Abstract
Background
The COVID-19 pandemic and related measures have negatively impacted mental health worldwide. The main objective of the present longitudinal study was to investigate mental health in people living in Tyrol (Austria) and South Tyrol (Italy) during the COVID-19 pandemic and to report the prevalence of psychological distress among individuals with versus those without pre-existing mental health disorders (MHD) in the long-term (summer 2020–winter 2022). Here, we specifically focus on the relevance of spirituality and perceived social support in this regard.
Methods
161 individuals who had been diagnosed with MHD and 446 reference subjects participated in this online survey. Electronic data capture was conducted using the Computer-based Health Evaluation System and included both sociodemographic and clinical aspects as well as standardized questionnaires on psychological distress, spirituality, and the perception of social support.
Results
The prevalence of psychological distress was significantly higher in individuals with MHD (36.6% vs. 12.3%) and remained unchanged among both groups over time. At baseline, the perception of social support was significantly higher in healthy control subjects, whereas the two groups were comparable in regards of the subjective relevance of faith. Reference subjects indicated significantly higher spiritual well-being in terms of the sense of meaning in life and peacefulness, which mediated in large part the between-group difference of psychological distress at follow-up. Notably, both faith and the perception of social support did not prove to be relevant in this context.
Conclusions
These findings point to a consistently high prevalence of psychological distress among people suffering from MHD and underscore the prominent role of meaning in life and peacefulness as a protective factor in times of crisis. Therapeutic strategies that specifically target spirituality may have a beneficial impact on mental health.
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Introduction
The COVID-19 pandemic and related measures such as quarantine, lockdowns, and social isolation have negatively impacted mental health worldwide [1] and have been associated with increased levels of anxiety, depression, frustration, insecurity, agitation, sleep disturbances, and boredom [2, 3]. Similar outcomes have already been observed during earlier epidemics like SARS, MERS, and Ebola virus disease [4].
In line with the findings from other countries, our group has recently shown that the COVID-19 pandemic has a negative impact on the psychological condition of the residents of Tyrol (Austria) and South Tyrol (Italy). At the early stages of the pandemic, approximately 15% of the study participants out of the general population reported on psychological distress with women, singles, low-income people, as well as those who were unemployed being particularly affected [5, 6]. This prevalence was markedly higher in patients suffering from severe mental illnesses (schizophrenia spectrum disorder, bipolar disorder, major depressive disorder with psychotic features: 23.9%) and significantly higher in patients suffering from major depressive disorder without psychotic features (approximately 45%) [7]. Notably, the prevalence of clinically relevant psychological symptoms remained unchanged among each group over time and a higher degree of resilience and extraversion as well as less loneliness and boredom predicted reduced psychological distress in the short-term [7, 8]. Yet, still other coping strategies and protective factors exist to deal with psychological distress in the context of a crisis, e.g., religiosity and spirituality which are well-known coping factors with a positive effect on physical and mental health [9, 10], as well as social support [7, 11].
Religiosity and spirituality may seem very similar at first glance. Religiosity refers to a person's behavior and attitudes toward a particular religion and its values, rules, and practices [12]. Spirituality, on the other hand, can be defined as the way individuals search for meaning and purpose in life, how they relate to and connect with themselves, others, the moment, nature, or even the saints [13], and it can also be understood as an inner belief system that gives meaning and vitality to all events and to life itself [14]. Accordingly, spiritual-religious coping means that religious beliefs, attitudes, and practices are used to reduce emotional distress caused by events beyond personal control in order to give meaning to suffering and making it more bearable [15]. For example, Schuster and co-workers have shown that after the terrorist attacks of 2001 people turned to religion and spirituality to cope better with those events [16] and similar findings have been obtained after war scenarios [17]. In general, spiritual individuals find it easier to cope with loss and the grief for loved ones [18]. However, spirituality is not only a good coping mechanism to deal with stressful situations but also a common way to cope with illness and chronic diseases [19, 20]. On the other hand, it has played a subordinate role in the treatment of mental health disorders (MHD)so far, yet many patients would like spirituality to become a relevant element of their therapy concept [21].
Numerous previous studies have emphasized the meaning of social support for physical and psychological well-being [22] and accordingly, the dramatic consequences of pandemic-associated social restrictions on mental health are not surprising [23]. For example, even before the pandemic, Peirce et al. have shown that social contact is positively related to perceived social support, which, in turn, is negatively associated with depression [24]. It has to be noted, however, that the social support actually received may correlate poorly with perceived social support [25, 26] and that the relationship between received social support and mental health may be weak [26,27,28]. In contrast, there is a strong negative association between social support and stress perception [29] and a strong positive association between perceived social support and mental health in general [30, 31]. For example, perceiving social support during the early phases of the COVID-19 pandemic was associated with a lower risk for depression [32].
Taking into consideration a history of MHD, the main objective of the present longitudinal study was to investigate the mental health of people living in Tyrol (Austria) and South Tyrol (Italy) during the COVID-19 pandemic. These populations have similar characteristics and are comparable in many ways (socio-economic context, health system, etc.) [33], however, due to rapid dissemination of SARS-CoV-2 and an overburdened national health system, public health policy measures to contain the pandemic were much stricter in Italy. Interestingly, the prevalence of psychological distress was comparable between study participants from Tyrol and South Tyrol in the short term and as expected, we found evidence for a particular burden in people with pre-existing MHD [7]. We now report the prevalence of psychological distress among individuals with versus those without pre-existing MHD in the long-term (summer 2020–winter 2022) focusing in particular on the relevance of spirituality and perceived social support in this regard.
Methods
Participants
3928 residents of Tyrol and 1587 residents of South Tyrol aged 18 and above who had been diagnosed with MHD during an inpatient stay at one of the local psychiatric wards in 2019 were invited by mail to participate in a longitudinal online survey. In parallel, reference subjects from the general population were recruited through advertising in print media, email lists, flyers, and social media. They were asked to provide an email address to be reminded for follow-up, however, this was not a prerequisite to participate in the baseline survey. Reference subjects under the age of 18 years or reporting to have been diagnosed with a MHD in the past as well as those reporting on current psychopharmacological and/or psychotherapeutic treatment were excluded from further analyses.
So far, three surveys have been conducted. For organizational reasons, the collection of baseline (T0) and short-term follow-up (T1) data took place at different dates in the two countries, however, the time interval between those surveys was equal (11 weeks). In Tyrol, T0 was conducted between June 26, 2020 and September 13, 2020 (South Tyrol: September 7, 2020–November 22, 2020) and T1 between November 30, 2020 and January 24, 2021 (South Tyrol: February 8, 2021–April 4, 2021). In both countries, the long-term follow-up (T2) was conducted between January 10, 2022 and February 21, 2022. At the end of each survey, participants received a downloadable information sheet on professional support numbers and addresses. The results of short-term follow-up have been reported previously [7, 8, 34]. Here, we focus on the findings of long-term follow-up.
Procedures
The study was approved by the Ethics Committees of the Medical University Innsbruck, Austria (Approval No. 1147/2020) and of the Sanitary Agency of South Tyrol, Italy (Approval No. 83/2020) and all participants provided informed consent online. Electronic data capture was conducted using the Computer-based Health Evaluation System (CHES) [35] and included both sociodemographic and clinical aspects as well as standardized questionnaires.
Psychological distress was assessed using the 53-item Brief Symptom Checklist (BSCL) [36]. This is a Likert-type scale whose items are rated from 0 (not at all/no distress) to 4 (extremely/very strong distress). Nine symptom groups of mental health problems are examined: anger-hostility, anxiety, depression, paranoid ideation, phobic anxiety, psychoticism, somatization, interpersonal sensitivity, and obsessive-compulsiveness. The Global Severity Index (GSI) used in the current study was calculated using the sum of the nine symptom dimensions plus four additional items not included in any of the dimension scores divided by the total number of answered items. Additionally, BSCL raw scores and GSI composite scores were transformed into sex- and age-specific normative T-scores (average: 50 ± 10) using a standardization reference table. A T-score ≥ 63 was defined to indicate clinically relevant psychological symptoms.
Spirituality was assessed with the Functional Assessment of Chronic Illness Therapy—Spiritual Well-Being Non-Illness Version (FACIT-Sp Non-Illness) [37]. The FACIT-Sp Non-Illness is a collection of health-related quality of life questionnaires that includes eight questions relating to the sense of meaning in life and peacefulness (FACIT-Sp MP) and four questions relating to the sense of strength and comfort from one’s faith (FACIT-Sp F), respectively. Of note, the FACIT-Sp is scored without referral to religious beliefs or practice. Each item is scored between 0 and 4 with higher scores indicating higher spiritual well-being.
Perceived social support was assessed with the Multidimensional Scale of perceived social support (MSPSS) [38], a 12-item self-report scale that measures perceptions and adequacy of social support from three sources: family, friends, and significant others. Each subscale includes four items: practical help, emotional support, availability to discuss problems, and help with decision making. The total score reflects the total degree of social support that individuals receive. Items were scored on a 5-point Likert scale ranging from 1 = “strongly disagree” to 5 = “strongly agree”. Scores > 50% indicate high perceived support.
Statistical analysis
Initially, metric variables were checked for deviations from normal distribution by visual inspection and investigating skewness and kurtosis. Cook’s distance, Mahalanobis distance, and leverage values were calculated to identify possible (multivariate) outliers. The statistical significance level was set to alpha = 5%. Depending on variable type, Chi2 test (dichotomous, categorical) and Mann–Whitney-U test (non-normally distributed metric) was applied for comparisons between patients and the reference group regarding sociodemographic data and psychological variables. For longitudinal comparisons between baseline and follow-up within the patient and the reference group the McNemar test was used for dichotomous variables and the Wilcoxon signed ranks test for (non)normally distributed metric variables. Possible associations between age, years of education, mediator, and dependent variables within the patient and the reference group at baseline and follow-up were analyzed by Spearman rank correlations. Fisher’s z-transformed correlation coefficients within the patient and the reference group were calculated and compared. Effect sizes can be interpreted as follows: r, V = 0.10–0.29; d = 0.2–0.4 small; r, V = 0.30–0.49; d = 0.5–0.7 medium, and r, V ≥ 0.50; d ≥ 0.8 high [39]. An odds ratio of 1.0 indicates that there is no difference between the patient and the reference group. An odds ratio > 1.0 indicates increased odds for the patient group, and an odds ratio < 1.0 indicates decreased odds for the patient group.
A logistic regression was conducted to find possible explanations for the high number of dropouts between baseline and follow-up measurement. This analysis included the following independent baseline variables: age, sex, residence, relationship status, years of education, physical health problems, spirituality, perceived social support, and psychological distress.
PROCESS v4.0 [40] was used to carry out the mediation analyses. This macro provides path coefficients for the direct, indirect, and total effects by means of ordinary least square regressions. Reported heteroscedasticity-consistent standard errors (HC3) [41] and the determined 95% confidence intervals are based on 10.000 percentile bootstrapped samples. When the confidence interval did not include zero, indirect effects were considered statistically significant. Interactions between independent and mediator variables were deemed statistically significant when p was < 0.05. Subjects (patients/reference group) were included as independent grouping variable. Spirituality (FACIT-Sp MP, FACIT-Sp F) and perceived social support (MSPSS) measured at baseline were assigned as mediator variables, whereas psychological distress (GSI) at follow-up was used as the dependent variable. Since patients and reference subjects differed significantly regarding the baseline variables sex, age, years of education, relationship status, and physical health problems, these variables were included in an initial mediation model to probe their explanatory contribution. Furthermore, residence and psychological distress at baseline were included during model building procedure. Yet, due to the strong association with the grouping factor, relationship status and physical health problems were not included as covariates in the final mediation analysis. Otherwise, there would have been the risk of overfitting the model, possibly leading to biased estimates.
Results
Out of 5517 patients suffering from MHD who had been invited for study participation 443 took part in the baseline survey. 185 completed both baseline and long-term follow-up surveys. However, patients diagnosed with behavioral syndromes associated with physiological disturbances and physical factors (ICD-10: F5x.xx) as well as those diagnosed with disorders of adult personality and behavior (ICD-10: F6x.xx) could not be considered in the analyses due to uneven distribution of psychological distress (GSI) values. This was confirmed by significant (p < 0.001) Kruskal–Wallis test and Bonferroni corrected pairwise comparison results. This resulted in a patient sample reduction of 14.8% (n = 28). Additionally, 1642 reference subjects fulfilling the inclusion criteria participated in the baseline survey, of whom 446 completed both baseline and follow-up surveys and were included in the analyses of the current report. Results of the logistic regression analysis revealed that age (OR = 0.976, 95% CI [0.967–0.985], p < 0.001), meaning and peacefulness (OR = 0.961, 95% CI [0.932–0.990], p = 0.009), and faith (OR = 1.043, 95% CI [1.013–1.074], p = 0.005) at baseline were associated with dropout at follow-up assessment.
Table 1 shows the baseline characteristics of study participants. Patients were older, less educated, and more often single. In both groups, the majority of participants were female. Table 2 depicts disease- and treatment-related characteristics of patients at baseline and follow-up. At follow-up, 62.7% of patients were receiving treatment for their MHD, which constitutes a significant decrease from baseline (72.5%).
Table 3 provides an overview of COVID-19-related characteristics. 28.3% of the patients and 17.4% of the reference subjects had suffered from COVID-19 up to follow-up. A total of 6 subjects required hospitalization and one required ICU treatment. Among both groups, confinement and negative press were the most distressing factors. In the reference group 32.1% were burdened by spatial separation from family and/or partner and 18.6% by home schooling, while in the patients group restricted access to retail and gastronomy (28.6% each) were the most stressful factors following isolation and negative press. However, in the subjective rating scale from 0 to 10 questioning how much psychological stress the COVID-19 crisis had caused, no between-group differences could be detected (median 5.1 in both groups).
Both at baseline (36.6% vs. 12.3%) and at follow-up (37.9% vs. 12.3%) patients were significantly more likely to be psychologically distressed than the reference subjects. In contrast, at baseline, the latter achieved significantly higher scores in the FACIT-Sp MP (25.1 ± 4.93 vs. 19.4 ± 7.40) and in the MSPSS (4.37 ± 0.61 vs. 3.86 ± 0.82), whereas the two groups were comparable in regards of FACIT-Sp F scores. Details are depicted in (Table 4)
.
Table 5 shows the correlations between age, years of education, psychological distress (GSI), spirituality (FACIT-Sp MP, FACIT-SP F), and perceived social support (MSPSS). Among both groups, simultaneous assessments at baseline revealed a strong negative correlation between GSI and FACIT-Sp MP scores and a moderate negative correlation between GSI and MSPSS scores. In addition, the GSI score was moderately negatively correlated with age and the FACIT-Sp F score in patients only.
In patients, significant negative correlations were detected between age (weak correlation) as well as baseline FACIT-Sp MP (strong correlation), MSPSS (moderate correlation), and FACIT-SP F values and GSI at follow-up. In reference subjects, in turn, merely baseline FACIT-Sp MP (strong correlation) and MSPSS (weak correlation) values correlated significantly negatively with GSI at follow-up. Further details are depicted in Table 4.
Results of mediation analysis
The analysis for (multivariate) outliers using Mahalanobis distance, Cooks distance, and leverage values indicated that the previously set limits were not exceeded. Thus, no outliers were detected. The analysis regarding possible interaction effects between the independent grouping variable and the mediators did not yield statistically significant results.
As can be seen in Fig. 1, patients achieved significantly lower scores on the FACIT-Sp MP compared to the reference group (a1 = − 2.592), and participants achieving higher FACIT-Sp MP scores at baseline described lower levels of psychological distress at follow-up (b1 = − 0.015). Compared to the reference subjects, patients were 0.039 units higher on the GSI considering the result of the effect of group differences on meaning and peacefulness, which, in turn, supposedly affected psychological distress.
When additionally including relationship status (38.6%), residence (40.9%), and physical health (37.3%; combined [40.8%]) as covariates, in the final model (Fig. 1) 38.2% of the total effect of the grouping variable on psychological distress could be accounted for by meaning and peace.
Concerning FACIT-Sp F, there was neither a statistically significant difference in baseline faith scores between patients and reference subjects (a2) nor was there a significant association between FACIT-Sp F and GSI scores at follow-up (b2).
Compared to patients, reference subjects indicated a significantly higher perception of social support at baseline (a3 = − 0.230), however, there were no statistically significant associations between the perception of social support (MSPSS) and psychological distress (GSI) at follow-up (b3).
On average, patients experienced statistically significantly more psychological distress at follow-up when the sense of meaning in life and peacefulness (FACIT-Sp MP), the sense of strength and comfort from one’s faith (FACIT-Sp F), and perceived social support (MSPSS) were considered (c = 0.102). However, when the mediator variables were not taken into account, this connection could not be shown (non-significance of c′).
Discussion
Our results show that patients suffering from MHD are significantly more burdened during the COVID-19 pandemic than healthy control subjects, both in the short—[8, 34] and in the long-term. At baseline, high perceived social support was significantly less frequently detected in patients, which corroborates the findings of previous studies [7, 34, 42]. On the other hand, the two groups were comparable concerning the subjective relevance of faith, while reference subjects indicated significantly higher spiritual well-being in terms of the sense of meaning in life and peacefulness, which mediated in large part the between-group difference of psychological distress at follow-up. Notably, both faith and the perception of social support did not prove to be relevant in this context.
Among both groups, the baseline assessment of psychological distress revealed a strong negative association with simultaneously assessed spiritual well-being in terms of meaning in life and peacefulness and a moderate negative association with perceived social support. This is consistent with the results of previous studies in both MHD patients and healthy control subjects [43,44,45,46]. In patients, a further moderate negative correlation was detected between psychological distress and age, which suggests that young MHD patients may represent a particularly vulnerable group in this regard and corroborates the findings of a number of previous studies showing that the young population is particularly burdened by the COVID-19 pandemic [47,48,49]. In addition, we also found a moderate negative correlation between patients’ psychological distress and their sense of strength and comfort from faith. It is generally well known that religiosity and spirituality may help people to cope with acute or chronic illness [18,19,20] and we, therefore, hypothesize that study participants with pre-existing MHD may have relied more heavily upon their faith and may have drawn strength from it even before the outbreak of the pandemic compared to the reference group. However, this issue cannot be addressed by our data. The fact that faith played a subordinate role in the reference group consisting of members of the general population is not surprising since religious affiliation has declined by 34% since 1951 in Austria [50] and is also decreasing in the Italian population [51].
Notably, the just mentioned significant associations persisted over the course of the pandemic, i.e., baseline FACIT-Sp MP, MSPSS, and FACIT-SP F values (patients only) were negatively associated with psychological distress (GSI) at follow-up. This suggests that psychological distress may not only have been caused by social isolation as a result of the pandemic, but by the pandemic itself and associated fears, e.g., about the future or one's own health or that of relatives [52]. Although life had largely normalized and quarantine conditions had been lifted, burden remained high over time, especially among MHD patients. In fact, the prevalence of psychological distress was three times higher in individuals with MHD compared to the reference group and remained unchanged among both groups over time. This difference was mediated in large part by spiritual well-being in terms of the sense of meaning in life and peacefulness and corroborates the findings of Lucchetti and coworkers who examined the association between religious and spiritual beliefs and the consequences of social isolation during the COVID-19 pandemic. In that study, spiritual participants showed lower levels of fear, anxiety, and sadness and higher levels of hope. Overall, higher spirituality was associated with better health outcomes [53]. Similarly, religious coping mechanisms such as reading the Bible or the Quran [54] and the perception of social support [55,56,57,58] also proved to be effective strategies to reduce stress, anxiety, and negative feelings in the context of the pandemic. However, the differences between MHD and control subjects in regards of psychological distress were not attributable to the mediating effect of spirituality in the sense of strength and comfort from faith or perceived social support in our survey. This suggests that independently of specific religious aspects, spirituality relating to the sense of meaning in life and peacefulness contributes to coping with crises such as the COVID-19 pandemic. In line with this consideration, spiritual interventions may improve both mental and physical health [59,60,61,62,63]. An experimental study has, for example, shown that spiritual interventions promote positive coping as well as the mental health of adult refugees [64]. However, there is still a lack of evidence-based spiritual interventions and further research on how they affect psychological distress caused by the COVID-19 pandemic is urgently needed.
Our study also has some limitations. Participation in the online study was voluntary and all results are based on self-report and may thus be biased. Furthermore, the reference group had to self-report of never having suffered from a mental illness. This clearly limits generalizability of our results to the entire population of Tyrol and South Tyrol. Another limiting factor is the lack of pre-pandemic data which would have been suitable as a reference point for comparison. In addition, the decreasing response rate from baseline to follow-up was associated with age, meaning and peacefulness, and faith. Younger participants and those with lower baseline scores regarding meaning and peacefulness and higher scores regarding faith were more likely to drop out. Therefore, the variability or the range of age and FACIT scores may be limited in our sample, possibly leading to limitations regarding the interpretability of the results. In summary, our results show that the prevalence of psychological distress during the pandemic was consistently higher among MHD patients compared to a healthy control group and that differences in spiritual well-being in terms of the sense of meaning in life and peacefulness were of major relevance in this regard. It remains to be seen whether the strengthening of spiritual well-being in the context of therapeutic inventions decreases psychological distress in MHD patients and ultimately leads to improved outcomes.
Data availability
The data that support the findings of this study are available on reasonable request from the corresponding author. The data are not publicly available due to ethical concerns, as data contains information that could compromise the privacy of research participants.
References
Hossain MM, Tasnim S, Sultana A, Faizah F, Mazumder H, Zou L et al (2020) Epidemiology of mental health problems in COVID-19: a review. F1000 Res 9:636
Chekole YA, Abate SM (2021) Global prevalence and determinants of mental health disorders during the COVID-19 pandemic: a systematic review and meta-analysis. Ann Med Surg (Lond) 68:102634
Wang Y, Shi L, Que J, Lu Q, Liu L, Lu Z et al (2021) The impact of quarantine on mental health status among general population in China during the COVID-19 pandemic. Mol Psychiatry 26(9):4813–4822
Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N et al (2020) The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet 395(10227):912–920
Tutzer F, Frajo-Apor B, Pardeller S, Plattner B, Chernova A, Haring C et al (2021) Psychological distress, loneliness, and boredom among the general population of Tyrol, Austria during the COVID-19 pandemic. Front Psychiatry 12(921):1
Chernova A, Frajo-Apor B, Pardeller S, Tutzer F, Plattner B, Haring C et al (2021) The mediating role of resilience and extraversion on psychological distress and loneliness among the general population of tyrol, Austria Between the First and the Second Wave of the COVID-19 Pandemic. Front Psychiatry 12:766261
Hofer A, Kachel T, Plattner B, Chernova A, Conca A, Fronthaler M et al (2022) Mental health in individuals with severe mental disorders during the COVID-19 pandemic: a longitudinal investigation. NPJ Schizophr 8(1):17
Tutzer F, Frajo-Apor B, Pardeller S, Plattner B, Chernova A, Haring C et al (2021) The Impact of resilience and extraversion on psychological distress, loneliness, and boredom during the COVID-19 pandemic: a follow-up study among the general population of tyrol, Austria. Front Psychiatry 12:777527
Ano GG, Vasconcelles EB (2005) Religious coping and psychological adjustment to stress: a meta-analysis. J Clin Psychol 61(4):461–480
Lucchetti G, Koenig HG, Lucchetti ALG (2021) Spirituality, religiousness, and mental health: a review of the current scientific evidence. World J Clin Cases 9(26):7620–7631
Park J, Roh S, Yeo Y (2012) Religiosity, social support, and life satisfaction among elderly Korean immigrants. Gerontologist 52(5):641–649
Sulmasy DP (2009) Spirituality, religion, and clinical care. Chest 135(6):1634–1642
Puchalski C, Ferrell B, Virani R, Otis-Green S, Baird P, Bull J et al (2009) Improving the quality of spiritual care as a dimension of palliative care: the report of the Consensus Conference. J Palliat Med 12(10):885–904
Saad M, Medeiros R (2012) Spiritual-religious coping—health services empowering patients’ resources
Koenig HG, Büssing A (2010) The Duke University Religion Index (DUREL): a five-item measure for use in epidemological studies. Religions 1(1):78–85
Schuster MA, Stein BD, Jaycox LH, Collins RL, Marshall GN, Elliott MN et al (2001) A national survey of stress reactions after the September 11, 2001, Terrorist Attacks. N Engl J Med 345(20):1507–1512
Ebadi A, Ahmadi F, Ghanei M, Kazemnejad A (2009) Spirituality: a key factor in coping among Iranians chronically affected by mustard gas in the disaster of war. Nurs Health Sci 11:344–350
Gonçalves Júnior J, Sales JPD, Moreira MM, Lima CKTD, Rolim Neto ML (2020) Spiritual beliefs, mental health and the 2019 coronavirus (2019-nCoV) outbreak: What does literature have to tell us? Front Psychiatry 11:1
Weaver AJ, Flannelly KJ, Oppenheimer JE (2003) Religion, spirituality, and chaplains in the biomedical literature: 1965–2000. Int J Psychiatry Med 33(2):155–161
Thuné-Boyle IC, Stygall JA, Keshtgar MR, Newman SP (2006) Do religious/spiritual coping strategies affect illness adjustment in patients with cancer? A systematic review of the literature. Soc Sci Med 63(1):151–164
Rao MS (2005) Spirituality in psychiatry? Psychiatry (Edgmont) 2(9):20–22
Gable SL, Bedrov A (2022) Social isolation and social support in good times and bad times. Curr Opin Psychol 44:89–93
Clair R, Gordon M, Kroon M, Reilly C (2021) The effects of social isolation on well-being and life satisfaction during pandemic. Human Soc Sci Commun 8(1):28
Peirce RS, Frone MR, Russell M, Cooper ML, Mudar P (2000) A longitudinal model of social contact, social support, depression, and alcohol use. Health Psychol 19(1):28–38
Haber MG, Cohen JL, Lucas T, Baltes BB (2007) The relationship between self-reported received and perceived social support: a meta-analytic review. Am J Community Psychol 39(1–2):133–144
Lakey B, Orehek E, Hain KL, Van Vleet M (2010) Enacted support’s links to negative affect and perceived support are more consistent with theory when social influences are isolated from trait influences. Pers Soc Psychol Bull 36(1):132–142
Son J, Lin N, George LK (2008) Cross-national comparison of social support structures between Taiwan and the United States. J Health Soc Behav 49(1):104–118
Uchino BN (2009) Understanding the links between social support and physical health: a life-span perspective with emphasis on the separability of perceived and received support. Perspect Psychol Sci 4(3):236–255
Yalcin-Siedentopf N, Pichler T, Welte AS, Hoertnagl CM, Klasen CC, Kemmler G et al (2021) Sex matters: stress perception and the relevance of resilience and perceived social support in emerging adults. Arch Womens Ment Health 24(3):403–411
Lakey B, Cronin A (2008) Chapter 17—Low social support and major depression: research, theory and methodological issues. In: Dobson KS, Dozois DJA (eds) Risk factors in depression. Elsevier, San Diego, pp 385–408
Liang J, Krause NM, Bennett JM (2001) Social exchange and well-being: is giving better than receiving? Psychol Aging 16(3):511–523
Grey I, Arora T, Thomas J, Saneh A, Tohme P, Abi-Habib R (2020) The role of perceived social support on depression and sleep during the COVID-19 pandemic. Psychiatry Res 293:113452
Eurostat (2021, November 14th). https://ec.europa.eu/eurostat/web/national-accounts/data/database
Lommer K, Schurr T, Frajo-Apor B, Plattner B, Chernova A, Conca A et al (2022) Addiction in the time of COVID-19: longitudinal course of substance use, psychological distress, and loneliness among a transnational Tyrolean sample with substance use disorders. Front Psychiatry 13:1
Holzner B, Giesinger JM, Pinggera J, Zugal S, Schopf F, Oberguggenberger AS et al (2012) The Computer-based Health Evaluation Software (CHES): a software for electronic patient-reported outcome monitoring. BMC Med Inform Decis Mak 12:126
Franke GH (2017) BSCL: brief-symptom-checklist: manual. Hogrefe, Göttingen
Peterman AH, Fitchett G, Brady MJ, Hernandez L, Cella D (2002) Measuring spiritual well-being in people with cancer: the functional assessment of chronic illness therapy—spiritual well-being scale (FACIT-Sp). Ann Behav Med 24(1):49–58
Zimet GD, Dahlem NW, Zimet SG, Farley GK (1988) The multidimensional scale of perceived social support. J Pers Assess 52(1):30–41
Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Lawrence Erlbaum Associates, Publishers, Hillsdale
Andrew F (2022) Hayes introduction to mediation, moderation, and conditional process analysis, 3rd edn. A Regression-Based Approach; ISBN 9781462549030; January 24
Davidson R, MacKinnon JG (1993) Estimation and inference in econometrics. Oxford University Press, Oxford
Wang J, Mann F, Lloyd-Evans B, Ma R, Johnson S (2018) Associations between loneliness and perceived social support and outcomes of mental health problems: a systematic review. BMC Psychiatry 18(1):156
Jones S, Sutton K, Isaacs A (2019) Concepts, practices and advantages of spirituality among people with a chronic mental illness in Melbourne. J Relig Health 58(1):343–355
Solaimanizadeh F, Mohammadinia N, Solaimanizadeh L (2020) The relationship between spiritual health and religious coping with death anxiety in the elderly. J Relig Health 59(4):1925–1932
O’Brien B, Shrestha S, Stanley MA, Pargament KI, Cummings J, Kunik ME et al (2019) Positive and negative religious coping as predictors of distress among minority older adults. Int J Geriatr Psychiatry 34(1):54–59
Cooke BD, Rossmann MM, McCubbin HI, Patterson JM (1988) Examining the definition and assessment of social support: a resource for individuals and families. Fam Relat 1988:211–216
Pieh C, Budimir S, Probst T (2020) The effect of age, gender, income, work, and physical activity on mental health during coronavirus disease (COVID-19) lockdown in Austria. J Psychosom Res 136:110186
McGinty EE, Presskreischer R, Anderson KE, Han H, Barry CL (2020) Psychological distress and COVID-19—related stressors reported in a longitudinal cohort of US Adults in April and July 2020. JAMA 324(24):2555–2557
Son C, Hegde S, Smith A, Wang X, Sasangohar F (2020) Effects of COVID-19 on college students’ mental health in the United States: interview survey study. J Med Internet Res 22(9):e21279
Statistik Austria. Religionszugehörigkeit 2021. 2022 [cited 2022, Dez 09]. Retrieved from Religionszugehörigkeit 2021: drei Viertel bekennen sich zu einer Religion (statistik.at)
Statista Research Department. Italien: Religionszugehörigkeit der Bevölkerung im Jahr 2010 und Prognosen bis 2050. 2015 [cited 2022, Dez 09]. Retrieved from Italien—Religionszugehörigkeit bis 2050 | Statista
Cao W, Fang Z, Hou G, Han M, Xu X, Dong J et al (2020) The psychological impact of the COVID-19 epidemic on college students in China. Psychiatry Res 287:112934
Lucchetti G, Góes LG, Amaral SG, Ganadjian GT, Andrade I, Almeida POA et al (2021) Spirituality, religiosity and the mental health consequences of social isolation during Covid-19 pandemic. Int J Soc Psychiatry 67(6):672–679
Labrague LJ (2021) Psychological resilience, coping behaviours and social support among health care workers during the COVID-19 pandemic: a systematic review of quantitative studies. J Nurs Manag 29(7):1893–1905
Nie A, Su X, Zhang S, Guan W, Li J (2020) Psychological impact of COVID-19 outbreak on frontline nurses: a cross-sectional survey study. J Clin Nurs 29(21–22):4217–4226
Giusti EM, Pedroli E, D’Aniello GE, Stramba Badiale C, Pietrabissa G, Manna C et al (2020) The psychological impact of the COVID-19 outbreak on health professionals: a cross-sectional study. Front Psychol 11:1684
Labrague LJ, De Los Santos JAA (2020) COVID-19 anxiety among front-line nurses: predictive role of organisational support, personal resilience and social support. J Nurs Manag 28(7):1653–1661
Xiao H, Zhang Y, Kong D, Li S, Yang N (2020) The effects of social support on sleep quality of medical staff treating patients with coronavirus disease 2019 (COVID-19) in January and February 2020 in China. Med Sci Monit 26:e923549
George M, Ellison V (2015) Incorporating spirituality into social work practice with migrants. Br J Soc Work 45(6):1717–1733
Hodge DR (2015) Spiritual assessment in social work and mental health practice. Columbia University Press, London
de Diego-Cordero R, Suárez-Reina P, Badanta B, Lucchetti G, Vega-Escaño J (2022) The efficacy of religious and spiritual interventions in nursing care to promote mental, physical and spiritual health: a systematic review and meta-analysis. Appl Nurs Res 67:151618
Gonçalves JP, Lucchetti G, Menezes PR, Vallada H (2015) Religious and spiritual interventions in mental health care: a systematic review and meta-analysis of randomized controlled clinical trials. Psychol Med 45(14):2937–2949
Dodd DW (2007) Exploring spirituality/religion related interventions used by mental health workers in psychotherapy and counseling. Masters thesis, Smith College, Northampton, MA. https://scholarworks.smith.edu/theses/1273
Pandya SP (2018) Spirituality for mental health and well-being of adult refugees in Europe. J Immigr Minor Health 20(6):1396–1403
Funding
Open access funding provided by University of Innsbruck and Medical University of Innsbruck. This work was supported by the federal state of Tyrol (Grant No. F.21427). The funder of this study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. All authors had final responsibility for the decision to submit for publication.
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AH, BF-A, SP, BP, and BH designed the study and wrote the protocol. Recruitment was performed by FT and AS. TS verified and analyzed the data. FT and TS interpreted the data. FT wrote the first draft of the manuscript with contributions by TS and AH. All authors participated in the critical revision and approved the submitted manuscript.
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The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008.
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Tutzer, F., Schurr, T., Frajo-Apor, B. et al. Relevance of spirituality and perceived social support to mental health of people with pre-existing mental health disorders during the COVID-19 pandemic: a longitudinal investigation. Soc Psychiatry Psychiatr Epidemiol (2023). https://doi.org/10.1007/s00127-023-02590-1
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DOI: https://doi.org/10.1007/s00127-023-02590-1