key: cord-0900931-jgwx6ezh authors: Padmanabhanunni, Anita; Pretorius, Tyrone B.; Stiegler, Nancy; Bouchard, Jean-Pierre title: A Serial Model of the Interrelationship Between Perceived Vulnerability to Disease, Fear of COVID-19, and Psychological Distress Among Teachers in South Africa date: 2021-11-30 journal: Ann Med Psychol (Paris) DOI: 10.1016/j.amp.2021.11.007 sha: a9dea75fcf0a789bf658448efc37cf88ae314ed3 doc_id: 900931 cord_uid: jgwx6ezh The current study examined the serial relationship between perceived vulnerability to disease, fear of COVID-19, anxiety, and psychological distress among schoolteachers. Participants were South African school teachers (N = 355) who completed the Perceived Vulnerability to Disease Questionnaire, Fear of COVID-19 Scale, trait scale of the State-Trait Anxiety Inventory, Beck Hopelessness Scale, and the Centre for Epidemiological Depression Scale. A path analysis confirmed that teachers who appraised themselves as more susceptible to disease experienced heightened levels of fear of COVID-19, which led to heightened levels of anxiety, depression, and hopelessness. Specifically, germ aversion and perceived infectability were separately associated with heightened fear of COVID-19, which in turn was associated with heightened anxiety. This serial relationship was associated with heightened levels of hopelessness and depression. The current study extends research on the impact of the COVID-19 pandemic among a distinct subgroup of the population. The COVID-19 pandemic impacted educational institutions globally and led to many countries instituting school closures to reduce transmission of the virus [38] . The closure of schools precipitated an unplanned and unprecedented transition from traditional classroom teaching to emergency remote teaching and changed the work of teachers in many ways. Teachers had to rapidly learn to use digital tools, adapt academic content to an online delivery format, and support students and parents in negotiating the transition to remote learning [17] . At the same time, teachers were also having to manage the impact of the pandemic on their own lives, including providing home schooling for their own children and caring for vulnerable family members [19] . These multiple stressors have been associated with heightened levels of psychological distress, including depression and anxiety, among teachers [35] . Numerous psychological and behavioural adaptive or pathological manifestations linked to the fear of Covid-19 have also been observed in the general population, including among health care workers and caregivers in France [3] [4] 9] , Spain [2, 6] and South Africa [37] . Most studies of the impact of COVID-19 on schoolteachers have been conducted in developed contexts, and comparatively fewer studies have emerged from low-to-middleincome countries [16] . In developing countries, access to technological resources is not uniform, and it has been argued that emergency remote teaching has further widened existing socioeconomic disparities [32] . The current study was conducted in South Africa, where school closures were implemented in March 2020 to curb the spread of COVID-19 [33] . Most schools in the country were not equipped for the transition to emergency remote teaching [11] . The few schools able to supplement state funding through private fees transitioned to online learning environments and continued to cover the curriculum during one of the strictest lockdowns globally [8] . For most South African school children, lack of access to digital technology, data, internet connectivity, and spaces conducive to learning was a salient barrier to education [11] .In essence, the pandemic exacerbated existing socioeconomic disparities [36] in access to education, which prompted the South African government to reopen schools. In August 2020, a phased reopening of schools was implemented, which featured a rotational teaching system in which specific groups of learners attended school on alternate weeks [33] . Conventional J o u r n a l P r e -p r o o f [30] . Media reports at the time of reopening suggested that teachers were experiencing heightened levels of fear and anxiety [20] . These fears were likely related to concerns about teacher safetyincluding access to personal protective equipment, sanitisation of classrooms, access to running water, and social distancingin the context of overcrowded classrooms [8] . The current study investigated the interrelationship between perceived vulnerability to disease, fear of COVID-19, and psychological distress among a sample of South African school teachers. It is proposed that individuals who perceive themselves to be at risk of contracting disease would experience heightened levels of fear of COVID-19, which in turn would lead to heightened anxiety and higher levels of psychological distress. The following hypotheses are postulated: Germ aversion, as a component of perceived vulnerability to disease, will be associated with heightened fear of COVID-19, which in turn will be associated with heightened anxiety. 2) Perceived infectability, as a component of perceived vulnerability to disease, will be associated with heightened fear of COVID-19, which in turn will be associated with heightened anxiety. Germ aversion will be associated with heightened fear of COVID-19, which in turn will be associated with heightened anxiety. The previous serial relationship would result in heightened depression. Perceived infectability will be associated with heightened fear of COVID-19, which in turn will be associated with heightened anxiety. The previous serial relationship would result in heightened depression. Germ aversion will be associated with heightened fear of COVID-19, which in turn will be associated with heightened anxiety. The previous serial relationship would result in heightened hopelessness. Perceived infectability will be associated with heightened fear of COVID-19, which in turn will be associated with heightened anxiety. The previous serial relationship would result in heightened hopelessness. The study used a cross-sectional survey design. A convenience sample of schoolteachers (N = 355) from across South Africa participated in the study. Table 1 contains a description of the sample. Table 1 here Participants completed a demographic survey, as well as the following questionnaires: The CES-D consists of 20 items that measure depression and is scored on a 4-point Likert scale that ranges from 0 (rarely or none of the time) to 4 (most or all the time). Example items of the CES-D include: "I thought my life had been a failure" and "I felt that everything I did was an effort" [27] reported highly satisfactory estimates of internal consistency (.85-.90). Similar satisfactory reliabilities have been reported in more recent studies [22, 31] . [24] used the CES-D scale in South Africa and reported highly satisfactory estimates of reliability (α and ω > .90). An electronic survey consisting of the measuring instruments was developed using Google Forms and distributed to schoolteachers via social media platforms. Some teacher groups requested the electronic link to be sent to them via email. The University's school liaison officer circulated the link to additional school contacts. J o u r n a l P r e -p r o o f The descriptive statistics, reliabilities, and intercorrelations are presented in Table 2 . Table 3 . All direct effects were significant except for perceived infectability and hopelessness Table 3 here The indirect effects are reported in Table 4 . The results indicate that all hypotheses were supported: -Germ aversion was positively associated with fear of COVID-19, which in turn was positively associated with anxiety (β =.027, p =.015). -Perceived infectability was positively associated with fear of COVID-19, which in turn was positively associated with anxiety (β =.079, p<.001). Anxiety is an adaptive response to threat that can prompt adaptive threat-mitigating cognitive appraisals and behaviours aimed at protecting the individual from harm [13] . When risk of contact with a pathogen is high, cognitive appraisals of threat typically prompt avoidant coping strategies (e.g., physical distancing and social isolation). However, the government mandate to resume conventional teaching has rendered the avoidance of threat impossible, which may contribute to heightened anxiety, despondency, and hopelessness among teachers about their inability to protect themselves. Second, the study found that perceived infectability was associated with heightened fear of COVID-19, which in turn was associated with heightened anxiety, depression, and hopelessness. Perceived infectability was also associated with anxiety, which in turn was associated with hopelessness and depression. Perceived infectability refers to appraisals of one's own susceptibility to infectious diseases [12] . Approximately 46% of South African teachers have reported having multiple comorbid conditions, such as diabetes, hypertension, and asthma [21] . For teachers, returning to school environments poses a real threat to their physical safety, and awareness of the severe complications associated with comorbidity may enhance their sense of susceptibility. Profound appraisals of threat have been found to result in excessive fear and have been associated with psychological distress, particularly anxiety and depression [23] . Teachers' difficulties in implementing protective measures and awareness of increased mortality due to comorbidities could lead to a sense of hopelessness about their situation. The study has certain limitations. First, the use of a cross-sectional survey design limits the extent to which causal relationships can be conclusively identified. Future research studies could recruit larger and more diverse samples of teachers, which would be beneficial in confirming the findings of the present study. Second, the internal consistency of the germ aversion subscale was moderate, which could potentially distort the observed correlations between measures of psychological constructs. However, the findings of the study are supported by existing research [16, 35] . The current COVID-19 pandemic is distinctive due to the high transmissibility and infectibility of the virus, as well as severe complications among those with comorbidities. Considering the potentially protracted nature of the pandemic, it is important to examine the psychological responses of specific subgroups of the population that have been differentially impacted by the pandemic. Doing so will allow for a more comprehensive understanding of the pandemic's impact and facilitate targeted psychosocial interventions. The current study extends existing research by highlighting the association of perceived vulnerability to disease to fear of COVID-19 and psychological distress among teachers. COVID-19 scale: Development and initial validation Covid-19, les effets psychopathologiques de la pandémie Covid-19: les dispositifs de soutien psychologique PSYCOVID-19, dispositif de soutien psychologique dans les champs de la santé mentale, du somatique et du médico-social The Beck Hopelessness Scale: Factor structure, validity, and reliability in a non-clinical sample of student nurses in South-western Nigeria Covid-19 en Espagne : l'impact psychologique de la pandémie sur les infirmiers Covid-19: les soignants entre héroïsation et ostracisation The role of age and gender in perceived vulnerability to infectious diseases Rural online learning in the context of COVID 19 in South Africa: Evoking an inclusive education approach Perceived vulnerability to disease: Development and validation of a 15-item self-report instrument State Anxiety and Pathogen Cues Jointly Promote Social Cognitive Responses to Pathogen Threats Anxiety about schools reopening: enhancing the voice of teachers, parents and learners through photovoice Trait emotional intelligence as a mediator of the relationship between self-esteem and university anxiety The Covid-19 epidemic: teachers' responses to school closure in developing countries How teachers experienced the COVID-19 transition to remote instruction Schools return to full-time teaching but the worries about Covid-19 remain Living in fear: The plight of educators with comorbidities Factor structure and measurement invariance of the Chinese version of the Center for Epidemiological Studies Depression (CES-D) scale among undergraduates and clinical patients The loneliness-life satisfaction relationship: The parallel and serial mediating role of hopelessness, depression and ego-resilience among young adults in south africa during covid-19 When coping resources fail: the health-sustaining and moderating role of fortitude in the relationship between COVID-19-related worries and psychological distress Validation de l'Échelle de la Peur de la COVID-19 en Afrique du Sud: trois analyses complémentaires A looming mental health pandemic in the time of COVID-19? Role of fortitude in the interrelationship between loneliness, anxiety, and life satisfaction among young adults The CES-D scale: A self-report depression scale for research in the general population Disrupted learning during COVID-19: The impact of school closures on education outcomes in South Africa Adaptation of the Fear of COVID-19 Scale: Its association with psychological distress and life satisfaction in Turkey Lessons from lockdown: South Africa's education system is just another Covid-19 statistic. The Daily Maverick Reliability Analysis of the Malay version of the Center for Epidemiologic Studies-Depression Scale (CESD) among adolescents in Malaysia The Impact of COVID-19 on a Fragile Education During Covid-19: Disruptions to Educational Opportunity Education System: The Case of Primary and Secondary During a Pandemic, F. M. Reimers Basic Education Gazette for reopening of schools Available:43372gen302.pdf -South African Government Manual for the State-Trait Anxiety Inventory The psychological impact of the COVID-19 pandemic on secondary school teachers South Africa: Challenges and successes of the COVID-19 lockdown Covid-19 en Afrique du Sud : les soignants impliqués School closure and management practices during coronavirus outbreaks including COVID-19: a rapid systematic review