Descriptive statistics.

Descriptive statistics was used to describe the variables of this

research, describe data characteristics, and test for assumptions. These measurements include
means and standard deviations. The level of measurement of the predictor and dependent
variables of stress, coping, illness perception and life satisfaction were analyzed as interval
variables.
Hypothesis testing. The assumptions for multiple regression analysis using SPSS will
be confirmed prior testing the study hypotheses. According to Warner’s (2013), regression
analysis is often used to assess how well multiple predictor variables, independently and
collectively predict the outcome variable.

Ethical Considerations
This study was in compliance with all procedures and approved by the Capella University
Institutional Review Board (IRB). The following are the pertinent ethical considerations.
71
The informational flyers regarding the study were posted in various social media interest
groups to solicit volunteers. Each flyer contained my identifying information as the researcher in
the study. The survey demographic portion served as a screener for eligibility (an adult 30–65
years old), diagnosed with a chronic or autoimmune disease by a qualified medical practitioner.
Prior to completion of the survey, participants were reminded of confidentiality and
anonymity and provided information regarding the process of the study. As the informed consent
contained all pertinent information, it was assumed that participants were aware of any
discomfort they might experience in filling out the survey items. Participants were not
considered a part of a vulnerable population and were all over the age of 18. The study required
only minimal risk to participants. All individuals were made aware that participation was
voluntary and that they could discontinue their involvement at any time and for any reason. It
should be noted that the researcher’s bias was considered due to the following information.
The researcher was diagnosed with a chronic autoimmune illness by the primary care
physician; the diagnosis was confirmed by a specialist in the autoimmune disease discipline.
First-hand experiences and knowledge undoubtedly left the researcher with an exceptional
perspective of the situation. This personal information was shared with potential participants as
part of the initial recruitment postings within the social media groups. It is possible that the
participants felt more inclined to participate in the survey. Nonetheless, it was crucial that no
biases were imposed due to the researcher’s own experiences living and coping with a chronic
illness. This potential predisposition was regarded due to the type of the questionnaire,
questionnaire items, and study design. This disclosure was imperative for future research in order
to assist researchers with participant selection and recruitment.
72
Voluntary Participation
The online survey began with an explanation of what the study was about, how long it
would take, and an explanation of the survey process, risks, and confidentiality procedures. The
phone number and e-mail address were provided, as well as contact information for the
researcher’s supervisor, and the Capella IRB. The researcher explained an informed consent and
it was stated repeatedly that participants could stop the survey at any time. The participants were
asked to click continue only if they desired to continue, therefore voluntarily participating in the
study.
Confidentiality
Confidentiality and anonymity of the participants was insured by not using any identifiers
such as names and addresses. The responses were kept according to the number that the
answered responses appeared in the file of the online survey. Numbers were adjusted when
entering data into SPSS due to the removal of surveys which were incomplete or did not comply
with eligibility criteria. The researcher was unaware of the identity of the participants throughout
the course of the study. Surveys were kept locked in a secure computer file folder at all times.
Based on IRB protocol, all research data will be kept for seven years after which all data related
to the study will be destroyed.
Expected Findings
For each of the hypotheses, it was expected that the null hypothesis would be rejected,
lending support to the alternative. It was expected that the interaction between perceived stress,
illness perception and coping styles would predict life satisfaction among patients diagnosed
with chronic illness such as autoimmune diseases.
A. Objectives
• To study the impact of the COVID 19 outbreak in the mental health of people living in
Alappuzha, Kollam,
and Pathanamthitta
• To study the factors of mental health deterioration during the COVID-19 pandemic situation.
• To find out which class of Gender is more mentally affected by COVID-19.
Hypothesis
• Mental Health Vs Districts
H0: The mental health of people is independent of the districts (Alappuzha, Pathanamthitta and
Kollam) to
which they belong.
H1: The mental health of people is dependent of the dis- tricts (Alappuzha, Pathanamthitta and
Kollam) to
which they belong.
• Mental Health Vs Gender
H0: The mental health status and Gender of the people are not related.
H1: The mental health status and Gender of the people are related.
• Mental Health Vs Age Group
H0: The mental health status and Age Group of the people are not related
H1: The mental health status and Age Group of the people are related.
• Mental Health Vs Employability
H0: The mental health status and Employability of the people are not dependent.
H1: The mental health status and Employability of the people independent.

PHQ-Q1 (Are you feeling depressed for most of the time?) 1.94 ± 0.90 2.35 ± 0.84
PHQ-Q2 (Do you worry too much about the effect of COVID on your health and
safety?)
1.94 ± 0.96 2.03 ± 0.77
PHQ-Q3 (Do you worry too much about the effect of COVID on your family’s
health and safety?)
2.11 ± 0.88 2.28 ± 0.96
PHQ-Q4 (Do you worry too much about the effect of COVID on your financial
status?)
2.48 ± 0.85 2.64 ± 0.94
PHQ-Q5 (Are you getting easily an1yed or irritable during COVID time than
before?)
2.23 ± 0.92 2.41 ± 0.98
PHQ-Q6 (Have you lost interest in doing things?) 2.29 ± 1.08 2.26 ± 0.93
PHQ-Q7 (Do you have trouble in concentrating or focusing your mind?) 1.98 ± 0.86 2.20 ± 0.87
PHQ-Q8 (Do you feel bad about 1t being able to help yourself and your family?) 2.01 ± 0.92
2.21 ± 0.95
PHQ-Q9 (Do you have difficulty in adjusting with the new routines in this
COVID period?)
2.16 ± 0.85 2.39 ± 1.36
PHQ-Q10 (Do you think COVID 19 has affected your mental status negatively?) 2.15 ± 0.87
2.35 ± 0.96
PHQ-Q11 (What is the serious issue that you faced during this COVID time?) 2.01 ± 0.96 2.04 ±
0.88
PHQ-4 (Total) 2.11 ± 0.76 2.36 ± 0.8
Coping

Coping is the execution of the response to a threat. Coping refers to active efforts to
master, reduce, or tolerate the demands created by stress (Weiten & Lloyd, 2005). How well
a person responds to stress is dependent on how much the person feels threatened by the
situation at hand. Once coping begins the situation changes, either in terms of its objective
characteristics (if the person actually does something to help deal with the situation) or in
terms of how the individual subjectively views the situation (Mehta, 2012)

Coping is demonstrated by the utilization of one or more coping strategies. Coping strategies are
the mechanisms which individuals use to deal with or resolve situations which disturb their
homeostasis. Lazarus & Folkman (1984) categorized coping strategies into two major categories,
problem-focused and emotion-focused; and further divided them into eight strategies that
individuals use to return to their homeostasis. These eight strategies are confrontative coping,
distancing, self-control, seeking social support, accepting responsibility, escape-avoidance,
painful problem solving and positive re-appraisal. However, in certain walks of life, coping
becomes challenging. One such domain is the military context. Working in defence services is
not easy for the individual, the spouse, or their family. McCubbin, Dahl, Lester, Benson, &
Robertson (1976) found that coping strategies among spouses whose husbands were unaccounted
for during the Vietnam conflict ranged from expressing personal feelings (particularly angry
feelings) and seeking social support from others, to hopeful coping, religious coping, and
behavioral and self-distraction. In an Australian study, with wives who were living alone as the
husbands were working on the borders or in war prone areas, it was found that the most frequent
coping strategies used were acceptance, planning, active coping, religion, self-distraction,
emotional support, and positive reframing (Dimiceli, Steinhardt, & Smith, 2010). Categorization
of coping strategies to understand the effectiveness or frequent usage was studied and established
by Lazarus & Folkman (1984) andwas further researched by Schneiderman, Ironson, and Siegel
(2008) to see their impact on biological and mental health. They found that if there is more often
or consistent use of emotion-focused coping it leads to physical and mental health issues. Their
study revealed that coping skills and psychosocial resources having biological vulnerability
leading to physical and psychological diseases which can be addressed and healed through
psychosocial treatments. American Psychological Association (APA) describes effective coping
strategies as, “…coping strategy which works and helps individual remain physically and
psychologically healthy” (VandenBos, 2007).
The concept of emotion focused coping and problem focused coping was explained by Lazarus
& Folkman (1984) bringing out the nuances of how we approach a problem. “Emotion focused
coping is a stress-management strategy in which a person focuses on regulating his or her
negative emotional reactions to a stressor. Rather than taking actions to change the stressor itself,
the individual tries to control feelings using a variety of cognitive and behavioural tools,
including meditation and other relaxation techniques, prayer, positive reframing, wishful
thinking and other avoidance techniques, self-blame, seeking social support (or conversely
engaging in social withdrawal), and talking with others (including mental health care
professionals). It has been proposed that emotion-focused coping is used primarily when a
person appraises a stressor as beyond his or her capacity to change” (Lazarus & Folkman, 1984).
“Problem focused coping is a stress-management strategy in which a person directly
confronts a stressor in an attempt to decrease or eliminate it. This may involve generating
possible solutions to a problem, confronting others who are responsible for or otherwise
associated with the stressor, and other forms of instrumental action. For example, a student
who is anxious about an upcoming examination might cope by studying more, attending
every class, and attending special review sessions to ensure he or she fully understands the
course material. It has been proposed that problem-focused coping is used primarily when a
person appraises a stressor as within his or her capacity to change” (Lazarus & Folkman,
1984).
Compilation of classification of various coping strategies into emotion-focused and
problem-focused is done based on various researchers, shown in tabular format in Table 1
18
(Tobin, 1995; Tobin, 2001; VandenBos, 2007; Carver, et.al., 1989; Nakano, 1991; Carver,
2007).
The core of Transactional Theory of Stress and
Coping (TTSC)
Lazarus and Folkman’s theory evaluates how significant life events, as well as
everyday affairs, affect emotions. The main focus of the theory lies on
cognitive assessment and dealing with stress (coping).

The definition of Transactional Theory of Stress and

Coping (TTSC)

Cognitive assessment consists of an initial primary assessment, a secondary

assessment, and potentially, a reassessment. The secondary assessment
entails assessing the possibilities in a certain situation and the person’s
ability to deal with this.
Coping follows on from the assessment described above, and can affect a
change in the relationship between a person and their environment, or the
level of emotional stress they are experiencing. Factors which influence both
the coping and judging mechanisms are personality traits, symptoms of
depression, and social influences.

To understand the power of the Transactional Theory of Stress and Coping

(TTCS), it is important to first understand what stress is exactly, and how
research on stress has evolved over the years. For this reason, in the next
section of this article, stress is defined in three ways: stress as a reaction,
stress as a stimulus, and stress as a transaction.

1. Stress as a reaction

In 1956 Hans Selye determined that stress can be a reaction. In his stress
model, he describes how stress creates a physiological pattern. He
documented this pattern in the General Adaptation Syndrome model. This
model describes stress as a reaction based on three concepts.

 Stress is a defence mechanism

 Stress arises when there is danger, resistance or exhaustion
 Stress, if long-term, can lead to adaption diseases and even death
After that, Selye discovered that stress can lead to both positive and negative
outcomes based on its cognitive interpretation. Therefore, stress can be
experienced in both a positive and negative way.

2. Stress as a stimulus

The theory behind the concept of stress as a stimulus was introduced by

Holmes and Rahe in the 1960s. They saw stress as an important event or
change which requires an adjustment or a response.

Following this, Rahe and Holmes created the Social Readjustment Rating
Scale (SRRS). This scale consists of 42 life events which are ranked based on
the estimated degree of influence these events have on a person.
Examples of these events include marriage, divorce, relocation, or the loss or
change of a job or loved one. Holmes and Rahe assumed that stress was a
variable in the comparison between stress and health. Even though some
correlations emerged, the extent to which stress affects health was not
clearly definable. The theory about stress as a stimulus can be summarised
as follows:

 Change is stressful
 The degree to which life events require adjustment is the same for
everyone.
 There is a threshold when it comes to adjustment and stress
beyond which becoming sick is a consequence.
3. Stress as a transaction

Several studies had been conducted on stress before Lazarus and Folkman
developed their Transactional Theory of Stress and Coping (TTCS). They
mainly did so in an attempt to explain stress as a dynamic process.

The theory describes stress as a product of interactions between a person

and their environment. When we talk about a person, we talk about multiple
systems within a person: the cognitive system, physiological state, affective
system, psychological system and the neurological system.

Winter hardiness

Attention to the Lazarus and Folkman theory was heightened when Suzanne
Kobassa used the concept of winter hardiness in 1979. Winter hardiness, or
also called cognitive or psychological hardiness, is a personality style.

Kobassa described a pattern of personality traits which distinguished

between managers and executives who remained healthy while under stress,
and those who developed health problems.

Evaluation levels for the assessment of stress

according to Lazarus
Lazarus discovered that each person assesses a situation in a different way,
and hence also the stress and threat which arise from it. He distinguished
between three different levels.

Level 1: Primary appraisal

According to Lazarus, situations are judged in different ways. A situation can

be assessed as positive, irrelevant or potentially dangerous.

In the case of the latter, stress arises more often in comparison to other
forms of stress. If a situation is considered stressful, assessment takes place
on different levels. If:

 Challenges in situations which are controllable

 Threats where loss is expected
 Damage or loss after the damage has already taken place
Level 2: Secondary assessment

The second level of assessment is called secondary assessment. The purpose

of the secondary assessment is to determine whether a specific situation can
be managed with the available resources. When insufficient resources are
available in order to deal with the situation, a stress reaction is triggered by
the human brain.

A coping strategy is the designed especially for this reaction. This strategy
depends on the situation and the person’s characteristics. This way of
dealing with stress and the threats which arise from it, is called coping.

Known behaviours in response to this are: fleeing, fighting, denying, changing

or any behavioural alternatives. When individuals use post-situation
feedback to evaluate success or failure, they learn to selectively apply
different strategies.

Level 3: Reassessment
The third level of assessment assesses the success of the coping strategy
adopted in order to guarantee adaptation to a new situation. Learning to
handle a stressful situation is always a challenge.

And a challenge can even become a threat if not addressed properly. Lazarus
describes the possibility of revising the initial assessment as a reassessment.

Transactional Theory of Stress and Coping:

dealing with stress
In his studies, Lazarus wrote about three types of stress management. They
include dealing with stress in a problem-oriented way, dealing with stress in
an emotion-oriented way and dealing with stress in an assessment-oriented
manner. The different ways of dealing with stress are briefly explained
below.

Dealing with stress in a problem-oriented way

Problem-oriented coping refers to a person who tries to control or adapt

problematic situations by seeking information, taking action, or by not acting
at all.

Dealing with stress in an emotion-oriented way

Emotion-oriented coping is also referred to as intrapsychic coping. The main

aim is to reduce emotional upsets.

Dealing with stress in an assessment-oriented way

The term reassessment is used by Lazarus in two contexts. On the one hand,
it relates to the evaluation process, but on the other reassessment is a
coping strategy. Coping can affect stress and emotions simply making a
reassessment of the situation.
The Transactional Theory of Stress and Coping
(TTSC) in short
The Transactional Theory of Stress and Coping (TTSC) was developed by Dr.
Richard Lazarus and Dr. Susan Folkman in 1966. Their framework illustrates
how major life events affect human emotions. The main focus of the theory
lies on cognitive assessment and dealing with stress (coping). The
assessment consists of three levels: primary, secondary and tertiary
(reassessment) assessment.

In the academic world of psychology, stress is defined in three ways. Hans

Selye defined stress as a defence mechanism which occurs during resistance,
exhaustion or danger. Stress, if long-term, can lead to adaption disease and
even death.

Holmes and Rahe thought stress was a stimulus. They stated that change is
always stressful, and that in certain events, such as divorces, relocations, loss
of loved ones or job, etc, an adjustment or reaction is required.

Folkman and Lazarus claimed stress to be a product of interactions between

a person and their environment. This theory received a lot of attention after
Suzanne Kobassa used the term winter hardiness, which is a personality trait.
This meant that stress, the experience of stress and the reaction to stress,
was first associated with personalities.

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to cope more effectively with stress in everyday life? Do you think stress is
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which different points in time do you experience stress? Do you have any tips
or comments? Please let us know in the comments section below.
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More information
1. Biggs, A., Brough, P., & Drummond, S. (2017). Lazarus and Folkman’s
psychological stress and coping theory. The handbook of stress and
health: A guide to research and practice, 351-364.
2. Folkman, S., & Lazarus, R. S. (1984). Stress, appraisal, and coping (p.
460). New York: Springer Publishing Company.
3. Lazarus, R. S. (2006). Stress and emotion: A new synthesis. Springer
Publishing Company.
4. Lazarus, R. S. (2013). Fifty years of the research and theory of RS Lazarus:
An analysis of historical and perennial issues. Psychology Press.
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