Integrative Literature Review

Clinical Medicine Insights: Psychiatry Volume 13: 1–5 © The Author(s) 2022 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/11795573211069912

Does fear mediate the neuroticism-psychopathology link for adults living through the COVID-19 pandemic?

Sherman A. Lee1 and Mary C. Jobe2 1Christopher Newport University, Newport News, VA, USA. 2The George Washington University, Washington, DC, USA.

ABSTRACT

BACKGROUND: COVID-19 has globally increased psychological distress. Although research has shown a clear link between neuroticism and psychopathology, pandemic fears—manifesting as fear of death and coronavirus anxiety, have not been examined as mediating factors for explaining this connection during the pandemic.

METHODS: Therefore, to fill this void in the literature, this study examined 259 U.S. MTurk adult workers in May 2020 using an online questionnaire. The study used the Patient Health Questionnaire, the 8-item Big Five Inventory neuroticism subscale, a single-item fear of death measure, and the Coronavirus Anxiety Scale as well as collected demographic information to perform correlational and meditation analyses.

RESULTS: The results showed that both coronavirus anxiety and fear of death partially mediated the relationship between neuroticism and symptoms of depression and generalized anxiety. The results also found that those high in trait neuroticism who were fearful of death or had coronavirus anxiety showed heightened levels of depression and general anxiety.

CONCLUSION: This study’s findings were consistent with previous research and current work on pandemic-related distress. In addition, the results of these findings can help bring to light the connectedness of these psychopathological constructs with fears surrounding the pandemic—which can be useful to both researchers and mental health professionals alike.

KEYWORDS: Neuroticism, COVID-19, fear of death, coronavirus, anxiety, depression

RECEIVED: February 7, 2021. ACCEPTED: December 10, 2021.

TYPE: Original Research

DECLARATION OF CONFLICTING INTERESTS: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

FUNDING: The author(s) received no financial support for the research, authorship, and/or publication of this article.

ETHICAL APPROVAL: All procedures performed in this study were in accordance with the ethical standards of Christopher Newport University’s ethics and IRB approval committee. In addition, the procedures are in accordance with the Declaration of Helsinki or ethical equivalent. In addition, informed consent was obtained from all individual adult participants included in the study.

CORRESPONDING AUTHOR: Mary C. Jobe, The George Washington University, 2125 G Street NW, Washington, DC, 20052, USA. Email: [email protected]

Introduction As the pandemic persists, so does the worsening of people’s

mental health and well-being.1 For example, during the first

months of the pandemic, 24.4% of Americans reported clinical

levels of depression, while 29.8% reported clinical levels of

anxiety.2 One factor that has been found to be strongly associated

with depression and generalized anxiety during the COVID-19

pandemic is neuroticism.3 According to the Five-Factor model,

neuroticism describes a broad dimension of personality concerned

with tendencies to experience negative affect, and disturbed

thoughts and behaviors that accompany emotional distress.4 The

finding that neuroticism is associated with adjustment difficulties

during the COVID-19 pandemic should not be surprising given

that individuals high in this personality trait have long been

known to suffer from a wide-range of mental and physical health

conditions5 as well as psychological distress during previous

pandemics.6,7 However, what is not clear is what the psycho-

logical mechanisms are that explain why individuals high in this

trait are experiencing heightened levels of psychological distress

during this particular global health crisis.

The COVID-19 pandemic has been shrouded by fear and

anxiety with millions of people dead from this highly infectious

disease. Consequently, many people living in this pandemic fear

for their lives and the coronavirus itself, as the virus can lead to

the death and suffering of oneself and their loved ones. Ac-

cordingly, research during this pandemic has shown that both

death anxiety and coronavirus anxiety are both positively cor-

related with depression and generalized anxiety.8,9 Moreover,

past7 and current research3,10 has shown that neuroticism is

strongly tied to pandemic-related fears and psychopathology.

That said, although research has shown a clear link between

neuroticism and psychopathology (i.e., anxiety and depression),

pandemic fears—such as fear of death and coronavirus anxiety,

have not been examined as mediating factors for explaining this

connection during the pandemic. Thus, this study will aim to

address this; we anticipate that fear of death and coronavirus

anxiety will mediate the relationship between neuroticism and

psychopathology in a sample of adults during the COVID-19

pandemic. These causal implications can enlighten the rela-

tionships these constructs hold—helping researchers better

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understand COVID-19’s psychological impacts and possible

avenues for treatment.

Method Participants and procedures

Data from 259 adult MTurk 11

workers in the U.S. who

completed an online survey on May 15 and 16, 2020 were used

in this IRB approved study. The sample consisted of 116

women and 143 men, with a median age of 33.00 years (ranging

from 18 to 65). Most of the participants were White (n = 165;

63.7%), had earned at least a Bachelor’s degree (n = 190; 73.4%),

had not tested positive for COVID-19 (n = 227; 87.6%), and

did not know someone with COVID-19 (n = 147; 56.8%). The

participants provided consent and received payment ($0.50) for

their involvement in this study.

Measures

Background information. Participants were asked to report their

age, gender, race, level of education, diagnosis of COVID-19,

and personal knowledge of someone with COVID-19.

Psychopathology. Symptoms of psychopathology were mea-

sured using the four-item Patient Health Questionnaire-4.12

Participants indicated how frequently they experienced symp-

toms of depression (e.g., feeling down, depressed, or hopeless; α = .80) and generalized anxiety (e.g., feeling nervous, anxious, or on

edge; α = .78) over the last 2 weeks using a 4-point scale. Neuroticism. The generalized tendency to experience negative

emotions was measured using the 8-item neuroticism subscale of

the Big Five Inventory. 13

Participants indicated how much they

agreed or disagreed with descriptions of neuroticism (e.g., I see

myself as someone who worries a lot) using a 4-point scale (α = .81). Fear of Death. Fear of death was measured using a single-item

Fear of Death measure.14 Although a single-item, it has been

found to reliably assess fear of death and moderately be associated

with multi-item death anxiety scales.14 For the item, participants

indicated how much they agreed or disagreed with the statement,

“I am afraid of death” using a 4-point scale. Most of the par-

ticipants reported that they agree a little (28.2%), followed by

neither agree nor disagree (19.7%), strongly agree (18.9%), disagree

a little (17.8%), and strongly disagree (15.4%) to the item.

Coronavirus anxiety. Dysfunctional anxiety over the coro-

navirus was measured using the 5-item Coronavirus Anxiety

Scale.15 Participants indicated how frequently they experienced

physiologically based symptoms of fear and anxiety over the

coronavirus (e.g., I felt dizzy, lightheaded, or faint, when I read or

listened to news about the coronavirus) over the last 2 weeks using

a 4-point scale (α = .94).

Statistical procedures

Statistical analyses were calculated using SPSS version 26.0,

except for the mediation analyses, which were run using AMOS

version 25.0. We tested mediators one at a time to determine

independent effects16 and employed bias-corrected bootstrap

procedures using 2,000 resamples to the models.17 We chose a

bootstrap resampling method because its calculation of confi-

dence intervals is not biased by sample size, effect size, or level of

statistical significance.18

Results Correlations

Zero-order correlations were run to examine the bivariate asso-

ciations between the measures of psychopathology, neuroticism,

and the proposed mediators of fear of death and coronavirus

anxiety (see Table 1). The results revealed that depression was

correlated with neuroticism (r = .64), fear of death (r = .40),

coronavirus anxiety (r = .66), and generalized anxiety (r = .76).

Generalized anxiety was also correlated with neuroticism (r =

.68), fear of death (r = .47), and coronavirus anxiety (r = .62).

Neuroticism was correlated with fear of death (r = .40), and

coronavirus anxiety (r = .42). Fear of death was correlated with

coronavirus anxiety (r = .33), supporting their related but

distinct expressions of pandemic fear. These intercorrelation

patterns support the inclusion of the variables in the mediation

analyses.

Mediation analyses

Four mediation analyses were conducted to examine the sep-

arate influences of proposed mediators on the association be-

tween neuroticism and psychopathology (i.e., depression and

generalized anxiety). The first model tested coronavirus anxi-

ety’s mediating influence on the relationship between neurot-

icism and depression (see Figure 1). The bootstrap results

showed that the standardized indirect (mediated) effect of

neuroticism on depression was significantly different from zero

(P = .001, 95% CI [.15, .27]). Therefore, this model demon-

strated that coronavirus anxiety partially mediated the

neuroticism-depression link (β from .64 to .44) with a stan- dardized indirect effect of .20.

The second model tested coronavirus anxiety’s mediating

influence on the relationship between neuroticism and gener-

alized anxiety (see Figure 2). The bootstrap results showed that

the standardized indirect (mediated) effect of neuroticism on

generalized anxiety was significantly different from zero (P =

.001, 95% CI [.12, .23]). Therefore, this model demonstrated

that coronavirus anxiety partially mediated the neuroticism-

generalized anxiety link (β from .68 to .51) with a standardized indirect effect of .17.

The third model tested death anxiety’s mediating influence

on the relationship between neuroticism and depression (see

Figure 3). The bootstrap results showed that the standardized

indirect (mediated) effect of neuroticism on depression was

significantly different from zero (P = .001, 95% CI [.03, .12]).

Therefore, this model demonstrated that fear of death partially

2 Clinical Medicine Insights: Psychiatry n n

T a b le

1 . D e sc ri p tiv e st a tis tic s a n d ze

ro -o rd e r co

rr e la tio

n s.

M S D

1 2

3 4

5 6

7 8

9 1 0

1 D e p re ss

io n

2 .6 1

1 .9 2

—

2 G e n e ra liz e d

a n xi e ty

2 .4 7

1 .7 7

.7 6 ** *

—

3 N e u ro tic is m

2 3 .3 7

6 .1 5

.6 4 ** *

.6 8 ** *

—

4 F e a r o f d e a th

3 .1 7

1 .3 5

.4 0 ** *

.4 7 ** *

.4 0 ** *

—

5 C o ro n a vi ru s

a n xi e ty

6 .0 4

5 .9 2

.6 6 ** *

.6 2 ** *

.4 2 ** *

.3 3 ** *

—

6 A g e

3 5 .4 6

1 1 .3 0

�. 1 0

�. 1 2

�. 2 1 **

�. 0 9

.0 1

—

7 G e n d e r

.5 5

.5 0

.0 3

�. 0 3

�. 2 1 **

.0 2

.1 4 *

.0 1

—

8 R a ce

.6 4

.4 8

.0 0

.0 5

.0 0

�. 1 2 *

�. 0 5

.1 8 **

�. 0 2

—

9 E d u ca

tio n

.7 3

.4 4

.1 4 *

.2 2 ** *

.0 4

.1 5 *

.2 8 ** *

.0 4

.1 4 *

.0 7

—

1 0

D ia g n o si s

.1 2

.3 3

.2 0 **

.1 9 **

.1 1

.1 0

.3 4 ** *

.0 1

.0 8

�. 0 1

.0 9

—

1 1

K n o w le d g e

.4 3

.5 0

.1 1

.1 4 *

.0 4

.0 8

.2 0 **

�. 1 0

.0 7

�. 0 2

�. 0 2

.2 6 ** *

N o te . N = 2 5 9 ; G e n d e r (0

= m a le ; 1 = fe m a le ); R a ce

(0 = n o n -W

h ite

; 1 = W h ite

); E d u ca

tio n (0

= L e ss

th a n a B a ch

e lo r’ s d e g re e ; 1 = B a ch

e lo r’ s d e g re e a n d h ig h e r) ; D ia g n o si s (0

= n o t d ia g n o se

d w ith

C O V ID -1 9 ; 1 = d ia g n o se

d w ith

C O V ID -1 9 ); K n o w le d g e (0

= d o e s n o t p e rs o n a lly

kn o w

so m e o n e w ith

C O V ID -1 9 ; 1 = p e rs o n a lly

kn o w s so

m e o n e w ith

C O V ID -1 9 ).

*P < .0 5 ; tw o -t a ile d , ** P < .0 1 ; tw o -t a ile d , ** *P

< .0 0 1 ; tw o -t a ile d .

3Lee and Jobe n n

mediated the neuroticism-depression anxiety link (β from .64 to .57) with a standardized indirect effect of .07. The last

model tested fear of death’s mediating influence on the re-

lationship between neuroticism and generalized anxiety (see

Figure 4). The bootstrap results showed that the standardized

indirect (mediated) effect of neuroticism on generalized

anxiety was significantly different from zero (P = .001, 95%

CI [.05, .15]). Therefore, this model demonstrated that fear

of death partially mediated the neuroticism-generalized

anxiety link (β from .68 to .59) with a standardized indi- rect effect of .09.

Discussion Overall, the COVID-19 pandemic has had an impact on mental

health. In addition, past literature has demonstrated that in

general and during pandemic times, neuroticism may play a role

in who may be more likely to experience such psychopathology

(i.e., anxiety and depression).5,19-21 Our study aimed to assess

what other mechanisms may help to explain this neuroticism-

psychopathology relationship—by exploring pandemic fears,

specifically fear of death and coronavirus anxiety. In sum, the

results demonstrated that the potential mediators explained

some of the reason as to why individuals high in trait neu-

roticism experienced elevated psychopathology symptoms

during the COVID-19 crisis. Our findings are consistent with

Nikčević and colleagues’ (2021) predicted model for COVID-19

anxiety as a mediator in the neuroticism-generalized anxiety and

neuroticism-depression relationships; however, the results of their

study did not yield significant findings between these variables.22

Moreover, our study’s findings support past literature and provide

further analysis, for using mediations to explain the fear rela-

tionships, within the pandemic context, between these commonly

associated variables: neuroticism and psychopathology. In addition,

the results demonstrate that those high in trait neuroticism, in

particular, who are fearful of death or have coronavirus anxiety may

also show these heightened levels of depression and general

anxiety. Literature has shown such psychopathology has been

increasing during COVID-1923,24 and that those high in trait

neuroticism are a vulnerable population during pandemics.7,25 This

study synthesizes these relationships, supporting Lee and Crunk

(2020)3 in showing how fears can explain these associations. After

accounting for pandemic specific fears, researchers and mental

health professionals are able to understand the bigger picture as to

why individuals high in trait neuroticism may be especially sus-

ceptible to such psychopathology, using these findings.

There are many possible approaches to treating people with

depression, generalized anxiety, and issues associated with

neuroticism during the COVID-19 pandemic. One method that

has been shown to successfully treat individuals suffering from

psychological distress and high in neuroticism, while considering

pandemic spatial distancing practices, has been the use of

Figure 4. Mediating effect of fear of death on the association between neuroticism and generalized anxiety. Note. Two-sided bias-corrected

bootstrap procedure (95% confidence intervals; 2,000 samples). Above

values reflect standardized regression coefficients. *** P < .001.

Figure 3. Mediating effect of fear of death on the association between neuroticism and depression. Note. Two-sided bias-corrected bootstrap

procedure (95% confidence intervals; 2,000 samples). Above values reflect

standardized regression coefficients. *** P < .001.

Figure 2. Mediating effect of coronavirus anxiety on the association between neuroticism and generalized anxiety. Note. Two-sided bias-corrected

bootstrap procedure (95% confidence intervals; 2,000 samples). Above

values reflect standardized regression coefficients. *** P < .001.

Figure 1. Mediating effect of coronavirus anxiety on the association between neuroticism and depression. Note. Two-sided bias-corrected bootstrap

procedure (95% confidence intervals; 2,000 samples). Above values reflect

standardized regression coefficients. *** P < .001.

4 Clinical Medicine Insights: Psychiatry n n

telehealth. Hedman et al (2014)26 found that using internet-

based cognitive behavior therapy, especially for individuals high

in neuroticism, has shown to be effective in and even lessened

both psychological distress and tendencies of those high in trait

neuroticism. Adopting this method of therapy to address pan-

demic fears and psychopathology for individuals high in trait

neuroticism may be both practical and beneficial, especially as the

pandemic persists and mental health issues rise.

This research has a major limitation worth noting. Specif-

ically, this study was constrained by a relatively small conve-

nience sample. Future research would benefit from a probability

sampling approach that would result in obtaining a large,

representative sample where more sophisticated mediation

analyses that examines both independent and simultaneous

effects could be applied. In addition, fear of death was only

assessed using a single item; further research could examine this

construct using longer measures. Further this research was

conducted using self-report measures, which could be subject to

possible social desirability. Notwithstanding these limitations,

our research reports important data that contribute to our

understanding of the mental health consequences of the pan-

demic. By understanding the causal implications of this study’s

findings, researchers can further explore COVID-19’s psy-

chological effects in relation to psychopathology and pandemic

fears; and mental health professionals can examine the effects of

neuroticism when adopting telehealth therapy and other ef-

fective approaches to help address these fears.(26)

Acknowledgements The authors would like to thank those who participated.

ORCID iD Mary C. Jobe  https://orcid.org/0000-0001-7106-7120

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