Anxiety and Coping Strategies During the COVID-19 Pandemic in Mothers of Children with Thalassemia

1. Background

The lack of effective treatment for COVID-19 has rendered the disease a significant stressor, particularly for mothers of children with thalassemia who are at the forefront of caregiving. High anxiety about caring for a child with thalassemia and the lifestyle changes necessitated by the outbreak are common problems reported by these mothers during infectious disease outbreaks (1, 2). People employ various coping strategies under stress. The type and level of anxiety, as well as the coping strategies used during the COVID-19 pandemic, may vary across different societies. Epidemiological data in this area can be instrumental in planning interventions to mitigate the negative impacts of the disease on these mothers. However, research at both global and national levels remains scarce in this area (3, 4).

2. Objectives

This study was conducted to improve the health of these mothers.

3. Methods

This cross-sectional study was conducted in May 2022 at the Children's Hospital in northern Iran. The research population included all mothers of children suffering from thalassemia who were treated at this hospital. Based on the study variables and an allocation of 15 samples per variable, the sample size was determined to be 200 individuals. Sampling was performed using the availability sampling method. The inclusion criteria for the study were mothers of children with thalassemia diagnosed for at least one year. On the other hand, exclusion criteria included the occurrence of a stressful event in the last six months (e.g., divorce, death of a close relative, a diagnosed mental disorder, a history of physical illness, use of drugs related to mental health disorders, and COVID-19 infection).

Data were analyzed using descriptive and inferential statistics, performed with SPSS software version 26. Data collection was facilitated through a questionnaire completed in person, comprising three sections. The first section gathered individual characteristics, such as age, education level (below high school diploma, high school diploma, and academic), occupation (employee, self-employed, homemaker), history of underlying diseases, and smoking status. The second section was the Corona Disease Anxiety Scale, developed and validated by Alipour et al. to measure anxiety related to the spread of coronavirus in Iran (5). This tool includes 18 items divided into two components: Items 1 to 9 assess psychological symptoms and 10 to 18 assess physical symptoms. The content validity of this tool was verified by presenting the questionnaire to 10 experienced psychologists, who confirmed its validity. The tool’s reliability was calculated using the Cronbach’s alpha method (α = 0.89). The third part assessed coping strategies using the Carver Coping Strategies Questionnaire, a self-report questionnaire containing 28 items that measure effective and ineffective methods for dealing with anxiety-inducing events (3). In this study, the tool’s validity was confirmed by experts, and its reliability was verified using Cronbach’s alpha (α = 0.87).

4. Results

Statistical tests at the error level of 0.01 revealed no significant correlation between anxiety, coping styles, and demographic factors (P > 0.01). The results of the t-test for two independent samples (Table 1) indicate that there is no significant difference in average anxiety between mothers with underlying diseases and healthy mothers at the error level of 0.01 (P > 0.01).

Multiple regression was performed to analyze the contribution of coping strategies to predicting anxiety caused by the coronavirus in mothers (Table 2). Prior to running the regression, default assumptions were verified. The assumption of the normal distribution of residuals was established using a normal probability plot, which displays the residuals against the values predicted by the model. This confirms the assumption of covariance of residuals. The presence of multicollinearity was investigated using the Variance Inflation Index (VIF) for each independent variable: Problem-oriented, emotion-oriented, and avoidance-oriented. With VIF values less than 5, the results indicate an absence of collinearity. The Durbin-Watson test results, ranging from 1.5 to 2.5, suggest the independence of errors, thus meeting the requirements for this analysis method. The results of the multiple regression analysis (F = 13.950, AR2 = 0.163, P < 0.01) affirm the model’s statistical significance. According to Table 2, problem-oriented, emotion-oriented, and avoidance-oriented styles significantly impact anxiety (P < 0.01). The avoidance style has a greater effect on mothers’ anxiety, as indicated by the largest absolute standardized coefficient of determination among the coping styles. Problem-oriented and emotion-oriented styles are ranked next in terms of their impact.

5. Discussion

Apart from its relatively high mortality and contagion rates, the coronavirus epidemic has caused serious mental health issues worldwide (1). This study aimed to investigate anxiety-causing factors and coping strategies during the COVID-19 pandemic in mothers with children suffering from Thalassemia. Our findings indicate that most participants experienced severe anxiety due to COVID-19. Additionally, the results support the findings of Martinsone and Tzivian, which suggest that parents of children with chronic diseases experienced more anxiety than mothers of healthy children during the COVID-19 pandemic (6, 7). While the pandemic adds an additional layer of stress for parents, positive parenting experiences were significantly associated with lower parental anxiety (8).

Another objective of the study was to determine the types of coping strategies related to the COVID-19 virus employed by mothers with children suffering from Thalassemia. Our findings revealed that most participants used avoidance-oriented strategies to manage their anxiety. These findings align with those of Martinsone and Tzivian, who found that parents of children with chronic diseases employed various coping strategies, such as spending time with family, to reduce the anxiety caused by the epidemic (6, 7).

People employ different methods to cope with anxiety-inducing conditions and situations. Problem-oriented coping is an effective style that helps individuals take value-based actions under conditions brought on by the coronavirus (3). This study showed that the problem-oriented style was a negative and significant predictor, while the emotion-oriented and avoidance-oriented styles were positive and significant predictors in explaining the anxiety of COVID-19 in mothers, with the contribution of avoidance being more significant than the other two variables (9). Lazarus's research indicated that individuals who use problem-oriented methods adapt better to stressful situations, whereas those with poor mental health tend to use inefficient methods (10).

5.1. Conclusions

This study found that the average anxiety levels of mothers with underlying diseases and healthy mothers were the same, and they primarily used avoidance-oriented coping strategies to manage anxiety. Although this coping style may temporarily reduce anxiety, further studies on the long-term effects of coping strategies in these mothers are necessary.