Psychological Wellbeing and Psychological distress in Elderly During Pandemic COVID-19



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Abstract

The elderly are the population most vulnerable to the effects of the COVID-19 pandemic. From March 2020 to April 2022, the implementation of psychological distancing is still being applied in Indonesia. Mental health problems appear to be interesting issues to be studied in the elderly. This study examines loneliness and attachment to God on mental health and how mental health conditions are explored using a mixed-method approach. 86 older people filled out loneliness and attachment to God questionnaires. Representatives from our participants were invited to be participants in collecting interview data. The results show that loneliness is a predictor of mental health in the elderly, while attachment to God does not correlate. More specifically, we describe what makes the elderly sad and happy and how the elderly carry out coping strategies to live life in these challenging times. Coping is done by the elderly such as productive activity, religious activity, and communication activity. Loneliness is a serious problem for the elderly during the COVID-19 pandemic. Even attachment to God did not positively affect mental health as we predicted. Coping in the form of activities carried out by the elderly is one of the activities that can divert the loneliness of the elderly.

Full Text

Psychological Wellbeing and Psychological distress in Elderly During Pandemic COVID-19

Herdian12 & Suwarti2

1Universitas Muhammadiyah Purwokerto, Indonesia

2Nanjing Normal University, China

Email: herdian@ump.ac.id

The elderly are the population most vulnerable to the effects of the COVID-19 pandemic. From March 2020 to April 2022, the implementation of psychological distancing is still being applied in Indonesia. Mental health problems appear to be interesting issues to be studied in the elderly. This study examines loneliness and attachment to God on mental health and how mental health conditions are explored using a mixed-method approach. 86 older people filled out loneliness and attachment to God questionnaires. Representatives from our participants were invited to be participants in collecting interview data. The results show that loneliness is a predictor of mental health in the elderly, while attachment to God does not correlate. More specifically, we describe what makes the elderly sad and happy and how the elderly carry out coping strategies to live life in these challenging times. Coping is done by the elderly such as productive activity, religious activity, and communication activity. Loneliness is a serious problem for the elderly during the COVID-19 pandemic. Even attachment to God did not positively affect mental health as we predicted. Coping in the form of activities carried out by the elderly is one of the activities that can divert the loneliness of the elderly.

Keywords: psychological wellbeing, Psychological distress, mental health, loneliness, attachment to God.

 

INTRODUCTION

In Indonesia, the COVID-19 pandemic began in March 2020 and is still ongoing as of April 2022. The government has taken various ways to overcome the COVID-19 virus, including implementing PSBB (Large-Scale Social Restrictions), transitional PSBB, and PPKM (Enforcement of Restrictions on Community Activities) up to four-level PPKM. However, the regulation cannot be said to be 100% effective because, until now, the term "pandemic" in the spread of the COVID-19 virus still applies.

In a study conducted by Hiscott et al. (2020) Regarding the global impact of the COVID-19 pandemic, there are at least three significant impacts that are felt globally, namely the economic impact (massive layoffs and reduced salaries), the psychological impact (increased fear of death, loneliness and related to future security). And the environment (industrial closures, tourism, etc.). Although in particular, the positive impact of the COVID-19 pandemic on the environment has been reported to have reduced global pollution levels throughout the world (Hiscott et al., 2020; Loh et al., 2021)

The psychological impact of the pandemic is of particular concern to many researchers, especially in the social and health sciences. Many studies report that the COVID-19 pandemic has an impact on mental health (Boden et al., 2021; Herdian & Qingrong, 2021; Johnson et al., 2021; Kola et al., 2021; Loh et al., 2021; Pan et al., 2021; Ravens-Sieberer et al., 2021; Thome et al., 2021; Wang et al., 2021; Yarrington et al., 2021). Common forms of mental health problems as a result of the COVID-19 pandemic include anxiety, stress, depression (Bareeqa et al., 2021; Dozois, 2021; Faisal et al., 2021; Hawes et al., 2021; Kibbey et al., 2021; Ozamiz-Etxebarria et al., 2021; Turna et al., 2021; Varma et al., 2021), loneliness and worries (Hansen et al., 2021; Heinberg & Steffen, 2021; Varga et al., 2021; Wickens et al., 2021). In addition, a study of 157,213 in America said that calm, happiness, and optimism decreased during the COVID-19 Pandemic (Yarrington et al., 2021).

Mental health research during the COVID-19 pandemic is very interesting to study, especially in the elderly population. Because the elderly are one of the most vulnerable populations to the impact of the COVID-19 Pandemic (Pradana & Casman, 2020), it has been proven that as many as 80% more deaths in the elderly in America over the age of 65 years (CDC COVID-19 Response Team, 2020). Those aged 60 had the most confirmed deaths compared to other age groups based on age group. In Indonesia, the number of COVID-19 deaths as of 5 November 2021 was 143,534 people (https://covid19.go.id/peta-sebaran-covid19).

The high mortality rate in the elderly allows increased concern for their group of COVID-19. This is evidenced in research reports that indicate high anxiety in the elderly who have comorbidities such as hypertension, heart disease, and diabetes mellitus (Tobing & Wulandari, 2021). Other studies report increasing mental health problems caused by social isolation, which impacts their bio-psycho-social vulnerability (Lumbantoruan et al., 2021). So that it causes loneliness, which in turn impacts the risk of depression, anxiety disorders, and suicide, especially in nursing homes (Lumbantoruan et al., 2021). Reinforced by Studies conducted by Stolz et al. (2021), who interviewed 557 participants aged 60 years and over, they showed that loneliness increased during the lockdown. This is seen from the comparison with previous years. So our hypothesis states that loneliness affects the mental health of the elderly.

Other factors that affect mental health include an attachment to God. Individuals believe their closeness to God will provide a sense of security and protection because God is the Almighty Essence (Sim & Yow, in Ghobary 2013). The research results conducted by (Homan, 2014) and (Kent et al., 2018) said that there is a link between attachment to God and mental health.

Based on a review of previous research results, this study provides an update on the research subject, namely the elderly. In addition, previous research has not revealed the actual conditions individually in depth. So it is necessary to conduct comprehensive research to see other factors that may be found through other methods such as interviews. This research is part of a mental health and community research scheme. The specific purpose of this research is to examine the mental health status of the elderly during the COVID-19 pandemic, especially during the implementation of the four-level PPKM system, and the factors that affect their mental health, such as loneliness and attachment to God. This research is important because the mental health of the elderly is still very rarely studied.

METHOD

This research uses a mixed-method approach with a sequential explanatory type. A method in which the researcher first conducts quantitative research analyzes the results and then constructs the results to explain them in more detail with qualitative research (Creswell & Creswell, 2017). Qualitative data help explain the initial quantitative results in more detail, so it is important to tie or link the quantitative results to the collection of qualitative data (Creswell & Creswell, 2017; Leavy, 2017). The sequential explanatory approach aims to determine the factors that influence mental health in the elderly. Then conducted, interviews with the elderly who have extreme high and low values ​​based on the quantitative results of mental health status to explore the factors that influence the mental health of the elderly.

Participants

This research was conducted on the elderly in Indonesia. Characteristics of participants, namely subjects aged 60 years and over, refer to the Regulation of the Minister of Health of the Republic of Indonesia Number 25 of 2016 that the elderly are a group over 60 years. The sampling technique in this study used incidental sampling. The procedure for collecting quantitative and qualitative data was carried out in a mixed manner (a mixture of online and offline), depending on the willingness of the subject to be involved as a participant. Information about the number of participants is shown in table 1. Based on table 1. The number of participants in this study was 82 elderly, with an age range of 60-90 years. The gender of the participants was dominated by women (73.2%) than men (26. 8%). In addition, we also collect data on internal medical history, current living with whom, and status of pensioners

Table 1. Participants of Quantitative Data Collection

Demographics

Levels

Counts

% of Total

Cumulative %

Gender

Man

22

26.8%

26.8%

 

Woman

60

73.2 %

100.0%

Age

60-65

36

43.9 %

43.9 %

 

66-70

12

14.6%

58.5 %

 

71-75

12

14.6%

73.2 %

 

76-80

15

18.3%

91.5%

 

81-85

4

4.9%

96.3%

 

86-90

3

3.7%

100.0%

Internal Medicine History

Not

44

53.7%

53.7%

Yes

38

46.3%

100.0%

Living with Children

Not

23

28.0%

28.0%

Yes

59

72.0%

100.0%

retirement

Not

57

69.5%

69.5%

 

Yes

25

30.5%

100.0%

Participants of qualitative data collection by interview consisted of 9 elderly with very low mental health categories (3 participants) and very high (6 participants). This is done to see the difference in how the elderly respond to a mental health problem from each perspective. Information about participants in qualitative data collection is presented in table 2.

Table 2. Participants in quantitative data collection

participant

AGE

Mental Health Status

participant 1

61

Very low

participant 2

77

Very low

participant 3

73

Very low

participant 4

62

Very high

participant 5

61

Very high

participant 6

73

Very high

participant 7

67

Very high

participant 8

65

Very high

participant 9

63

Very high

Measurement

Mental Health Inventory

The data collection tool using MHI-5 is a shortened version of the 38-item based on fundamental theory (Veit & Ware, 1983), then expanded to 5 items (Berwick et al., 1991). This measuring tool reveals two important aspects: psychological well-being (2 items) and psychological distress (3 items). Examples of psychological well-being items “How much of the time, during the last month, have you felt calm and peaceful?” while the example of psychological distress item is “How much of the time have you been very nervous during the last month person?” MHI-5 measuring instrument has a reliability value of 0.67

Attachment to God

Attachment to God measuring tool using The Muslim Spiritual Attachment Scale (M-SAS) developed by Miner et al. (2017) which includes 16 items arranged based on four factors, namely Proximity, Positive model of God, Positive Model of Self, and Separation Protest. Each factor of the M-SAS Scale consists of 4 items. An example of an item is “God's love for me is unconditional.” Attachment to God measuring instrument reliability is 0.62

Loneliness

To measure loneliness, we used the University of California, Los Angeles (UCLA) Loneliness Scale 6, also known as ULS-6. The ULS-6 measuring instrument was developed by Hudiyana et al. (2021). The ULS-6 measuring instrument has shown good quality to measure loneliness because it has been tested in three countries, namely Indonesia, Germany, and America. ULS-6, so its use is appropriate for cross-cultural studies. An example of an item from ULS-6 is “I lack friendship.” Likert Scale was used for answer choices (Never, Rarely, Usually, and Often). Loneliness measuring instrument reliability is 0.89

Guide Interview

Data collection tool to use an interview guide. Contains questions that aim to explore the mental health status of the elderly. Qualitative data collection uses in-depth interviews or in-depth interviews with 11 participants who have an ice cream value in data categorization (very low and very high). The interview guide is prepared based on the theory of Veit & Ware (1983), who said that mental health was measured based on two positive dimensions represented by psychological well-being and a negative dimension, namely psychological distress. The question points in the interview guide are in table 3.

Table 3. Interview Guide

No

Question

1

How did you feel during the COVID-19 pandemic?

2

What makes you feel peaceful and calm during the COVID-19 pandemic?

3

How can you stay happy during the COVID-19 pandemic?

4

What made you feel very sad or uneasy during the COVID-19 pandemic?

5

What do you do when you feel sad and uneasy during the COVID-19 pandemic?

Data analysis

Analysis of data from two different approaches in the form of a mix method is analyzed separately, according to the opinion Creswell & Creswell (2017) who said that the quantitative and qualitative databases were analyzed separately in a sequential explanatory approach. Then the researcher combined the two databases in an integrated form called linking quantitative results with qualitative data collection. In this study, quantitative data analysis was carried out by categorizing, correlation between variables, then performing regression analysis of the independent variables on the dependent variable. The analytical tool uses JAMOVI. The results of quantitative data analysis became the basis for determining informants to conduct interviews. Qualitative data analysis using content analysis.

RESULTS AND DISCUSSION

This study aims to find out how the mental health status of the elderly during the COVID-19 Pandemic is and the factors that affect mental health, such as the role of loneliness and attachment to God. The results of this study are explained separately for the two methods used, namely quantitative and qualitative. It is explained in more detail in the following sub-chapters:

QUANTITATIVE RESULT

Intercorrelation between variables

Based on the results of the correlation analysis, it was found that the mental health variable has a correlation value of -0.447 with a significance value of <.001. This indicates a negative correlation between health and the two variables. This means that the higher the loneliness in the elderly, the lower or worse their mental health. On the other hand, the lower the loneliness in the elderly, the higher or better their mental health. Other variables, such as the correlation between attachment to God and mental health, did not get the expected results that there was no significant correlation between the two. In the correlation between loneliness and attachment to God, it was also found that no significant results were found between the two. Based on the results of correlation analysis,

Table 4. Intercorrelation Among Variables

 

mean

SD

Mental Health

Loneliness

Attachment to God

Mental Health

15.05

2.63

  

 

  
   

  

 

  

Loneliness

11.18

3.15

-0.447

***

 

  
   

< .001

 

 

  

Attachment to God

69.29

7.91

0.183

 

-0.055

 

 
   

0.099

 

0.622

 

 

Notes.* p < .05, ** p < .01, *** p < .001

          

Regression Analysis

Based on the regression analysis shown in table 5. It can be seen that there is a significant effect of loneliness on mental health (R²= 0.20; p<0.001). However, the effect is relatively small. The magnitude of the influence of loneliness on mental health is 20%, while other factors influence the remaining 80%.

Table 5. Regression analysis results

 

Overall Model Test

Model

R

Adjusted R²

F

df1

df2

p

1

0.44

0.20

0.19

20

1

80

< .001

         

QUALITATIVE RESULT

The categorizing qualitative data are described based on two dimensions of mental health, which are measured based on their opinions Veit & Ware (1983), namely psychological well-being and psychological distress. The following explains each dimension based on the results of in-depth interviews.

Psychological distress

Two questions explore psychological distress: What makes you feel very sad or uneasy during the COVID-19 pandemic? And what do you do when you feel sad and uneasy during the COVID-19 pandemic?. Based on the results of interviews with 9 elderly, the results show that what makes the elderly sad during the COVID-19 pandemic are limited activities (not being able to recite the Koran together, visiting neighbors), being anxious and suspicious of others who may be positive for COVID-19, unable to visit or visited by children and grandchildren. The way to prevent the elderly from sadness or coping is by doing religious activities as away when they are not calm, such as praying, praying, reading the Qur'an, and dhikr. Besides doing other activities although limited but still using prokes, such as going to the fields, productive activities at home. Other activities include using telecommunications equipment to make voice or video calls with family members who are far away and communicating with children and grandchildren at home.

Psychological well-being

Two questions explore psychological well-being: how do you stay happy during the COVID-19 pandemic? And 5. What makes you feel peaceful and calm during the COVID-19 pandemic?. Based on the results of interviews conducted with 9 elderly, it was found that what makes them happy and how not to be sad have almost the same answers. Like doing activities going to the fields, doing productive activities at home such as making coffee, and selling crackers. Religious activities such as worship, prayer, and dhikr. Each other does not harbor suspicions because they are exposed to COVID-19, healthy family members, use telecommunication tools to stay in touch with family members, are close to children and grandchildren so they feel cared for and support each other.

Communication Activities:

make voice/video calls with family members who are far away with smartphones, communicate with children and grandchildren who are at home, don't talk about COVID-19 in communication with neighbors by maintaining progress

Religious Activity:

praying, praying, reading the Qur'an, dhikr.

COPING

HAPPY

Healthy family members, close to children and grandchildren, feel cared for, do not feel suspicious of neighbors

SAD

Limited activities (unable to make friends, cannot meet grandchildren, cannot recite the Koran together) and are suspicious of others regarding COVID-19

Productive Activity:

Productive activities are going to the fields, planting flowers, making coffee and selling crackers.

Based on the results of interviews with 9 elderly related to psychological distress and psychological well-being, the flow of themes found in the interviews is shown in Figure 3. It is explained that the elderly feel sad (part of psychological distress) due to several things such as limited activities, unable to meet distant family members, and there is suspicion among people affected by the COVID-19 virus, then coping with themed into 3 forms to relieve sadness. The first form of coping is productive coping activities, such as doing activities as part of a form of diversion. The second form of coping is the religious activity by doing worship activities such as praying, praying, reading the Qur'an, and dhikr. The third form of coping is with communication activity,

Figure 4. Qualitative research results

The form of coping carried out creates happy feelings such as healthy family members, close to children and grandchildren at home and far away, feeling cared for, and not feeling suspicious in communication with neighbors.

Based on the results of quantitative research, mental health, which is the total score of the two dimensions of psychological distress and psychological well-being, is only influenced by loneliness, which is as much as 20%. The results of the quantitative research were strengthened by the results of interviews on qualitative data collection, which said that limitations in activities so that they could not be in touch, could not meet children and grandchildren who were far away, could not recite the Koran together were one of the factors for the sadness of the elderly during the COVID-19 pandemic. The results of this study generally confirm that psychological distancing causes problems of feeling lonely (Miller, 2020), especially in adults who cannot use technology (Dahlberg, 2021). The same was found in adults in Europe who reported a higher frequency of physical distancing offset by higher loneliness during the Pandemic (Cohn-Schwartz et al., 2022). Although other studies confirm that loneliness in the elderly occurs only in those with multiple physical and mental health diagnoses, it is associated with less loneliness in those with larger social network sizes (Rumas et al., 2021).

The analysis results between attachment to God and mental health confirmed that there was no correlation. It can be concluded that attachment to God does not contribute to mental health. Confirmed by the results of qualitative research, problems such as sadness triggered by loneliness actually make the elderly closer to God in the form of worship practices. They are included in the category of religious coping. The concept of religious coping is almost similar to the attachment to God, which is related to God. We suspect that attachment to God can be a moderating variable, while religious coping is a mediator between loneliness and mental health.

The results of our study have limitations, especially the need for further testing using more participants as suggestions for future researchers. This research implies that the elderly can do more activities to maintain their mental health. In addition, other coping, such as productive activities, gives the elderly the breadth to do free but meaningful activities as a way to maintain mental health. Communication coping is also a form of coping found in the elderly as a form of behavior to avoid loneliness. Productive seniors are balanced with worship activities and maintain communication even with communication media such as smartphones.

CONCLUSION

The elderly are a population that rarely attracts the attention of researchers, especially the mental health Indonesian elderly. The results of our study indicate that the mental health of the elderly is correlated with loneliness, while attachment to God does not correlate. Although loneliness is relatively small, it impacts the sustainability of the mental health of the elderly during the COVID-19 pandemic. More specifically, we describe what makes the elderly sad and happy and how the elderly perform coping strategies to live life activities in these challenging times. Coping is done by the elderly such as productive activity, religious activity, and communication activity.

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Thome, J., Deloyer, J., Coogan, A. N., Bailey-Rodriguez, D., da Cruz e Silva, O. A. B., Faltraco, F., Grima, C., Gudjonsson, S. O., Hanon, C., Hollý, M., Joosten, J., Karlsson, I., Kelemen, G., Korman, M., Krysta, K., Lichterman, B., Loganovsky, K., Marazziti, D., Maraitou, M., … Fond-Harmant, L. (2021). The impact of the early phase of the COVID-19 pandemic on mental-health services in Europe. The World Journal of Biological Psychiatry, 22(7), 516–525. https://doi.org/10.1080/15622975.2020.1844290

Tobing, C., & Wulandari, I. S. M. (2021). Tingkat Kecemasan bagi Lansia yang Memiliki Penyakit Penyerta Ditengah Situasi Pandemik Covid-19 di Kecamatan Parongpong, Bandung Barat. Community of Publishing In Nursing (COPING), 9(2), 135–142.

Turna, J., Zhang, J., Lamberti, N., Patterson, B., Simpson, W., Francisco, A. P., Bergmann, C. G., & Ameringen, M. Van. (2021). Anxiety, depression and stress during the COVID-19 pandemic: Results from a cross-sectional survey. Journal of Psychiatric Research, 137, 96–103. https://doi.org/https://doi.org/10.1016/j.jpsychires.2021.02.059

Varga, T. V, Bu, F., Dissing, A. S., Elsenburg, L. K., Bustamante, J. J. H., Matta, J., van Zon, S. K. R., Brouwer, S., Bültmann, U., Fancourt, D., Hoeyer, K., Goldberg, M., Melchior, M., Strandberg-Larsen, K., Zins, M., Clotworthy, A., & Rod, N. H. (2021). Loneliness, worries, anxiety, and precautionary behaviours in response to the COVID-19 pandemic: A longitudinal analysis of 200,000 Western and Northern Europeans. The Lancet Regional Health - Europe, 2, 100020. https://doi.org/https://doi.org/10.1016/j.lanepe.2020.100020

Varma, P., Junge, M., Meaklim, H., & Jackson, M. L. (2021). Younger people are more vulnerable to stress, anxiety and depression during COVID-19 pandemic: A global cross-sectional survey. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 109, 110236. https://doi.org/https://doi.org/10.1016/j.pnpbp.2020.110236

Veit, C. T., & Ware, J. E. (1983). The structure of psychological distress and well-being in general populations. Journal of Consulting and Clinical Psychology, 51(5), 730–742. https://doi.org/10.1037/0022-006X.51.5.730

Wang, Y., Shi, L., Que, J., Lu, Q., Liu, L., Lu, Z., Xu, Y., Liu, J., Sun, Y., Meng, S., Yuan, K., Ran, M., Lu, L., Bao, Y., & Shi, J. (2021). The impact of quarantine on mental health status among general population in China during the COVID-19 pandemic. Molecular Psychiatry. https://doi.org/10.1038/s41380-021-01019-y

Wickens, C. M., McDonald, A. J., Elton-Marshall, T., Wells, S., Nigatu, Y. T., Jankowicz, D., & Hamilton, H. A. (2021). Loneliness in the COVID-19 pandemic: Associations with age, gender and their interaction. Journal of Psychiatric Research, 136, 103–108. https://doi.org/https://doi.org/10.1016/j.jpsychires.2021.01.047

Yarrington, J. S., Lasser, J., Garcia, D., Vargas, J. H., Couto, D. D., Marafon, T., Craske, M. G., & Niles, A. N. (2021). Impact of the COVID-19 Pandemic on Mental Health among 157,213 Americans. Journal of Affective Disorders, 286, 64–70. https://doi.org/https://doi.org/10.1016/j.jad.2021.02.056

 

×

About the authors

herdian herdian

Universitas Muhammadiyah Purwokerto

Email: herdian@ump.ac.id
ORCID iD: 0000-0003-3452-1843
Indonesia

suwarti suwarti

Universitas Muhammadiyah Purwokerto

Email: suwarti@ump.ac.id
ORCID iD: 0000-0002-4705-1011
Scopus Author ID: 57212407483
Indonesia

Suci Ratna Estria

Author for correspondence.
Email: estriasuci@yahoo.co.id
ORCID iD: 0000-0003-3685-9944
Indonesia

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