key: cord-0845674-9c5inhau
authors: Karadag, Mehmet; Demir, Bahadir
title: The impact of impulsivity and school attendance on COVID‐19 spread: A web‐based cross‐sectional questionnaire
date: 2022-04-18
journal: Psychol Sch
DOI: 10.1002/pits.22700
sha: eef896b51b613650660df081e76aaa699702af73
doc_id: 845674
cord_uid: 9c5inhau

Some personal and social decisions can be influential in the spread of COVID‐19. There are no studies examining school attendance, impulsivity, COVID‐19 phobia, and psychological resilience together while the effect of some individual and social measures on COVID‐19 has been frequently investigated. In this study 360 participants were evaluated through an online questionnaire method during the peak of the COVID‐19 pandemic. Sociodemographic data form prepared by the researchers, COVID‐19 Phobia Scale, Barratt Impulsivity Scale, and Brief Resilience Scale were used in the study. In all, 20.6% (n = 74) of participants had previously experienced COVID‐19. The rate of individuals who experienced the death of any of their relatives due to COVID‐19 was 17.8%. Only 65.8% of respondents fully complied with government‐implemented measures for the outbreak. School attendance (OR = 1.983, p = .033) and impulsivity (OR = 1.115, p < .001) were found to be positively correlated with COVID‐19. The presence of a significantly higher psychiatric disease admission history in patients with COVID‐19 in binary comparisons did not reach the level of significance in regression analysis. Our results suggest that high school attendance and impulsivity scores are positively correlated with COVID‐19 in young people. Government strategies related to schools need to be carefully reviewed for this reason.

impulsivity and high compulsivity may engage in specific behaviors on a regular basis under lockdown, but they may be able to inhibit these newly acquired routine behaviors if they become maladaptive. When these features are coupled, however, an individual may engage in typical coping activities (owing to compulsive tendencies) and find it difficult to stop them if they become maladaptive (due to the impaired response inhibition that characterizes impulsivity). As a result, those who are both high compulsive and impulsive may be at a higher risk of developing long-term, maladaptive coping habits during the present pandemic (Albertella et al., 2021) . Moreover, it is known that comorbidity of psychiatric diseases and Internet addiction is common (R. C. Ho et al., 2014) . For this reason, special attention should be paid to Internet addiction in people with high impulsivity. Some studies found that low levels of resilience are related to high levels of impulsivity (Choi et al., 2015) . For this reason, it is important to evaluate impulsivity and resilience together. However, the literature has been found to be insufficient in this regard.

Psychological resilience means that the individual facing difficulties adapts positively to them and has a high level of coping skills (Luthar & Cicchetti, 2000) . It was observed in a study conducted in the first weeks of the COVID-19 outbreak that the psychological resilience of individuals was lower compared with normal conditions (Killgore et al., 2020) .

The continuation of the COVID-19 outbreak, uncertainty of patient outcomes, practices such as physical and social isolation to protect the health of the public, and news on written, visual, and social media covering the number of individuals infected with COVID-19 and the deaths caused by it have caused COVID-19-related phobia in many people around the world (Guan et al., 2020; Huang & Zhao, 2020) . Research has found that lockdown, quarantine, and social isolation increase psychological symptoms, such as depression, anxiety, phobia, trauma, and so forth (X. T. T. Le, Dang, et al., 2020; Tran et al., 2020) .

The COVID-19 pandemic is still having an effect on society, especially in schooling. While many countries interrupted face-to-face education during the peak periods of the epidemic, they switched to face-to-face education with the decrease in the number of cases. The prolonged lockdown has a number of negative effects on mental health, particularly for second-survey respondents aged 12-21.4 years, who showed a greater psychological impact of COVID-19. This age group was primarily made up of pupils who had been affected by protracted school closures, necessitating online education help as well as concern about tests and matriculation arrangements (Wang, Pan, Wan, Tan, Xu, McIntyre, et al., 2020) . While government precautions such as high standards of hygiene (e.g., through regular hand sanitizing, deep cleaning, and avoiding pupils sharing equipment) and splitting classes into smaller groups are taken, students were also expected to comply with the physical distance and mask rules during the periods when the school is open. In addition to all these, it is thought that students with high impulsivity have difficulty in obeying these rules (Harazni & Alkaissi, 2016) .

This study first aims to determine whether impulsivity, psychological resilience, and COVID-19 phobia scores affect the risk of COVID-19 in the Turkish sample. In addition, the effect of school attendance on being infected is other purpose of the study. Past studies examined often belong to the early stages of the COVID-19 outbreak and the number of studies with such a high rate of infected people is very limited. We think that our study evaluates more than one parameter (impulsivity, resilience, COVID-19 phobia, and school attendance) and that it was carried out at a time when the epidemic peaked will contribute to the literature. Immediately after clicking on the electronic link, participants confirmed their participation in the current study from the first page of the questionnaire displayed and redirected to the questionnaire, and completed the study.

Participants filled in the sociodemographic data form prepared by the researchers, COVID-19 Phobia Scale, Barratt Impulsivity Scale, and the Brief Resilience Scale (BRS). In all, 360 young people aged 16-24 years participated in the study, which was conducted between November 2020 and January 2021.

This form was prepared by the researchers based on the information obtained from the literature. The form included questions about gender, age, and educational status, whether they went to school, whether they had a psychiatric disease previously determined by a mental health specialist, their attitudes towards COVID-19, and whether they had COVID-19.

COVID-19 Phobia Scale consists of five-point Likert-type questions and validity reliability was tested with 1243 participants. The questions in the scale are as follows: 1, Strongly Disagree; 2, Disagree; 3, Undecided; 4, Agree; 5, Strongly Agree. Exploratory and confirmatory factor analyses revealed the final version of the COVID-19 Phobia Scale, consisting of four subscales consisting of 22 items, namely, worry, mood, reassurance seeking/prevention, and avoidance. The internal consistency of the COVID-19 Phobia Scale measured by Cronbach's α coefficient was 0.84 (Dilbaz et al., 2020) .

It is a scale filled by the patient used to evaluate impulsivity (Patton et al., 1995) . It consists of 30 items and has three subscales: attentional or cognitive impulsivity, motor impulsivity, and nonplanning impulsivity. Carelessness is defined as rapid decision-making, motor impulsivity; taking action without thinking, not making plans; being focused on that moment or not thinking about the future. Four different subscores are obtained when evaluating BIS-11: total, nonplanning, attention, and motor impulsivity scores. The higher the total BIS-11 score, the higher the level of impulsivity of the patient. The Turkish validity and reliability study of BIS-11 was conducted by Güleç et al. (2008) .

Cronbach's αs for internal consistency were 0.78 (students) and 0.81 (patients), and 2-month test-retest reliability was 0.83 (students).

BRS was developed to enable people to understand themselves, measure their potentials, and resilience. "BRS" was developed by Smith et al. (2010) and was adapted to Turkish by Doğan after the reliability and validity studies of the scale (2015). The scale is five-point Likert-type (5, Completely Suitable; 4, Suitable; 3, Partially Suitable; 2, Not Suitable; 1, Not Suitable at All) and consists of six items and one scale. Three negative items (i2, i4, and i6) are reverse coded in the scale. The lowest 6 and the highest 30 scores can be obtained from the scale. High score indicates high psychological resilience. Cronbach's α coefficient is 0.79. Corrected item correlation coefficients of the scale items range from 0.45 to 0.63 (Doğan, 2015; Smith et al., 2010) .

IBM SPSS Statistics 25 package software was used to analyze the data. Variables were investigated using Kolmogorov-Smirnov or Shapiro-Wilk test to determine whether they were normally distributed. Descriptive statistics were given mean and standard deviation or median and min-max values for continuous data, number, and percentage values for qualitative data. Independent groups t test was used for normal distribution for continuous data and Mann-Whitney U test was used for nonnormally distributed variables in group comparisons (without COVID-19 experience vs with COVID-19 experience, and no COVID-19 deaths vs COVID-19 deaths). χ 2 test or Fisher's exact test was used when appropriate to examine differences in categorical data. Logistic regression analysis was used to calculate the risk of COVID-19 infection. Statistical significance level was considered p < .05.

The mean age of the young people participating in the study was 18.8 years (±2.4) and their gender was 69.4% (n = 250). In all, 54.4% of respondents (n = 196) were not currently attending any school due to COVID-19 related shutdowns. In addition, 11.7% (n = 42) had previously applied to the psychiatry department for any reason. It was learned that anxiety disorders were the most common diagnosis in these admissions (21.5%). The most commonly used drug therapy was Selective Serotonin Reuptake Inhibitors (5.6%). Frequency distributions and percentages of participants' sociodemographic properties are presented in Table 1 .

Results of variables related to the COVID-19 outbreak are presented in Table 2 . Young people followed the information about the outbreak most frequently on television (36.1%), second on social media (34.2%), and third on the Internet (28.3%). Only 1.4% of respondents did not follow the COVID-19 news. In all, 65.8% fully complied with government-implemented measures for the COVID-19 outbreak whereas 34.2% reported partially compliant. Furthermore, 20.6% (n = 74) of participants had previously experienced a COVID-19 infection. The proportion of their relatives diagnosed with COVID-19 increased to 68.9%. The rate of individuals who experienced the death of any of their relatives due to COVID-19 was 17.8%. There was no significant difference in Barratt Impulsivity Scale scores between groups that fully or partially complied with COVID-19 measures (p = .555) whereas there was a difference in COVID-19 Phobia Scale (p = .032). Those with higher COVID-19 phobia were more in line with the measures, as expected.

The applied scale results are presented in Table 3 . The mean COVID-19 Phobia Scale of the participants was 77.8 ± 17, the mean Barratt Impulsivity Scale was 66.7 ± 7.5, and the BRS was 18.1 ± 2.6. The comparison between young people with and without COVID-19 revealed a statistically significant difference in Barratt Impulsivity Scale means (p < 0.001), the presence of a previous psychiatric history (p = 0.010), and the presence of impulsivity (p < 0.001). Those who had COVID-19 infection consisted of individuals with a more impulsivity and previous history of psychiatric illness according to these results.

There was a statistically significant difference in COVID-19 Phobia Scale (p = 0.017), Barratt Impulsivity Scale (p = 0.046), and history of previous psychiatric admission (p = 0.005) in statistical analyses comparing participants whose relatives died and did not die due to COVID-19 infection. COVID-19 phobia was higher in individuals whose relatives died due to COVID-19, as well as impulsivity and previous history of psychiatric illness according to these results. However, It was also found that impulsivity decreased relatively in individuals who witnessed the death of a relative when the Barratt Impulsivity Scale averages and statistical significance rates were examined. Results of young people whose relatives died due to COVID-19 and did not die are presented in Table 4 .

Regression analysis examining the relationship between COVID-19 infection and sociodemographic data and measurement tools included age, gender, young people's school attendance, previous psychiatric admission, partial or complete compliance with COVID-19 measures, impulsivity, COVID-19 phobia, and psychological resilience scores. School attendance (OR = 1.983, p = .033) and impulsivity (OR = 1.115, p < .001) were found to be positively correlated with COVID-19 as a result of the analysis conducted. The presence of a significantly higher psychiatric disease admission history in patients with COVID-19 in previous analyses did not reach the level of significance in regression analysis. The relationship between COVID-19 infection and sociodemographic and measurement tools is presented in Table 5 . 

We found that the rate of COVID-19 infection is positively correlated with impulsivity and school attendance. It was reported in a modeling study conducted in 11 European countries that general quarantine reduced the transmission rate of COVID-19 infection by 81% (Flaxman et al., 2020) . These results support the results of our study. It was seen in our study that school attendance increased the risk of COVID-19 approximately twofold.

Schools are closed and transition to online education is made in cases where there is a general quarantine practice.

This reduces the number of people outside the home and prevents time spent in environments where it is difficult to comply with physical distance rules, such as classrooms. It has been documented by many studies that schoolaged individuals play an important role in the spread of infection even though it is known that they are less affected by COVID-19 (Hyde, 2020; Vermund & Pitzer, 2020) . It has been reported that the transition of schools to online education reduces the spread rate of COVID-19 infection, as well as causing disruptions in education (Sikali, 2020) .

For this reason, decision makers should be sensitive when making decisions about schools.

Impulsivity has been reported to be negatively associated with the potential use of contact tracking application in a recent study conducted in France (Guillon & Kergall, 2020) . This study was also determined that the impulsive group had negative thoughts about the prolongation of quarantine conditions. Similar results were obtained from a study conducted in Turkey. A negative correlation was found between impulsivity and compliance with preventive measures in this study (Alper et al., 2020) . There was no significant difference between the participants who fully or partially complied with COVID-19 measures in terms of impulsivity whereas the positive relationship between COVID-19 and impulsivity may raise a question such as the low awareness of impulsive participants about measures in their self-reports in our study. In the literature, it has been reported that in addition to personality traits, economic and social components also affect compliance with COVID-19 measures (H. T. Le, Lai, et al., 2020) .

The fact that there was no significant difference between impulsivity and compliance with the importance of COVID-19 in our sample group may support that other influencing factors may also play a role. However, since no data were collected from the participants on this subject, it is not possible to give clear results. According to a survey, 66.9% of 341 participants reported a loss of household income as a result of COVID-19's influence. People with undergraduate degrees, those working in industries other than healthcare, and those on a fixed-term contract had a higher chance of losing their jobs . In our study, COVID-19 phobia was found to be high in many individuals. A study was found that adolescents with subthreshold psychiatric/psychological problems and COVID-19-related acute stress disorder and posttraumatic stress disorder symptoms reported the highest levels of personal stress, while adolescents with psychiatric/psychological disorders reported the greatest levels of stress. Prioritizing psychosocial stresses among the adolescent population should be a top priority for health efforts (Mensi et al., 2021) . Individuals who fully complied with COVID-19 measures had higher phobia scores associated with COVID-19 as expected in our study.

High perceived stress associated with COVID-19 and increased fear are positively associated with compliance with measures (Guillon & Kergall, 2020; Jungmann & Witthöft, 2020) . Witnessing or hearing the death of a relative creates significant changes in people's behavior and emotions (Millar et al., 2020) . As a matter of fact, an increase in phobia scores and a decrease in impulsivity scores were observed in our study. COVID-19-related deaths affect the relatives of patients as well as the healthcare staff. Studies have shown that posttraumatic stress symptoms increase and cause emotional and behavioral changes in healthcare professionals who witness the deaths of COVID-19 patients (Mosheva et al., 2021; Portoghese et al., 2021) . Finally, fear of COVID-19 was consistently found to be the primary predictor of beneficial behavior change (e.g., social distancing and enhanced hand cleanliness), with no effect from politically significant variables (Harper et al., 2020) .

COVID-19 phobia, impulsivity, and psychological resilience of individuals were examined and there was no correlation between them in our study. It was also found that psychological resilience scores did not differ between individuals with and without COVID-19. Previous studies demonstrated that fear of COVID-19 can be associated with beliefs, knowledge levels, risk perceptions, and sociodemographic characteristics (Malesza & Kaczmarek, 2021) .

However, the effect of resilience, which is an important component of the individual background, on COVID-19 phobia has rarely been examined. A study conducted in China showed a high prevalence of psychological distress among the general population at the peak of the COVID-19 outbreak, which was negatively correlated with resilience (Ran et al., 2020) . Increased personal endurance and coping skills were associated with lower levels of lockdown fatigue in another study. Another study findings supported the hypothesis that the construct of resilience statistically significantly affects the level of COVID-19 phobia (Lindinger-Sternart et al., 2021) . No results were reached to support these results in our study. This difference suggests that there may be few individuals with psychological problems among the participants in our study, as well as that the results in other studies are not yet definitive and should be supported by further research. The COVID-19 pandemic was found to cause hemodynamic changes in the brain (Olszewska-Guizzo et al., 2021 ). This study mainly used self-reported questionnaires to measure psychiatric symptoms and impulsivity. The gold standard involves functional neuroimaging to assess frontal lobe function that is involved in impulsivity and emotion regulation (C. S. H. Ho, Lim, et al., 2020; .

The main limitations of our study lie in the data used in the analysis. Since the forms are delivered to the participants via social media and mail groups, no comments can be made on the response rates. First, our sample does not represent the entire population of Turkey given our recruitment process. However, our recruitment process may have also led to participants who are more interested in COVID-19 compared with the general population. In addition, the cross-sectional design used in our study makes it difficult to draw conclusions about causal effects. Our regression results may have alternative interpretations in the case of retrospective causality or if unobserved factors affect both our dependent and independent variables. However, we included multiple socioeconomic and demographic characteristics as control variables to limit neglected variable worry.

Provide new information that can help guide future quarantine strategies during infectious disease outbreaks in Turkey despite these limitations. For example, the high risk of COVID-19 among school attendees may lead to a review of decisions on the opening of schools or tightening measures in the school. It can also help develop the idea

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