Satisfaction With Life Among Vaccinated Turkish People
The Role of Anxiety, Fear, and Preventive Behaviors
Abstract
Abstract.Introduction: Past research has shown that psychological and behavioral factors, including anxiety, fear, and preventive behaviors, are related to well-being outcomes during the COVID-19 pandemic. Yet little is known about the simultaneous effects of those factors in predicting satisfaction with life among vaccinated people. Methods: This cross-sectional study is among the first to examine whether COVID-19 anxiety, fear of COVID-19, and preventive behaviors predicted satisfaction with life among the vaccinated general public in Turkey. Participants were 1,017 Turkish adults (69.71% female; mean age = 36.28, SD = 10.83 years) who completed online self-reported questionnaires. Results: Results showed that increased levels of anxiety and fear of COVID-19 significantly predicted reduced satisfaction with life over and above the effects of sociodemographic and clinical factors. Discussion: The findings suggest the importance of tailoring and implementing interventions focusing on the improvement of the well-being of people during the pandemic.
The adverse psychological effects of COVID-19 are increasing worldwide despite rapidly growing vaccination rates. While countries have provided varying numbers of COVID vaccinations, by 5 March 2022, nearly 444.3 million confirmed cases and around 6 million deaths had been reported (Center for Systems Science and Engineering, 2020). Although some countries declared having stopped the surge after the first peak, when this article was being written, most countries had experienced the third peak of the infection (European Commission [EC], 2020). COVID-19-related preventive strategies such as social distancing, mask-wearing, and hand-washing seemed to have slowed the pandemic. However, because these precautionary measures decreased social activities, in the long run, they may become a risk factor for mental health and satisfaction with life. Social interactions are known to satisfy the biological need for psychological wellness and prosperity (Holt-Lunstad et al., 2017), so that the lack of socialization during lockdowns negatively impacted psychological and emotional wellness (Holt-Lunstad, 2017).
Studies conducted on the effects of pandemics on individual lives suggest that quarantining increase depression, health anxiety, financial apprehension, and loneliness (Reger et al., 2020; Thunström et al., 2020). Another study shows that the fear of COVID-19 is not always related to behavior concerning protecting health but, conversely, is mostly about mental health and satisfaction with life issues (Özmen et al., 2021). Thus, studies that relate the fear of COVID-19 (Ahorsu et al., 2020) to depression, anxiety, and stress increased recently (Dsouza et al.,2020; Qiu et al., 2020; Wang et al., 2020).
On the other hand, several studies provided evidence describing a direct relationship between mental health and COVID-19 (Rehman et al., 2022; Yıldırım & Çiçek, 2021; Yıldırım & Güler, 2020). Even though many psychological preventions and intervention programs aimed at reducing the impact of pandemic-related stressors on well-being and satisfaction with life outcomes, COVID-19 vaccination still can be the most effective preventive factor to manage the pandemic process (Arslan et al., 2021). As of 4 June 2021, when this study was conducted, Turkey had administered over 30 million doses of COVID vaccines, with more than 12.9 million people having gotten both doses (Republic of Turkey, Ministry of Health).
In addition to studying the physical effects of the vaccine, this research studied its psychological effects as well. Previous studies showed that vaccinated individuals have less mental distress and higher life satisfaction scores. Further, they have lower depression, anxiety, hopelessness, and hypersensitivity to physical symptoms, so the vaccine may have positively affected mental health and satisfaction with life (Bilge et al., 2022; Perez-Arce et al., 2021). Nevertheless, studies examining the psychological effects of the vaccine are limited (Cunningham et al., 2022; Madison et al., 2021; Perez-Arce et al., 2021).
Life satisfaction is a set of processes related to individuals’ life patterns and standards. Yet, individual life satisfaction is quickly impacted by many other factors (Lavallee et al., 2007). Both because of its importance and considering the current situation, life satisfaction in the context of COVID-19 and its relationship with mental health become crucial issues (Arslan et al., 2022; Diener & Suh 1997; Geçer & Yıldırım, 2021). Individuals with a high level of life satisfaction or those with positive emotions and perceptions regarding their lifestyles are better able to solve problems and be more resilient toward stressful conditions (Huebner et al., 2004, Sahranç, 2007). Studies in this regard suggest that anxiety is a significant predictor of well-being and satisfaction with life outcomes in the context of the COVID-19 pandemic (Rehman et al., 2022; Satici et al., 2020; Yıldırım & Güler, 2021a).
During the pandemic, those who had information about how to get protected from the Coronavirus took precautionary measures to reduce the infection risk, and this emerges as an important factor in protecting against mental health problems caused by the Coronavirus (Brug et al., 2004; Geçer et al., 2020; Yıldırım & Güler 2020). Fear of COVID-19 is also related to preventive behaviors, which include the physiological or psychological response an individual develops against fears and the individual activities motivated by the desire to reduce the COVID-19 risk (Lin & Chen, 2021). Notably, among infected health workers and others, COVID-19 has had a serious long-term impact on satisfaction with life and mental health issues with tangible results (Cleland, 2020; Söğütlü et al., 2021; Unützer et al., 2020).
This study identifies the role of self-reported psychological and behavioral factors in predicting the satisfaction with life of the people who have received vaccinations in Turkey and whose vaccinations were verified by the local health authorities. This has not yet been examined in the relevant literature, which focuses mostly on antivaccination and related concerns. Thus, in this context, anxiety is future-oriented and a reaction that develops mostly against a threat (Tükel & Alkın, 2006), whereas fear is a reaction that develops against a painful and/or dangerous stimulus. Yet, they both are somehow interrelated. Anxiety is a fear-like response that occurs in likely dangerous situations where the threat is unknown or unrecognized. Therefore, the main difference between anxiety and fear is ambiguity: The object of anxiety is ambiguous, and this uncertainty is what threatens human psychology (Özturk & Uluşahin, 2008). Although some studies have examined the individual contributions of COVID-19 anxiety (Rogowska et al., 2020) and fear of COVID-19 (Green & Yıldırım, 2022) in predicting satisfaction with life, there is little research explicitly investigating the simultaneous impacts of COVID-19 anxiety and fear of COVID-19 on satisfaction with life among vaccinated people. The current study examines the role of COVID-19 anxiety, fear of COVID-19, and preventive behaviors related to COVID-19 on life satisfaction in vaccinated individuals. It is one of the first studies to significantly contribute to research on the COVID-19 pandemic and the vaccination literature. We hypothesized that, after controlling for age, gender, experience of COVID-19, and vaccination status, (1) COVID-19 anxiety and fear of COVID-19 negatively predict satisfaction with life, and (2) preventive behaviors positively predict satisfaction with life.
Methods
Participants
Table 1 reports the sociodemographic and clinical characteristics of study participants. A total of 1,017 participants completed the questionnaires. In our sample, 69.71% of the participants were female, the age of participants varied between 19 and 70 years with a mean of 36.28 years (SD = 10.83), and 45.92% of the participants had a university degree. Most participants were married (58.41%) and had an average socioeconomic status (78.86%). Nearly half of the participants (46.02%) had been tested at least once for COVID-19. While 21.93% of the participants had experienced COVID-19 (outpatient or inpatient), 14.95% of their household members had been confirmed with COVID-19, with 22.62% of all participants reporting preexisting chronic diseases. All participants were vaccinated, and more than three-quarters (77.78%) had received a second COVID-19 vaccination. Nonvaccinated participants (n = 34) were excluded from the study. 39.13% of the participants preferred vaccination with an international vaccine produced in Western countries such as Germany, the United States, and the United Kingdom. More than half of the participants (52.80%) believed in the benefits of vaccination. Table 1 presents a detailed description of the participants.
Measures
COVID-19 Anxiety Scale (COVID-19 AS)
Yıldırım et al. (2021) developed the COVID-19 Anxiety Scale (COVID-19 AS), a 5-item scale designed to assess anxiety specific to COVID-19. Each item is rated on a 5-point Likert scale, ranging from 1 (strongly disagree) to 5 (strongly agree). There is no reverse coding item on the scale. Possible scores range from 5 to 25, with higher scores indicating greater Coronavirus anxiety. Sample items are “I feel anxious about my future because of COVID-19” and “I feel anxious about my health because of COVID-19.” The COVID-19 AS was originally developed in the context of Turkish culture. Yıldırım et al. (2021) reported good evidence of construct, convergent, and predictive validity for the COVID-19 AS. Cronbach’s alpha in this study was .89.
Fear of COVID-19 Scale (FCV-19S)
We utilized the Fear of COVID-19 Scale (FCV-19S) to assess the fear associated with COVID-19 (Ahorsu et al. 2020). The scale is a 7-item scale developed to assess fear in the context of the pandemic. Each item is rated on a 5-point Likert scale, varying from 1 (strongly disagree) to 5 (strongly agree). There is no reverse coding item on the scale. Sample items are “I am most afraid of Coronavirus-19” and “It makes me uncomfortable to think about Coronavirus-19.” Scores range from 7 to 35, with higher scores demonstrating greater Coronavirus fear. Cross-cultural studies showed that the FCV-19S has a unidimensional factor structure that is partially invariant across the 11 countries and fully consistent across age and gender (Lin et al., 2021). The scale was translated into Turkish by Haktanir et al. (2020). Cronbach’s alpha in this study was .87.
COVID-19 Preventive Behaviours
We measured COVID-19 preventive behaviors with 5 items developed in the study of Yıldırım et al. (2021). The items were specifically designed to assess the extent to which individuals engage in preventive behaviors regarding COVID-19. Participants rated each question using a 5-point Likert-type scale ranging from 1 (decreased substantially) to 5 (increased substantially). Sample items are “Avoid public transportation” and “Washing hands frequently with soap and water or alcohol-based hand rub.” There is no reverse coding item on the scale. The possible scores range from 5 to 25, with higher scores indicative of greater engagement in preventive behaviors regarding COVID-19. The measure of preventive behaviors was constructed in the context of Turkish culture, and the original authors (Yıldırım et al., 2021) present acceptable internal consistency reliability and good evidence of convergent validity with vulnerability, perceived risk, and fear of Coronavirus. Cronbach’s alpha in this study was .65, which is considered acceptable (Nunnally, 1967).
Satisfaction with Life Scale (SWLS)
We used the Satisfaction with Life Scale (SWLS) in the Turkish version by Durak et al. (2010) to evaluate life satisfaction. The SWLS (Diener et al. 1985) is a 5-item scale designed to assess the cognitive component of well-being. For each question, participants rated the extent to which they usually felt satisfied with their life on a 7-point Likert-type scale ranging from 1 (strongly disagree) to 7 (strongly agree). Sample items are “In most ways, my life is close to my ideal” and “The conditions of my life are excellent.” There is no reverse coding item on the scale. Scores range from 5 to 35, with higher scores indicating greater satisfaction with life. Evidence from 26 countries showed that the SWLS presents good evidence of configural and metric invariances (Jang et al., 2017). Cronbach’s alpha in this study was .90.
Procedure
To collect data, we created and distributed an online survey through social networking sites (e.g., Facebook, Twitter, and WhatsApp) and invited participants to take part in the study via social networking sites. We presented information on the study to the participants on the first page of the online survey. All participants voluntarily participated in the study with the assurance of confidentiality and anonymity of responses. Participants were informed about the purpose of the study and their rights before and after participation. Participants were not paid for their participation and completed the online survey in the same order. Ethical approval was obtained from the authors’ university (University of Health Sciences, Istanbul; Approval Number: 2021-02-12T23_00_28, dated 17 February 2021) before the data collection took place.
Results
Descriptive Statistics and Correlation Analysis
Table 2 shows the means, standard deviations, skewness, kurtosis, reliability estimates, and correlations of all variables. Skewness and kurtosis were within acceptable levels, indicating that the data were normally distributed (skewness range = 0.36–0.69; kurtosis range = −0.34–2.86) and had acceptable to excellent internal consistency reliability estimates (α = .65–.90). COVID-19 anxiety was positively correlated with fear of COVID-19 (r = .07, p < .05) and preventive behaviors (r = .56, p < .01) and negatively correlated with satisfaction with life (r = −.07, p < .05). Also, the correlation between fear of COVID-19 and preventive behaviors was positive (r = .06, p < .05), and the correlation between fear of COVID-19 and satisfaction with life was negative (r = −.13, p < .01). There was no significant correlation between preventive behaviors and satisfaction with life (r = .01, p > .05). The size of the correlation coefficients ranged from small to large based on Cohen’s (1988) classification, where 1 ≤ r < .3 denotes a small effect, 3 ≤ r < .5 denotes a medium effect, and r ≥ 5 denotes a large effect.
Regression Analysis
To further examine the relationships between anxiety, fear, and preventive behaviors of COVID-19 and satisfaction with life, we ran a hierarchical multiple regression to examine whether psychological (anxiety and fear) and behavioral factors (preventive behaviors) predicted unique variance in satisfaction with life. We controlled for age, gender, experience of COVID-19, and vaccination status in these relationships and entered into the regression model in Step 1. The increased number of vaccinations may give a feeling of security and reassurance (Hatmal et al., 2021), which in turn may relate to satisfaction with life (Vittersø, 2016). Given this theoretical relevance between the variables, it is plausible to control for the effect of vaccination status to examine the unique contribution of COVID-19 stressors in predicting satisfaction with life. In the proposed regression model, we treated satisfaction with life as an outcome variable, while treating psychological and behavioral factors as main predictors, entering the model in Step 2. Table 3 presents the results of the regression analysis in Table 3. Among the sociodemographic and clinical variables, age and vaccination status demonstrated statistical significance in predicting satisfaction with life, F(4, 1,014) = 7.28, R = .17, R2 = .03, p < .01). Higher age (β = 0.15) and a low number of vaccinations (β = −0.07) were associated with greater satisfaction with life. When psychological and behavioral factors were entered into Step 2, COVID-19 anxiety and fear of COVID-19 uniquely predicted satisfaction with life, F(7, 1,014) = 7.82, R = .23, R2 = .05, ΔR2 = .02, p < .01. Lower anxiety (β = −0.08) and fear (β = −0.14) related to COVID-19 are associated with higher satisfaction with life. Preventive behaviors (β = 0.14) were not associated with satisfaction with life.
Discussion
At the time of writing, COVID-19 is still a big problem worldwide, and while it is a physical health condition, its psychological effects are a major concern as well (Tušl et al., 2022). Despite vaccination being the probably most important defense mechanism against the virus, studies regarding the psychological influences of the pandemic on vaccinated people are limited (Fiolet et al., 2022). This study is among the first to examine whether anxiety, fear of COVID-19, and preventive behaviors can predict life satisfaction among the vaccinated public in Turkey. The results typically demonstrated that COVID-19 anxiety and fear significantly impact and predict satisfaction with life.
Life satisfaction is a cognitive appraisal and is largely influenced by the pandemic process. Satisfaction assessment is a significant factor for individuals to continue their psychological health and is related to people’s ability to compare their existing conditions with other situations and thoughts (Diener et al., 1985). One of the prominent studies on COVID-19 suggests that Coronavirus times have negatively affected life satisfaction (Ammar et al., 2020). Studies also showed that fear of COVID-19 was significantly related to depression, anxiety, stress, and life satisfaction (Çağış & Yıldırım, 2022; Moroń et al., 2021; Satici et al., 2020). Another cross-sectional study demonstrated that university students had higher anxiety during the pandemic, and that this anxiety negatively impacted their life satisfaction (Hu et al., 2022; Rogowska et al., 2020). Similar research also suggests that the fear of COVID-19 increases anxiety symptoms. Furthermore, a study comparing adolescents’ life satisfaction before and after the pandemic showed that life satisfaction decreased during the pandemic, and that the novel Coronavirus anxiety is related to low life satisfaction (Alyami et al., 2021; Magano et al., 2021).
Our study also finds a positive association between anxiety, fear of COVID-19, and related preventive behaviors. Only few studies have examined the relationship between COVID-19 preventive behaviors and psychological factors. Research shows a positive relationship between precautionary behaviors and perceived individual risk, fear, and vulnerability (de Zwart et al., 2009; Liao et al., 2019; Oh et al., 2020). A study in Turkey shows that individuals mostly exhibit preventive activities to protect themselves from the virus, and that the COVID-19 fear predicts these precautionary behaviors (Yıldırım et al, 2021). During previous epidemics, studies suggest that fear and anxiety increased protective behaviors (Lau et al., 2003; Leung et al., 2005; Rubin et al., 2009). Anxiety and fear seem to drive the use of preventive behaviors, which may indicate potential directions for future research. Thus, our research has the potential to guide further studies that focus on the promotion of protective measures regarding fear and anxiety. However, this study failed to provide a significant contribution of preventive behaviors to the prediction of life satisfaction.
Our study also suggests that age was a significant predictor of satisfaction with life as older people reported greater life satisfaction. The studies focusing on the relationship between life satisfaction and age produced different results. For instance, cross-sectional research on life satisfaction in older people demonstrates that life satisfaction increases in older years and anxiety and fear decrease (Bidzan-Bluma et al., 2020). A study with 337 adults finds a positive relationship between life satisfaction and age (Li et al., 2021; Pothisiri & Vicerra, 2021). This research demonstrates that fear and anxiety of COVID-19, on the other hand, reduce satisfaction with life, which highlights the fact that those who are vaccinated experience poor life satisfaction in due course. However, it is important to note that psychological and behavioral factors accounted for 2% of the total variance in satisfaction with life. A small or, at times, negligible correlation or the amount of total variance explained in the dependent variable could be related to a large sample size employed in this study. Although the amount of variance accounted for is relatively small for this model, it is significantly distinct from 0, suggesting that the proposed model has critical explanatory power (Yıldırım & Güler, 2021b). Cohen (1988) provided a classification for the assessment of effect size where 0.02, 0.15, and 0.35, respectively, represent small, medium, and large effects. However, despite the small effect, the total amount of variance explained in the satisfaction with life by psychological and behavioral factors can be meaningful practically (Pintea, 2010).
Strengths and Limitations
The study has several limitations to address in future studies. First, because we used an online approach to collect data, persons unable to use the internet or with limited internet access were not sufficiently represented. Second, participants in this study were disproportionally distributed, being primarily females, highly educated, married, and belonging to average socioeconomic backgrounds. Therefore, the sample cannot be assumed to be representative of the overall Turkish population. At the time we conducted this study, the number of vaccinations was still low. Hence, future studies should (and can) employ samples with more varied socioeconomic characteristics representative of the whole population. Also, the inclusion of unvaccinated individuals would add to the study and should be included in future research. Furthermore, people’s appreciation for the benefits of vaccination could play a role in explaining satisfaction with life in the context of moderation. Yet, this study utilized self-reported preventive behaviors as we have no way of knowing people who engage in them. Therefore, subsequent research should consider this limitation. Additionally, because the survey was self-reported, social desirability might have been present when recording responses. Finally, because our study was a cross-sectional study, we cannot assume a causal relationship among the analyzed variables. Longitudinal or experimental studies are needed to ascertain whether COVID-19-related stressors diminish satisfaction with life.
Conclusion
In conclusion, this study shows that psychological factors (i.e., COVID-19 anxiety, fear of COVID-19) and behavioral factors (i.e., preventive behaviors) are important in understanding satisfaction with life among vaccinated people in Turkey. Given the lack of empirical evidence in the relevant literature, the present findings represent an important contribution to both theory and practice.
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