CHAPTER I

INTRODUCTION

Background of the Study

It was reported that a new severe type of pneumonia, later known as novel

coronavirus disease 2019 (COVID-19) first emerged in Wuhan, Hubei, China in

December 2019, and has since evolved into a global pandemic. COVID-19 is an

infectious disease caused by a newly discovered coronavirus. World Health

Organization (WHO) announced the COVID-19 outbreak as a pandemic on

March 11, 2020. According to the Center for Disease Control and Prevention, a

pandemic is referred to as an epidemic that has spread over several countries or

continents, usually affecting a large number of people. A decision to declare a

disease as fatal and pandemic in nature has a consequence beyond the physical

health domain. Every country affected by the spread of pandemic not only faces

political and economic difficulties but also witnesses a severe impact on the

mental health component on the general public. The pandemic, which is

characterized as an unrestricted form of disease spread, has the potential to have

a psycho-social impact on society (Singhal, et. al, 2020).

Public health emergencies may affect the health, safety, and well-being of

both individuals and communities. These effects may translate into a range of

emotional reactions, unhealthy behaviors, and noncompliance with public health

directives in people who contract the disease and in the general population
(Pfefferbaum, et al., 2020). The COVID-19 pandemic is a major health crisis

affecting several nations, with as of September 14th, 2020, there are more than

29,119,433 confirmed cases, and 925,965 deaths globally with 265,888

confirmed cases, and 4,630 deaths from COVID-19 in the Philippines. And here

in Zamboanga City, 1,479 total confirmed cases of COVID-19, including 68

deaths.

In a cross-sectional survey of 52,730 participants in China conducted

between the 31st January to the 10th of February 2020 (Qiu J, et al., 2020),

29.3% of respondents experienced mild to moderate psychological distress, and

5.1% experienced severe distress. In another survey of 1,210 members of the

general public conducted between 31st January to 2nd February 2020, (Wang et

al., 2020) found that over half (53.8%) of participants rated the psychological

impact of the COVID-19 outbreak as moderate to severe, three quarters were

worried about their family members contracting COVID-19, and rates of moderate

to severe depression, anxiety and stress were 16.5%, 28.8%, and 8.1%

respectively. Outside of China, rates of psychological distress have varied across

countries and contexts in online mental health surveys, although high rates of

psychological distress have been found in countries such as Mexico 50.3%

reported psychological distress as moderate to severe (Piñeiro, et al., 2020),

Spain 72% had elevated psychological distress (Gomez, et al., 2020), in India

25%, 28%, and 11.6% had moderate to extremely severe depression,

anxiety and stress symptoms respectively (Verma, et al., 2020) during the

COVID-19 pandemic.
 It is important to understand the impact on the general public by examining

their psychological responses to the situation (Singhal, et al., 2020). Studies state

that the outbreak of SARS and Ebola virus disease in the years 2003 and 2014

had caused widespread public fear and fear-induced emotional reactions that

went to an extent of impeding infection control (Shultz et al., 2016). China was

the first country affected by the pandemic outbreak of COVID-19 and it had

reported a severe mental health crisis in the affected regions (Dong et al., 2020).

This information strengthens the general public’s perception and meaning-making

on their vulnerabilities. Their probability of exposure to the disease and one’s

resources to handle it acts as a potential stressor in their mind. The studies

inform that psychological disturbance during an outbreak can possibly leave the

affected general public less capable of handling it (Taha et al., 2014). These

studies’ findings show that the outbreak can lead the entire population to

experience stress, and make them feel vulnerable.

Anxiety and fear regarding a new disease and what could happen can be

overwhelming and cause strong emotions both in children and adults. Public

health actions, such as social distancing, can make people feel isolated and

lonely and can increase stress and anxiety (Centers for Disease Control and

Prevention, 2020). The lives of people were seriously affected by lock-down and

fear related to the disease’s potential effects and transmission (Shah, et al.,

2020). The fear due to the contraction of COVID -19 is on the rise because of the

death tolls and global spread (Dong, et al., 2020) (Goyal, et al., 2020).

Consequently, this study attempts to determine the initial psychological impact of

COVID-19 among the general public.

Theoretical Framework

The section below presents the literature on Health Anxiety, Coping

mechanisms and Locus of Control.

Health Anxiety

Singhal, et al., 2020 emphasized that onset of an outbreak can instill fear in most

individuals. The fear of concern can be amplified by pre-existing anxiety and

depressive disorder (Taha, et al., 2014). Studies conducted during the H1N1

outbreak in 2009 and Ebola outbreak in 2014 produced finding that general public

experienced rise in anxiety and depression during those periods (Shultz et al.,

2016). Another survey conducted on February 2019, during the Covid-19

outbreak found that 62% of Britons responded that it was hard to stay positive

about the future after the outbreaks and particularly the survey narrated that

younger people and women displayed a grim outlook (Pinnington, 2020).

Individuals tend to overestimate the likelihood and severity of illness as a thought

to drive anxiety. It involves frequency to indulge in self-monitoring for unexplained

bodily sensation and constantly being body vigilant to a specific disease outbreak

(Blakey et. al. 2015). During Covid-19 outbreak, the information overflow through

social media including misinformation has heighted public mental health crisis

(Dong, 2020).
Coping Mechanisms

Individuals risk perception influences the choice over the adoption of

recommended protective behavior (Wang, et.al. 2018) while appraising an

uncertain situation. Personal reaction to the threat may differ from individual to

individual; however, increased rumination about the possibility of accuracy on

illness can influence the behavior (Singhal et al., 2020). An effective coping

strategy and a health related behavior towards threat is built when an emotional

response to the problem interacts to understand the reality.

Locus of Control

Locus of control refers to the tendency to perceive outcomes in life as a result of

one’s own actions and thus being within one’s own control as opposed to being

determined by external factors, such as chance or powerful others (Rotter, 1966;

Keenan and McBain, 1979). However, at a later time, locus of control has also

been described as a coping resource facilitating certain coping styles (Van

den Brande et al., 2016). Illustrative of this, placing the cause of an outcome

upon others has been related to avoidance coping/ resignation, greater stress,

and poor health. Internal locus of control, on the other hand, has been associated

with help-seeking and positive thinking, as well as lower levels of work stress in

general (Gore et al., 2016).

Conceptual Framework
 A concept provides an analytical tool which guides the researchers in the

interpretation of information and organization of thoughts or ideas to determine

the key question.

Independent Variable Dependent Variables

Figure 1
Conceptual Paradigm of the Study

The General public serves as the independent variable while the

Psychological responses are the dependent variables. This study will determine

the public’s reactions towards Covid-19’s outbreak by gauging the psychological

response in terms of anxiety and their coping behavior adapted during that time

period.

Statement of the Problem

The primary purpose of the study is to determine the public’s psychological

responses during Covid-19 pandemic lockdown period in Zamboanga City.

Specifically, this study seeks to answer the following problem:

1. What is the level of psychological response towards Covid-19 lockdown

 period in Zamboanga City among respondents in terms of?

1.1 Health anxiety

1.2 Coping mechanism

1.3 Locus of control

2. Is there a significant difference in the psychological responses towards

Covid-19 lockdown period in Zamboanga City among respondents when

demographic profile is considered?

3. Is there a significant correlation in the health anxiety, coping mechanism

and locus of control of the respondents?

Hypothesis

This study presents two hypotheses indicated below:

There is no significant difference in the psychological responses during

Covid-19 pandemic lockdown period in Zamboanga City in terms of respondent’s

demographic profile, health anxiety, coping mechanism and locus of control.

There is a significant difference in the psychological responses during

Covid-19 pandemic lockdown period in Zamboanga City in terms of respondent’s

demographic profile, health anxiety, coping mechanism and locus of control.

Significance of the Study

The findings of this study will give bearing to the following:

Public

The general public will gain awareness of how they appraise a pandemic

and how they mentally and behaviourally respond to this threat.

For the City Health Office (CHO)

The results will provide insights to strengthen mental health related

communication along with other preventive efforts taken by public health

mechanisms in the Zamboanga City.

For the Student Nurses

The results will help the student to gain knowledge on the public’s

psychological responses in terms of anxiety and their coping behavior adapted

during that time period.

For the Local Government

The results can potentially help policymakers in formulating

comprehensive interventions.

For the Future Researchers

 The results may provide the baseline data for further studies on

psychological responses and mental health threats individuals experienced

during the COVID-19 pandemic. This research will be a useful reference for the

researchers who would plan to make any related study.

Scope and Delimitation of the Study

The study will focus on the determination of respondents’ reactions

towards Covid-19’s outbreak by gauging the psychological response in terms of

anxiety and their coping behavior adapted during that time period.

The respondents will be individuals who are ages 18 years old and above

and residing in Zamboanga City for the entire duration of the Covid-19 pandemic

lockdown period.

Operational Definition of Terms

The following terminologies used in the study will be defined operationally:

General Public. Refers to individuals or persons, a resident of Zamboanga City

whose psychological reaction to Covid-19 outbreak will be determined.

Psychological responses. Refers to the mental and behavioral reactions of

individuals to the Covid-19 outbreak. Specifically, in terms of health, anxiety,

coping mechanism, and locus of control.

Health anxiety. Refers to the public’s anxiety and fear towards Covid-19

outbreak.

Coping mechanisms. Refers to the public's coping strategy or health related

behavior that is effective or works for them.

Locus of control. Refers to the public’s belief or how the public perceived the

causes of Covid-19 pandemic.