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Attitudes Towards COVID-19 vs Stress Levels

Abigale Reynolds

University of Colorado Boulder

PSYC 3111

Dr. Kelly Gildersleeve

December 1, 2020
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Abstract

There is little known about how a person’s attitude towards COVID-19 affects their stress levels,

the aim of this study was to resolve this gap. This study hypothesized that there is a negative

correlation between a person’s attitude and their stress levels, pertaining to COVID. The sample

for this study included seventeen participants, recruited from an upper-level psychology course

at the University of Colorado at Boulder. Participants completed a one-time online survey

inquiring about their attitudes towards COVID and their current stress levels. Researchers then

analyzed this data, which revealed a weak positive correlation, which was not statistically

significant, between the attitudes of the participants and their stress levels. While these results

imply that having a positive attitude towards COVID corresponds to higher stress levels, this is

not statistically significant, and thus lacks the strength to be applied to the general population.

More research pertaining to this topic is needed.

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Attitudes Towards COVID-19 vs Stress Levels

COVID-19 is a deadly pandemic that originated in China in November of 2019

(“Coronavirus,” 2020). Almost everyone in the world is aware and or has been personally

affected by this disease. There has been some research done about COVID, but because the

disease began so recently, there are still large gaps in many areas of research. For one, very few

studies have considered perceived stress in relation to attitudes about Covid-19 in the US among

the general population. The Current Study aims to fill this gap.

Many researchers began by examining the stress levels due to COVID of healthcare

workers. One group of researchers examined physician trainees and their levels of stress

(Kannampallil et al., 2020). Researchers used an online survey to compare levels of depression,

anxiety, stress, burnout, and also professional fulfillment of two groups of trainees; one group

was exposed to patients being tested for COVID-19, and one group was not exposed to those

patients (Kannampallil et al., 2020). Kannampallil et al. (2020) were able to conclude that ​the

exposed group had higher levels of stress compared to the non-exposed group​.​ These results

demonstrating one cause of stress may be COVID exposure, or the fear of developing COVID.

Another group of researchers then examined how levels of stress are affected by a positive

attitude, among healthcare workers (Lombardi et al., 2020). The data for this study was collected

during the peak of COVID-19, and mainly analyzed the coping strategies used by healthcare

professionals when compared to their stress levels (Lombardi et al., 2020). Lombardi discovered

that the main protective factor towards a stressful situation, in this case, COVID-19, was having

a positive attitude. It was also noted that economic factors, problem-solving ability, and religion

did not have an impact on stress levels (Lombardi et al., 2020). These results show that while
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COVID may increase stress levels, for healthcare workers, a positive attitude can decrease this

stress.

While research has been conducted in regards to attitudes surrounding Covid compared to

stress levels, there are many variables within these studies that could be considered confounds. In

Hungary, researchers realized this and conducted a study examining not only the attitudes

towards covid in comparison to stress levels, but also examined the effects of age, perceived

health status, and gender on the participant’s stress level (Szabo et al., 2020). Through analysis,

the researchers found differences between three age groups: 18-30, 31-59, and 60+ years old, and

differences between differing perceived health status: good, average, and below average, and

also between different genders (Szabo et al., 2020). Researchers were able to conclude that

women and participants with perceived average or below average health status were the most

stressed (Szabo et al., 2020). These results demonstrate there may be some groups, or variables,

that could be factors affecting people’s stress levels besides COVID-19.

There was also evidence that caused researchers to investigate how people’s behavior,

and not just stress levels, changed because of attitudes towards COVID-19. For example, a group

of researchers examined a sample of dental students (Ammar et al., 2020). In this study

researchers used online surveys to collect information pertaining to participants' stress levels,

attitudes, perceived control, norms, and backgrounds (Ammar et al., 2020). Researchers of this

study were able to conclude that there was a direct association between change in behaviors and

the participants level of worriedness, however, there was no association between changes and the

training of protocol of public health emergencies (Ammar et al., 2020).​ It was also noted that

there was an association of the more fears and stressors, in this case COVID-19, the larger

adoption of preventative measures (Ammar et al., 2020). Overall, these results imply while there
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was no change to the training protocol, as stress goes up, th​ere was an increase in preventative

measures for COVID-19. This agrees with what a group of researchers in Saudi Arabia

discovered. Researchers of this study examined the attitudes of Saudi Arabian healthcare

professionals in regards to the COVID-19 pandemic, along wit​h the potentially associated

predictors (Abolfotouh et al., 2020). Researchers of this study concluded that health care workers

reported significantly higher concerns when it came to COVID-19. And it was noted that there

are many necessary measures that could enhance the protect​ion of healthcare workers and

minimize the perceived risk of infection (​Abolfotouh ​et al., 2020). ​Showing that there are

behaviors and protocols that could be changed in order for healthcare workers to increase their

protection towards the virus, and therefore, decrease the risk of developing the virus and also

their decreased perceived stress levels.

Through research, it was determined that there was a negative, or inverse, correlation

between stress levels, and attitudes towards COVID-19 of healthcare professionals. But

researchers also identified that there may be confounding factors resulting in this correlation,

such as gender, age, or health status. Researchers were also able to conclude that stress levels

caused a change in behaviors among healthcare professionals, but there has been little change to

the protocol of dealing with a pandemic, which could further help reduce stress levels pertaining

to COVID-19. However, there are ​very few studies that have considered perceived stress in

relation to attitudes pertaining to Covid-19 among the general population of the United States,

the current study aims to fill this gap. It was hypothesized that having a greater, more positive,

attitude towards the COVID-19 pandemic results in a decrease in perceived stress, a negative

correlation.
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Method

Design

This research problem utilized a correlation study. This was tested in R studio using a

bivariate correlation test. The independent variable was the participant’s attitude, which they

self-ranked on a scale of 1 to 7. The dependent variable of this study was the participant’s stress

level, which was also self-ranked on a scale of 1 to 5.

Participants

The random sample for this study included a total of 17 participants, made up of 6 males

and 11 females. Participants were recruited from an upper-level psychology course at the

University of Colorado Boulder. The participants ranged from 20 to 55 years old (​M​ = 25.5, ​SD

= 11.1). All participants took part in this study as an additional requirement for the class, with no

additional incentivizing. The initial sample included 20 total participants, however, the data for 3

participants were excluded from the data analysis as they had missing responses for some of the

survey questions.

Measures

Kwan and Bryan (2010) developed and published research using the attitude, norms,

intention, perceived behavioral control, and self-efficacy scales used to collect and report data

posed by the research question in this study. The hypothesized question that was evaluated

utilized the attitude scale, which assessed how participants viewed their attitudes towards

COVID-19 and consisted of 7 items. Each of these 7 items was rated by participants on a 7-point

semantic differential-type scale. The first item addressed health (1 = unhealthy, 7 = healthy), the

second asked about benefits (1= harmful, 7 = beneficial), the third about the level of pleasantness

(1 = unpleasant, 7 = pleasant), the fourth addressed whether it would be good or bad (1 = bad, 7
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= good), the fifth asked about its worth (1 = worthless, 7 = valuable), the sixth determined level

of enjoyment (1 = unenjoyable, 7 = enjoyable), and the seventh inquired about whether or not it

was rewarding (1 = punishing, 7 = rewarding). Overall, lower numbers indicated that a

participant had a negative attitude towards COVID-19 and a higher number indicating a very

positive attitude towards COVID-19. An example of one of the statements a participant rated is

Viewing COVID-19 related news for 30 minutes a day for at least 5 days a week would be

beneficial. ​The mean response for these 7 items was calculated to create a measure of overall

attitudes (α = ​0.83). This alpha value is a measure of internal consistency, so having an alpha that

is greater than .70, shows a good amount of reliability within the attitude scale.

Cohen, S., et al. (1983) also developed and then validated a global measure of perceived

stress, the perceived stress scale, that was used to answer and support the research question

posed within this paper. ​The hypothesized question that was evaluated utilized the perceived

stress scale, which assessed participants’ stress levels, and consisted of 10 items. Each of these

10 items was rated by participants on 5 point Likert-type scale. The first item addressed how

often participants were upset because of something that happened unexpectedly (1 = never, 3 =

sometimes, 5 = fairly often). The second item asked participants how often they were unable to

control the important things in their lives (1 = never, 3 = sometimes, 5 = fairly often). The third

item inquired about the frequency in which participants felt nervous or stressed (1 = never, 3 =

sometimes, 5 = fairly often). The fourth addressed how often participants felt confident that they

could handle personal problems (1 = never, 3 = sometimes, 5 = fairly often). The fifth question

asked participants how often they felt like things were going their way (1 = never, 3 =

sometimes, 5 = fairly often). The sixth question asked participants about how often participants

felt they could not cope with everything they had to do (1 = never, 3 = sometimes, 5 = fairly
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often). The seventh question inquired about how often participants felt they could control the

irritation in their lives (1 = never, 3 = sometimes, 5 = fairly often). The eighth question addressed

how often participants felt like they were on top of things (1 = never, 3 = sometimes, 5 = fairly

often). The ninth question asked participants how often they were angered because of something

that was outside of their control (1 = never, 3 = sometimes, 5 = fairly often). And lastly, the tenth

question addressed how often participants felt as though their difficulties were piling up so high

they could not overcome them (1 = never, 3 = sometimes, 5 = fairly often). Overall, lower

numbers indicated that a participant had lower levels of stress and a higher number indicated a

very high level of stress. However, questions 4, 5, 7, and 8 were reverse coded, meaning those

for those questions a lower number indicated a higher level of stress and a higher number

indicated a lower level of stress. An example of one of the statements a participant rated is ​In the

last month, I have sometimes been upset because of something that happened unexpectedly. ​The

mean response for these 10 items was calculated to create a measure of overall stress (α = ​0.82).

This alpha value is a measure of internal consistency, thus by having an alpha that is greater than

.70, it shows a good amount of reliability within the perceived stress scale.

Procedures

Within this study, participants completed a one-time online survey, created and taken

through Qualtrics. They first answered questions pertaining to their age and gender. They then

completed multiple Likert-type questions that made up a full scale about their perceived stress

levels. After that, they completed 7 multiple semantic differential-type questions that made up a

full scale about their attitudes towards COVID-19. This survey was created by the researchers

who designed this study, thus this study only included relevant questions, and the results from all
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four of the questions were analyzed. This one-time survey took participants less than 10 minutes,

and the data was then analyzed by researchers using R studio version 4.0.2.

Results

A Pearson’s R correlation was used to determine whether there was a correlation between

a person’s attitude towards COVID-19 and their stress levels. With both the independent and

dependent variables being continuous. Through bivariate correlation testing, it was shown that

there was a very weak positive correlation between the attitudes of participants and their stress

levels, however these results were not statistically significant, (r(15) = 0.21, p = 0.410). Figure 1

shows this relationship. These results did not confirm the initial hypothesis, however, the results

were not statistically significant. This means that the strength of the relationship between

attitudes and stress within this study, would most likely not be observed within the population.

To be able to apply the results of the current sample to the general population, more research

would have to be done. Once more research is done, this may also provide support for the initial

hypothesis of this study.

Discussion

In this study, it was hypothesized that there was going to be a negative correlation

between a person’s attitude towards COVID-19 and their perceived stress levels. However, the

calculated results contradict the previously stated hypothesis, as there was a very weak positive

correlation found between a person’s attitude and their stress levels. This means that as attitude

towards COVID-19 improved or went up, the participants’ stress levels also increased. However,

this result was not statistically significant. Which means the strength of the correlation found in

the study, would not be observed within the general population. Meaning to find a correlation

with more certainty, more research on this topic needs to be conducted.

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While this study was created to attempt to find evidence for a gap in the literature, there

were still numerous research articles that conduct a variety of research pertaining to the variable

involved in this study. ​Lombardi​ et al., (2020) previously completed a study that examined the

relationship between the attitude of health care professionals and their stress levels. Similar to

the current study they measured stress levels through the use of online surveys. ​Lombardi

discovered that the main protective factor towards a stressful situation, in this case, COVID-19,

was having a positive attitude. However, it was also noted that economic factors,

problem-solving ability, and religion did not have an impact on stress levels (Lombardi et al.,

2020). This study supports the initial hypothesis, showing that having a more positive attitude

pertaining to COVID, reduces stress levels. The current study, however, did not find the

hypothesized result and thus does not agree with the previous research conducted by Lombardi​ et

al., (2020).

As stated above economic factors, problem-solving ability and religion did not have an

impact on stress levels (Lombardi et al., 2020), but there may be some other factors that do have

an impact on stress levels. For example, even the protocol can have an impact on stress levels,

especially for healthcare workers. Researchers of a study involving healthcare workers in Saudi

Arabia concluded that there are many necessary measures that could enhance the protection of

healthcare workers and minimize the perceived risk of infection (​Abolfotouh ​et al., 2020). And

thus by minimizing the perceived risk of infection, the stress level of the healthcare workers

would also be decreased. Meaning that there can be variables changed, that also change the

perceived stress levels. This research is relevant to the current study, because this could allow

future researchers to investigate stress levels in comparison to attitudes pertaining to COVID-19

in different settings. For example one setting could be equipped with enhanced protection and
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one setting could be the typical, control setting. Allowing researchers to have a better picture of

how attitude truly affects stress levels.

Limitations and Future Directions

One limitation of this study was in terms of diversity. Data for this research question was

obtained from a survey sent to students of an upper-level psychology course at the University of

Colorado Boulder. By only sending it to this class it first limits the age range. Because most

college students are aged 18-22 with minimal deviation it creates a very small age range that this

study could potentially apply to. It also creates a very small demographic. Overall CU Boulder

has less diversity when compared to other universities, so by sending this survey to a singular

class at CU the results are centered mainly around a singular race, Caucasian, from similar

economic backgrounds and with similar morals. If this study were to be replicated in the future

one possibility to fix this could be to send the survey to multiple universities around the countries

thus to get a more adequate representation of all ethnicities and economic groups. Professors and

parents could also be asked to complete the survey in order to also represent a wider age range.

Another limitation of this study was the timeline. The survey sent to the participants was

only available for 7 days. This short availability could have potentially excluded people from

taking the survey, and, overall this could be a large reason for the small sample size. If this study

were to be replicated in the future one possibility to fix this would be to leave the survey open to

participants for a longer period of time. This might allow researchers to obtain a larger sample

size, and then also be able to calculate results that are statistically significant.

Lastly, another limitation of this study is that it did not account for other stressors besides

COVID-19. The participants in this study centered around university students. These students

could have been stressed by COVID, but they also could have been stressed by final exams, a
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paper they had due, or something going on with their families. The survey sent to participants

within the current study didn’t ask participants about these other stressors, which could’ve been a

reason that caused the results to be not statistically significant. If this study were to be replicated

in the future, one possibility to account for this would be to create a survey that asks about these

stressors. Thus the new study could take into account other stressors, along with COVID, to find

a more accurate representation of the correlation between attitudes towards COVID-19 and a

perceived stress towards COVID-19.

Implications

It was shown that there was a weak positive correlation between the attitudes of

participants pertaining to COVID-19 and their perceived stress levels. However, this was not

statistically significant. This essentially means that a person with a positive attitude towards

COVID means they are more stressed, but because these results were not statistically significant

this means that the strength of the relationship between attitudes and perceived stress in the

current study would mostly likely not be observed within the general population. Thus outside of

a research findings, the current results would not be applicable. This tells the researchers that

more research needs to be done on this study in order to form a conclusion that has more

strength, validity, and could be potentially applied to the general population. If eventually more

research was conducted, and the original hypothesis was confirmed, it would show that a person

with a positive attitude towards COVID would have lower stress levels. Which could be applied

to the general population, if people wanted to be less stressed about COVID, research would

show if they changed their mindset to a positive attitude this could be a potential way to lower

stress levels.
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References

Abolfotouh, M. A., Almutairi, A. F., Banimustafa, A. A., & Hussein, M. A. (2020). Perception

and attitude of healthcare workers in Saudi Arabia with regard to Covid-19 pandemic and

potential associated predictors. ​BMC Infectious Diseases,​ ​20​(1), 1.

doi:10.21203/rs.3.rs-35022/v3

Ammar, N., Aly, N. M., Folayan, M. O., Khader, Y., Virtanen, J. I., Al-Batayneh, O. B.,

Tantawi, M. E. (2020). Behavior change due to COVID-19 among dental academics—The

theory of planned behavior: Stresses, worries, training, and pandemic severity. ​Plos One,

15​(9), 1-13. doi:10.1371/journal.pone.0239961

Babore, A., Lombardi, L., Viceconti, M. L., Pignataro, S., Marino, V., Crudele, M., ... &

Trumello, C. (2020). Psychological effects of the COVID-2019 pandemic: Perceived

stress and coping strategies among healthcare professionals. ​Psychiatry research,​ ​293,​

113366.

Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress.

Journal of Health and Social Behavior,​ 24, 385-396.

Coronavirus. (2020). Retrieved November 30, 2020, from

https://www.who.int/health-topics/coronavirus/coronavirus

Kannampallil, T. G., Goss, C. W., Evanoff, B. A., Strickland, J. R., Mcalister, R. P., & Duncan,

J. (2020). Exposure to COVID-19 patients increases physician trainee stress and burnout.

Plos One,​ ​15(​ 8), 1-12. doi:10.1371/journal.pone.0237301

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Kwan, B.M. & Bryan, A.D. (2010). Affective response to exercise as a component of exercise

motivation: Attitudes, norms, self-efficacy, and temporal stability of intentions.

Psychology of Sport and Exercise,​ 1112), 71-79.

Szabo, A., Ábel, K., & Boros, S. (2020). Attitudes toward COVID-19 and stress levels in

Hungary: Effects of age, perceived health status, and gender. ​Psychological Trauma:

Theory, Research, Practice, and Policy,​ ​12(​ 6), 572.

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Figure 1.
Scatterplot of participants self-reported attitude, attitudescale, corresponding to their
self-reported stress level, stressscale, pertaining to COVID-19.