Anxiety and fear of COVID-19 in the UK general population: a cross-sectional study

Obse a ional S udy 1 Medicine® Anxie y and ea o COVID-19 in he UK gene al popula ion A c oss-sec ional s udy C is inaMo gado-Toscano, RNa,b, JuanGómez-Salgado, PhDc,d,* , Ja ie Fagundo-Ri e a, PhDe, YolandaNa a o-Abal, PhD , LucasRod íguez-Jiménez, RNg, José An onioClimen -Rod íguez, PhD , ReginaAllande-Cussó, PhDh Abs ac The e is s ill a gene alized eeling o unce ain y in he popula ion due o he co ona i us disease 2019 (COVID-19) pandemic, as es ic ions on daily ou ines and social con ac , accompanied by a la ge numbe o in ec ions, nega i ely a ec di e en a eas o people’s li es and, he e o e, hei men al heal h. The aim o he p esen s udy was o assess he p esence o anxie y and ea o COVID-19 in he gene al UK popula ion, using he Anxie y and Fea o COVID-19 Assessmen Scale (Ansiedad y Miedo al COVID-19) (AMICO) scale. A desc ip i e, c oss-sec ional s udy based on a ques ionnai e was conduc ed in a sample o he UK gene al popula ion in 2021. Socio-demog aphic and employmen a iables we e included. The AMICO scale was included o measu e ea and anxie y abou COVID-19. The ela ionship be ween a iables was s udied wi h a ca ego ical eg ession analysis. In gene al, pa icipan s ega ded hemsel es as well-in o med abou he pandemic, al hough 62.6% had only ecei ed 1 dose o he accine. Rega ding he AMICO scale he o al sco e was 4.85 (ou o 10; s anda d de ia ion 2.398). Women showed highe sco es o he AMICO han men. The bi a ia e analysis e ealed s a is ically signi ican di e ences in ela ion o sel -con idence, amoun o in o ma ion ecei ed, and accina ion a iables as ela ed o he mean AMICO sco es. An a e age le el o anxie y and ea o COVID-19 is shown in he gene al UK popula ion, which is lowe han mos o he s udies ha assessed he impac o he pandemic on he gene al popula ion. Abb e ia ions: AMICO = Anxie y and Fea o Co id-19 Assessmen Scale (Ansiedad y Miedo al COVID-19), COVID-19 = co ona i us disease 2019, EFA = explo a o y ac o analysis, FCV-19 = ea o COVID-19. Keywo ds: anxie y, COVID-19, ea , psychological dis ess, UK 1. In oduc ion In Decembe 2019, he i s case o pneumonia caused by he new o m o co ona i us was de ec ed in Wuhan, China, wi h se e e acu e espi a o y synd ome co ona i us 2 con i med as he causa i e agen on Janua y 7, 2020.[1] The eme gence o his new i us igge ed a con using si ua ion, as i quickly sp ead o o he p o inces and egions o he coun y and subsequen ly wo ldwide and was cha ac e ized by an ex emely high in ec- ion a e and ela i ely high mo ali y.[2] Thus, on Janua y 30, 2020, he Wo ld Heal h O ganiza ion decla ed his disease a “public heal h eme gency o in e na ional conce n.”[3] The UK was one o he i s coun- ies a ec ed in Eu ope, wi h i s i s 2 con i med cases o co ona i us disease 2019 (COVID-19) de ec ed on Janua y 31, 2020.[4] F om his poin onwa ds, cases began o inc ease exponen ially, leading o he decla a ion o a lockdown o he en i e UK popula ion om Ma ch 23, 2020, un il July 31, 2020.[5] Howe e , he UK’s ini ial esponse o he pandemic was slow.[6] Due o he la ge olume o in ec ed people, he e was e en a need o c ea e hospi als wi h he speci ic pu pose o ea ing hese pa ien s, as was he case o he “Nigh ingale Hospi al,” which was buil in London o ecei e up o 4000 The au ho s ha e no unding o disclose. The au ho s ha e no con lic s o in e es o disclose. The da ase s gene a ed du ing and/o analyzed du ing he cu en s udy a e a ailable om he co esponding au ho on easonable eques . Pe mission o conduc his s udy was ob ained om he Na ional Heal h Se ice (NHS) Heal h Resea ch Au ho i y, IRAS p ojec ID 283849, REC e e ence 20/ HRA/3997. This s udy also complied wi h he guidelines se in he Decla a ion o Helsinki ega ding e hical p inciples o medical esea ch in ol ing human subjec s. a Heal h Sciences Doc o a e School, Uni e si y o Huel a, Huel a, Spain, b Heal h Sciences Resea ch Uni : Nu sing, Uni e si y o Coimb a, Coimb a, Po ugal, c Depa men o Sociology, Social Wo k and Public Heal h, Facul y o Labou Sciences, Uni e si y o Huel a, Huel a, Spain, d Sa e y and Heal h Pos g adua e P og amme, Uni e sidad Espí i u San o, Guayaquil, Ecuado , e Cen o Uni e si a io de En e me ía C uz Roja, Uni e si y o Se ille, Se ille, Spain, Facul y o Educa ion Science, Uni e si y o Huel a, Huel a, Spain, g Eme gency Depa men , Royal F ee London NHS Founda ion T us , h Depa men o Nu sing, Uni e si y o Se ille, Se ille, Spain. * Co espondence: Juan Gómez-Salgado, Depa men o Sociology, Social Wo k and Public Heal h, Facul y o Labou Sciences, Uni e si y o Huel a, A enida T es de ma zo, s/n, Huel a 21007, Spain (e-mail: [email p o ec ed]). Copy igh © 2023 he Au ho (s). Published by Wol e s Kluwe Heal h, Inc. This is an open-access a icle dis ibu ed unde he e ms o he C ea i e Commons A ibu ion-Non Comme cial License 4.0 (CCBY-NC), whe e i is pe missible o download, sha e, emix, ans o m, and buildup he wo k p o ided i is p ope ly ci ed. The wo k canno be used comme cially wi hou pe mission om he jou nal. How o ci e his a icle: Mo gado-Toscano C, Gómez-Salgado J, Fagundo-Ri e a J, Na a o-Abal Y, Rod íguez-Jiménez L, Climen -Rod íguez JA, Allande-Cussó R. Anxie y and ea o COVID-19 in he UK gene al popula ion: A c oss-sec ional s udy. Medicine 2023;102:10(e33045). Recei ed: 18 Oc obe 2022 / Recei ed in inal o m: 30 Janua y 2023 / Accep ed: 31 Janua y 2023 h p://dx.doi.o g/10.1097/MD.0000000000033045 Downloaded om h p://jou nals.lww.com/md-jou nal by BhDM 5ePHKa 1zEoum1 Q N4a+kJLhEZgbsIHo4XMi0hCy wCX1AWnYQp/IlQ HD3i3D0OdRyi7T SFl4C 3VC4/OAVpDDa8K2+Ya6H515kE= on 09/27/2023 2 Mo gado-Toscano e al. • Medicine (2023) 102:10 Medicine pa ien s wi h COVID-19.[6] Since hen, up o 6 wa es o in ec- ions ha e occu ed in Eu ope, o cing coun ies such as he UK o ake d as ic measu es o cu b he numbe o in ec ed people. Cu en ly, 11,518,255 cases and 147,723 dea hs ha e been con i med.[7] To add ess his si ua ion, on Decembe 8, 2020, he UK became he i s coun y o ini ia e a COVID-19 accina ion p og am. Ini ially, accina ion was p io i ized o he elde ly o e 80 yea s o age and on line heal hca e wo ke s,[8] each- ing 47,051,876 people who a e cu en ly ully accina ed, ha is, 70.40% o he UK popula ion.[7] Howe e , al hough accina ion has conside ably educed he likelihood o de eloping se e e disease om he i us, i has no p o ed o be an e ec i e measu e o educe he numbe o in ec- ions due o he mul iple mu a ions he i us has unde gone. All his leads o a gene alized eeling o unce ain y in he popula- ion, inc eased by he es ic ions on mobili y and social con ac imposed in all coun ies, hus nega i ely a ec ing di e en a eas o people’s li es and men al heal h.[9] In gene al, he e ec s caused by COVID-19 on he physical and men al heal h o he popula ion ha e been and con inue o be s udied. Apa om he medical consequences o COVID-19, his pandemic has also been cha ac e ized by i s p opaga ion o e ime, hus de ining he e m “co onaphobia” o designa e he long- e m men al illnesses ela ed o he pandemic.[10] This aises he need o enewal and o he de elopmen o ools ha measu e speci ically pandemic- ela ed ea and anx- ie y in he gene al popula ion. One o he i s scales designed o his pu pose was he ea o COVID-19 (FCV-19).[11] The Anxie y and Fea o Co id-19 Assessmen Scale (Ansiedad y Miedo al COVID-19) (AMICO) was designed ollowing he me hodology p oposed by Eps ein e al.[12] Ini ially, i was based on he 10 i ems o he FCV-19 scale, which we e e alu- a ed by a panel o expe s p io o he psychome ic analyses conduc ed o ha s udy.[11] Wi h hese 10 i ems, a ansla- ion/back- ansla ion p ocess was applied and he c oss-cul- u al adap a ion was s udied by a panel o expe s. I was made up o 10 subjec s, namely p o esso s and esea che s om di e en Spanish uni e si ies, wi h he academic le el o Doc o o O icial Mas e and whose a eas o knowledge we e public heal h, amily medicine, clinical psychology, nu s- ing, and social wo k. In addi ion o he 10 i ems, he panel o expe s p oposed and ag eed, using he Delphi echnique, o conside 8 new i ems measu ing he anxie y cons uc . The 18 i ems we e hen submi ed o a new Delphi ound. The explo a o y ac o analysis (EFA) p oduced a dimensional ma ix o 16 i ems and 2 ac o s, explaining 64.8% o he a iance (Kaise -Meye -Olkin es = 0.94; Ba le es : P = .001). The eliabili y s udy p o ided a C onbach α alue o 0.92. The esponse op ions o he AMICO scale ange om 1 o 10 poin s, whe e 1 co esponds o “s ongly disag ee” and 10 o “s ongly ag ee.”[10] Likewise, he AMICO scale was alida ed concu en ly wi h he S a e-T ai Anxie y In en o y ques ionnai e.[13] As in Spain, nu ses in he UK ha e el o e whelmed by he hea y wo kload. Likewise, he gene al popula ion has also been se e ely a ec ed in his espec . The AMICO scale has p o ed o be a alid and eliable ool in he Spanish gene al popula- ion o iden i y he ex en o which he COVID-19 pandemic has a ec ed he men al heal h o he popula ion and hus o e speci ic in e en ions o add ess a global popula ion p oblem. The e o e, he e is a need o alida e his scale in he UK popu- la ion as well. Wi h ega d o he so-called ad e se e ec s, o e he las 40 yea s, wi h he i s In e go e nmen al Panel on Clima e Change in 1988, a consensus has eme ged on he ole o human ac i i y in inc easing global empe a u e and accele - a ing clima e change, ac o s ha signi ican ly h ea en public heal h.[14] These h ea s ha e a di ec impac on heal h and a e expec ed o cause 250,000 dea hs pe yea wo ldwide be ween 2030 and 2050, mainly om malnu i ion, in ec- ious diseases, and hea s ess, acco ding o he Wo ld Heal h O ganiza ion.[15] Fu u e esea ch on ad e se e ec s also helps o p edic in ec- ious espi a o y diseases, including COVID-19, and o he non- espi a o y diseases.[16] Gi en hese possible ad e se e ec s and in an a emp o an icipa e he p oblem in o de o p e en possible ela ed men al heal h condi ions, i would be ad is- able o de elop new s udies ha assess he p esence o anxi- e y and ea in speci ic popula ion g oups such as he elde ly, child en, people wi h men al heal h p oblems, and ail people wi h he aim o explo ing wha hey expe ience when aced wi h ce ain heal h si ua ions. Knowing how ce ain popula- ion g oups beha e in he ace o an ad e se e ec o his ype, such as he COVID-19 pandemic, can be o g ea help o u u e in e en ions.[17] In his con ex , he aim o he p esen s udy was o assess he p esence o anxie y and FCV-19 in he gene al UK popula ion, using he AMICO scale. 2. Ma e ials and me hods 2.1. Design A desc ip i e, c oss-sec ional s udy based on a ques ionnai e was conduc ed acco ding o he He zog e al classi ica ion,[18] which was dissemina ed be ween Ap il and June 2021. 2.2. Popula ion and sample This s udy was conduc ed in he UK, a coun y wi h a popula- ion o 67,025,542 as o 2019.[19] A sample o a leas 239 peo- ple was es ima ed o his s udy, wi h a con idence le el o 95%, a p ecision o 3%, and an expec ed loss a io o 15%. Finally, he o al sample o his s udy was 657. 2.3. Pa icipan s and public in ol emen This s udy de eloped i s esea ch ques ion wi h a basis on expe- iences and psychological needs exp essed by he public. The public was no in ol ed in he design o he s udy. Pa icipan s we e encou aged o dissemina e he ques ionnai e o ela i es who li ed in he UK. The pa icipan s could ag ee on ecei ing he in es iga ion esul s, once he s udy had concluded and ou - comes we e published. 2.4. Va iables Socio-demog aphic a iables such as sex, age, egion o esi- dence, ma i al s a us, le el o educa ion, numbe o cohabi an s, size o he dwelling, heal h s a us, diagnosis and hospi al admis- sions o COVID-19, olun a y sel -con inemen o a oid in ec- ion, accina ion, and side e ec s we e included. Employmen a iables we e also included, such as employmen s a us, wo k sec o , and sala y. Finally, he AMICO scale a iable was included o measu e ea and anxie y abou COVID-19. 2.5. Ins umen s The Anxie y and Fea o COVID-19 Assessmen (AMICO) scale was used. This scale was al eady designed and alida ed in p e- ious s udies. The alida ion o he AMICO_UK scale was ca - ied ou in a p e ious s udy. Fo he adap a ion o he AMICO scale o he UK con ex , a p ocess o di ec ansla ion in o English and back- ansla ion in o Spanish was ca ied ou in o de o e i y ha he ansla ed e sion e lec ed he same con- en as he o iginal e sions.[20] This double ansla ion p ocess was pe o med by 2 ansla o s who we e na i e Spanish speak- e s, bu who esided and wo ked in he UK and had a minimum Downloaded om h p://jou nals.lww.com/md-jou nal by BhDM 5ePHKa 1zEoum1 Q N4a+kJLhEZgbsIHo4XMi0hCy wCX1AWnYQp/IlQ HD3i3D0OdRyi7T SFl4C 3VC4/OAVpDDa8K2+Ya6H515kE= on 09/27/2023 3 Mo gado-Toscano e al. • Medicine (2023) 102:10 www.md-jou nal.com o a Mas e ’s deg ee. The ansla ed e sion was e alua ed by a panel o 10 expe s.[21] Subsequen ly, a pilo es was ca ied ou wi h 20 subjec s o de ec unde s anding p oblems, a e which he ield s udy was ini ia ed wi h a sample o subjec s li ing in he UK. P io o he EFA, a Kaise -Meye -Olkin measu e o 0.961 and a signi icance le el o 0.000 in he Ba le es o sphe ici y we e ob ained. Wi h hese esul s, he EFA was implemen ed in acco dance wi h he c i e ia o p incipal componen s analysis and a imax o a ion, which yielded a ac o ial solu ion o 2 dimensions and 16 i ems. This ac o ial solu ion explained 76% o he a iance. A eliabili y s udy was also ca ied ou , p o iding an o e all C onbach α alue o 0.964, and 0.90 and 0.92 o each o he ac o s. A e ha , con i ma o y ac o analysis was pe o med o assess cons uc alidi y, which o e ed he ollowing alues: dis- c epancy di ided by deg ee o eedom = 4.59 (P = .17; No med Fi Index = 0.97; Tucke -Lewis index = 0.956; compa a i e i index = 0.976; oo mean squa e e o o app oxima ion = 0.07; and Quad a ic s anda dized esidual = 0.04). 2.6. P ocedu e/se ings A non-p obabilis ic snowball sampling was ca ied ou . Fo he ec ui men o he sample subjec s, an online ques ionnai e was elabo a ed using Qual ics©, which included in o ma ion abou he s udy and he i ems ela ed o he a iables o said s udy. The ques ionnai e was sen o he popula ion h ough social ne wo ks. All pa icipan s we e duly in o med o he pu pose o he s udy, as well as o he possibili y o pa icipa ing olun a ily, anonymously, and con iden ially. To pa icipa e, subjec s had o ick a box o g an pa icipa ion on a olun a y and anonymous basis. Once his box was icked, pa icipan s had access o he ques ionnai es. O he wise, hey could no be accessed. 2.7. Da a analysis The Kolmogo o –Smi no es was i s applied o es no mal- i y, ob aining a P < .005 and allowing he use o non-pa ame ic es s. Con as es s we e pe o med wi h he Mann–Whi ney U and K uskal–Wallis es . The co ela ion be ween quan i a i e a iables was checked wi h he Kendall au b es . The ela ionship be ween quali a i e a iables was checked wi h a ca ego ical eg ession analysis, which included a iance, coe icien o de e mina ion (R2), eg ession analysis, and signi - icance o model pa ame e s.[22] Uni a ia e and bi a ia e desc ip i e analyses we e pe o med using he SPSS© s a is ical so wa e[23] (IBM, A monk, NY). Fo he calcula ion, he op imal scaling op ion was chosen in he so wa e. 2.8. E hical aspec s This s udy in he UK is pa o he IMPACTCOVID-19 in e - na ional in es iga ion p ojec , which ollowed he me hodology o a p e ious in es iga ion in Spain consis ing o he alida ion and c oss-cul u al adap a ion o he AMICO scale[12] and con- sequen ly assessmen in a speci ic popula ion.[24] As men ioned be o e, he AMICO scale was designed by a eam o di e en p o essionals,[17] based on he FCV-19 scale.[11] No pe missions no licenses we e equi ed o i s use. Pe mission o conduc his s udy was ob ained om he Na ional Heal h Se ice Heal h Resea ch Au ho i y, IRAS p oj- ec ID 283849, REC e e ence 20/HRA/3997. This s udy also complied wi h he guidelines se in he Decla a ion o Helsinki ega ding e hical p inciples o medical esea ch in ol ing human subjec s.[25] All indi iduals in he sample ag eed o pa icipa e on a olun a y basis by eading and signing in o med consen . Con iden iali y o da a and anonymi y o pa icipan s was ensu ed, always espec ing he p o ec ion o he igh s o he pa icipan s o he s udy. 3. Resul s 3.1. Desc ip i e analysis The sample selec ed o he s udy consis ed o 657 people li ing in he UK. As can be seen in Table1, o he o al sample, 80.5% we e women, wi h a mean age o 48.25 yea s (Table1). As ega ds income, 71.7% said hey had su icien esou ces o make ends mee . Wi h ega d o gene al heal h s a us, he mean sco e o his a iable was 6.67. Also, 58.8% had ne e sel -con ined o p o- ec hemsel es, al hough he majo i y did conside hemsel es o be a isk o one eason o ano he . In gene al, pa icipan s ega ded hemsel es as well-in o med abou he pandemic, wi h a mean sco e o his a iable o 7.94 poin s. Also, a he ime o he su ey, only 14.5% o he sam- ple had been accina ed wi h bo h doses and 62.6% had only ecei ed 1 dose; on he o he hand, 6.2% claimed hey did no wan o ge he accine. O hose who had been accina ed, 35.6% had had no side e ec s a e he adminis a ion bu jus pain a he injec ion spo (Table1). Rega ding he AMICO scale a iable, he mean AMICO o al sco e was 4.85 (SD = 2.398), wi h a ange o sco es om 1 o 10. On he o he hand, he Kolmogo o –Smi no es , wi h a signi icance o 0.000, e ealed ha he dis ibu ion o sco es ob ained on he AMICO scale did no ollow a no mal dis ibu- ion, so non-pa ame ic es s we e pe o med. The bi a ia e analysis e ealed s a is ically signi ican di - e ences in ela ion o sex, end-o -mon h income, heal h s a us sco e, sel -con idence, amoun o in o ma ion ecei ed, and ac- cina ion a iables ela ed o he mean AMICO sco es (Table2). Thus, women showed highe sco es on he AMICO scale han men. In e ms o income, hose who did no make ends mee showed highe le els o ea and anxie y abou COVID-19. In addi ion, hose who had no sel -con ined o p o ec hemsel es agains he disease go he highes sco es on his scale. On he o he hand, hose who had no ye been accina ed wi h any dose we e he mos ea ul and anxious (Table2). 3.2. Reg ession analysis The calcula ion o he ca ego ical eg ession was implemen ed, i s , wi h he mean o al sco e o he AMICO ques ionnai e as he dependen a iable and he es o he a iables ha showed signi ican di e ences in he desc ip i e bi a ia e anal- ysis (Table3). In his sense, he esul s sugges ha women who epo ed no ecei ing enough money o make ends mee , who did no sel -con ine, and who had been accina ed wi h only 1 dose p esen ed highe le els o anxie y and FCV-19. 4. Discussion The alida ion o he AMICO_UK scale was ca ied ou in a p e ious s udy. Fo he adap a ion o he AMICO scale o he UK con ex , a p ocess o di ec ansla ion in o English and back- ansla ion in o Spanish was ca ied ou . The ansla ed e sion was e alua ed by a panel o 10 expe s. Subsequen ly, a pilo es was ca ied ou wi h 20 subjec s o de ec unde s and- ing p oblems.[21] On he o he hand, he s udy o pe cen iles and qua iles wi h espec o he dis ibu ion o mean scale sco es allowed iden- i ying 3 p oposed le els o anxie y using a box-and-whiske Downloaded om h p://jou nals.lww.com/md-jou nal by BhDM 5ePHKa 1zEoum1 Q N4a+kJLhEZgbsIHo4XMi0hCy wCX1AWnYQp/IlQ HD3i3D0OdRyi7T SFl4C 3VC4/OAVpDDa8K2+Ya6H515kE= on 09/27/2023 4 Mo gado-Toscano e al. • Medicine (2023) 102:10 Medicine plo . Le els we e iden i ied as low, wi h sco es anging om 0 o 4.7 poin s, in e media e, wi h sco es anging om 4.71 o 6.7 poin s, and high, wi h sco es anging om 6.71 o 10 poin s. The analysis o he s a is ical signi icance o he di e ences be ween he iden i ied le els, using he Mann–Whi ney U s a is- ic o each pai o le els es ed, always ga e a alue o P = .000; hus, i can be concluded ha he e a e signi ican di e ences be ween he iden i ied le els, and he ele ance o hese di e - ences is con i med by he Mann–Whi ney U s a is ic o each pai o le els es ed.[17] The esul s o he s udy showed an a e age le el o anxie y and FCV-19 in he gene al UK popula ion, as measu ed by he AMICO_UK scale. Howe e , mos o he e iewed s udies p o- ide e idence o he high impac o he COVID-19 pandemic Table 1 Desc ip ion o he sample p o ile. Quan i a i e a iables Value Resul Range Age Mean S anda d de ia ion 48.25 14.861 Minimum = 16 Maximum = 80 No o co-dwelle s Mean S anda d de ia ion 2.58 1.3 Minimum = 1 Maximum = 10 Heal h s a e sco e Mean S anda d de ia ion 6.67 2.061 Minimum = 0 Maximum = 10 Le el o in o ma ion Mean S anda d de ia ion 7.94 2.078 Minimum = 1 Maximum = 10 Quali a i e a iables Value Resul To al Sex Male Female n = 120 (18.3%) n = 529 (80.5%) To al sample 657 Ma i al s a us Ma ied Single Widow/e Sepa a ed/di- o ced Doesn’ say O he n = 318 (48.4%) n = 174 (26.5%) n = 25 (3.8%) n = 63 (9.6%) n = 17 (2.6%) n = 60 (9.1%) Educa ional le el Seconda y Highe seconda y Uni e si y (Mas e ’s o Doc o a e) Uni e si y (deg ee) Wi hou s udies Doesn’ say O he n = 120 (18.3%) n = 108 (16.4%) n = 97 (14.8%) n = 263 (40%) n = 8 (1.2%) n = 21 (3.2%) n = 40 (6.1%) Wo k si ua ion S udying Doesn’ say Full- ime ou side o home Full- ime om home Pa - ime ou side o home Pa - ime om home On sick lea e Re i ed Unemployed O he n = 14 (2.1%) n = 13 (2%) n = 134 (20.4%) n = 116 (17.7%) n = 81 (12.3%) n = 50 (7.6%) n = 21 (3.2%) n = 135 (20.5%) n = 39 (5.9%) n = 54 (8.2%) Su icien income Yes No No always Doesn’ say O he n = 471 (71.7%) n = 58 (8.8%) n = 103 (15.7%) n = 20 (3%) n = 5 (0.8%) COVID-19 diagnosis Yes No n = 69 (10.5%) n = 586 (89.2%) Sel -con inemen Yes No n = 264 (40.2%) n = 386 (58.8%) Vaccina ion Yes, wi h 2 doses Yes, wi h 1 dose No No, I e use accina ing Doesn’ say n = 95 (14.5%) n = 411 (62.6%) n = 105 (16%) n = 41 (6.2%) n = 5 (0.8%) COVID-19 = co ona i us disease 2019. Downloaded om h p://jou nals.lww.com/md-jou nal by BhDM 5ePHKa 1zEoum1 Q N4a+kJLhEZgbsIHo4XMi0hCy wCX1AWnYQp/IlQ HD3i3D0OdRyi7T SFl4C 3VC4/OAVpDDa8K2+Ya6H515kE= on 09/27/2023 5 Mo gado-Toscano e al. • Medicine (2023) 102:10 www.md-jou nal.com Table 2 Bi a ia e desc ip i e analysis. Va iables To al sample (n = 657) Mean AMICO sco e Con as hypo hesis Sex Male Female n = 120 (18.3%) n = 529 (80.5%) 4.15 5.09 P = .000* Ma i al s a us Ma ied Single Widow/e Sepa a ed/ di o ced Doesn’ say O he n = 318 (48.4%) n = 174 (26.5%) n = 25 (3.8%) n = 63 (9.6%) n = 17 (2.6%) n = 60 (9.1%) 4.82 4.89 4.83 4.81 4.6 5.55 P = .426‡ Educa ional le el Seconda y Highe seconda y Uni e si y (Mas e ’s o Doc o a e) Uni e si y (deg ee) Wi hou s udies Doesn’ say O he n = 120 (18.3%) n = 108 (16.4%) n = 97 (14.8%) n = 263 (40%) n = 8 (1.2%) n = 21 (3.2%) n = 40 (6.1%) 4.84 4.85 4.46 5.02 6.44 4.77 5.20 P = .239‡ Wo k si ua ion S udying Doesn’ say Full- ime ou side o home Full- ime om home Pa - ime ou side o home Pa - ime om home On sick lea e Re i ed Unemployed O he n = 14 (2.1%) n = 13 (2%) n = 134 (20.4%) n = 116 (17.7%) n = 81 (12.3%) n = 50 (7.6%) n = 21 (3.2%) n = 135 (20.5%) n = 39 (5.9%) n = 54 (8.2%) 5 4.81 4.55 5.4 4.55 5.25 5.93 4.75 5.09 5.47 P = .165‡ Su icien income Yes No No always Doesn’ say O he n = 471 (71.7%) n = 58 (8.8%) n = 103 (15.7%) n = 20 (3%) n = 5 (0.8%) 4.61 5.94 5.64 4.93 5.03 P = .000‡ COVID-19 diagnosis Yes No n = 69 (10.5%) n = 586 (89.2%) 4.44 4.96 P = .127* Sel -con inemen Yes No n = 264 (40.2%) n = 386 (58.8%) 4.31 5.76 P = .000* Vaccina ion Yes, wi h 2 doses Yes, wi h 1 dose No No, I e use accina ing Doesn’ say n = 95 (14.5%) n = 411 (62.6%) n = 105 (16%) n = 41 (6.2%) n = 5 (0.8%) 4.60 5.16 5.11 2.53 4.00 P = .000‡ Age Signi icance (SD) 48.25 (14.861) Tau b = −0.047† No o co-dwelle s Signi icance (SD) 2.58 (1.3) Tau b = 0.008† Heal h s a e sco e Signi icance (SD) 6.67 (2.061) Tau b = −0.2757† Le el o in o ma ion Signi icance (SD) 7.94 (2.078) Tau b = −0.120† AMICO = Anxie y and Fea o COVID-19 Assessmen Scale (Ansiedad y Miedo al COVID-19), COVID-19 = co ona i us disease 2019, SD = s anda d de ia ion. * Mann–Whi ney U. † Kendall au b. ‡ Analysis o a iance (ANOVA). Downloaded om h p://jou nals.lww.com/md-jou nal by BhDM 5ePHKa 1zEoum1 Q N4a+kJLhEZgbsIHo4XMi0hCy wCX1AWnYQp/IlQ HD3i3D0OdRyi7T SFl4C 3VC4/OAVpDDa8K2+Ya6H515kE= on 09/27/2023 6 Mo gado-Toscano e al. • Medicine (2023) 102:10 Medicine on he men al heal h o he gene al popula ion. This is he case o a s udy in Romania whe e, al hough olde people a e mo e likely o ha e se ious p oblems associa ed wi h COVID-19 han younge people, he esul s showed ha people cope wi h his ea ega dless o age.[26] Ano he s udy conduc ed in Ge many posi i ely ela ed FCV-19 o he pe cei ed isk o con ac ing he disease.[27] In line wi h he esul s o a e iew ha was de eloped du ing he i s pandemic,[28] his s udy highligh ed ha hose who habi ually wo e masks epo ed highe le els o FCV-19 han hose who did no comply wi h mask egula ions. This ac could e eal ha COVID-19 is commonly associa ed wi h se e e ad e se eelings, including ea , ange , o dep ession, bu he in luence o indi iduals’ emo ional s eng h and con ic ions is essen ial o deepen he unde s anding o he psychia ic and psychological consequences o he pandemic.[29] On he o he hand, a s udy conduc ed in New Zealand, a coun y ha sha es his o ical ies wi h he UK, ound ha dep ession and anxie y we e nega i ely a ec ed du ing he i s en weeks o social dis ancing o he COVID-19 pandemic. This was e iden in he mean sco es ob ained in ha s udy o dep ession and anxie y du ing he COVID-19 pandemic, which signi ican ly exceeded hose ob ained in no mal epidemiological si ua ions.[30] Al hough age was no a de e mining ac o in he p esen s udy, da a om he Eu opean COVID Su ey highligh ed ha in coun ies such as I aly o he UK, people aged 18 o 29 yea s who had been in ec ed wi h he new co ona i us had high p e - alence a es o dep ession and anxie y in all wa es.[31] Wi h ega d o age, a s udy in New Zealand, men ioned abo e, e ealed ha , al hough he mos se e e symp oms o he disease end o de elop in olde people, i was a g oup o young people aged 18 o 24 yea s who we e disp opo iona ely mo e a ec ed and mo e likely o su e anxie y, s ess, and dep ession associa ed wi h COVID-19. One explana ion o his phenom- enon could be ha many young s uden s expe ienced academic delays and signi ican changes in daily ou ine du ing he.[32] O he esea ch highligh s ha younge popula ions end o ha e poo e men al heal h ou comes in gene al.[33] Wi h ega d o he sex a iable, i is wo h men ioning ha in all he a icles e iewed as well as in he p esen s udy, he le el o anxie y and, in gene al, men al heal h p oblems, was highe in women han in men. Fo example, a s udy by Zanino o e al epo ed a g ea e de e io a ion o men al heal h in he gen- e al popula ion in he UK[34] in line wi h a s udy conduc ed in Spain[17] based on he AMICO scale, which concluded ha he p e alence o symp oms o psychological dis ess and a ec i e diso de s in Spain p o es ha women p esen some ype o men al heal h p oblem in 14% o he popula ion, compa ed o 7.2% o men. This may be due o he ac ha a ound 70% o ca e wo k ends o all on women, which may ha e inc eased due o he si ua ion o con inemen expe ienced wi h he conse- quen closu e o schools and elewo king.[17] As o he sala y a iable, which has also been signi ican in he p esen s udy, an analysis conduc ed in he UK e ealed ha he es ic ions also impac ed people’s socioeconomic posi ion, wi h an inc ease in po e y.[34,35] In addi ion o his, i was also ound ha people wi h men al heal h p oblems a e subs an ially mo e likely o de elop in ec ious diseases such as pneumonia and o su e cogni i e impai men ,[36] so lowe socioeconomic s a us no only a ec s he quali y o men al heal h bu also goes hand in hand wi h being mo e p one o illness. When he in luence o socio-demog aphic a iables dec eases, hose indi iduals who showed highe le els o dis- ess also epo ed ha ing had COVID-19 and a g ea e num- be o se e e symp oms.[37] On he o he hand, he g ea e impac o li ing wi h es ic- ions had a di ec impac on de e io a ing physical and men al heal h, and social isola ion exace ba ed he poo men al heal h s a us ha al eady exis ed in he UK popula ion.[38] In his sense, he indings by Jani i e al con i m he need o be con- ce ned no only wi h p o ec ing he physical heal h o heal h p o essionals bu also wi h he e ec s on hei men al heal h, some hing ha has been con i med by a la ge numbe o s ud- ies.[39] Res ic ions also impac ed people’s socioeconomic posi- ion, so i is no su p ising ha he majo i y o he sample ep esen ed in his s udy chose no o sel -con ine.[40] Las ly, al hough only 14.5% o he sample was accina ed wi h bo h doses a he ime o he ques ionnai e, a UK s udy ound ha a ound 82% o UK adul s a e willing o ecei e a COVID-19 accine i o e ed.[41] Limi a ions o he p esen s udy include he ac ha non-p obabili y sampling p ecludes accu a e knowledge o he ep esen a i eness o he sample. On he o he hand, esea che s mus ely on he e aci y o he da a p o ided by pa icipan s, as hese we e sel -adminis e ed ques ionnai es. Also, du ing he pandemic, he e ha e been si ua ions o g ea e es ic ions depending on he cumula i e incidence o COVID-19, so he esponse o he pa icipan s may ha e also been in luenced by he ime a which he ques ionnai es we e comple ed. Besides, as he da a collec ion ool is elema ic, he e may ha e also been an accessibili y bias, as olde people and/o people a isk o social exclusion may no ha e been able o answe he ques ionnai e. On he o he hand, he highe numbe o women in he sam- ple implies ano he limi a ion in i sel . The e o e, i is necessa y o examine, h ough a new ield s udy, whe he he “sex” a i- able may ha e such an e ec on he cons uc alida ion o he AMICO_UK scale om a sex pe spec i e. 5. Conclusion This s udy highligh s he need o ac ion by heal h manage s o p o ide ca e and suppo o he gene al popula ion o he UK in o de o mi iga e he nega i e men al heal h e ec s caused by COVID-19. The esul s o he p esen s udy ha e shown an a e age le el o anxie y and FCV-19 in he gene al UK popula ion, as mea- su ed by he AMICO UK scale. In addi ion, he eg ession s udy showed ha women who epo ed no ea ning enough o make ends mee , who had no sel -con ined, and who had ecei ed only 1 dose o he accine had highe le els o anxie y and FCV-19. Table 3 Model adjus men and signi icance o he eg ession analysis. S anda dized coe icien s d F Sig. Be a Boo s apping (1000) o s anda d e o Sex −.126 .038 1 11.121 .001 Su icien income −.170 .042 4 16.123 .000 Sel -con inemen .221 .053 2 17.212 .000 Vaccina ion .259 .111 1 5.466 .020 d = deg ee o eedom, Sig = signi icance. Downloaded om h p://jou nals.lww.com/md-jou nal by BhDM 5ePHKa 1zEoum1 Q N4a+kJLhEZgbsIHo4XMi0hCy wCX1AWnYQp/IlQ HD3i3D0OdRyi7T SFl4C 3VC4/OAVpDDa8K2+Ya6H515kE= on 09/27/2023 7 Mo gado-Toscano e al. • Medicine (2023) 102:10 www.md-jou nal.com Au ho con ibu ions Concep ualiza ion: C is ina Mo gado-Toscano, Juan Gómez- Salgado, Ja ie Fagundo-Ri e a, Yolanda Na a o-Abal, Lucas Rod íguez-Jiménez, José An onio Climen -Rod íguez, Regina Allande-Cussó. Da a cu a ion: C is ina Mo gado-Toscano, Juan Gómez- Salgado, Lucas Rod íguez-Jiménez, Regina Allande-Cussó. Fo mal analysis: C is ina Mo gado-Toscano, Juan Gómez- Salgado, Ja ie Fagundo-Ri e a, Yolanda Na a o-Abal, Lucas Rod íguez-Jiménez, José An onio Climen -Rod íguez, Regina Allande-Cussó. In es iga ion: C is ina Mo gado-Toscano, Juan Gómez-Salgado, Ja ie Fagundo-Ri e a, Yolanda Na a o-Abal, Lucas Rod íguez-Jiménez, José An onio Climen -Rod íguez, Regina Allande-Cussó. Me hodology: C is ina Mo gado-Toscano, Juan Gómez- Salgado, Ja ie Fagundo-Ri e a, Yolanda Na a o-Abal, Lucas Rod íguez-Jiménez, José An onio Climen -Rod íguez, Regina Allande-Cussó. P ojec adminis a ion: C is ina Mo gado-Toscano, Juan Gómez-Salgado, Regina Allande-Cussó. Resou ces: C is ina Mo gado-Toscano, Juan Gómez-Salgado, Ja ie Fagundo-Ri e a, Yolanda Na a o-Abal, Lucas Rod íguez-Jiménez, José An onio Climen -Rod íguez, Regina Allande-Cussó. So wa e: C is ina Mo gado-Toscano, Juan Gómez-Salgado, Lucas Rod íguez-Jiménez, Regina Allande-Cussó. Supe ision: C is ina Mo gado-Toscano, Juan Gómez-Salgado, Ja ie Fagundo-Ri e a, Yolanda Na a o-Abal, Lucas Rod íguez-Jiménez, José An onio Climen -Rod íguez, Regina Allande-Cussó. Valida ion: C is ina Mo gado-Toscano, Juan Gómez-Salgado, Ja ie Fagundo-Ri e a, Yolanda Na a o-Abal, Lucas Rod íguez-Jiménez, José An onio Climen -Rod íguez, Regina Allande-Cussó. Visualiza ion: C is ina Mo gado-Toscano, Juan Gómez- Salgado, Ja ie Fagundo-Ri e a, Yolanda Na a o-Abal, Lucas Rod íguez-Jiménez, José An onio Climen -Rod íguez, Regina Allande-Cussó. W i ing – o iginal d a : C is ina Mo gado-Toscano, Juan Gómez-Salgado, Ja ie Fagundo-Ri e a, Yolanda Na a o- Abal, Lucas Rod íguez-Jiménez, José An onio Climen - Rod íguez, Regina Allande-Cussó. W i ing – e iew & edi ing: C is ina Mo gado-Toscano, Juan Gómez-Salgado, Ja ie Fagundo-Ri e a, Yolanda Na a o- Abal, Lucas Rod íguez-Jiménez, José An onio Climen - Rod íguez, Regina Allande-Cussó. Re e ences [1] Johnson M. Wuhan 2019 no el co ona i us - 2019-nCoV. Ma e Me hods. 2020;10:1–5. [2] Shigemu a J, U sano RJ, Mo gans ein JC, e al. Public esponses o he no el 2019 co ona i us (2019-nCoV) in Japan: men al heal h conse- quences and a ge popula ions. Psychia y Clin Neu osci. 2020;74:281–2. [3] B o e de en e medad po co ona i us (COVID-19): o ien aciones pa a el público. 2020. 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