Adolescence and emerging adulthood in the face of COVID-19 in Spain and the Dominican Republic 19-11-2020
By: Blas Valenzuela
Since the emergence of the Russian coronavirus in December 2019, it affects physical health and has an economic impact and known as COVID-19, they have been affected more than psychologically in the population (Cao et al., 2020; Mamun & Griffi-19,187,943 people around the world (08/08/2020; ths 2020; Schimmenti, Billieux & Starcevic, 2020; Wang et al., WHO, 2020). This pandemic, caused by said coronavi-2020). Only in the first weeks after the onset of the outbreak of COVID-19 in China, the number of deaths had exceeded those recorded by other pandemics such as Severe Acute Respiratory Syndrome (SARS) (Hawryluck et al., 2004). Faced with this scenario, an emotional and behavioral reaction of fear is generated in the population. Lazarus and Folkman (1984) defined this type of situation as a single stressor.
Estudios previos realizados tras el brote de Influenza (H1N1) en 2009 entre 10% y 30% de las personas mostraron preocupación por la posibilidad de contraer el virus (Rubin, Potts & Michie, 2010). En el caso de los brotes del ébola en diversas partes del mundo, con el cierre de escuelas y negocios se intensificaron las emociones negativas de los individuos (Van Bortel et al., 2016). Por consiguiente, urge la valoración de la salud mental de la población (Xiang et al., 2020).
Previous studies carried out after the outbreak of Influenza (H1N1) in 2009 between 10% and 30% of people showed concern about the possibility of contracting the virus (Rubin, Potts & Michie, 2010). In the case of the Ebola outbreaks in various parts of the world, the closure of schools and businesses intensified the negative emotions of individuals (Van Bortel et al., 2016). Therefore, the assessment of the mental health of the population is urgent (Xiang et al., 2020).
As a result of this situation, the psychosocial consequences of the disease are being investigated. Most studies agree that being a woman is a risk factor, both in the adult and adolescent population, presenting a greater psychological impact. Specifically, women have reported greater anxious and depressive symptomatology during COVID-19 confinement than men (Duan et al., 2020; Wang et al., 2020; Zhou et al., 2020).
Depending on the age and psychological impact of COVID-19, various investigations found no significant differences between young people and adults, thus presenting mild emotional symptoms in the young population (Wang et al., 2020; Zhou et al., 2020). In contrast, other studies found more anxious and depressive symptomatology in the under-35s (Huang & Zhao, 2020). Specifically, in the adolescent population, a prevalence during this pandemic of between 22% and 43% of emotional problems is estimated (Duan et al., 2020; Zhou et al., 2020).
Other variables analyzed as a result of this situation are the fear of COVID-19 and the responses caused by lockdown measures during the pandemic. These variables have been considered predictive variables of emotional symptomatology in adolescents and adults (Brooks et al., 2020; Seçer & Ulaş, 2020). The stress caused by the current situation has a predictive effect on psychological problems, optimism and cognitive inflexibility in adults. The latter two are variables that mediate the effect of coronavirus stress (Arslan et al., 2020). One month after the end of confinement, a study with Chinese university students has found a prevalence of 2.9% of post-traumatic stress and 9% of depressive symptoms in this population (Tang et al., 2020).
On the other hand, in relation to coping strategies, having the specific health information updated and certain precautionary measures were associated with a lower psychological impact (Wang et al., 2020). The use of strict protective measures, social isolation measures, knowledge of the virus, positive attitude (Cai et al., 2020, Blake et al., 2020; Khalid, Khalid, Qabajah, Barnard, & Qushmaq, 2016), social support (Cai et al., 2020, Blake et al., 2020) and self-care and health-promoting strategies (Blake et al., 2020; Khalid, et al., 2016) are also stress-reducing strategies in similar situations. During the 2009 H1N1 pandemic, individuals with a high uncertainty intolerance were more likely to perceive the pandemic as threatening and were more likely to use emotion-centered coping strategies, both predicting high levels of anxiety (Taha et al., 2014). In summary, the use of maladaptive coping strategies positively correlates with psychological symptoms. However, adaptive coping strategies cushioned the negative impact of stressors on perceived overall health (Main, Zhou, Ma, Luecken, & Liu, 2011, Morales & Trianes, 2010).
---------------------+Data from other studies suggest that the psychological consequences of the pandemic and lockdown measures due to COVID-19 may be relevant (Tang et al., 2020), specifically, studies with children and adolescents have a high psychosocial impact derived from this situation (Duan et al., 2020; Orgilés, Morales, Delveccio, Mazzeschi, & Espada, 2020; Zhou et al., 2020). Taking into account that adolescence is the period between 10 and 19 years, according to the World Health Organization (who, 2015). This stage is characterized by great changes both physically and psychologically in which the adolescent must face new difficulties.
After this stage, individuals go through what some theorists call Emerging Adulthood (EA), described as the cultural phenomenon seen in different industrialized societies as a consequence of the sociodemographic changes of recent decades. Some of these changes are the increase in access to higher education and the postponement of certain milestones such as marriage and childbearing (Arnett, 2000). The life span that represents this stage is between 18 and 29 years (Barrera & Vinet, 2017).
Previous research with the adolescent population shows in this population a belief of invulnerability and a low perception of risk that favor the decrease of the acceptance of health promotion strategies (Wickman, Anderson, & Greenberg, 2008). The effect of this exaggerated optimism decreases compliance with standards such as social distancing, the use of masks, etc. (Dolinski, Dolinska, Zmaczynska-Witek, Banach, & Kulesza, 2020) contributing to a greater risk of contagion. Regarding emergency adulthood, research carried out as a result of the COVID-19 pandemic is scarce. The objective of this study is to analyze the impact caused during the confinement due to COVID-19 between adolescents and people in the so-called emerging adulthood coming from two different countries, Spain and DR.
The latest data provided by the World Health Organization report that in DR there are 77,709 confirmed cases, and Spain 314,362 cases so far (08/08/2020; who, 2020) and cases and deaths continue to increase day by day. The global population is undergoing constant changes in its day-to-day life. And, specifically, it is children and young people who may have experienced the greatest change in recent months. The pandemic and its aftermath may still have a long way to go. Therefore, knowing the variables related to the psychosocial impact in these populations, usually little studied, is necessary to be able to carry out effective interventions and prevention programs from a multidisciplinary perspective (at the school, work, primary care, etc.), which allow better management in this situation and mitigate the psychological consequences derived from the pandemic in the long term.
Next, and in accordance with the previous literature, this study aims to test the following hypotheses: (1) Adolescents will report a lower psychological impact than those in emerging adulthood; (2) Women will report greater symptomatology than men; (3) DR residents will have greater fear and stress than residents in Spain; (4) Fear of COVID-19 will influence Acute Stress.
Method
Participants
The population resides in Spain and DR. The incidental sample consists of 399 participants, of whom 38 are under 12 to 17 years of age, and 361 are adults over 18 years of age. The age range ranges from 12 to 29 years (M =22.57; DT = 3.67). 49.12% of the participants reside in Spain, of which 15.2% are minors, while 50.88% of the total sample reside in DR, of which 2.6% are under the age of 18. In terms of sex, 23.6% are men and 76.4% are women.
Instruments
Online ad hoc questionnaire for sociodemographic data collection.
Scale from Fear to COVID-19 (FCV-19S; Ahorsu, et al., 2020; Spanish adaptation of Piqueras et al., in press). The scale consists of seven items that are answered on a Likert scale of 5 points from 1 (strongly disagree) to 5 (strongly agree). The total score ranges from 7 to 35, with higher scores indicating a higher level of fear of COVID-19. The psychometric properties of the instrument are acceptable.
Revised Stressful Events Impact Scale (IES-R; Weiss, 1996; Spanish adaptation by Baguena et al., 2001). It consists of 22 items with a 4-point Likert scale (0 = not at all, 1 = rare, 3 = sometimes, 4 = often) composed of three subscales: avoidance, intrusion and hyperactivation. The IES assesses subjective distress resulting from a traumatic life event. Psychometric properties are good, his Cronbach's Alpha ranges between .82 .92 for the subscales and the total.
Short coping inventory (COPE-28; Carver, 1989; Spanish adaptation by Moran, Landero and González, 2010). Inventory of 28 items and 14 scales that assess how people handle stressful situations. It features a Likert type scale, ranging from 0 (I never do) to 3 (I always do). Stress coping strategies were grouped into adaptive (active coping, planning, use of instrumental support, emotional support, positive reinterpretation, acceptance, use of humor and religion) and maladaptive (self distraction, release, behavioral disconnection, denial, substance use, and self-incrimination) strategies (Carver Scheier, & Weintraub, 1989; Carver, 1997; Crockett et al., 2007; Belizaire & Fuertes, 2011). Psychometric properties are good, his Cronbach's Alpha ranges between .71 and .80.
Questionnaire of Capabilities and Difficulties (SDQ; Burdon & Goodman, 2005; Spanish adaptation by Rodríguez-Hernández, et al., 2012). The SDQ is a clinical screening questionnaire consisting of 25 items with 3 response options (0 = not true, 1 = somewhat true, 2 = totally true) evaluates 5 subscales: hyperactivity, emotional symptoms, behavioral problems, peer relationship problems, and prosocial behavior. Internal consistency is acceptable (α = .77). The version used in the SDQ was that of self-reporting in both adolescents and emerging adults.
Process
This study is part of a cross-sectional and cross-cultural research. A quasi-experimental, descriptive and correlational design has been carried out. Data were collected through online surveys recruited from social media and email. Informed consent was obtained electronically prior to data collection, in the case of adolescents, informed consent was obtained from both parents and the adolescent. A convenience sampling was carried out where a total of 727 people voluntarily gave their consent to participate in the research. This study included 399 cases that met the inclusion criteria: i) being resident in Spain or DR; ii) being between 12 and 29 years old; and iii) being able to understand written Spanish.
Statistical analysis
Data analysis was performed with the SPSS statistical program (version 25). Next, the Kolmogorov-Smirnov contrast test of fit to a normal distribution was carried out. The values showed a non-normal distribution (p < .05). The non-parametric U. Mann-Whitney test was used to identify the differences between the populations evaluated and Spearman's Rho correlation (rs) to analyze the association between the different variables. Rosenthal's R was used to calculate the effect size of differences that were statistically significant. Due to the results obtained in previous investigations, a linear regression analysis was also carried out in order to verify whether the relationship between the Fear of COVID-19 and Acute Stress acts in the same way.
Results
Groups were formed according to age from 12 to 17 years in the adolescent group (M = 15.18; DT = 1.71) and from 18 to 29 years in the emerging adult group (M = 23.37; DT = 2.85). It was found that there were significant differences according to age in: Acute stress (Z = -3,328, p < .01), Fear of COVID-19 (Z = -2,507, p < .05), coping strategies and challenges and capabilities. Emerging adults scored higher than adolescents in both stress and Fear of COVID-19. Those over 18 years of age presented clinical scores in acute stress (M = 25.62; SD = 16.34) versus adolescents whose scores were within the average (Table 1). Subsequently, the effect size was calculated to be very small (r < .20) regarding both acute stress and fear of COVID-19 (Table 2).
Significant differences were also found in the Coping Strategies: Planning (Z = -2,706, p < .01), Religion (Z = -4,259, p < .01) and Substance Use (Z =-2.108, p < .05) with respect to age (Table 2). Regarding difficulties and abilities, adolescents presented a higher score on the hyperactivity subscale (Z = -2,209, p < .05) and emerging adults higher scores in prosocial behavior (Z = -2.304, p < .05) (Table 2).
Regarding sex, women presented higher scores in emotional symptoms, acute stress (Z = -5,381, p < .0), fear of disease (Z = -4,601, p < .01), (Table 3) and emotional difficulties (Z = -3.406, p < .01) (Table 3) than males being the size of these differences small. Regarding Coping Strategies, women made greater use of Religion and Emotional Support (Z = -2,244, p < .05) that males and these, used Humor (Z = -3.605, p < .01) and Acceptance (Z = -3.222, p < .01) being the differences between these significant variables (Table 3).
Based on the place of residence, no differences were found with respect to Acute Stress, however, there were significant differences in the Fear of COVID-19 (Z = -3,134, p < .01) presenting more fear among residents in DR than in Spain, although with a very small effect size (r < .Table 4 If there were differences in the coping strategies used, Religion was the most used by the residents of DR (Z = -9,770, p < .01) with a mean effect size (r =.50), emotional support (Z = -3.368, p < .01) and humor were most used by residents in Spain (Z = -4,922, p < .01) with a very small effect size (r <.Table 4 Likewise, a direct and significant relationship was found between Acute Stress and Fear of COVID-19 with all the IES-R scales (rs = .619; p < .01) (Table 5).
prediction through linear regression studies between Fear of COVID-19 and Acute Stress. In addition, another analysis was carried out, including the Maladaptive Strategies, both in a simple linear regression and with a multiple regression along with Acute Stress. The model that explained the greatest variance in Fear of COVID-19 was Acute Stress (F = 271.36, R² = .405; p < .01), dismissing the other model that included maladaptive strategies (Table 6).
Discussion
The objective of this study was to evaluate the variables involved in the impact caused by the lockdown measure against COVID-19 in a sample of adolescents and emerging adults residing in Spain and DR. The current pandemic has had a global impact on the population in the health, psychological, social and economic fields (Cao et al., 2020; Huang & Zhao, 2020; Lei et al., 2020; Peng et al., 2020) and it is necessary to analyze the repercussions in these relevant evolutionary periods. The stage of adolescence is the most vulnerable phase of development and the risk of developing internalised problems (e.g. anxiety or depression) increases (Danneel et al., 2019). The current situation could act as a precipitant and increase the prevalence of different mental disorders both in this stage and in the next, the AE.
The results obtained agree with previous studies (Wang et al., 2020; Zhou et al., 2020) in which there is greater stress and fear of COVID-19 in emerging adults than in adolescents. The differences found could be explained by the perception of invulnerability of adolescents (Wickman et al., 2008), this could be related to the idea of not contracting the disease in the same way as adults.
The analyses carried out according to the place of residence showed differences as in previous studies (Piqueras et al., in press). It would be interesting to analyze whether the different health systems are a modulating variable of the perception of fear. Large differences were found in the use of Religion as a coping strategy. These results could suggest a greater number of religious practitioners in DR, or the perception of loss of personal control in this situation, which leads to seeking a higher power to manage the stressor (Koenig, George & Siegler, 1988). Differences in this variable could also suggest a different cultural view of religion, knowing more about these differences and their impact at the psychosocial level could favor the development of specific tools that take into account sociocultural aspects specific to each population.
On the other hand, women show a greater emotional symptomatology than men, according to previous studies. Zhou et al. (2020) argue that being a woman, regardless of age, is a risk factor for greater anxiety and stress, however, women present effective strategies that can act by decreasing this risk (Cai et al., 2020). It would be interesting to analyze whether the use of these strategies helps alleviate the long-term emotional impact.
The additional regression analysis made it possible to identify how the Fear of COVID-19 predicted in a large proportion the Acute Stress, data consistent with the validation in Spanish of the FCV-19S (Piqueras et al., in press) where, in addition, a mediating relationship was found between maladaptive coping strategies and the other two variables.
The use of an incidental sample, a lower percentage of adolescents versus emerging adults, and a higher number of women are limitations of this study. In addition, in the Dominican population, no similar studies have been carried out to compare the results, as well as the instruments only adapted to the Spanish population with the exception of FCV-19S, which has been validated taking into account the Dominican sample. It is recommended that these variables be assessed in different contexts with the aim of identifying whether the results are constant or vary in each of the populations.
However, there are few cross-cultural studies that investigate the same psychological variables in the face of the same single stressor, such as COVID-19, and, in addition, that compare the differences between adolescents with emerging adults.
This scenario could imply several long-term changes, both in the way of socializing as a result of social distancing measures, as well as in the constant uncertainty in the face of a possible contagion, etc. The previous literature informs us that currently there are consequences on mental health derived from the pandemic in the population in general and in youth in particular. Therefore, knowing the impact that a situation such as confinement has caused is necessary to be able to create and implement effective preventive programs focused on educating in adaptive coping strategies and management of discomfort, adapted to the younger population, which can favor adequate psychosocial development in this new normality.
Conflict of interests
The authors of this paper declare that there is no conflict of interest
