, they experience
greater goal attainment (Sheldon & Kasser, 1998). For employees
working during the pandemic, goal progress is an important indi-
cator of work success because formal performance metrics may
have been unclear during this unprecedented time. As noted by
Gabriel, Volpone, MacGowan, Butts, and Moran (in press), goal
progress reflects employee perceptions of whether they have been
able to meet work goals. Given the alignment between SDT and
goal progress, the more competent a person feels, the more likely
they will strive to meet their goals (e.g., Gagné & Deci, 2005).
Thus, need fulfillment should facilitate goal progress.
Psychological need fulfillment can also facilitate individuals’
relational behaviors. During the early stages of the pandemic,
people were largely cut-off from members of their social network
outside of their immediate households. As such, the primary outlet
for social engagement for many people was their own family.
Thus, family engagement, which reflects the extent to which
individuals’ direct attention to, and are absorbed in, their family
(Rothbard, 2001), represents a critical outcome for people during
the pandemic. SDT’s emphasis on relatedness as a critical need
also aligns with workers’ family engagement. Past research sup-
ports this notion. For instance, psychological need fulfillment can
increase relationship commitment and warmth toward partners
(Ducat & Zimmer-Gembeck, 2010; Patrick, Knee, Canevello, &
Lonsbary, 2007). Moreover, need fulfillment is related to reduced
hostile behaviors in family relationships (Petit, Knee, Hadden, &
Rodriguez, 2017), and facilitates more open, understanding, and
less aggressive responses during family conflicts (Deci & Ryan,
2014). When individuals’ needs are met, they are also less likely to
alienate themselves from family or engage in family conflict
(Senécal, Vallerand, & Guay, 2001). Thus, we expect psycholog-
ical need fulfilment to be positively related to employees’ family
engagement.
Finally, we build on past work demonstrating that need fulfil-
ment plays a critical role in influencing individuals’ health (Deci &
Ryan, 2000) by examining psychosomatic complaints as a core
outcome, which is an important physical indicator of well-being
(e.g., Bennett, Gabriel, Calderwood, Dahling, & Trougakos, 2016;
Trépanier, Fernet, & Austin, 2016). Employees’ personal well-
being has long been aligned with SDT needs, most closely with
autonomy (Deci & Ryan, 1985, 2000). According to Deci and
Ryan (2000), the satisfaction of autonomy needs is energizing and
promotes health and well-being, while lack of need satisfaction
contributes to pathology and ill-being. Need fulfilment has been
shown to be relevant for numerous well-being indicators, such as
self-esteem and physical symptoms (Sheldon, Ryan, & Reis,
1996), variability in daily well-being (Reis, Sheldon, Gable, Ros-
coe, & Ryan, 2000), as well as energy and sleep quality (Campbell,
Soenens, Beyers, & Vansteenkiste, 2018). Jointly, we predict that:
Hypothesis 3: Psychological need fulfillment is associated
with greater (a) goal progress, (b) family engagement, and (c)
lower somatic complaints.
In sum, Hypotheses 1–3 suggest a serial mediation process.
Thus, we propose:
Hypothesis 4: There is a serial indirect effect of CovH anxiety
on (a) goal progress, (b) family engagement, and (c) somatic
complaints via emotion suppression and psychological need
fulfillment.
Handwashing as a Moderator
The transactional model of stress (Lazarus & Folkman, 1987)
also provides insight into factors that may mitigate the effects of
CovH anxiety. As previously noted, emotion suppression is an
emotion-focused coping strategy that can help manage the impact
of the experienced threat. At the same time, individuals can engage
in problem-focused coping strategies to diminish the impact of
CovH anxiety on emotion suppression (Lazarus & Folkman,
1984). In other words, while suppression focuses on managing
one’s emotional response to the threat, problem-focused coping
involves strategies that will enable the threat to be endured and/or
minimized. This is consistent with other stress theories, which
suggest that when faced with situational demands, problem-
focused coping can attenuate the adverse effects of stressors (Hob-
foll, 1998). Thus, problem-focused strategies are expected to mod-
erate the negative effects of the stressor. Empirical findings help
support this proposition as emotion-focused coping has been found
to mediate, and problem-focused coping has been found to mod-
erate, the relationship between stress and well-being (Aldwin &
Revenson, 1987; Bhagat, Allie, & Ford, 1995; Parkes, 1990).
In the midst of the current pandemic, handwashing is one of the
most central forms of problem-focused coping. Indeed, the first
piece of advice on the World Health Organization’s (WHO)
COVID-19 website is: “Regularly and thoroughly clean your
hands with an alcohol-based hand rub or wash them with soap and
water” (WHO, 2020). Given that handwashing, when done prop-
erly, kills the virus (Hillier, 2020), it provides individuals with a
mechanism to cope with the threat of COVID-19. This is important
because anxiety typically triggers a loss of control (Bandura, 1988;
Fiske et al., 1996; Spector, 1986), which can be alleviated by
engaging in proactive forms of coping—such as handwashing—
aimed at minimizing the threat.
In terms of empirical research, while the impact of handwashing
on the relation between anxiety and emotion suppression has not
been examined, there is evidence that handwashing mitigates the
impact of stressors. For instance, past work has indicated that
handwashing diminishes the detrimental effects of personal threats
by evoking positive emotions (Tang et al., 2017) and minimizing
cognitive interference (Kalanthroff, Aslan, & Dar, 2017). Based on
the above discussion, we posit that handwashing frequency may
buffer the impact of CovH anxiety:
Hypothesis 5: Handwashing moderates the positive relation-
ship between CovH anxiety and emotion suppression, such
that the positive relationship is weaker when the frequency of
handwashing is greater.
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4TROUGAKOS, CHAWLA, AND MCCARTHY
Method
Participants and Procedure
To test the impact of CovH anxiety on employees’ experiences
and behaviors, we strategically began recruitment during the week
that social distancing measures were implemented in Canada.
2,3
In
an effort to obtain employees from a diverse range of industries,
we posted advertisements on several social networking sites (e.g.,
LinkedIn, Facebook, Twitter; Chawla, MacGowan, Gabriel, &
Podsakoff, 2020). Within the advertisement was a link to the Time
1 survey, which included a measure of CovH anxiety. To qualify
for the study, participants had to be employed and work at least 20
hrs per week in Canada. The remaining three surveys were each
sent approximately one week apart in an effort to reduce concerns
tied to common method biases (Podsakoff, MacKenzie, Lee, &
Podsakoff, 2003). Participants received a link to each survey via
e-mail on Friday at noon and had until the following Monday at
noon to complete it. At Time 2, participants rated their emotion
suppression and handwashing habits. At Time 3, participants com-
pleted the measure of psychological need fulfillment. At Time 4,
we assessed participants’ behaviors across the work and home
domains, as well as psychosomatic complaints. Participants re-
ceived a $4 CAD Tango gift card for each completed survey.
A total of 709 participants met the eligibility criteria. Our study
inherently included identity checks, as the surveys and Tango gift
cards were distributed to valid e-mail addresses, alleviating some
concerns with snowball samples (Marcus, Weigelt, Hergert, Gurt, &
Gelléri, 2017). We also included CAPTCHA verification and attention
checks in the surveys. Our final sample consisted of 503 participants
(70.9%) who provided matched responses across the four surveys. Par-
ticipants were predominantly female (63.2%), Caucasian (74.6%), and
full-time employees (89.7%). On average, participants were 36.8 years
old (SD 10.2), worked 7.9 (SD 1.7) hours per day, and employed in
their current organization for 6.3 years (SD 7.0).
4
Measures
Table 1 provides details about each of the substantive scales
used in the current study.
5
We included two control variables that
were theoretically relevant to our hypotheses. First, we controlled
for employees’ trait levels of anxiety (see Table 1) in an effort to
show the unique effects of anxiety stemming from the COVID-19
pandemic. We also controlled for the number of hours employees
spent working during the week in which we assessed our outcome
variables, given that it may have a substantive impact on our
behavioral criteria (see Table 3).
Results
Descriptive statistics, reliabilities, and correlations are presented in
Table 2. We tested our conceptual model using path analysis and
followed recommended practices (please see Appendix A for details
on our analytic approach and results of our confirmatory factor
analysis). Results of the path analyses are reported in Table 3 and
illustrated in Figure 1. Hypothesis 1 predicted that CovH anxiety
would positively relate to emotion suppression. As reported in Table
3, we found a significant positive effect of CovH anxiety on suppres-
sion (b.17, SE .04, p.01). Importantly, this effect held even
after controlling for trait anxiety (b⫽⫺.01, SE .04, ns)
6
, suggest-
ing anxiety relating to a specific situation (COVID-19) has unique
effects on suppression.
Hypothesis 2 proposed that emotion suppression negatively
relates to psychological need fulfillment. Results provided support
for this hypothesis, as we found a negative effect of emotion
suppression on psychological need fulfillment (b⫽⫺.13, SE
.04, p.01). In addition, consistent with Hypothesis 3, psycho-
logical need fulfillment was positively associated with goal prog-
ress (b.51, SE .07, p.01) and family engagement (b.20,
SE .07, p.05), but negatively related to somatic complaints
(b⫽⫺.33, SE .06, p.01).
Hypothesis 4(a– d) theorized that CovH anxiety would have
serial indirect effects on the behavioral criteria via emotion sup-
pression and need fulfillment. Bootstrap results supported this
hypothesis: CovH anxiety had a negative indirect effect on goal
progress (estimate ⫽⫺.011, 95% CI [.024, .004]) and family
engagement (estimate ⫽⫺.004, 95% CI [.012, .001]) via
suppression and need fulfillment. In contrast, CovH anxiety had a
positive indirect effect on somatic complaints (estimate .007,
95% CI [.002, .016]) via suppression and psychological need
fulfillment. Thus, individuals with greater CovH anxiety suffer
from reduced work effectiveness (i.e., lower goal progress), family
engagement, and greater somatic complaints due to their lack of
psychological need fulfillment as a result of suppressing emotions.
Our final hypothesis (Hypothesis 5) proposed a moderating
effect of handwashing frequency on the relationship between
CovH anxiety and emotion suppression. As illustrated in Figure 2,
we found a significant interaction effect of CovH anxiety and
handwashing frequency on emotion suppression (b⫽⫺.01, SE
.00, p.05). Simple slope analyses revealed that the relationship
between CovH anxiety and emotion suppression was significant
and positive when handwashing frequency was lower (simple
slope: b.25, t4.61, p.01) but not when the frequency was
higher (simple slope: b.08, t1.40, ns). Thus, proactive
coping mechanisms—such as handwashing frequency— buffered
individuals from suppressing their emotions.
7
2
Strict social distancing protocols, including closure of non-essential
businesses, were in place during our study.
3
This data is the first study published as part of a larger data collection
(University of Toronto IRB # 00032439; Patterns of recovery: Workplace
wellbeing study).
4
We ran supplemental analyses to examine whether the participants who
opted-in differed from our final sample on CovH anxiety, trait anxiety, and
other key demographics. Results indicated that there were no significant differ-
ences with one exception, such that the final sample had higher organizational
tenure. Please contact the authors for additional details on these analyses.
5
Although we followed prior work in examining overall need fulfill-
ment (e.g., Foulk, Lanaj, & Krishnan, 2019; Lanaj, Johnson, & Lee, 2016),
for the sake of thoroughness we also conducted supplemental analyses
wherein we separated the three psychological needs. Please see the Sup-
plemental Appendix for details of this model.
6
We also tested a model that did not include trait anxiety as a control
variable. The hypothesized effects remained qualitatively unchanged. Re-
sults of this model are available from the authors.
7
Conditional indirect effects indicated that CovH anxiety was associated
with lower goal progress and family engagement, but greater somatic
complaints, via emotion suppression and need fulfillment when handwash-
ing frequency was lower. A detailed description of these analyses is
presented in Appendix B.
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5
IMPACT OF COVID-19 HEALTH ANXIETY
Discussion
We advance a model that integrates the transactional model of
stress with SDT to elucidate the effects of workers’ CovH anxiety
on outcomes across a number of critical life domains. Using a
longitudinal design, we found CovH anxiety to be positively
related to emotion suppression, which in turn was negatively
related to psychological need fulfillment. Considering the three
domains of SDT (competence, relatedness, and autonomy), need
fulfillment was related to increased goal progress and family
engagement, and reduced somatic complaints. Further, the effects
of CovH anxiety on emotion suppression were moderated by
handwashing, a problem-focused coping strategy that is a wide-
spread means of combating the current pandemic.
Contributions to Theory and Research
The current study contributes to the existing literature by exam-
ining suppression as an emotion-focused coping mechanism of
CovH anxiety. We demonstrate that in situations wherein an im-
minent threat is uncontrollable, as in the current pandemic, indi-
viduals are more likely to withdraw from the situation by sup-
pressing their emotions. Past research has long conceptualized
threatening situations as potential precursors to emotion suppres-
sion (Hagemann, Levenson, & Gross, 2006), but has largely
treated this as a given assumption, focusing instead on the conse-
quences of suppression. Our study empirically demonstrates sup-
pression as a reaction to a high-anxiety situation, thereby expand-
ing knowledge of the antecedents of suppression. Importantly, we
Table 1
Measures Used in the Study
Variable
Number
of items Measure Sample item Scale anchors Reliability
Time
period
CovH anxiety 3 Simms et al. (2011) “I am worried about catching
COVID-19.”
Not at all—Very
much
.77 1
Trait anxiety 4 Goldberg (1999) “I get stressed out easily.” Strongly disagree—
Strongly agree
.86 1
Emotion
suppression
3 Gross and John (2003) “When I was feeling negative, I was
careful not to express it.”
Strongly disagree—
Strongly agree
.70 2
Handwashing
frequency
1 “On average, how many times did you
wash or sanitize your hands each
day this week?
—2
Psychological need
fulfillment
9 La Guardia, Ryan,
Couchman, and Deci
(2000)
“I felt free to be who I am.” Strongly disagree—
Strongly agree
.84 3
Goal progress 3 Wanberg, Zhu, and van
Hooft (2010)
“I have made good progress on my
job-related goals.”
Strongly disagree—
Strongly agree
.90 4
Family
engagement
3 Rich, LePine, and Crawford
(2010)
“I focused my attention on my family
and/or friends.”
Not at all—Very
much
.87 4
Somatic
complaints
5 Spector, Dwyer, and Jex
(1988)
“Headache.” Not at all—Very
much
.75 4
Note. CovH anxiety COVID-19 health anxiety. CovH anxiety was assessed with items adapted from Simms et al.’s (2011) measure of health anxiety,
which assesses the extent to which individuals are worried about health-related issues. All items were measured on a 5-point scale and referred to
participants’ experiences or behaviors the past week.
Table 2
Means, Standard Deviations, and Correlations of Study Variables
Study variables MSD 1234567891011
1. CovH anxiety (T1) 2.60 .95 (.77)
2. Emotion suppression (T2) 2.70 .80 .20
ⴱⴱ
(.70)
3. Handwashing frequency (HWF; T2) 14.83 12.30 .08 .03
4. Psychological need fulfillment (T3) 3.32 .66 .10
.17
ⴱⴱ
.09
(.84)
5. Goal progress (T4) 3.20 1.00 .08 .00 .11
.39
ⴱⴱ
(.90)
6. Family engagement (T4) 2.77 .99 .16
ⴱⴱ
.02 .04 .09
.00 (.87)
7. Somatic complaints (T4) 2.22 .84 .13
ⴱⴱ
.09
.16
ⴱⴱ
.32
ⴱⴱ
.21
ⴱⴱ
.05 (.75)
8. Trait anxiety (T1) 3.23 .93 .33
ⴱⴱ
.07 .04 .31
ⴱⴱ
.15
ⴱⴱ
.04 .26
ⴱⴱ
(.86)
9. Hours worked from home (T4) 20.09 17.56 .08 .07 .28
ⴱⴱ
.17
ⴱⴱ
.31
ⴱⴱ
.07 .07 .06 —
10. Hours worked outside (T4) 10.79 16.81 .03 .06 .27
ⴱⴱ
.06 .08 .13
ⴱⴱ
.03 .05 .57
ⴱⴱ
11. CovH Anxiety HWF .90 11.64 .06 .10
.18
ⴱⴱ
.05 .01 .10
.02 .04 .01 .06 —
Note.N465–503 (after accounting for missing data). CovH anxiety COVID-19 health anxiety; SD standard deviation; T1 time 1 survey; T2
time 2 survey; T3 time 3 survey; T4 time 4 survey. Each survey was sent one week apart. Handwashing frequency refers to the average number of
times employees washed or sanitized their hands per day. Hours worked from home refers to the number of hours employees spent working from home
that week whereas hours worked outside refers to the number of hours employees spent working outside their homes (e.g., at a job site, traditional office
setting, etc.). The interaction term was computed based on the grand-mean centered scores of each of the variables (Aiken & West, 1991).
p.05.
ⴱⴱ
p.01.
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6TROUGAKOS, CHAWLA, AND MCCARTHY
controlled for trait anxiety, highlighting that situation-specific
anxiety (e.g., CovH anxiety) triggers maladaptive emotion-focused
coping beyond individuals’ typical experiences of anxiety. As
such, we also contribute to the anxiety literature by elucidating
emotion suppression as a crucial mechanism linking anxiety ex-
periences to downstream consequences. Thus, we advance schol-
arly understanding of the impact of anxiety on individuals’ self-
regulation, particularly during situations characterized by high
levels of threat and lack of control (e.g., pandemics, wars, natural
disasters, threat of layoff).
Our research also represents one of the few studies to integrate
insights from transactional stress theory (Lazarus & Folkman,
1984) with SDT (Roth et al., 2014) to highlight—for the first
time—the impact of emotion suppression on employees’ psycho-
logical need fulfillment. Expanding on research demonstrating the
negative impact of suppression on a host of factors (Gross, 2015),
we explicitly found an inhibiting effect of emotion suppression on
individuals’ need fulfillment, which had critical implications for
people’s abilities to effectively work and engage with their family,
as well as their personal health. This integration of the emotion
regulation and SDT literatures in relation to work outcomes rep-
resents a substantial contribution, as previous research on conse-
quences of emotion suppression aligns with the three SDT needs
but had yet to be adequately and empirically explored.
Finally, drawing from literature on problem-focused coping
(Lazarus & Folkman, 1984), we demonstrate that washing one’s
hands can help individuals regain control of the situation and
alleviate the detrimental effects of CovH anxiety. This highlights
Table 3
Simultaneous Path Analysis Results
Emotion suppression
(Time 2)
Psychological need
fulfillment (Time 3)
Goal progress
(Time 4)
Family engagement
(Time 4)
Somatic complaints
(Time 4)
Predictor BSEbSEbSEbSEbSE
CovH anxiety .17
ⴱⴱ
.04 .20 .02 .03 .03 .00 .05 .00 .17
ⴱⴱ
.05 .16 .05 .04 .06
Emotion suppression .13
ⴱⴱ
.04 .15 .09 .05 .08 .02 .06 .02 .02 .05 .02
Psychological need fulfillment .51
ⴱⴱ
.07 .34 .20
.07 .14 .33
ⴱⴱ
.06 .26
Trait anxiety .01 .04 .02 .23
ⴱⴱ
.03 .31 .02 .05 .02 .00 .05 .00 .15
ⴱⴱ
.05 .17
Hours worked from home .03
ⴱⴱ
.00 .46 .01
ⴱⴱ
.00 .23 .00 .00 .01
Hours worked outside .02
ⴱⴱ
.00 .34 .02
ⴱⴱ
.00 .25 .00 .00 .02
Handwashing frequency (HWF) .00 .00 .04
CovH Anxiety HWF .01
.00 .10
R
2
.05 .12 .28 .10 .14
Note.N465 (after accounting for missing data). CovH anxiety COVID-19 health anxiety. CovH anxiety and trait anxiety were measured at Time
1; handwashing frequency was measured at Time 2; and, hours spent working were assessed at Time 4. CovH anxiety and handwashing frequency were
grand-mean centered prior to the creation of the interaction term. The residuals of our outcome variables were allowed to co-vary. The standardized
coefficients, as well as the R
2
values, were obtained using the STDYX command in Mplus. Participants in our sample came from a broad range of industries
across the economy (e.g., sales, consulting, education, healthcare, information technology, manufacturing, oil and gas, marketing, and banking services/
finance). The top five industries represented included healthcare (12.6%), Government/Public Sector (9.7%), Education (7.5%), Retail (5.2%), and
Banking/Finance (3.9%).
p.05.
ⴱⴱ
p.01.
1.5
2
2.5
3
3.5
4
Low COVID-19 Health
Anxiety
High COVID-19 Health
Anxiety
Emotion Suppression
Low hand
washing
frequency
High hand
washing
frequency
Figure 2. Moderating effect of handwashing frequency on the relationship between COVID-19 health anxiety
and emotion suppression.
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7
IMPACT OF COVID-19 HEALTH ANXIETY
the importance of problem-focused coping as a means to buffer the
impact of situations characterized by high levels of anxiety due to
imminent threat and uncertainty (Fiske et al., 1996).
Practical Implications
From a practical standpoint, our study speaks powerfully to the
experiences of employees during the COVID-19 crisis. We cap-
tured the experiences of workers from the first week social dis-
tancing orders were enacted, and are thus able to provide a fun-
damental understanding of how the situation has impacted
workers’ lives, as well as how they might experience and deal with
anxiety-inducing threat situations more broadly. First, it is clear
that CovH anxiety has implications for work effectiveness, family
engagement, and personal health. Our work also demonstrates that
in the face of an unprecedented threat, problem-focused coping in
the form of a simple behavior such as handwashing can help
mitigate the impact of the situation-specific anxiety. Critically, we
do not suggest that handwashing is a universal coping mechanism
that would work across a variety of threat situations. Rather, we
highlight the importance of engaging in appropriate coping behav-
iors relevant to the situation individuals are dealing with. In the
COVID-19 crisis, handwashing has been widely recommended as
a way to combat the threat. In other situations, such as when
someone is under threat of layoffs, taking active steps to make sure
work is effectively done might similarly mitigate the impact of
threat-related anxiety.
Our research also highlights the detrimental impact of emotion
suppression (and related emotion regulation strategies, such as
surface acting) for employees and organizations alike, highlighting
that suppression inhibits both organizationally relevant (goal prog-
ress) as well as personal (family engagement, health complaints)
outcomes. As such, our findings underscore the importance of
engaging in more effective means of emotion regulation. We also
add to the body of evidence that need fulfillment is critical for
employee effectiveness and health. Thus, organizations should
help employees mitigate anxiety broadly by offering training in
effective emotional coping methods as well as strategies to ensure
they fulfill their psychological needs. Training and seminars (or
webinars in the time of COVID-19) on topics such as resilience,
stress management, and work-life balance may be particularly
beneficial.
Strengths, Limitations, and Directions for Future
Research
The current study has both strengths and limitations. We used a
longitudinal design, separating variables across time points and
captured employees’ experiences from the first week social dis-
tancing and stay-at-home orders were enacted. Thus, we were able
to more accurately capture individuals’ experiences during the
crucial initial days through the first month of the lockdown. Yet, a
potential limitation is that all measures came from the same source,
raising the potential for same-source measurement biases. How-
ever, we used a variety of means to reduce this issue including
varying our response scales, using a count variable as a moderator,
separating our measures in time, and running alternative models
controlling for trait positive and negative affectivity (Podsakoff et
al., 2003).
8
Further, as we were interested in how employees have
dealt with the pandemic over time, focusing on self-reported
experiences was appropriate. Another potential limitation of our
study is concerns about causality. Yet, we separated all of our
variables at each stage of the mediational chain across time.
Additionally, our moderation hypothesis is unlikely to be affected
by this concern (Podsakoff et al., 2003).
Our study raises several avenues for future research. Our work
reflects only the precipice of the impact of the COVID-19 pan-
demic, which is likely to have far-reaching consequences for
months, years, and even decades ahead. Much work is needed to
gain a more complete understanding of the implications of this
crisis for employees, families, and organizations. Research can
build on our initial examination of the role of emotion suppression,
examining changes over time as individuals may begin becoming
de-sensitized to feelings of CovH anxiety. It would also be valu-
able for future research to consider alternative responses to anxiety
that we were unable to capture (e.g., mood repair and/or cognitive
interference; Cheng & McCarthy, 2018; Larsen, 2000).
9
Research
focused on within-person fluctuations during this time would also
be instructive, as there is no doubt that individuals have experi-
enced considerable variability on a daily basis during the pan-
demic. Beyond the current pandemic, scholars should extend re-
search on the relationship between emotion regulation and SDT in
the work domain. Finally, we encourage scholars to examine if our
model applies to high-threat work contexts more generally, such as
military, police, or hospitals, and/or environments that employees
might have little control over, as well as high-threat situations such
as working in an organization in the midst of layoffs or working
for an abusive supervisor.
Conclusion
In this moment in history, we are in the midst of a global crisis
unlike any humanity has faced in more than a century. Our
research represents a first step to understanding the work-, home-,
and health-related implications of this unprecedented situation,
highlighting the detrimental impact of the anxiety stemming from
the COVID-19 pandemic. However, there are proactive means
(i.e., handwashing) by which the consequences of this anxiety can
be mitigated. While there is still much to be understood about the
impact of the current pandemic on employees and organizations,
the present study offers critical insights into people’s experiences
during the initial phases of this crisis, especially in regards to the
role of CovH anxiety.
8
We tested a model that controlled for trait positive affectivity and trait
negative affectivity, but our conclusions remained qualitatively unchanged.
Please contact the authors for details on the measures and results.
9
We tested two additional models. In the first, we included COVID-19
detachment (adapted from Sonnentag & Fritz, 2007) as a simultaneous
mediator with emotion suppression; results of this analysis did not quali-
tatively alter our findings. In the second, we included emotional exhaustion
as a simultaneous mediator with need fulfillment. Results of our model
held except for the link between need fulfillment and somatic complaints,
which became non-significant. This was not surprising considering the
high correlation (.50) and conceptual overlap between exhaustion and
somatic complaints. Please contact the authors for details on the measures
and results.
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8TROUGAKOS, CHAWLA, AND MCCARTHY
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(Appendices follow)
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11
IMPACT OF COVID-19 HEALTH ANXIETY
Appendix A
Analytic Approach
Prior to running our analyses, we conducted a confirmatory
factor analysis to test the hypothesized seven-factor measurement
structure, excluding handwashing as well as number of hours spent
working given that they represented single item measures. Our
hypothesized model adequately fit the data, (384)
2914.359, p
.01, RMSEA .05, CFI .92, SRMR .05.
10
We tested our hypotheses using a path analysis in Mplus Ver-
sion 8.3 (Muthén & Muthén, 1998 –2015). To examine serial
mediation (Hypothesis 4), we used a Monte Carlo bootstrap sim-
ulation with 20,000 replications to create our bias-corrected 95%
confidence intervals (CIs) around our indirect effects. Consistent
with guidelines (Preacher & Hayes, 2004, 2008), we modeled the
direct effects of CovH anxiety on each of the outcome variables
when testing mediation. Further, the residuals of our outcome
variables were allowed to covary (as is the default in Mplus).
Following recommendations by Aiken and West (1991), we cen-
tered CovH anxiety and handwashing frequency before computing
the interaction term (Hypothesis 5).
10
Our hypothesized model demonstrated a better fit than (a) a structure
that collapsed CovH anxiety and trait anxiety onto one factor and, (b) a
structure that collapsed all the constructs onto a single factor. Please
contact the authors for detailed results.
Appendix B
Conditional Indirect Effects
Albeit not formally hypothesized, our arguments suggest that
there may be conditional indirect effects, such that the impact of
CovH anxiety on our work-, home-, and health-related outcomes
via emotion suppression and psychological need fulfillment are
weakened for individuals who exhibit greater handwashing fre-
quency. Thus, we also examined conditional serial indirect effects
of CovH anxiety on our outcomes at high and low (1SD) levels
of handwashing frequency. We utilized a Monte Carlo bootstrap
simulation with 20,000 replications to calculate the bias-corrected
95% CIs. Analyses indicated that CovH anxiety was associated with
lower goal progress (estimate ⫽⫺.016, 95% CI [.033, .006]) and
family engagement (estimate ⫽⫺.006, 95% CI [.017, .002]) via
emotion suppression and psychological need fulfillment when hand-
washing frequency was lower. However, these indirect effects did not
emerge when handwashing frequency was higher (goal progress:
estimate ⫽⫺.005, 95% CI [.019, .001]; family engagement: esti-
mate ⫽⫺.002, 95% CI [.009, .000]). Finally, CovH anxiety had a
positive indirect effect on somatic complaints via emotion suppres-
sion and psychological need fulfillment when handwashing frequency
was lower (estimate .010, 95% CI [.004, .022]), but not when
handwashing frequency was higher (estimate .003, 95% CI [.000,
.013]). In sum, our findings highlight that the negative impact of
CovH anxiety on employees’ behaviors and experiences across the
work, home, and health domains occur when employees do not
proactively cope by washing their hands.
Received May 13, 2020
Revision received July 21, 2020
Accepted August 3, 2020
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12 TROUGAKOS, CHAWLA, AND MCCARTHY
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Rumination is typically thought of as pessimistic, repetitive thinking or mulling that is deleterious for one’s health. Rumination, however, can take several forms and is not always harmful. In fact, it could actually be helpful in certain circumstances. It is common and often helpful when something stressful happens, like a health scare or problematic health diagnosis, for people to ponder or reflect on why it happened and brainstorm potential solutions to it. This is referred to as reflective rumination. Rumination affects people’s risk perceptions related to their personal and relational health and decisionmaking about their health. Research on negative rumination and health and positive rumination and health focuses on the impact of these patterns of thinking on health outcomes such as mental health, physical health, and relational health and as perceptions of health messages and risk likelihood.
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Some of the most important outcomes of romantic relationships are those related to the mutual fulfillment of basic psychological needs (Deci & Ryan, 2014; Knee, Hadden, Porter, & Rodriguez, 2013). The present study tested an actor–partner interdependence model of self-determination theory’s mutual need fulfillment in couples as a predictor of intimate partner violence (IPV) perpetration. Couples (N = 78 dyads) completed measures of basic psychological need fulfillment, relationship satisfaction, and intimate partner violence perpetration. Results suggest that women’s need fulfillment matters more in predicting men’s IPV perpetration, whereas men’s need fulfillment does not significantly predict women’s IPV perpetration. In other words, women’s need fulfillment acts as a protective factor against men’s IPV perpetration.