1. Background
The World Health Organization (WHO) has identified COVID-19 as the most significant global health crisis (1), leading to nurses frequently working overtime due to staffing shortages. This situation often results in the cancellation of much of their free time (2), which can make them more susceptible to illnesses and impact their clinical decision-making abilities (3).
Social capital involves the norms, networks, and trust that allow groups to achieve goals that their members cannot accomplish individually (4). The demanding work shifts can eliminate opportunities for nurses to engage in activities that help them manage stress in healthy ways (5). As a result, they may exhibit aggressive behaviors. Understanding the relationship between social capital and psychological variables is essential in strengthening the nursing team.
2. Objectives
The study aimed to assess the relationship between social capital and psychological symptoms among nurses caring for COVID-19 patients in two hospitals in southwestern Iran.
3. Methods
In this descriptive-analytical study, the sample size was calculated to be at least 180 individuals, ultimately completed by 207 nurses working at Imam Ali Andimeshk and Khatam al-Anbia hospitals in Shoushtar, accounting for a 15% dropout rate. The sampling method employed was systematic. The demographic questionnaire and subsequent electronic questionnaires were utilized (date range: 2021-10-02 to 2022-01-04). This study received an ethical approval code (IR.SHOUSHTAR.REC.1400.004) from the Ethics Committee of Shoushtar Faculty of Medical Sciences. To maintain confidentiality, there was no requirement to enter the completers' first and last names. Completing the questionnaire implied consent to participate in the study. Inclusion criteria included not having a mental illness and having worked in a hospital for at least 6 months prior to the coronavirus outbreak. Exclusion criteria included the use of psychoactive drugs.
3.1. Onyx and Bullen’s Social Capital Scale
This 31-item questionnaire uses a four-point Likert scale and includes domains such as participation in local communities, social trust, relationships with neighbors, friends, and family, appreciation of life, proactivity in a social context, and acceptance of differences. The total score ranges from 31 to 124, with higher scores indicating greater social capital. Its reliability and validity were confirmed in previous studies (6).
3.2. Corona Disease Anxiety Scale (CDAS)
This 18-item scale (four-point Likert scale) assesses psychological and physical symptoms. The total score ranges from 0 to 54, with higher scores indicating higher levels of COVID-19 anxiety. The reliability of the entire scale was confirmed (α = 0.919) (7).
3.3. Buss Perry Aggression Questionnaire (BPAQ)
This 29-item questionnaire (five-option scale) measures aspects of physical and verbal aggression, anger, and hostility. In Zahedi Rad et al.’s study, Cronbach's alpha was 0.74 for physical aggression, 0.69 for verbal aggression, and 0.67 for anger, 0.72 for hostility, and 0.77 for the entire questionnaire (8).
The obtained data were analyzed using descriptive and inferential statistics in SPSS 22.
4. Results
Among the participants (n = 207), 167 individuals (80.67%) were female. The mean ± SD age of the nurses was 33.6 ± 7.76 years. The numbers of single, married, and divorced individuals were 82, 122, and 3, respectively.
In Table 1, the mean ± SD scores for social capital, anxiety, and aggression among participants were moderate (55.18 ± 16.61), mild (14.08 ± 9.53), and low (47.40 ± 14.45), respectively. The mean total anxiety scores were higher among women than men, while the mean total social capital scores were higher among men.
Table 1.The Mean ± SD of Social Capital, Anxiety, and Aggression by Participant Gender
| Variables | Mean ± SD | |
|---|---|---|
| Female | Male | |
| Total social capital | 52.23 ± 15.11 | 67.52 ± 17.08 |
| Total aggression | 47.31 ± 13.77 | 47.80 ± 17.19 |
| Total COVID-19 Anxiety | 14.55 ± 9.55 | 12.10 ± 9.31 |
In Table 2, a significant relationship was observed between participants' anxiety scores related to COVID-19 and their social capital (P = 0.005), and anger (P = 0.049).
Table 2.The Relationships of Social Capital (and Its Domains) with COVID-19 Anxiety (and Its Symptoms) and Aggression (and Its Components)
| Variables | Beta | Adjusted R2 | Sig. |
|---|---|---|---|
| Relationships of social capital and its domains with anxiety | |||
| Appreciation of life | -0.048 | 0.038 | 0.003 |
| Social trust | -0.07 | 0.062 | 0.001 |
| Relationships with neighbours | -0.091 | 0.003 | 0.19 |
| Relationships with friends and family | -0.043 | 0.017 | 0.03 |
| Participation in local communities | -0.038 | -0.003 | 0.49 |
| Proactivity in a social context | -0.095 | 0.061 | 0.001 |
| Acceptance of differences | -0.040 | -0.002 | 0.08 |
| Social capital | -0.195 | 0.038 | 0.005 |
| Relationship between social capital and COVID 19 anxiety domains | |||
| Physical symptoms | -0.075 | 0.001 | 0.28 |
| Psychological symptoms | -0.68 | 0.058 | 0.001 |
| Relationships of social capital with aggression and its components | |||
| Physical | -0.055 | -0.002 | 0.42 |
| Hostility | -0.10 | 0.006 | 0.14 |
| Anger | -0.13 | 0.014 | 0.049 |
| Verbal | -0.098 | 0.005 | 0.16 |
| Total aggression | -0.11 | 0.009 | 0.097 |
5. Discussion
Men exhibited higher levels of social capital compared to women. The rate of local participation for men was 12.20 ± 6.94, whereas for women it was 7.31 ± 6.04. This discrepancy might be attributed to different roles and limitations faced by women and men in society. Men also displayed higher levels of social trust (8.12 ± 2.94) compared to women (5.78 ± 2.49). A possible reason for the declining trust among women could be their lower participation in local communities, which may be further exacerbated by the fear of contracting COVID-19. Additionally, the vulnerabilities women face in today's society might contribute to their decreased social trust (9). Married nurses showed the lowest levels of social capital (53.29 ± 16.39) and the highest scores of COVID-19 anxiety (15.86 ± 9.88), aligning with Jafari et al.'s findings (P < 0.05) (10). Haghbin et al. found higher levels of anxiety among married and divorced women compared to single women (11). Difficulty in controlling the disease provokes anxiety, and high levels of anxiety can lead to social rejection. In the present study, social capital was inversely associated with COVID-19 anxiety, which was not consistent with the study by Chang et al. (12). This discrepancy may be due to age and cultural differences.
Considering the ambiguous nature of the relationship between social capital and aggression, studies have yielded conflicting results (13). Social capital was only related to anger (a component of aggression). This may be due to the small sample size. Nurses may suppress their anger due to fear of dismissal and inadequate support.
5.1. Conclusions
Officials should strive to strengthen the nursing team by providing conditions for nurses to engage in various social situations and developing social trust and anger management skills.
