The results of this study once again corroborate the findings of the initial validation study that suggest that the Fear of COVID-19 is correlated with anxiety, depression, and stress symptoms (Pang et al. 2020a). Although it appears that there might be higher rates of fear, depression, anxiety, and stress in older individuals, but when analysed by age group, it is interesting to observe the reverse conclusion being true—that there are significantly higher mean scores for all psychopathologies for younger age groups.
This can be related to multiple factors. There are most certainly psychological knock-on effects of COVID-19 on students. On a surface level, they are more cocooned from COVID-19’s impact on the economy at large, as their livelihood is unaffected. This contrasts with the general public, who have clear and present fears about COVID-19, which relate to their employment, the prospects of closure and loss of livelihood for self-employed business owners, the stressors of childcare and total shutdown of schooling, and more fears about more severe health consequences of COVID-19, as research generally demonstrates that older people are more susceptible to the morbidity and mortality of COVID-19. There are most certainly behavioural changes in COVID-19, for instance hoarding and altruism, that can potentially explain a lot of human behaviour in the pandemic (Koh et al. 2020).
The results from this study indicate that the difficulties faced by students due to COVID-19 may actually only represent the proverbial tip of an iceberg. Undergraduates no doubt face a multitude of challenges both from a mental health symptoms point of view, which includes current quarantine prospects, future employment uncertainties, and the effect on delayed study completion (Sahu 2020). Due to the sudden and dramatic nature of the Malaysian national lockdown, undergraduates living in-campus in Malaysian universities were forced to undergo an unexpected lockdown for over 2 months. Hence, the uncertainty stemming from the insecurity of knowing when the students are going to go home, the fear of isolation, and the fear of lack of support from university authorities were all factors that could have potentially increased the levels of the respective psychopathologies. Once again, the results suggest that being female and single are also risk factors for developing psychopathologies in the COVID-19 pandemic. This correlates with similar findings from previous studies in the pandemic (Liu et al. 2012; Wang et al. 2020). Hence, it is important that these two risk factors are addressed by clinicians and university student affairs departments, and universal screening and treatment options offered.
Apart from that, the result of this study indicates that people living in urban area have lower fear of COVID-19 as compared to those in rural area. This could be attributed to better connectivity to regular updates and information regarding COVID-19, as well as close proximity to the hospital (Acuto 2020). On the other hand, the rural communities have poorer populations, poor access to COVID-19 information, and lesser hospital or medical facility as compared to urban area (Erwin et al. 2020; Smith and Trevelyn 2019; Summers-Gabr 2020). These limitations could be the contributing factors to higher level of fear of COVID-19 among those aforementioned communities.
There are multiple pathways for intervention that can be activated during the unique COVID-19 crisis, which call for creative solutions to age-old problems made complicated by social distancing rules and lockdowns. Telecounselling and telepsychiatry, previously much maligned due to the perceived efficacy of face to face interactions, have experienced a resurgence in the pandemic (Kannarkat et al. 2020). However, there are most certainly ethical and boundary issues surrounding these developments. Therefore, it is incumbent upon nation states and health authorities to jointly form steering committees to produce Standard Operating Procedures and fallback face to face alternatives for emergency situations. Counselling and psychology interventions can boost psychological mindedness, which have been shown in previous research to be efficacious as a partial mediator of the relationship between dysfunctional coping styles and depressive symptoms (Pang et al. 2020b). To combat the difficulties of having long psychotherapy protocols, obfuscating service delivery, there has been an ultra-brief psychological interventions module created in the midst of the COVID-19 crisis, that has been piloted amongst undergraduate students and frontline healthcare workers (Pang et al. 2020c). A timely and concise psychological intervention has been proven to be an effective tool in assisting those affected, and could be promoted as one of the important healthcare strategies in Malaysia’s quest to strengthen its national resilience (Francis et al. 2020; Sulaiman et al. 2020).
This study does have certain limitations that preclude it from being fully generalisable to all strata of society. Due to its cross-sectional nature, only associational rather than causal linkages are able to be demonstrated. Moreover, it was done in a population that was largely university educated, hence there may be difficulties in extrapolating it to a general public with more secondary levels of education. Finally, it would have been helpful to look at mediational models had measurements of coping styles or psychological process variables been performed. Due to time constraints and the fact that students had already returned to their hometowns, it was crucial the authors captured the psychological zeitgeist of COVID-19 as swiftly as possible before a second wave of infection.
This is the first study to utilise the Fear of COVID-19 scale in Malay, and it again corroborates that the extant relationships between fear of COVID-19, depression, anxiety, and stress are present in larger magnitudes in a sample population that models the general population better than the predominantly undergraduate sample in the validation study. This study also provides preliminary evidence that magnitude of fears, worries, and stress is higher significantly in a university student group compared to a general public group. As students prepare to re-enter universities in stages in Malaysia beginning July 2020, it is imperative that a public health primary prevention approach, rather than a tertiary prevention approach to reduce the burden of pre-existing depression and anxiety, be deployed upon students’ return. This will hopefully flatten the curve of the predicted second wave of increasing mental health illness and symptoms that pundits anticipate after the quelling of the physical pandemic.