Edited by: Yuan-Pang Wang, University of São Paulo, Brazil
Reviewed by: Amit Shrira, Bar-Ilan University, Israel; Gabriele Sani, Università Cattolica del Sacro Cuore, Italy; Maria Casagrande, Sapienza University of Rome, Italy
This article was submitted to Mood and Anxiety Disorders, a section of the journal Frontiers in Psychiatry
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Since the beginning of the year 2020 the lives of people around the globe have been dominated by one particular stressor: the outbreak of the Coronavirus disease (COVID-19). A growing number of studies have reported on the extensive negative psychological reactions to COVID-19, which amount to a global mental health crisis (
However, the specific mechanisms that determine the debilitating effect of COVID-19 on mood and emotionality as well as cultural differences in this respect, are only beginning to be explored. Additionally, research is needed to better understand the importance of the local context for the response to the outbreak. The present study, therefore, examined the association of COVID-19 related fear and negative affect in two samples collected in Israel and Switzerland with the aim to identify potential mechanisms underlying this association.
As has been observed during previous epidemics, the COVID-19 pandemic has caused global anxiety and heightened stress (
Although findings have shown that most people report a certain level of COVID-19 related fear (
Expert opinions predominantly highlight the importance of individual control, beliefs, and perceptions of helplessness with regard to suffering from emotional distress during the present pandemic (
The first concept of interest, fatalism, describes the general belief that one's destiny is externally determined and that one's actions have little or no significant impact on important outcomes (
The second concept of interest, health-related internal locus of control, refers to people's attribution of their own health to either personal or environmental factors (
When facing a global crisis, such as the spread of COVID-19, it seems that the government and healthcare systems play a significant role in the degree to which the new virus threatens individuals and societies. Perceived institutional betrayal, the third concept of interest, occurs when people perceive powerful and trusted institutions as causing harm to those dependent on them for safety and wellbeing, either by action or inaction in times of crisis or when mistakes or crimes have been committed (
Despite the fact that COVID-19 is a global phenomenon, relatively few studies have focused on the similarities and differences of mental health reactions to COVID-19 between different countries. Therefore, the current study explores two general population samples collected in two different countries: Switzerland and Israel. These two countries are of particular interest as they entail several differences as well as similarities. Although the population size in these countries is very similar (8.57 million in Switzerland and 9.23 million in Israel), the sociopolitical climate, economic status, as well as mentality, are significantly different. Concerning the COVID-19 outbreak, both countries experienced significant health risks to the population, however, these challenges were dealt with differently by the two governments.
The aim of this study was to assess the association between COVID-19 related fears and negative affect as well as potential differences between the two countries. A moderated competitive mediation model was suggested, wherein country affiliation would moderate the direct and indirect paths. We hypothesized that a lower locus of control, higher fatalism, and higher perceived institutional betrayal would be associated with more COVID-19 related fear and more negative affect. We also assumed that the three types of control perceptions would mediate the association of COVID-19 related fear and negative affect. We also aimed to identify the most relevant control-related mediator in regards to negative emotions to determine potential starting points for interventions.
This study was conducted during the peak of the COVID-19 outbreak in Switzerland and Israel when both countries were in lock-down. The educational systems were closed, classes took place online, and most people were working from home. In Israel, data collection took place from March 30 to May 16, 2020. During the initial stage of the data collection, there were 4,695 verified cases of COVID-19 and 16 deaths in Israel. By the end of the data collection, there were 16,607 verified cases and 268 deaths. During the majority of this time, the Israeli government had imposed quarantine on the entire population, apart from limited activities, such as healthcare and essential grocery shopping. In Israel, recent studies identified elevated levels of depression which were predicted by loneliness due to the social-distancing policy (
In Switzerland, data collection commenced on April 24, when there were 29,014 verified cases of COVID-19 and 1,496 deaths. By the end of data collection on May 23, there were 30,628 verified COVID-19 cases and 1,677 deaths. While the population had not been required to be in quarantine, it was strongly recommended for people to remain at home during the time of the data collection. As in Israel, first studies conducted in Switzerland among student populations suggest that COVID-19 specific worries, lack of interaction and emotional support, and physical isolation were associated with negative mental health trajectories [e.g., (
A convenience sample of 595 Swiss and 639 Israeli participants was recruited via avenues of social media (e.g., Facebook) and a snowball technique. Participants were invited to participate in a study aiming to uncover psychosocial coping with challenges regarding COVID-19. Questionnaires were distributed electronically in local languages (i.e., German in Switzerland, and Hebrew and Arabic in Israel), using Unipark and Qualtrics Research Software. Inclusion criteria were a) above the age of 18, and b) fluent in the local language(s). The study was approved by the Institutional Review Boards in each country and all participants signed a consent form.
Exposure to COVID-19 was assessed using 7 questions specifically tailored to assess COVID-19-related stressors (
Fear of COVID-19 was evaluated by three questions specifically tailored to the COVID-19 experience (
Fatalism was evaluated using the six-item Fatalism scale (
Health-related internal locus of control was measured with the Internal Health Locus of Control Scale [IHLC; (
Perceived institutional betrayal was assessed by a new questionnaire, partially based on the Institutional Betrayal Questionnaire—Health [IBQ-H; (
Negative affect was assessed using the negative affect subscale from the Positive and Negative Affect Schedule—Short form (PANAS; 48). The PANAS negative affect subscale consists of five emotions, including afraid, upset, and distressed. Participants were instructed to rate the extent to which they experienced each of the emotions during the last 2 weeks on a five-point Likert scale ranging between 1 (very little) to 5 (very much). The PANAS-negative affect score was calculated by summing the responses to all of the items, with higher scores indicating higher negative affect. Previous findings have documented the scale's validity and reliability (
First, the groups' background and demographic variables were compared. Additionally, independent sample
Background variables of the Swiss and Israeli samples are depicted in
Demographic characteristics by study group.
Female | 439 (73.8%) | 534 (84.1%) | Chi square (1) = 19.77 |
Male | 156 (26.2%) | 101 (15.9%) | |
Age |
43.15, 14.77 | 47.25, 14.38 | |
Primary/middle school | 157 (26.4%) | 3 (0.5%) | Chi square (2) = 235.54 |
Highschool | 98 (16.5%) | 42 (6.6%) | |
Academic | 340 (57.1%) | 587 (92.9%) | |
Number of people in household (M, SD) | 2.68, 1.57 | 3.02, 1.58 | |
No financial loss | 418 (70.5%) | 123 (19.2%) | Chi square (2) = 331.08 |
Minor financial loss | 135 (22.8%) | 356 (55.7%) | |
Major financial loss | 40 (6.7%) | 160 (25%) |
As can be seen in
Study variables by study group.
Exposure to COVID-19 (M, SD) | 1.41, 1.44 | 1.38, 1.15 | |
Fear of COVID-19 (M, SD) | 6.32, 1.82 | 7.82, 2.01 | |
Fatalism (M, SD) | 15.02, 5.65 | 16.1, 5.11 | |
Locus of control (M, SD) | 20.38, 4.32 | 22.72, 4.43 | |
Institutional betrayal (M, SD) | 19.13, 8.79 | 34.68, 9.33 | |
Negative affect (M, SD) | 10.09, 4.01 | 12.24, 4.84 |
As depicted in
Intercorrelations between study variables.
Exposure to COVID-19 | 1 | 0.13 |
−0.074 | −0.06 | 0.004 | 0.074 |
Fear of COVID-19 | 0.004 | 1 | −0.12 |
−0.26 |
0.09 |
0.52 |
Fatalism | −0.084 |
0.009 | 1 | 0.19 |
0.15 |
0.024 |
Locus of control | −0.025 | −0.12 |
0.14 |
1 | 0.14 |
−0.12 |
Institutional betrayal | −0.053 | 0.094 |
−0.024 | 0.07 | 1 | 0.32 |
Negative affect | 0.01 | 0.54 |
0.045 | −0.16 |
0.13 |
1 |
We assessed whether the association between fear of COVID-19 and negative affect differed between the Israeli and Swiss samples. Additionally, we examined the potential mediating role of fatalism, locus of control, and perceived institutional betrayal. We controlled for the effects that age and gender bear for negative affect and for the three mediators, fatalism, locus of control, and perceived institutional betrayal. To this end, we ran multigroup path analysis models that estimated the relation between fear of COVID-19 and negative affect, and the indirect effects via fatalism, locus of control, and institutional betrayal, controlling for age and gender, separately for the Israeli and Swiss samples. The multigroup model fit the overall data well, χ2(
The control variables were removed from the models and excellent model fit was found with similar effects, both in estimates' direction and intensity. The multigroup model fit the overall data well, χ2(
The analysis revealed that for both the Israeli and Swiss samples, higher levels of fear of COVID-19 were related to higher levels of negative affect. This path was not significant between the groups, Δχ2(7) = 10.79,
The relationship between institutional betrayal and negative affect was significant in both samples, indicating that higher institutional betrayal was associated with higher negative affect, although this path was significantly stronger in the Swiss sample, Δχ2(7) = 18.96,
The total indirect effect (comprised of the sum of the three indirect effects) was significant in the Israeli sample (total indirect effect: Estimate =.06,
The results indicate that there are moderated mediations with the country as the moderator. In the Israeli and Swiss samples, higher levels of fear of COVID-19 were related to higher institutional betrayal, which was associated with a higher negative affect. In the Israeli sample, higher levels of fear of COVID-19 were related to higher locus of control, which was associated with higher negative affect. Fatalism did not mediate the path between fear of COVID-19 and negative affect.
It is a basic human instinct to strive for control when adversity strikes. In this study, we sought to explore three different control perceptions (fatalism, internal locus of control, and perceived institutional betrayal) as potential mediators of the association between COVID-19 related fear and negative affect in two samples collected during the lockdown periods in Israel and Switzerland. This study aims to contribute to our understanding of the mechanisms associated with negative affect in the general population during a global health crisis and to better understand the role the local context plays in the stress response. The results revealed that perceived institutional betrayal was the strongest mediator of the association between COVID-19 related fear and negative affect, which was significant in both samples. In addition, health related internal locus of control was a mediator among the Israeli sample only.
As was found in previous studies [e.g., (
Perceived institutional betrayal was the concept of interest that explained most of the variance in the current model. In both Switzerland and Israel, higher COVID-19 related fears were associated with reduced trust in local government and healthcare institutions to protect against the virus and a higher perceived institutional betrayal was associated with more negative emotions. In addition, institutional betrayal mediated the association between COVID-19 related fears and negative affect in both samples. These findings highlight the central role of the authorities in an individual's mental well-being during times of crisis. In a situation as threatening as a pandemic, people turn toward the authorities whose responsibility includes supporting and protecting the individual. If such support is not granted, it is a grave source of distress. The current results thus suggest that in order to mitigate the negative psychosocial consequences of COVID-19, special attention should be paid to strengthening trust in the authorities as this has the potential to buffer the negative impact of fears. Future research should formally explore the specific factors that influence perceptions of institutional betrayal and develop appropriate intervention strategies. The ongoing pandemic offers the chance to learn important lessons that may serve to improve general crisis management in the future.
Interestingly, there was a striking difference in perceived institutional betrayal in the two samples with significantly higher mean values in Israel (
In line with the hypotheses, less fear of COVID-19 was associated with higher health locus of control in both samples, thereby extending findings by Brailovskaia and Margraf (
In Switzerland, COVID-19 related fear was associated with increased fatalism. This is in line with previous research that found negative associations of fatalism and anxiety [e.g., (
Finally, contrary to our hypothesis, higher fatalism was not associated with a stronger negative affect in either of the samples and also did not represent a mediator in the current model. Despite previous findings, which have shown strong positive associations between fatalism with psychological distress (
Several limitations should be acknowledged when interpreting the current findings. First, the samples were recruited via social media and, therefore, are not representative of the Swiss and Israeli populations, which limits the generalization of the results. Additionally, females were overrepresented in the sample and participants were relatively highly educated. Second, the cross-sectional nature of the data does not allow for any inferences on causality. Third, the study relied on self-report data rather than clinician-administered interviews. Due to the urgency of the COVID-19 pandemic, the questionnaires assessing institutional betrayal as well as COVID-19 exposure and fear had not been validated in Israeli and Swiss populations. Finally, comorbid mental health problems are likely related to negative affect during the COVID-19 pandemic but have not been considered in the current models. Nevertheless, given the timeliness of the research question and the urgency of understanding negative emotional reactions in the context of the COVID-19 pandemic, this first examination yielded important exploratory information on predictors of COVID-19 related mental health burdens. Future research should evaluate how they relate to other risk factors, such as temperament traits and related personality constructs, which have been shown to be relevant to the mental health response to COVID-19 (
Within the framework of these empirical findings, it can be concluded that the reaction of the authorities appears to be of crucial importance with regard to the emotional state and well-being of the population in both countries. As international experts warn of a possible rise in mental health problems in the aftermath of COVID-19 (
The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.
The studies involving human participants were reviewed and approved by Institutional Review Boards of the University of Zurich and Tel Aviv University. The patients/participants provided their written informed consent to participate in this study.
RB: contributed to the conceptualization and design of the study, collected the data in Switzerland, and drafted the manuscript. NT: contributed to the conceptualization and the design of the study, collected the data in Israel, contributed to the data analysis and reporting, and conducted a critical review of the manuscript. YL: contributed to the conceptualization and the design of the study, contributed to the data analysis and reporting, and conducted a critical review of the manuscript. HA-R and AM: contributed to the conceptualization and the design of the study and conducted a critical review of the manuscript. All authors contributed to the article and approved the submitted version.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
The authors would like to thank Prof. Karni Ginzburg of Tel Aviv University for her contribution to this manuscript.
The Supplementary Material for this article can be found online at:
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