Fear of COVID-19 and emotional dysfunction problems: Intrusive, avoidance and hyperarousal stress as key mediators

Table 1 Descriptive data and sex differences

Study variables	α	Total sample, n = 439		Females, n = 321		Males, n = 118		Mann-Whitney U test
		Mdn	Rng	Mdn	Rng	Mdn	Rng	U	P value	g
Fear of COVID-19	0.84	15	26	15	26	13	23	26026	< 0.001	0.37
Avoidance stress	0.83	8	28	9	27	6	23	15317	< 0.001	0.42
Intrusive stress	0.83	7	27	7	27	6	23	16208	0.001	0.38
Hyperarousal stress	0.84	6	27	7	25	5	27	16771	0.003	0.30
Depression	0.86	2	20	3	20	2	17	15536	0.004	0.27
Agoraphobia	0.83	3	19	3	19	2	15	16309	0.024	0.22
Obsessive-Compulsive	0.69	4	17	4	17	4	15	18604	0.775	0.01
Panic	0.88	1	19	1	19	0	16	16480	0.027	0.28
Health anxiety	0.87	3	20	3	18	3	20	17374	0.180	0.15
Generalized anxiety	0.91	5	20	6	20	3	20	13322	< 0.001	0.50
Social anxiety	0.84	3	20	4	19	2	20	15102	0.001	0.33

COVID-19: Coronavirus disease 2019; Mdn: Median; Rng: Range; U: Mann-Whitney U test; Hedge’s g effect size: Approximately 0.20 small, approximately 0.50 medium, approximately 0.80 large.

Table 2 Mann-Whitney U Test according to the grouping of participants above/below the cutoff point in emotional dysfunction, n = 439

Emotional dysfunction		n	Fear of COVID-19					Acute stress associated to COVID-19 pandemic
								Avoidance stress					Intrusive stress					Hyperarousal stress
			Mdn	Rng	U	P value	g	Mdn	Rng	U	P value	g	Mdn	Rng	U	P value	g	Mdn	Rng	U	P value	g
Depression	≤ 8	390	15	26	9080	0.515	0.15	7	28	6045	< 0.001	0.69	6	26	5140	< 0.001	0.91	5	22	2821	< 0.001	1.60
	≥ 9	49	15	26				11	27				12	26				14	27
Agoraphobia	≤ 4	301	14	25	11712	< 0.001	0.86	7	28	15261	< 0.001	0.53	6	26	11894	< 0.001	0.80	5	22	12931	< 0.001	0.83
	≥ 5	138	17.5	26				10	27				10	27				10	27
Obsessive-Compulsive	≤ 8	380	14	26	6931	< 0.001	0.84	8	28	9584	0.060	0.32	6	26	7616	< 0.001	0.66	6	22	6707	< 0.001	0.86
	≥ 9	59	19	26				9	27				12	27				10	27
Panic	≤ 5	389	14	25	5844	< 0.001	0.90	7	28	5779	< 0.001	0.79	6	26	4269	< 0.001	1.16	5	22	3147	< 0.001	1.57
	≥ 6	50	19.5	26				11.5	26				12	25				14	25
Health anxiety	≤ 8	388	14	22	4551	< 0.001	1.17	8	28	8011	0.022	0.33	7	27	5591	< 0.001	1.04	6	25	5013	< 0.001	1.07
	≥ 9	51	21	26				10	27				13	24				12	27
Generalized anxiety	≤ 14	402	15	26	6009	0.046	0.49	8	28	3915	< 0.001	0.87	6	26	2676	< 0.001	1.45	6	22	2033	< 0.001	1.70
	≥ 15	37	16	26				13	23				14	23				16	23
Social anxiety	≤ 9	388	15	26	7438	0.003	0.47	8	27	6277	< 0.001	0.80	6	26	5276	< 0.001	0.91	6	22	5242	< 0.001	0.96
	≥ 10	51	16	26				12	28				12	26				11	27

COVID-19: Coronavirus disease 2019; ≤/≥: Normative/clinical cutoff points of ESTAD; Mdn: Median; Rng: Range; U: Mann-Whitney U test; Hedge’s g effect size: Approximately 0.20 small, approximately 0.50 medium, approximately 0.80 large.

Table 3 Bivariate correlations and descriptive statistics among all study variables

No.		1	2	3	4	5	6	7	8	9	10	11
1	Fear of COVID-19	1
2	Avoidance stress	0.39c	1
3	Intrusive stress	0.55c	0.60c	1
4	Hyperarousal stress	0.45c	0.60c	0.80c	1
5	General anxiety	0.36c	0.45c	0.59c	0.68c	1
6	Depression	0.18c	0.36c	0.45c	0.63c	0.71c	1
7	Agoraphobia	0.41c	0.30c	0.41c	0.40c	0.52c	0.42c	1
8	Social Anxiety	0.24c	0.27c	0.38c	0.40c	0.59c	0.55c	0.56c	1
9	Panic	0.39c	0.37c	0.52c	0.61c	0.69c	0.63c	0.60c	0.54c	1
10	Obsessive-Compulsive	0.40c	0.20c	0.32c	0.33c	0.43c	0.31c	0.56c	0.43c	0.46c	1
11	Health anxiety	0.56c	0.27c	0.44c	0.45c	0.54c	0.36c	0.49c	0.42c	0.52c	0.56c	1
12	Sex	0.15b	0.18c	0.17c	0.14b	0.22c	0.12a	0.10a	0.15b	0.12a	-0.00	0.07
13	Age	0.08	-0.20c	-0.07	-0.24c	-0.28c	-0.27c	-0.10a	-0.24c	-0.12a	-0.08	-0.04

^aP < 0.05.

^bP < 0.01.

^cP < 0.001.

Sex was coded 0 = male, 1 = female. COVID-19: Coronavirus disease 2019.

Table 4 Summary of total, indirect, and direct effects of mediation models

Predictor variable: Fear of COVID-19	Depression	Agoraphobia	Obsessive-Compulsive	Panic	Health anxiety	Generalized anxiety	Social anxiety
Total	0.197 (0.074, 0.316)	0.423 (0.296, 0.535)	0.423 (0.295, 0.536)	0.402 (0.252, 0.533)	0.569 (0.463, 0.663)	0.376 (0.261, 0.487)	0.253 (0.115, -0.379)
Total indirect	0.293 (0.190, 0.402)	0.143 (0.006, 0.232)	0.083 (0.006, 0.166)	0.253 (0.166, 0.346)	0.111 (0.035, 0.203)	0.310 (0.211, 0.414)	0.183 (0.100, 0.276)
Avoidance stress	-0.007 (-0.058, 0.041)	0.006 (-0.067, 0.080)	-0.024 (-0.091, 0.042)	-0.012 (-0.068, 0.045)	-0.031 (-0.088, 0.020)	-0.002 (-0.050, 0.043)	-0.013 (-0.077, 0.053)
Intrusive stress	-0.041 (-0.145, 0.064)	0.070 (-0.066, 0.208)	0.034 (-0.080, 0.147)	0.007 (-0.118, 0.134)	0.023 (-0.092, 0.148)	0.067 (-0.024, 0.167)	0.114 (-0.013, 0.241)
Hyperarousal stress	0.340 (0.236, 0.460)	0.067 (-0.047, 0.197)	0.073 (-0.028, 0.188)	0.258 (0.155, 0.382)	0.120 (0.025, 0.229)	0.245 (0.162, 0.343)	0.082 (-0.013, 0.189)
Direct	-0.096 (-0.224, 0.026)	0.281 (0.135, 0.411)	0.340 (0.196, 0.475)	0.148 (0.009, 0.289)	0.458 (0.340, 0.568)	0.066 (-0.056, 0.193)	0.069 (-0.076, 0.206)

β (99%CI): Significant associations were determined by a 99% bias-corrected standardized bootstrapped confidence interval (based on 10000 bootstrapped samples) that does not contain zero. COVID-19: Coronavirus disease 2019.