Mental Health: Global Challenges Journal
https://www.sciendo.com/journal/MHGCJ
ISSN 2612-2138
The Mental Burden of COVID-19 in Pulmonary
Patients: An Investigation of Fear, Anxiety, and
Quality of Life
Maria Saridi 1, Ioanna Dimitriadou 1, Evangelos C. Fradelos 1, Athanasia Christara 2, Ioanna V.
Papathanasiou 3, Kyriakos Souliotis 2, Aikaterini Toska 1
1Laboratory of Clinical Nursing, Department of Nursing, University of Thessaly, Larisa, Greece
2Department of Social & Educational Policy, University of Peloponnese, Corinth, Greece
3Community Nursing Lab, Department of Nursing, University of Thessaly, Larisa, Greece
Abstract
Introduction: The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted
various aspects of life, particularly mental health and quality of life.
Purpose:
This study aims to assess the levels of anxiety and fear experienced during the
coronavirus disease 2019 (COVID-19) pandemic, examine how these factors vary according to
sociodemographic and individual characteristics, and explore their impact on the quality of life
of individuals attending private pulmonology clinics.
Methodology: A descriptive cross-sectional study was conducted with 112 patients who visited a
private pulmonology clinic in Greece during the COVID-19 pandemic. Data were collected via
a questionnaire that included six sections, covering demographics, stigma, fear, quality of life,
coping strategies, and mental health. Statistical analysis was performed via SPSS 25.
Results: The survey revealed high rates of COVID-19-related stigma, especially for foreigners
(50.9%) and health workers (29.5%), with half of the participants believing that people were ill due
to irresponsible behaviour. Fear of COVID-19 appears to be significantly high (m = 15.7), with
gender (women) being among the determinants of the highest levels of fear. Anxiety occurs at
normal levels (m = 5.6), although higher levels of fear have been shown to lead to higher levels
of anxiety. Finally, both fear (p = 0.000) and anxiety (p = 0.003) are negatively correlated with
most dimensions of quality of life.
Conclusions: The present research highlights the stigma created by COVID-19, especially for
specific groups of people. In addition, increased levels of fear and anxiety affect the quality of
life of individuals.
Keywords
Mental Health, anxiety, COVID-19, fear, pandemic, quality of life, stigma
Address for correspondence:
Evangelos C. Fradelos, Department of Nursing,
University of Thessaly. Gaiopolis Campus, Larissa - Trikala Ring Road, 41500, Larissa,
GREECE
Email: efradelos@uth.gr
This work is licensed under a Creative Commons Attribution- 4.0 International License
(CC BY 4.0).
©Copyright: Fradelos et al., 2025
Publisher: Sciendo (De Gruyter)
DOI: https://doi.org/10.56508/mhgcj.v8i1.288
Submitted for publication:03
December 2024
Revised: 09 July 2025
Accepted for publication: 18
July 2025
12
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Introduction
The effects of the COVID-19 pandemic on
social cohesion, the economy, and individual lives
remain incalculable. In addition to infections, the
psychological burden has significantly increased,
as evidenced by heightened levels of generalized
anxiety and persistent fear, which adversely affect
quality of life (Shereen 2020, Taylor 2020).
Numerous studies have linked the COVID-19
outbreak to emotional responses such as
increased anxiety, depression, posttraumatic
stress disorder, psychological distress, and stress,
as well as the prevalence of physical and
psychological symptoms (Chew 2020, Kapteyn
2020). Similar trends were observed during
previous pandemics, such as H1N1, bird flu, Ebola,
and SARS (Secor 2020, Sim 2010). Thus, it is
unsurprising that stress, fear, and anxiety escalate
when deadly diseases spread.
Fear and worry are natural responses in
humans and animals during challenging times.
Fear, however, can also have positive effects.
Recent research has indicated that fear of
contracting COVID-19 is correlated with
adherence to health guidelines (Pakpour 2020).
This aligns with broader findings suggesting that
fear drives safety behaviours such as hand
washing and mask wearing. These negative
emotions can impact quality of life (Harper 2021).
Purpose
This study aims to evaluate anxiety and fear
levels during the COVID-19 pandemic, their
sociodemographic variations, and their effects on
the quality of life of patients visiting private
pulmonology clinics.
Methodology
Study Settings and Participants
A descriptive, cross-sectional study was
conducted from 1st September to 28th February
2021 in a private pulmonology clinic in Greece.
The sample included 112 patients who visited the
clinic during the pandemic. The inclusion criteria
were as follows: (1) aged 18 years or older; (2)
proficiency in Greek and capable of
communication; and (3) consent to participate.
The study's purpose was explained to all
participants, who then signed an informed
consent form.
Assessment instruments
The data for the implementation of the
research were collected via a questionnaire
consisting of 6 separate sections. For each of the
tools used, the relevant permission was obtained
from the manufacturers. The sections of the survey
questionnaire are analysed as follows:
1. Demographic and Occupational
Characteristics Questionnaire:
Sociodemographic (age, residence, marital
status, number of children, education, religion)
and occupational/clinical data (COVID-19
infection, vaccination) were collected.
2. COVID-19 Stigma–Discrimination Toward Health
Workers Scale:
Compared with 18 yes–no questions, this
scale measures stigma and discrimination levels
among health workers due to COVID-19. Each
question individually assesses the severity of
COVID-19-related stigma (Campo-Arias 2021,
Saridi 2022).
3. Fear of COVID-19 Scale Questionnaire:
A self-report tool with 7 items measuring fear
of contracting COVID-19. Participants indicate
agreement on a five-point Likert scale ranging
from 'strongly disagree' to 'strongly agree', with
scores ranging from 1 to 5 per question (Ahorsu
2022, Tsipropoulou 2021).
4. Missoula – VITAS Quality of Life Index 15
(MVQOLI-15):
Quality of life was evaluated across five
domains: symptoms, functionality, interpersonal
relationships, prosperity, and spirituality. It uses a
five-point Likert scale, where lower scores indicate
less desirable states (Byock 1998, Theofilou 2013).
5. Coping Orientations to Problems Experienced
Inventory (COPE), Brief-Cope:
Twenty-eight questions were divided into
problem-focused, emotion-focused, and
avoidance coping categories and were answered
on a four-point Likert scale from 1 (not at all) to 4
(a lot) (Charles 1997, Kapsou 2010).
6. Depression Anxiety Stress Scale-21 (DASS 21):
The scale consists of 21 items grouped into
depression, anxiety, and stress subcategories. The
participants rated each statement on a four-point
Likert scale (0=Not at all true to 3=True most of the
time). Scores are summed for a total negative
emotional state value, with higher scores
indicating higher anxiety and depression levels
(Antony 1998, Lurakos, 2011).
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Statistical analysis
The data were analyzed via IBM SPSS Statistics
Version 25. Descriptive statistics (frequency,
percentage distribution, mean, and standard
deviation) were used, along with inductive
statistical methods to examine variable
correlations. Specifically, the x2 test, Student's t
test, Mann‒Whitney test, Kruskal‒Wallis test,
Pearson correlation, and Spearman correlation
were employed. All tests were conducted with a
significance level of p=0.05, indicating a 5%
probability of error (95% confidence level).
Ethical considerations
The study adhered to the ethical standards of
the Declaration of Helsinki. The participants were
fully informed of the study's purpose, procedures,
risks, and benefits before providing written
informed consent. The research protocol received
approval from the Department of Social and
Educational Policy of the University of
Peloponnese.
Results
Sociodemographic and occupational
characteristics of the sample
The sample included 112 patients from a
private pulmonology clinic during the COVID-19
pandemic. Table 1 shows their sociodemographic
and occupational characteristics: 76.1% were
female (n=83), 23.9% were male (n=26), 52.7%
were aged 40-59, and 40.2% held a university or
technological institute degree. During the
pandemic, 61.2% of the respondents continued
working at their workplace.
Stigma and COVID-19
Key topics included xenophobia, mass
media effects on mental health, individual
responsibility for COVID-19, and perspectives on
healthcare workers. The important characteristics
were sex, age, chronic illness, and COVID-19
infection. Most participants viewed foreigners as
having greater transmission risk and blamed
irresponsible behavior for the illness (50.9% and
49.5%, respectively). Approximately one-third
believed that healthcare workers should avoid
public transport. Gender influenced xenophobia,
with men being more likely to see foreigners as
higher risk (73.1%) and to blame illness for
irresponsibility (61.4%). Age also influenced
xenophobia; those over 40 years of age saw
foreigners as having greater risk (72.7%) and felt
more anxious due to media (40.9%). People with
chronic illnesses were less accepting of
healthcare workers in contact with COVID-19
patients, believing that they should be isolated
(16.7%), as were those who had COVID-19
(33.3%).
The correlations between the questionnaire
items on COVID-19 stigma and the fear scale
scores are shown in Table 2. Half of the stigma-
related items (9 out of 18) correlated with the total
fear scale score, indicating a positive correlation
between greater COVID-19 stigma and fear.
Quality of Life
The calculation of scores in its five individual
dimensions questionnaire is complex. Each
dimension provides information about that
dimension's impact on the patient’s quality of life.
The final score for each dimension reflects its
overall effect on the patient’s quality of life.
Negative dimensions reduce quality of life,
whereas positive dimensions enhance it, and the
score reflects the dimension's impact size, acting
as a weighting factor.
Three dimensions improve quality of life, and
two dimensions reduce it. Specifically, the positive
dimensions, in order of importance, are spirituality
(mean=2.85), well-being (mean=1.04), and
functionality (mean=0.95). Conversely, the
dimensions that reduce quality of life during the
pandemic are interpersonal relationships
(mean=-3.21) and symptoms (mean=-0.47)
(Table 3).
Fear of COVID-19, anxiety, and quality of life
A significant portion of the sample fears
COVID-19 (mean=2.99), feels unsafe
(mean=2.76), and becomes nervous and anxious
when watching related news (mean=2.38).
Factors influencing COVID-19 fear include
gender (higher in women), occupation (private
employees and freelancers), work status during
restrictive measures (higher fear in those
suspended or working normally), chronic disease
presence (higher in those with chronic conditions),
vaccination status (higher fear in the
unvaccinated), trust in the health system (positive
correlation with fear), and beliefs about the
pandemic’s end.
No significant differences were found in the
scales for depression, anxiety, or stress. Stress is
influenced by family situation, area of residence,
chronic illness, regular medication, exercise,
computer and mobile phone use, trust in the
health system, and medical and nursing
personnel.
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Table 1: Sociodemographic characteristics and health conditions of the sample (n=112)
Characteristics
N(%)
Gender:
Male
26 (23.9%)
Female
83 (76.1%)
Age:
19-28
12 (10%)
30-40
34 (30.4%)
41-59
59 (52.7%)
60-70
5 (4.7%)
71 +
2 (1.8%)
Education level:
Elementary/Junior High
16 (14.3%)
High School
42 (37.5%)
University/Technological Institute
45 (40.2%)
Postgraduate
9 (8%)
Work situation:
Unemployed
4 (3.8%)
Private employee
37 (35.2%)
Civil servant
28 (26.7%)
Freelancer
11 (10.5%)
Retired
12 (11.4%)
Other
13 (12.4%)
Work during the period of restrictive measures:
Suspended
13 (12.6%)
Telecommunity
20 (19.4%)
Normally in the workplace
63 (61.2%)
Complete stoppage of work
7 (6.8%)
Chronic illness:
Yes
30 (26.8%)
No
82 (73.2%)
Chronic mental health:
Yes
4 (3.6%)
No
107 (95.5%
Covid-19 Infection:
Yes
15 (13.4%)
No
97 (86.6%)
Covid-19 vaccination
Yes
83(74.1%)
No
29 (25.9%)
The Pearson correlation coefficient was used
to examine the relationships between the fear of
COVID-19, anxiety, and quality of life dimensions,
as shown in Table 4. Fear of COVID-19 is correlated
with all quality-of-life dimensions (except
symptoms) and overall quality of life.
Functionalism has a moderate negative
correlation with fear; less functional individuals
exhibit greater fear. Interpersonal relationships are
moderately positively correlated with fear. Both
well-being and spirituality have moderate
negative correlations with fear; lower levels of well-
being and spirituality correspond to greater fear.
Overall quality of life also has a moderate
negative correlation with fear; lower quality of life
corresponds to greater fear. All these correlations
are bidirectional.
The stress level is correlated with several
quality-of-life dimensions. Specifically, stress level
has a moderately negative relationship with
functionality (-0.352), well-being (-0.248), and
spirituality (-0.330); higher levels of these
dimensions correspond to lower stress levels.
Overall quality of life has a moderate negative
correlation with stress levels (-2.82); better quality of
life corresponds to lower stress. Finally, both fear
(p=0.000) and anxiety (p=0.003) negatively
correlate with most quality-of-life dimensions.
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Table 2. Correlations between evidence of COVID-19 stigma and fear of COVID-19
Evidence from the Covid-19 stigma
Mean fear
score
P
Value
Yes
No
Should people be afraid of those with Covid-19?
18,1
15,1
0,001
When I see news and hear stories about Covid-19 on TV, in the press or on social
media, I feel nervous or anxious.
17,7
14,7
0,000
People who work in health services and meet Covid-19 patients must isolate
themselves from society.
20,1
15,4
0,001
Patients with Covid-19 must be isolated from society.
17,5
14,9
0,002
I am afraid of being infected by the health personnel I meet on public transport,
on the street or even at home.
18,6
15,0
0,000
People with Covid-19 are guilty.
19,7
15,3
0,005
Should people who have recovered from Covid-19 stay away from their
workplaces for a long time.
16,9
15,3
0,029
Health care workers should avoid returning home to avoid infecting their
families.
19,9
15,2
0,000
Health care workers should avoid going out to avoid infecting other populations
20,6
15,3
0,000
Table 3.Basic descriptive measures for the
dimensions of quality of life
Mean
Median
Std deviation
Min
Max
Symptoms
-.4732
-3.0000
8.36333
-12.00
30.00
Functionality
.9554
.0000
6.66764
-9.00
30.00
Interpersonal
relationships
-3.2143
-3.0000
5.39841
-30.00
12.00
Well-being
1.0455
.0000
4.70484
-6.00
15.00
Spirituality
2.8482
2.000
8.98568
-30.00
30.00
Table 4. Pearson’s (r) correlation of fear of COVID-19, anxiety and dimensions of quality of life.
Dimensions of quality of life
Fear
Anxiety
Coefficient
correlation
(Pearson
Correlation)
P Value
Coefficient
correlation
(Pearson
Correlation)
P
Value
Quality of life - Symptoms
-0.094
0,325
-0.160
0,097
Quality of life – Functionality
-0.493
0,000
-0.352
0,000
Quality of life - Interpersonal
relationships
0.374
0,000
0.168
0,081
Quality of life - Well-being
-0.364
0,000
-0.248
0,010
Quality of life - Spirituality
-0.472
0,000
-0.330
0,000
Overall quality of life
-0.458*
0,000
-0.282*
0,003
*Spearman correlation
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Discussion
Interpretation of findings
Diseases that cause pandemics, such as
COVID-19, affect both the medical and mental
health of individuals. During a pandemic, people
may experience anxiety, discrimination, stigma,
fear, guilt, and shame, which affect their mental
state and cause serious problems in their quality of
life. The main purpose of this research was to
investigate the levels of anxiety and fear caused
by the pandemic and their relationships with the
quality of life of people who visit private
pulmonology clinics during the COVID-19
pandemic.
The stigma created by COVID-19 for
individuals and society was investigated, revealing
elevated stigma levels in most of the assessed
situations. The survey revealed a link between high
fear of COVID-19 and increased stigmatization
across multiple questions. The sample perceived
a greater transmission risk from foreigners (OR =
1.49, Std. Dev=0.502), aligning with previous
studies on other epidemics or pandemics (e.g.,
H1N1, bubonic plague, Asian flu, cholera, Ebola,
Zika, HIV, tuberculosis, SARS, MERS), which reported
connections between weight stigma,
discrimination, and virus fear (Fischer 2019).
Consequently, high levels of fear and stigma in
these groups could hinder transmission prevention
practices. These situations indicate that preexisting
stigmas were reinforced and found new spaces to
grow during the COVID-19 pandemic (Turner-Musa
2020).
Healthcare workers in COVID-19 care units
face significant stigma, discrimination, and social
stigmatization, which also extends to their family
and friends as "secondary" or "associative" stigma.
This study highlighted considerable stigma against
health workers, which is strongly correlated with
heightened fear of the disease. The "infodemic,"
or the spread of misinformation about COVID-19,
exacerbates both stigmatization and fear (Hudson
2020). This study revealed a positive association
between misinformation and fear of COVID-19 (OR
= 1.67, Std. Dev=0.472).
The link between fear and stigma underscores
the pandemic's severe public health impact. Fear
can lead to concealment of the disease,
hindering pandemic control activities such as
contact tracing and delaying medical care for
symptomatic individuals (Ornell 2020). A
moderate positive correlation was also noted
between fear, depression, and anxiety, which
aligns with the findings of Ahorsu et al. (2020), who
reported that fear of COVID-19 adversely affects
mental health (Ahorsu 2020). Fear may stem from
catastrophizing, a cognitive error linked to anxiety
and depression, exacerbated by the pandemic's
negative outlook and containment measures. This
negative feedback loop heightens fear and,
consequently, depressive and anxiety symptoms.
However, the impact of the pandemic on this
sample was not significant. The average anxiety
(5.6), depression (8.2), and stress (11.4) levels were
within normal ranges, although 25% exceeded
normal stress limits, with 6.4% experiencing severe
or extremely severe anxiety disorders. This finding is
similar to the prevalence of anxiety disorders
worldwide, which is estimated to be approximately
7.3% (95% CI: 4.8% to 10.9%) before the onset of
the pandemic (Stein 2017).
The sample exhibited high levels of problem-
focused and emotion-focused coping but
moderate levels of avoidant coping. Notably,
problem-focused coping was negatively
correlated with anxiety, whereas avoidant coping
was positively correlated with anxiety. Thus, anxiety
levels are influenced by coping strategies, with
greater anxiety linked to increased use of avoidant
coping, supporting previous findings (Satija 1998).
This research underscores the significant
impact of spirituality on quality of life and well-
being during the COVID-19 pandemic. Well-
being, which affects multiple life sectors, is crucial,
as highlighted by Hodge et al. (2020), who
emphasized considering the complex
intersections of various life aspects during the
pandemic. Functionality also emerged as a
crucial positive factor during this period.
Conversely, interpersonal relationships and
symptoms are factors that diminish quality of life.
COVID-19 has significantly affected social
connections and interpersonal relationship quality.
Strengths and Limitations
The strengths of this study include the
comprehensive approach of combining
validated instruments such as the Fear of COVID-
19 Scale, Depression Anxiety Stress Scale (DASS-
21), and Missoula-VITAS Quality of Life Index
(MVQOLI-15). This allows for nuanced insights into
fear, anxiety, and their effects on quality of life
during the COVID-19 pandemic. Its focus on a
specific patient demographic (those visiting
pulmonology clinics) offers targeted relevance,
whereas the use of descriptive cross-sectional
methodology provides a snapshot of
psychological and social impacts during a critical
period. Statistical rigor with a variety of tests
enhances the reliability of the analysis. Limitations
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are limited by its sample size (112 participants),
which may reduce the generalizability of the
findings. Self-reported measures introduce the
possibility of response bias, and the cross-sectional
design precludes the establishment of causal
relationships. Moreover, the reliance on patients
from private pulmonology clinics might skew
results towards a subset of the population with
better health care access.
Conclusions
Overall, quality of life decreases as fear of
COVID-19 increases across all associated
dimensions. Functionality and spirituality are key
factors in reducing fear, whereas frequent
interpersonal interactions can significantly
increase it.
Funding Statement
The authors declare that this research did not
receive any specific grant from public,
commercial, or not-for-profit funding agencies.
The publication fee was covered by the authors
personally.
Conflict of interest
The authors declare no conflicts of interest.
References
Ahorsu, D. K., Lin, C. Y., Imani, V., Saffari, M.,
Griffiths, M. D., & Pakpour, A. H. (2022). The
Fear of COVID-19 Scale: Development and
initial validation. International Journal of
Mental Health and Addiction, 20(3), 1537–
1545. https://doi.org/10.1007/s11469-020-
00270-8
Antony, M. M., Cox, B. J., Enns, M. W., Bieling, P. J.,
& Swinson, R. P. (1998). Psychometric
properties of the 42-item and 21-item versions
of the Depression Anxiety Stress Scales in
clinical groups and a community sample.
Psychological Assessment, 10(2), 176–181.
https://doi.org/10.1037/1040-3590.10.2.176
Byock, I. R., & Merriman, M. P. (1998). Measuring
quality of life for patients with terminal illness:
The Missoula-VITAS® quality of life index.
Palliative Medicine, 12(4), 231–244.
https://doi.org/10.1191/02692169867023461
8
Campo-Arias, A., Álvarez-Solorza, I., Tirado-
Otálvaro, A. F., & Cassiani-Miranda, C. A.
(2021). Proposal of a scale for COVID-19
stigma-discrimination toward health workers.
Journal of Investigative Medicine, 69(1), 100–
101. https://doi.org/10.1136/jim-2020-001647
Carver, C. S. (1997). You want to measure coping
but your protocol’s too long: Consider the
brief COPE. International Journal of
Behavioral Medicine, 4(1), 92–100.
Chew, N. W. S., Lee, G. K. H., Tan, B. Y. Q., Jing, M.,
Goh, Y., Ngiam, N. J. H., ... Meenakshi, P. V.
(2020). A multinational, multicentre study on
the psychological outcomes and associated
physical symptoms amongst healthcare
workers during COVID-19 outbreak. Brain,
Behavior, and Immunity, 88, 559–565.
https://www.ncbi.nlm.nih.gov/pmc/articles/P
MC7172854/
Fischer, L. S., Mansergh, G., Lynch, J., &
Santibanez, S. (2019). Addressing disease-
related stigma during infectious disease
outbreaks. Disaster Medicine and Public
Health Preparedness, 13(5–6), 989–996.
https://doi.org/10.1017/dmp.2018.157
Harper, C. A., Satchell, L. P., Fido, D., & Latzman,
R. D. (2021). Functional fear predicts public
health compliance in the COVID-19
pandemic. International Journal of Mental
Health and Addiction, 19, 1875–1888.
https://doi.org/10.1007/s11469-020-00281-5
Hodge, J. G., Wetter, S., Carey, E., Pendergrass, E.,
Reeves, C. M., & Reinke, H. (2020). Legal “tug-
of-wars” during the COVID-19 pandemic:
Public health vs. economic prosperity.
Journal of Law, Medicine and Ethics, 48(3),
603–607.
https://doi.org/10.1177/107311052095888
Hudson, J. (2020). Coping with information
overload in the COVID-19 age: A compilation
of trustworthy information sources. Journal of
Geriatric Care and Research, 7(1), 43–46.
https://www.midyorks.nhs.uk/covid-19-
bulletins
Kapteyn, A., Angrisani, M., Bennett, D., de Bruin, W.
B., Darling, J., Gutsche, T., ... Weerman, B.
(2020). Tracking the effect of the COVID-19
pandemic on American households. Survey
Research Methods, 14(2), 179–186.
https://doi.org/10.18148/srm/2020.v14i2.773
7
126
Mental Health: Global Challenges Journal
https://www.sciendo.com/journal/MHGCJ
ISSN 2612-2138
Kapsou, M., Panayiotou, G., Kokkinos, C. M., &
Demetriou, A. G. (2010). Dimensionality of
coping: An empirical contribution to the
construct validation of the Brief COPE with a
Greek-speaking sample. Journal of Health
Psychology, 15(2), 215–229.
https://doi.org/10.1177/1359105309346516
Lyrakos, G. N., Arvaniti, C., Smyrnioti, M., &
Kostopanagiotou, G. (2011). Translation and
validation study of the depression anxiety
stress scale in the Greek general population
and in a psychiatric patient’s sample.
European Psychiatry, 26(S2), 1731.
https://doi.org/10.1016/s0924-
9338(11)73435-6
Ornell, F., Schuch, J. B., Sordi, A. O., & Kessler, F. H.
P. (2020). ‘Pandemic fear’ and COVID-19:
Mental health burden and strategies. Brazilian
Journal of Psychiatry, 42(3), 232–235.
https://doi.org/10.1590/1516-4446-2020-
0008
Pakpour, A. H., & Griffiths, M. D. (2020). The fear of
COVID-19 and its role in preventive
behaviours. Journal of Concurrent Disorders,
2(1). https://doi.org/10.54127/wcic8036
Saridi, M., Latsou, D., Gamvroula, A.,
Antonopoulos, S., Panoutsopoulos, A., Albani,
E., Milionis, C., & Tsolka, A. (2022). Validation
and reliability of a scale for COVID-19 stigma-
discrimination on general population in
Greece. International Journal of Caring
Sciences, 15(2), 1528–1532.
Satija, Y. K., Advani, G. B., & Nathawat, S. S. (1998).
Influence of stressful life events and coping
strategies in depression. Indian Journal of
Psychiatry, 40(2), 165–171.
http://www.ncbi.nlm.nih.gov/pubmed/21494
464
Secor, A., MacAuley, R., Stan, L., Kagone, M.,
Sidikiba, S., Sow, S., ... Sanderson, J. (2020).
Mental health among Ebola survivors in
Liberia, Sierra Leone and Guinea: Results from
a cross-sectional study. BMJ Open, 10(5),
e035217. https://doi.org/10.1136/bmjopen-
2019-035217
Shereen, M. A., Khan, S., Kazmi, A., Bashir, N., &
Siddique, R. (2020). COVID-19 infection:
Origin, transmission, and characteristics of
human coronaviruses. Journal of Advanced
Research, 24, 91–98.
https://doi.org/10.1016/j.jare.2020.03.005
Sim, K., Chan, Y. H., Chong, P. N., Chua, H. C., &
Soon, S. W. (2010). Psychosocial and coping
responses within the community health care
setting towards a national outbreak of an
infectious disease. Journal of Psychosomatic
Research, 68(2), 195–202.
https://doi.org/10.1016/j.jpsychores.2009.04.
004
Stein, D. J., Scott, K. M., De Jonge, P., & Kessler, R.
C. (2017). Epidemiology of anxiety disorders:
From surveys to nosology and back.
Dialogues in Clinical Neuroscience, 19(2),
127–136.
Taylor, S., Landry, C. A., Paluszek, M. M., Fergus, T.
A., McKay, D., & Asmundson, G. J. G. (2020).
Development and initial validation of the
COVID Stress Scales. Journal of Anxiety
Disorders, 72, 102232.
https://doi.org/10.1016/j.janxdis.2020.102232
Theofilou, P., Aroni, A., Ralli, M., Gouzou, M., &
Zyga, S. (2013). Measuring health-related
quality of life in hemodialysis patients:
Psychometric properties of the Missoula-VITAS
Quality of Life Index (MVQOLI-15) in Greece.
Health Psychology Research, 1(2), e17.
https://doi.org/10.4081/hpr.2013.e17
Tsipropoulou, V., Nikopoulou, V. A., Holeva, V.,
Nasika, Z., Diakogiannis, I., Sakka, S., ...
Parlapani, E. (2021). Psychometric Properties
of the Greek Version of FCV-19S. International
Journal of Mental Health and Addiction, 19(6),
2279–2288. https://doi.org/10.1007/s11469-
020-00319-8
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