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Psychiatria Danubina, 2020; Vol. 32, No. 3-4, pp 505-512 Original paper
© Medicinska naklada - Zagreb, Croatia
WHY DO PEOPLE HIGH IN COVID-19 WORRY HAVE MORE
MENTAL HEALTH DISORDERS? THE ROLES OF RESILIENCE
AND MEANING IN LIFE
Murat Yıldırım1,2, Gökmen Arslan3 & Izaddin Ahmad Aziz4
1Ağrı İbrahim Çeçen University, Ağrı, Turkey
2University of Liecester, Liecester, United Kingdom
3Mehmet Akif Ersoy University, Burdur, Turkey
4Salahaddin University, Erbil, Iraq
received: 28.4.2020; revised: 15.5.2020; accepted: 22.5.2020
SUMMARY
Background: The existing literature has not adequately studied the influence of COVID-19 worry on mental health disorders.
This study tested the mediating roles of resilience and meaning in life between COVID-19 worry and mental health disorders.
Subjects and methods: We recruited 284 Arabic speaking young adults (60.6% females; mean age = 26.25±7.57 years) to
complete the COVID-19 Worry Scale, Brief Resilience Scale, Meaning in Life Measure, and Patient Health Questionnaire-9.
Results: Results showed that COVID-19 worry negatively predicted resilience and meaning in life and positively predicted
mental health disorders. Furthermore, indirect effect of COVID-19 worry on mental health disorders via resilience and meaning in
life was significant.
Conclusion: These results will contribute to find effective measures to prevent mental health disorders and promote reduced
mental health disorders from the perspective of mitigating COVID-19 worry and increasing resilience and meaning in life.
Key words: COVID-19 worry – resilience - meaning in life - mental health disorders - Arab-speaking population
* * * * *
INTRODUCTION
In late December 2019, a new type of coronavirus
diseases (COVID-19) emerged in Wuhan city, the
capital of Hubei Province in China and has expo-
nentially spread throughout world. Recently, the World
Health Organization (WHO) has declared the COVID-
19 a public health emergency of global concern (WHO
2020). By 23 August 2020, the COVID-19 pandemic
has spread across 188 countries and regions, with almost
23.2 million confirmed cases and 805.230 deaths. Iraq
reported its first case of COVID-19 on 22 February
2020 and confirmed 201.050 cases and 6.353 deaths
(Center for Systems Science and Engineering 2020). Due
to the high infection rates of the virus and the necessity
to protect the health of people, governments have
implemented many measures to respond to reduce the
spread of the virus. The COVID-19 can be considered
as the first virus that drastically affect daily life of the
general public across the globe since the 1918 Spanish
flu pandemic. This study endeavoured to test the
underlying mechanism between COVID-19 worry and
mental health disorders by considering the role of
resilience and meaning in life.
Despite its threat on physical health, the effects of
COVID-19 on mental health have also been studied.
The COVID-19 pandemic is likely to threaten not only
people’s lives and physical health, but also their mental
health by leading to a wide range of psychological pro-
blems including depression, anxiety and stress (Arslan
et al. 2020a, Burke & Arslan 2020, Taylor et al. 2020),
burnout (Yıldırım & Solmaz 2020), nervousness, xeno-
phobia, uncertainty, panic attacks, depression, obsessive
compulsory disorder (Anjum et al. 2020), and general
mental health problems (Yıldırım & Güler 2020a). A
high prevalence of symptoms of posttraumatic stress
(7%) such as re-experiencing, adverse alterations in
thoughts or mood levels, and hyper-arousal was reported
on the general population in China due to COVID-19
quarantine (Liu et al. 2020) as well as high prevalence
rates of 30% of anxiety and 17% of depression (Wang
et al. 2020). Another study with more than 18,000
people in Italy reported high levels of depression,
anxiety, stress, post-traumatic stress disorder, adjust-
ment disorders, and insomnia during the COVID-19
and lockdown measures (Rossi et al. 2020). Similarly,
Yıldırım and Güler (2020b) provided evidence from
Turkey and showed that the general public experienced
greater levels of death distress such as anxiety, de-
pression, and obsession and lower levels of happiness
and positivity.
Worry is a psychological factor that can trigger men-
tal health problems during public health crisis like
COVID-19 pandemic. Worry can be defined as conti-
nuous thinking about actual or possible future threats,
risks, and uncertainties (Watkins 2008). During pande-
mic, the prevalence of psychological distress can be
high due to worry about and fear of being infected with
COVID-19 (Ahorsu et al. 2020, Šljivo et al. 2020).
Increasing number of confirmed and suspected cases in
Murat Yıldırım, Gökmen Arslan & Izaddin Ahmad Aziz: WHY DO PEOPLE HIGH IN COVID-19 WORRY HAVE MORE
MENTAL HEALTH DISORDERS? THE ROLES OF RESILIENCE AND MEANING IN LIFE
Psychiatria Danubina, 2020; Vol. 32, No. 3.4, pp 505-512
506
all over the world have resulted in public worry about
being infected by the virus, which has increased
anxiety (Bao et al. 2020). It is established in previous
research that worry about economic influences and
worry about academic delays were moderately related
with the increased level anxiety among Chinese col-
lege students during COVID-19 pandemic (Cao et al.
2020). Evidence within the wider literature also sug-
gests that worry is positively related with symptoms of
depression and anxiety and negatively related with
coping strategies (Hong 2007). A study with 788
survivors of the Wenchuan Earthquake showed that
individuals with low level of trait resilience and worry
about others was positively related with the symptoms
of PTSD, while individuals with high level of trait
resilience demonstrated little difference in PTSD
symptoms as a function of worry about others (Ying et
al. 2014).
Resilience refers to being capable of effectively
“bounce back” from stressful situation in the face of
adversity (Smith et al. 2008). With the capability of
reframing their perspectives, resilient individuals tend to
direct their attentions to positives, emphasise their
strengths, and seek for opportunities to protect their
mental health rather than negatives such as focusing on
their weaknesses and vulnerability (Harrison 2013). Stu-
dies have reported that resilience strengthens our coping
skills, which could increase well-being and flourishing
(Kansky & Diener 2017, Yildirim 2019, Yıldırım &
Belen 2018) and reduce mental health problems (Florez
et al. 2020, McDonnell & Semkovska 2020, Williams
2016). Resilience can facilitate an individual to cope
with stressors associated with increased mental health
problems including worry (Matthews et al. 2019). Resi-
lience was associated with depression, anxiety and life
satisfaction (Beutel et al. 2010) and a strong predictor of
depression (Hjemdal et al. 2007). Promoting resilience
could lead to better mental health and positive func-
tioning (Yildirim 2019). While earlier research reported
that resilience mediated the relationship between risk
perception, fear, depression, anxiety, and stress (Yildirim
et al. 2020), stress and burnout (Yıldırım & Solmaz
2020), and meaning in life, affect balance and psycho-
logical health (Arslan et al. 2020b) within the context of
current pandemic, the role of resilience playing in the
relationship between worry specific to COVID-19 and
mental health disorders has not been explored. Investi-
gating these relationships during pandemic could help to
suggest alternative solutions to high mental health dis-
orders, targeting mitigating role of resilience instead of
directly address mental health disorders of individuals.
Meaning in life is another variable that is believed to
be related to COVID-19 worry, mental health disorders
and resilience. Meaning in life refers to individuals’
beliefs that their lives are important, purposeful, cohe-
rent and seeking for worthwhile goals, and that are
endowed with a sense of innate aim (Steger 2009). It is
one of the key elements of psychological well-being
(Ryff & Keyes 1995). Although individuals differ in the
degree to which they pursuit of meaning in life (Mas-
caro & Rosen 2008), those who have a sense of mea-
ning in life are more likely to have better mental health.
Previous studies have shown that meaning in life is
negative associated with depression, anxiety and stress
(Riichiro & Masahiko 2006) and positively related with
mental health and psychological well-being (Alandete
2015). Longitudinal studies have demonstrated that
meaning in life can predict changes in psychological
distress like depressive symptoms (Mascaro & Rosen
2008). In addition, meaning in life is considered to be a
mediator between stress and depressive symptoms in the
context of COVID-19 pandemic (Arslan & Yildirim
2020). Cultivating meaning in life can reduce symptoms
of depression and stress in the face of adversity.
This study aimed to examine the mediating roles of
resilience and meaning in life in the relationship bet-
ween the COVID-19 worry and mental health disorders.
As such, the findings obtained from the study were
considered to contribute to the understanding of the
relationship between the measured variables alongside
facilitating mental health professionals to develop and
implement mental health intervention programs to
protect psychological health of individuals in the face
of the COVID-19 pandemic. Based on the literature
review above, we propose the following hypotheses:
(1) COVID-19 worry can significantly and negatively
predict resilience and meaning in life and positively
predicted mental health disorders. (2) Resilience and
meaning in life can significantly and negatively predict
mental health disorders. (3) Resilience and meaning in
life play mediating roles in the relationship between
COVID-19 worry and mental health disorders. The
hypothesised model of the study is presented in Figure 1.
SUBJECTS AND METHOD
Participants
The sample was composed of 284 Arabic speaking
young adults (60.6% females) aged 18–57 years (M=26.25,
SD=7.57) who were mostly university graduate (46.1%),
single (60.9%), without any chronic disease (97.9%),
non-smoker (90.9%), and with no confirmed or sus-
pected COVID-19 including their first-degree relative
(70.8%). Data were collected from those who have been
confirmed or suspected with COVID-19 including their
first-degree relative. All participants were imposed by
government to quarantine at the designated places such
as hotel and dormitories for 14 days following arrival
from abroad.
Measures
Mental Health Disorders
Depressive symptoms were assessed with Patient
Health Questionnaire-9 (Spitzer et al. 1999). The ques-
tionnaire comprises of 9 items and each item is an
Murat Yıldırım, Gökmen Arslan & Izaddin Ahmad Aziz: WHY DO PEOPLE HIGH IN COVID-19 WORRY HAVE MORE
MENTAL HEALTH DISORDERS? THE ROLES OF RESILIENCE AND MEANING IN LIFE
Psychiatria Danubina, 2020; Vol. 32, No. 3.4, pp 505-512
507
Figure 1. Structural model indicating the associations between the variables (**p<0.001)
swered using a 4-point point Likert type scale ranging
from 1 (not at all) to 4 (nearly every day). Higher total
scores reflect to more depressive symptoms while lower
total scores reflect to better physical and psychological
health. This scale has been used among Arab population
(AlHadi et al. 2017). The internal consistency reliability
was 0.81 in the present study.
COVID-19 worry
This variable was measured by the 3 statements
generated for the purpose of this study. Each item is
rated on a 5-point Likert scale, ranging from 0 (never)
to 4 (very often). Higher scores indicate higher levels of
worry related to COVID-19. Cronbach's alpha coeffi-
cient was 0.73 in the present study. Exploratory factor
analysis yielded a one-factor solution explaining 65.37%
of the variance.
Resilience
Brief Resilience Scale (Smith et al. 2008) was used
to assess the ability to bounce back from stressful
situation. There are 6 items scored on a 5-point Likert
scale, ranging from 1 (strongly disagree) to 5 (strongly
agree). Higher scores refer to higher levels of resi-
lience. This scale has been used among Arab popu-
lation (Younes & Alzahrani 2018). In the present study,
Cronbach's alpha coefficient for the scale was 0.53.
Meaning in Life
Meaning in life was measured using Meaningful
Living Measure (MLM; Arslan 2020). This scale in-
cludes 6 items answered using a 7-point Likert type
scale ranging from 1 (strongly disagree) to 7 (strongly
agree). Higher scores indicate higher levels of meaning
in life. In the present study, Cronbach's alpha coefficient
was 0.89. Here, we further presented psychometric
properties of the scale to enhance the utility of the scale
in the target language.
Procedure
A cross-sectional web-based survey was adopted to
collect data. All participants provided on-line consent.
Participants were made aware about their right to
terminate the survey at any time they want. The
responses were anonymous, and confidentiality of given
information was assured. Data collection were held
between 18th May and 25th June 2020 using an on-line
questionnaire distributed via the internet, using social
networking sites such as WhatsApp. The on-line survey
was developed using a free and secure software.
Data Analyses
Prior to testing the proposed mediation model, con-
firmatory factor analysis was first employed to examine
factor structure of the Meaningful Living Measure (MLM)
with the sample of the study, which was described in pre-
vious MLM validity study (Arslan 2020). After evalua-
ting the structure validity of the measure, descriptive
statistics and correlation analysis were conducted to ex-
plore the analysis assumptions and the association bet-
ween the variables of the study. Normality was checked
using skewness and kurtosis scores (Curran et al. 1996).
Subsequently, the mediation model proposing the media-
ting role of meaning in life and resilience in the link of
COVID-19 worry with mental health disorders was
performed using the PROCESS macro (Model 4) for
SPSS version 3.4 (Hayes 2018). Standardized regression
estimate (β) scores and squared-multiple correlations
(R2) were examined to interpret the results of the
mediation analysis, with the following effect sizes: 0.01-
0.059 = small, 0.06–0.139 = moderate, and ≥ 0.14 =
large (Cohen 1988). In addition to testing the model, the
bootstrapping procedure with 10,000 resamples to
estimate the 95% confidence intervals was employed to
investigate the significance effect of indirect estimates
(Hayes 2009, 2018, Preacher & Hayes 2008). All study
analyses were performed using SPSS version 25.
Murat Yıldırım, Gökmen Arslan & Izaddin Ahmad Aziz: WHY DO PEOPLE HIGH IN COVID-19 WORRY HAVE MORE
MENTAL HEALTH DISORDERS? THE ROLES OF RESILIENCE AND MEANING IN LIFE
Psychiatria Danubina, 2020; Vol. 32, No. 3.4, pp 505-512
508
RESULTS
Structure Validity of the MLM
We first examined factor structure of the MLM with
the sample of the present study. Findings from the
measurement model were evaluated using several data-
model fist statistics and their cut points: The
standardized root mean square residual (SRMR≤0.05=
good data-model fit and ≤0.08 = adequate) and the root
mean square error of approximation (RMSEA ≤0.05 =
good data-model fit, ≤0.08 = adequate, and ≤0.10 =
acceptable); Tucker-Lewis index and comparative fit
index (TLI and CFI ≥0.95 = close data-model fit and ≥
0.90 = adequate) (Hooper et al. 2008, Hu & Bentler
1999). The measurement model, which structured the
six items loading to meaningful living latent construct,
provided good-data model fit statistics (χ2=33.03, df=9,
p<0.001, CFI=0.97, TLI=0.95, RMSEA [95% CI] =
0.099 [0.064, 0.136], SRMR = 0.035). Factor loadings
of the measure were strong and between 0.57 and 0.81,
with robust indicator reliabilities, ranging from 0.32 to
0.65, see Table 1. The findings also showed that the
MLM had strong latent construct reliability estimate
(H=0.89). Taken together, these results provide initial
evidence suggesting that the measure could be used to
assess the sense of meaningful living in Iraq adults.
Table 1. Factor loadings of the MLM
Scale items λ ℓ2
As a whole, I find my life meaningful 0.72 0.52
I find a meaning and purpose in the difficulties that I experience. 0.74 0.55
I have an ultimate purpose and meaning of my life. 0.81 0.65
I strive to achieve my goals. 0.80 0.64
I have meaningful social and intimate relationships. 0.75 0.57
My values and beliefs add more meaning to my life. 0.57 0.32
Table 2. Descriptive statistics and correlations
Mean SD Skew. Kurt. α 1. 2. 3. 4.
COVID-19 Worry 8.27 2.82 0.07 -0.47 0.73 – -0.33 -0.30 0.54
Meaning in life 33.78 7.95 -1.10 0.68 0.87 – 0.43 -0.46
Resilience 19.99 3.73 -0.19 0.19 0.53 – -0.48
Mental health disorders 18.67 5.53 0.47 -0.17 0.80 –
Table 3. Unstandardized coefficients for the mediation model
Consequent
M
1 (Resilience)
Antecedent Coeff. SE t p
X (COVID-19 worry) a
1 –0.30 0.05 –5.25 <0.001
Constant i
M1 23.98 0.79 30.39 <0.001
R
2 =0.09; F = 27.52; p <0.001
M
2 (Meaning in life)
X (COVID-19 worry) a
2 –0.69 0.12 –5.75 <0.001
Constant i
M2 42.98 1.66 25.83 <0.001
R
2=0.11; F=33.01; p<0.001
Y (Mental health disorders)
X (Coronavirus stress) c' 0.56 0.07 7.76 <0.001
M1 (Resilience) b1 –0.41 0.08 –5.34 <0.001
M2 (Meaning in life) b2 –0.15 0.04 –4.23 <0.001
Constant iy 24.52 2.12 11.56 <0.001
R
2 =0.44; F = 70.48; p <0.001
Note. SE = standard error; Coeff = unstandardized coefficient; X = independent variable; M = mediator variable;
Y = outcomes or dependent variable
Murat Yıldırım, Gökmen Arslan & Izaddin Ahmad Aziz: WHY DO PEOPLE HIGH IN COVID-19 WORRY HAVE MORE
MENTAL HEALTH DISORDERS? THE ROLES OF RESILIENCE AND MEANING IN LIFE
Psychiatria Danubina, 2020; Vol. 32, No. 3-4, pp 504-511
509
Table 4. Standardized indirect effects
Path Effect SE BootLLCI BootULCI
Total indirect effect 0.16 0.03 0.10 0.21
COVI-19 worry–>Meaning–>Mental health disorders 0.08 0.02 0.05 0.13
COVI-19 worry–>Resilience–>Mental health disorders 0.07 0.02 0.03 0.12
Note. Number of bootstrap samples for percentile bootstrap confidence intervals: 10,000
Mediation Analysis
Findings from descriptive statistics demonstrated
that skewness ranged from -1.10 to 0.47, and kurtosis
were between -0.47 and 0.68. these results suggested
that all variables of the study had relatively normal
distribution. Correlation results also indicated that
COVID-19 worry had significant and negative asso-
ciation with meaning in life (r=-0.33, p<0.001) and
resilience (r=-0.30, p<0.001), as well as was positively
and significantly related to mental health disorders
(r=0.54, p<0.001). Further, mental health disorders had
negative and significant correlation with meaning in life
(r=-0.46, p<0.001) and resilience (r=-0.48, p<0.001), as
shown in Table 2.
We examined the mediating effect of meaning in life
and resilience in the link between COVID-19 worry and
mental health disorders using the PROCESS macro with
Model 4 (Hayes 2018). Results from the analyses sho-
wed that COVID-19 worry was a significant predictor
of resilience (β = –0.30, p <0.001), meaning in life (β=-
0.33, p<0.001), and mental health disorder (β=0.39, p <
0.001). Worry accounted for 9% of the variance in
resilience and 11% of the variance in meaning in life.
Subsequently, further results indicated that COVID-19
worry had indirect effects on mental health disorders
through resilience (β = –0.28, p < 0.001) and meaning in
life (β = –0.22, p < 0.001). Resilience and meaning in
life partially mediated the effect of COVID-19 worry on
mental health disorders. COVID-19 worry, resilience,
and meaning in life, together, explained 44% of the
variance in mental health disorders, as shown in Table 3
and Figure 1. The indirect effects of COVID-19 worry
on mental health through resilience and meaning in life
was significant. Standardized total and indirect effects
with 95% bias-corrected confidence interval predicting
mental health disorders scores are presented in Table 4.
DISCUSSION
The aim of this study was to test how extensively
COVID-19 worry is associated with mental health
disorders, and to evaluate whether resilience and mea-
ning in life mediate the COVID-19 worry – mental
health disorders association. Results showed a
significant and positive association between COVID-19
worry and mental health disorders assessed in this
investigation. In addition, there was equally consistent
evidence that resilience and meaning in life mediated
the association between COVID-19 worry and mental
health disorders.
Although it is evident that worry is associated with
an extensive range of mental health and behavioural
problems (Anniko et al. 2015), investigation of COVID-
19 specific worry within the context of pandemic has
been neglected. Results from this study reveal that
COVID-19 specific worry is associated with more mental
health disorders. Although the positive associations
between worry and mental health disorders have been
previously documented within the wider literature (Young
& Dietrich 2015), this association has rarely, if ever, been
demonstrated in the context of COVID-19 pandemic,
particularly in a community based sample of young adults
who have been infected or suspected with COVID-19.
This suggests consistent relationship between worry and
mental health disorders in different contexts.
The assumption that COVID-19 worry is associated
with mental health disorders because of resilience and
meaning in life is well-supported by the findings from
this study. COVID-19 worry was significantly
associated with resilience. This is in accordance with the
findings of Hrozanova et al. (2019) who documented
that a significant negative association between worry
and resilience. Resilience is a fundamental element
well-being and mental health (Yildirim 2019). It is
plausible to believe that why people with high levels of
worry have poor ability to “bounce back” from stressful
situations in the face of adversity. People who are able
to manage their worry in times of crisis can effectively
cope with difficulties arisen from the crisis. This study
and those in the literature support the assumption that
worry can hinder resilience (Hrozanova et al. 2019).
Second, COVID-19 worry was significantly negate-
vely associated with meaning in life. That is, those who
experienced more worry related to COVID-19 had a
lower level of sense of meaning in life, confirming that
worry is an important influencing factor of meaning in
life (Negru-Subtirica et al. 2016). Our study also showed
that resilience and meaning in life were associated with
mental health disorders, meaning that individuals with
high levels resilience and meaning in life tended to have
lowered mental health disorders. These findings are in
line with earlier research showing that those with a
higher level of resilience tend to deal more effectively
with depression (Elisei et al. 2013, Wingo et al. 2010).
This finding is also in line with the notion that meaning
in life is essential for offsetting the detrimental impact
of traumatic life events on depressive symptoms
(Krause 2007). As such, high resilience and meaning in
life appear to play key mechanisms that explain why
some people can cope with worry and depressive
symptoms better than others in difficult times.
Murat Yıldırım, Gökmen Arslan & Izaddin Ahmad Aziz: WHY DO PEOPLE HIGH IN COVID-19 WORRY HAVE MORE
MENTAL HEALTH DISORDERS? THE ROLES OF RESILIENCE AND MEANING IN LIFE
Psychiatria Danubina, 2020; Vol. 32, No. 3-4, pp 504-511
510
This study also found that resilience and meaning in
life mediated the association between COVID-19 worry
and mental health disorders. Specifically, higher worry
related to pandemic was associated with decreased
resilience and meaning in life, which partially explained
why worry was positively associated with mental health
disorders. This cross-sectional result is consistent with a
conceptual model where resilience explains the link
between negative life events and mental health (Gao et
al. 2019) and a model where meaning in life mediated
the relationship between coronavirus stress and depres-
sive symptoms (Arslan & Yildirim 2020). To gain more
confidence in this model, future studies should use
longitudinal analyses to test the causal chain that may
lead COVID-19 worry to mental health disorders. It
would be particularly informative to investigate indivi-
duals who have been infected with virus.
This study has important contributions. The current
study, to the authors’ knowledge, is the first study to
empirically test a mechanism (i.e. resilience and mea-
ning in life) that explains the association between
COVID-19 worry and mental health disorders. It pre-
sents an empirical framework for the researchers by
simultaneously testing resilience and meaning in life as
mediators between COVID-19 worry and mental health
disorders. Prior research has found a positive associa-
tion between resilience, meaning in life, and psycho-
logical health within the context of COVID-19 pan-
demic (Arslan et al. 2020b). This study proposed that
people worry during pandemic and their worries may
generate mental health disorders. However, holding the
ability to cope with stress or bounce back quickly from
adversity and a sense of meaning in life can mitigate the
impact of COVID-19 worry on mental health disorders.
It is reasonable to assume that the more one is resilient
and has a sense of meaning in life, the less chance they
experience mental health disorders in difficult times.
The fact that resilience and meaning in life partially
mediated the association between worry and mental
health disorders is a powerful evidence to the reduction
of stressors in influencing mental health. In the light of
these findings, mental health practitioners can take
resilience and meaning in life into consideration when
designing interventions aimed at reducing the impacts
of pandemic specific stressors on mental health as here
resilience and meaning in life have been found to be
pivotal strengths for the promotion of mental health.
Further, this study presents preliminary evidence regar-
ding psychometric properties of MLS among an Arabic
speaking population. This is beneficial for the compa-
rison of research outcomes across cultures.
In this study, some limitations should be acknow-
ledged. First, this study used a cross-sectional design,
which cannot draw conclusions about a causal relation-
ship among the measured variables. The emerging
results of mediation analyses must be interpreted with
caution on cross-sectional data. Future studies may test
the hypothesised mediating model utilising longitudinal
or experimental studies. Second, all the measures used
in the current study were self-report. As such, the
relationships found in this study might be affected by
common variance bias. Furthermore, using self-report
measures might carry other biases such as recall bias
and social desirability. Nevertheless, self-reports mea-
sures used in this study were advantageous in terms of
providing low-cost and speedy data collection that are
needed to respond in a timely manner to the demand of
reaction toward COVID-19 during the pandemic. It
would be useful that future research considers utilising
other types of measurement approaches such as peer
reports to corroborate the current study’s findings.
Third, the participants were those who were either
infected or suspected with COVID-19 during the study
period. As such, the current study’s findings may not be
generalized to those without such conditions. Finally,
the participants were collected only from several
institutions in Iraq. Considering that different countries
have implemented different policies to prevent the
spread and infection of COVID-19, people confirmed or
suspected with COVID-19 may receive different levels
of COVID-19 treatment. Thus, the current study’s
findings may not be replicated to other countries due to
the adapting various policies toward the virus.
CONCLUSION
This study proposed a model to understand mental
health disorders among a sample of individuals who
were either confirmed or suspected with COVID-19 in
Iraq. The results showed that COVID-19 worry was a
significant factor explaining mental health disorders via
resilience and meaning in life. More worry related to
COVID-19 was associated with less resilience and mea-
ning in life, which in turn led to mental health disorders.
Therefore, healthcare providers may want to reduce
worry related to COVID-19 among individuals confir-
med or suspected with COVID-19 to mitigate mental
health disorders via improving their ability to bounce
back from adversity and sense of meaning in life.
Acknowledgements:
We would like to thank all participants who contri-
buted to this study.
Ethical approval: All procedures performed in stu-
dies involving hu\man participants were in accordance
with the ethical standards of the institutional and/or
national research committee and with the 1964
Helsinki declaration and its later amendments or
comparable ethical standards.
Informed consent: Consent was obtained from all
participants included in the study.
Data availability statement: The data that support
the findings of this study are available from the
corresponding author upon reasonable request.
Murat Yıldırım, Gökmen Arslan & Izaddin Ahmad Aziz: WHY DO PEOPLE HIGH IN COVID-19 WORRY HAVE MORE
MENTAL HEALTH DISORDERS? THE ROLES OF RESILIENCE AND MEANING IN LIFE
Psychiatria Danubina, 2020; Vol. 32, No. 3-4, pp 504-511
511
Conflict of interest: None to declare.
Contribution of individual authors:
Murat Yildirim: study design, literature review, method,
discussion, approval of the final version.
Gökmen Arslan: study design, statistical analysis,
results, approval of the final version.
Izaddin Ahmad Aziz: data collection, approval of the
final version.
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Correspondence:
Murat Yıldırım, Md, PhD
Ağrı İbrahim Çeçen University, Department of Psychology, Faculty of Science and Letters
Erzurum Yolu 4 Km 04100, Merkez, Ağrı, Turkey
E-mail: muratyildirim@agri.edu.tr; muratyildirimphd@gmail.com
