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      Resilience, Social Support, Loneliness and Quality of Life during COVID-19 Pandemic: A Structural Equation Model

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          Abstract

          Aim

          To determine the parsimonious model of the interrelationships of personal resilience, social support, loneliness and quality of life (QoL) and to identify the mediating effect of loneliness among nursing students amidst the pandemic.

          Background

          The coronavirus 2019 (COVID-19) pandemic led to control measures which increased loneliness among students due to disrupted social connections and sudden shift to virtual learning. During these changes, resilience and social support can significantly influence how learners deal with pandemic-related stresses thus, minimizing loneliness and enhancing QoL. Although studies posited the influence of resilience and social support with loneliness and QoL, these were conducted prior the COVID-19 pandemic wherein loneliness and feelings of isolation play a crucial part.

          Design

          Correlational, theory testing using covariance-based structural equation modelling

          Methods

          A total of 550 nursing students from a comprehensive university in Manila, Philippines were recruited from September to October 2021 and answered four standardized, validated scales.

          Results

          A good and parsimonious model (x 2/df=2.84, RMSEA=0.058, GFI=0.999, CFI=0.999, PNFI=0.048) highlighted the mediating effect of loneliness between social support, personal resilience and QoL. While personal resilience positively influenced the physical and psychological domains of QoL, social support positively affected the social relationships and environmental domains. Loneliness was a strong, negative predictor of the psychological and social domains of QoL and had a moderate, negative effect on the physical domain. Personal resilience also mediated the influence of social support on loneliness and QoL.

          Conclusion

          Social support and personal resilience positively affected QoL, while loneliness had a negative effect. Through the mediation of loneliness, the effects of social support on QoL decreases. However, the mediation of resilience further decreases loneliness and improves QoL. The presented model assists nurse educators and administrators in developing strategies to enhance social support, resilience and QoL among students while mitigating the negative effects loneliness during the pandemic.

          Tweetable abstract

          Loneliness and Resilience are mediators of student nurses’ quality of life during COVID-19 pandemic. Social support is the common predictor.

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          Most cited references57

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          The brief resilience scale: assessing the ability to bounce back.

          Bruce W. Smith, Jeanne Dalen, Kathryn J Wiggins … (2008)
          While resilience has been defined as resistance to illness, adaptation, and thriving, the ability to bounce back or recover from stress is closest to its original meaning. Previous resilience measures assess resources that may promote resilience rather than recovery, resistance, adaptation, or thriving. To test a new brief resilience scale. The brief resilience scale (BRS) was created to assess the ability to bounce back or recover from stress. Its psychometric characteristics were examined in four samples, including two student samples and samples with cardiac and chronic pain patients. The BRS was reliable and measured as a unitary construct. It was predictably related to personal characteristics, social relations, coping, and health in all samples. It was negatively related to anxiety, depression, negative affect, and physical symptoms when other resilience measures and optimism, social support, and Type D personality (high negative affect and high social inhibition) were controlled. There were large differences in BRS scores between cardiac patients with and without Type D and women with and without fibromyalgia. The BRS is a reliable means of assessing resilience as the ability to bounce back or recover from stress and may provide unique and important information about people coping with health-related stressors.
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            Rapid Systematic Review: The Impact of Social Isolation and Loneliness on the Mental Health of Children and Adolescents in the Context of COVID-19

            Maria Loades, Eleanor Chatburn, Nina Higson-Sweeney … (2020)
            Objective Disease containment of COVID-19 has necessitated widespread social isolation. We aimed to establish what is known about how loneliness and disease containment measures impact on the mental health in children and adolescents. Method For this rapid review, we searched MEDLINE, PSYCHINFO, and Web of Science for articles published between 01/01/1946 and 03/29/2020. 20% of articles were double screened using pre-defined criteria and 20% of data was double extracted for quality assurance. Results 83 articles (80 studies) met inclusion criteria. Of these, 63 studies reported on the impact of social isolation and loneliness on the mental health of previously healthy children and adolescents (n=51,576; mean age 15.3) 61 studies were observational; 18 were longitudinal and 43 cross sectional studies assessing self-reported loneliness in healthy children and adolescents. One of these studies was a retrospective investigation after a pandemic. Two studies evaluated interventions. Studies had a high risk of bias although longitudinal studies were of better methodological quality. Social isolation and loneliness increased the risk of depression, and possibly anxiety at the time loneliness was measured and between 0.25 to 9 years later. Duration of loneliness was more strongly correlated with mental health symptoms than intensity of loneliness. Conclusion Children and adolescents are probably more likely to experience high rates of depression and probably anxiety during and after enforced isolation ends. This may increase as enforced isolation continues. Clinical services should offer preventative support and early intervention where possible and be prepared for an increase in mental health problems.
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              Loneliness matters: a theoretical and empirical review of consequences and mechanisms.

              Louise C. Hawkley, John T. Cacioppo (2010)
              As a social species, humans rely on a safe, secure social surround to survive and thrive. Perceptions of social isolation, or loneliness, increase vigilance for threat and heighten feelings of vulnerability while also raising the desire to reconnect. Implicit hypervigilance for social threat alters psychological processes that influence physiological functioning, diminish sleep quality, and increase morbidity and mortality. The purpose of this paper is to review the features and consequences of loneliness within a comprehensive theoretical framework that informs interventions to reduce loneliness. We review physical and mental health consequences of loneliness, mechanisms for its effects, and effectiveness of extant interventions. Features of a loneliness regulatory loop are employed to explain cognitive, behavioral, and physiological consequences of loneliness and to discuss interventions to reduce loneliness. Loneliness is not simply being alone. Interventions to reduce loneliness and its health consequences may need to take into account its attentional, confirmatory, and memorial biases as well as its social and behavioral effects.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Nurse Educ Pract
                Journal ID (iso-abbrev): Nurse Educ Pract
                Title: Nurse Education in Practice
                Publisher: Elsevier Ltd.
                ISSN (Print): 1471-5953
                ISSN (Electronic): 1873-5223
                Publication date PMC-release: 21 July 2022
                Publication date (Electronic): 21 July 2022
                Electronic Location Identifier: 103419
                Affiliations
                [0005]College of Nursing, University of Santo Tomas, España, Manila, Philippines 1015
                Author notes
                [* ]Correspondence to: University of Santo Tomas, España, Manila, Philippines 1015.
                [1]

                Twitter @nursixgroup5

                [2]

                Twitter @surGEEEEry

                Article
                Publisher Item ID: S1471-5953(22)00133-0 Publisher ID: 103419
                DOI: 10.1016/j.nepr.2022.103419
                PMC ID: 9301165
                PubMed ID: 35952471
                SO-VID: 1a0f1ef7-7357-40f5-9161-6429991bc004
                Copyright © © 2022 Elsevier Ltd. All rights reserved.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                Date received : 3 February 2022
                Date revision received : 28 June 2022
                Date accepted : 18 July 2022
                Categories
                Subject: Article

                Keywords: covid-19 pandemic,loneliness,nursing students,personal resilience,quality of life (qol),social support,structural equation modelling (sem)
                Data availability:
                Keywords: covid-19 pandemic, loneliness, nursing students, personal resilience, quality of life (qol), social support, structural equation modelling (sem)

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