The Influence of Cultural and Psychological Factors on Mental Health Status during COVID-19 in Saudi Arabia

1. INTRODUCTION

COVID-19 can be transmitted to and by humans, as reported by WHO [1]. According to the Saudi health ministry, COVID-19 can spread easily in public places, and public gatherings can raise the infection rate to 10% [2]. Social distancing, curfews, lockdowns, and associated health problems during the ongoing COVID-19 pandemic are all factors that might cause psychological and social impacts on individuals and societies.

Every pandemic is associated with problems in addition to the disease outbreak itself, such as psychological and mental health problems [3]. Research is needed to improve coping strategies in similar situations. Saudi Arabia, like every other part of the world, was affected by the pandemic. However, the Saudi government responded in a timely manner and took several precautionary measures, such as lockdown of workplaces, increasing medical tests, educating the public regarding social distancing, and encouraging scientific research on the virus and its health, social, psychological, and economic effects. In this regard, this study is an attempt to add to the cumulative knowledge that will help manage this pandemic.

Although the issue of COVID-19 is new to the world, research to help understand the various effects of the pandemic is accumulating fast. In China, Wang et al . investigated the psychological impact of COVID-19 on 1210 respondents [4]. More than half of the sample rated the effect of the pandemic as moderate or severe. Furthermore, the psychological impact of COVID-19 was greater for females, and for students who showed higher levels of depression, anxiety, and stress [4].

The COVID-19 pandemic has affected both developed and developing economies, and has resulted in a huge reduction in agricultural, tourism, trade, and industrial activities [5, 6]. In wealthy developed economies, such as most European countries, the pandemic has led to long-term economic consequences, increasing the unemployment rate [6]. Furthermore, the European Commission found an effect on household incomes, employment, and welfare. The economic impact of the pandemic was observed in developing countries not only in multiple industries, such as airline, but also in how these industries manage job insecurity [7].

COVID-19 social isolation magnified social class differences in societies with different isolation situations ranging from isolation in expansive houses to isolation in small houses [8]. In addition to the difficulty of maintaining social distance within poor families, Acciari (2020) discussed the difficulty faced by poorer families in obtaining essential personal protection products, such as gloves, masks, and alcohol gel [8].

A previous study by Qiu et al. examined the relationship between demographic variables, such as gender, level of education, and age, and the psychological impact of the COVID-19 pandemic. The findings showed that almost 35% of their sample experienced psychological distress. Female respondents showed significantly higher psychological distress as well as respondents between 18 and 30 years of age, those above 60, and more highly educated respondents [9-11].

Cao et al. studied the psychological impact of the COVID-19 pandemic on college students in China [12]. The results indicated that less than 1% of the respondents experienced severe anxiety, 2.7% moderate anxiety, and 21.3% mild anxiety. Furthermore, knowing that their relatives had been infected with COVID-19 increased their anxiety [12].

Puyod and Charoensukmongkol investigated the effect of social media crisis communication on change resistance of university employees [10]. The study collected data from 522 employees from three public universities in the Philippines and examined the role of organizational citizenship behavior (OCB) in predicting change resistance. Findings of this study showed that social media crisis communication could strongly lower employees’ resistance to change when OCB is high [10].

Psychological distress associated with a diagnosis of COVID-19 was examined by Cai et al. among 126 survivors in China [13]. Having infected family members was significantly associated with high psychological distress. However, the survivors aged 60 or above experienced less severe stress symptoms and fewer emotional symptoms of depression and anxiety than younger survivors [13].

González-Sanguino et al . investigated the psychological impact of the COVID-19 outbreak in a sample of 3480 Spanish individuals and found that 18.7% of the sample had depressive symptoms, 21.6% had anxiety symptoms, and 15.8% had PTSD symptoms [14]. Furthermore, being female, having previous diagnoses of mental health problems, or having a close relative infected, were associated with higher levels of depression, anxiety, and PTSD symptoms [14].

In Saudi Arabia, there has been less research conducted on the issue than in the other countries discussed above. Alsukah et al . examined the psychological impact of the pandemic on 1272 respondents [15]. Awareness of COVID-19 among the Saudi population was more than 90% and that was reflected in its psychological impact, as 75% of the sample showed a high level of positive psychological responses to the COVID-19 pandemic [15].

Although COVID-19 is a global pandemic, the level of impact is varied, and evidence suggests that cultural and social factors are among the causes of differences in the number of infected cases and the use of non-pharmaceutical technological interventions for pandemic easement [16, 17]. Governments and citizens from different cultures differ in their enactment and degree of compliance with public health measures during pandemics, such as COVID-19. Some countries may make COVID-19 vaccination compulsory, but others would have to make their immunization voluntary. What may work in Saudi Arabia is unlikely to work in the UK. Recent research examined the relationship between national culture and non-pharmaceutical technological interventions during pandemic easement. For example, countries with high collectivism and power distance index scores have used NPTIs to control the COVID-19 pandemic more than countries with low collectivism and power distance index scores [16].

Based on the work of Hofstede, in this study, cultural differences in the individualism-collectivism dimension were assessed [18, 19]. Hofstede derived his theory about cultural dimensions from his project conducted within a multinational corporation in 40 nations with responses from over 70,000 employees. The individualism-collectivism cultural dimension seems to be the most significant difference among cultures [20, 21]. The primary issue addressed by this dimension is the relationships between people. In individualistic societies, the ties between individuals are loose. A person is supposed to take care of his or her own self-interest and maybe the interest of his or her immediate family. In collectivist societies, the ties between individuals are tight. A person is supposed to take care of the interest of his or her ingroup and to have opinions and beliefs that serve the interests of their ingroup. In turn, the ingroup will take care of the individual when he or she needs help [18].

Saudi Arabia is often conceptualized as a collectivistic society [19]. Alharbi examined Saudi participants with respect to measures of individualism/collectivism and power distance and found that Saudi adults described social relationships as vertical, with clear and steep social hierarchies [22]. Furthermore, in comparison to Western European culture, Saudi culture emphasizes social hierarchies and respect for authority. Saudi society’s structure is built on families, as they form the primary source of identity, personality, values, and behaviour development [23]. Moreover, the people of Saudi Arabia have been described as sensitive to criticism, resistant to change, conforming, obedient, and dependent. In Saudi society, social relations are more continuous and involuntary, and life satisfaction is impacted by social norms [24].

Past research has suggested that collectivism, among other cultural factors, is correlated with a lower infection rate [17]. Respect for authority, conformity, and adhering to cooperative norms are all key concepts in collectivist cultures, and this can explain the slower growth of COVID-19 cases in collectivist than in individualistic cultures. Combining research in cross-cultural psychology on social norms with government institutions would give us a clear picture of the variation in how communities respond to collective threat [17].

The first aim of this study was to survey individuals in Saudi Arabia in order to examine the psychological impact of the COVID-19 outbreak. The second goal of this study was to explore the relationship between mental health status and demographic variables, and the psychological impact of COVID-19. Finally, the third goal of this study was to explore the relationship between collectivism and infection rates.

2. METHODS

An online survey was distributed via social media platforms, email, and Whatsapp for a period of one month. Participants were reached by circulating the questionnaire in Whatsapp groups, posting tweets on Twitter, and sending emails. Participants were asked whether they had been diagnosed with COVID-19 and administered a series of questionnaires. Demographic data were also obtained. Psychological impact of the pandemic was measured with the Impact of Event Scale-Revised (IES-R), a 22-item scale that can be applied to the COVID-19 outbreak. Mental health status was assessed with the Depression, Anxiety and Stress Scale (DASS-21), a 21-item scale divided into three sections.

3. RESULTS

4. DISCUSSION

In the current study, we aimed to assess the level of public health in Saudi Arabia to understand factors associated with psychological impact, anxiety, depression, and stress during the COVID-19 outbreak. Furthermore, we aimed to investigate the relationship between mental health status and demographic variables, and the psychological impact of COVID-19. In addition, we aimed to test Gelfand et al.’s assumption that collectivism as a cultural dimension is related to having a lower infection rate [17].

The current study investigated the relationship between demographic variables and mental health status, and the psychological impact of COVID-19. Depression, anxiety, and stress correlated positively with the psychological impact of COVID-19, as expected. In line with previous research [4], participants with a high level of stress, depression and anxiety tended to endorse intrusion, hyperarousal, and avoidance more. In terms of relationships with occupation, health care workers, military personnel, and teachers showed higher level of the psychological impact of COVID-19. In line with previous research [4, 11], there was a higher level of psychological impact of COVID-19 among students. Students tended to endorse intrusion and hyperarousal more than other occupational groups during the COVID-19 pandemic.

The current study investigated the relationship between being diagnosed with COVID-19 and psychological disorders, and the psychological impact of COVID-19. Having been diagnosed with COVID-19 predicted higher psychological impact in the avoidance and intrusion subscales, as expected. These findings are in line with Cai et al ., who also found that participants diagnosed with COVID-19 endorsed avoidance and intrusion more [13]. Furthermore, having been diagnosed with a psychological disorder was associated with a greater psychological impact of COVID-19 in the hyperarousal and intrusion subscales, as expected. These findings are in line with González-Sanguino et al ., whose participants diagnosed with psychological disorders tended to endorse hyperarousal and intrusion more [14].

Another goal of this study was to measure the number of COVID-19 cases. The findings showed that percentage infected with COVID-19 within the study sample was less than 5%. According to Gelfand and colleagues, collectivism as a cultural dimension is related to having a lower infection rate [17]. The findings closely replicated previously found cross-cultural differences in relation to number of COVID-19 infected cases. Given that Saudi Arabia is considered a collectivistic culture involving vertical social relationships with clear and steep social hierarchies and respect towards authorities, it is not surprising that the percentage of participants who reported having been infected with COVID-19 in this study was very small.

LIMITATIONS AND CONCLUSION

The findings of this study significantly contribute to our knowledge in the field of general health, especially mental health. First, the relationship between demographic variables and mental health status, and the psychological impact of COVID-19, were examined. Our findings show that depression, anxiety, and stress correlate to the psychological impact of COVID-19. Moreover, students on average experience a higher level of psychological impact of COVID-19 than other occupational groups. In addition, we showed that having been diagnosed with a psychological disorder or COVID-19 predicted higher psychological impact of COVID-19. Second, this study provides support for the existence of cultural differences in the infection of COVID-19, in which collectivism as a cultural dimension is related to lower number of infected cases. The results showed the percentage of infected cases with COVID-19 within the study sample to be less than 5%, supporting previously found cultural differences in relation to number of COVID-19 infected cases by Gelfand et al . [17].

The COVID-19 pandemic has alarming implications for the mental health of society. In any society experiencing a pandemic, providing not only medical care but also psychological support for individuals is essential. It is recommended based on the findings of this paper that the mental health of university students should be observed and assessed during epidemics. Training regarding mental health should be provided to university faculty and staff.

There are several limitations associated with the current findings. First, this study relied only on self-reported data, which can be subject to social desirability. A possible area of future research would be to investigate this relationship by combining self-report measures and accurate hospital diagnoses to avoid social desirability bias. Second, lack of prior studies on mental health during the COVID-19 pandemic in the Middle East region might influence the base of our literature review, as most of the included studies were outside the Middle East. Lack of prior cross-cultural studies on COVID-19 might make it hard to make assumptions regarding the relationship between collectivism as a cultural dimension and infection rates. More cross-cultural studies are needed on this topic to better assess the relationship between cultural differences and infectious disease incidence.

REFERENCES