Next Article in Journal
Characteristics of the Thermal Environment and its Guidance to Ecological Restoration in a Resource-Based Area in the Loess Area
Next Article in Special Issue
Linguistic Predictors of Psychological Adjustment in Healthcare Workers during the COVID-19 Pandemic
Previous Article in Journal
Distance to Natural Environments, Physical Activity, Sleep, and Body Composition in Women: An Exploratory Analysis
Previous Article in Special Issue
Social Environment and Attitudes toward COVID-19 Anti-Contagious Measures: An Explorative Study from Italy
 
 
Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
Journals
IJERPH
Volume 20
Issue 4
10.3390/ijerph20043649
ijerph-logo
Submit to this Journal Review for this Journal Propose a Special Issue
► Article Menu

Article Menu

share Share announcement Help format_quote Cite question_answer Discuss in SciProfiles thumb_up
...
Endorse textsms
...
Comment
first_page
settings
Order Article Reprints
Font Type:
Arial Georgia Verdana
Font Size:
Aa Aa Aa
Line Spacing:
Column Width:
Background:
Article

Threat Appraisal, Resilience, and Health Behaviors in Recovered COVID-19 Patients: The Serial Mediation of Coping and Meaning-Making

by
Dariusz Krok
1,
Ewa Telka
2,
Małgorzata Szcześniak
3 and
Adam Falewicz
3,*
1
Institute of Psychology, University of Opole, 45-052 Opole, Poland
2
Department of Radiotherapy, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-101 Gliwice, Poland
3
Institute of Psychology, University of Szczecin, 71-017 Szczecin, Poland
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2023, 20(4), 3649; https://doi.org/10.3390/ijerph20043649
Submission received: 30 January 2023 / Revised: 14 February 2023 / Accepted: 16 February 2023 / Published: 18 February 2023
(This article belongs to the Special Issue Changes in Psychic Life and Psychological Treatments during COVID-19 Pandemic)
Browse Figure
Review Reports Versions Notes

Abstract

:
Research indicates that both cognitive appraisal and personal resources can noticeably influence health behaviors, as individuals modify their health convictions and practices on the basis of threat appraisal, personality, and meaning. The aim of the current study was to investigate whether coping strategies and meaning-making can serially mediate the relationship of threat appraisal and resilience with health behaviors in recovered COVID-19 patients. Self-report measures of threat appraisal, resilience, coping, meaning-making, and health behaviors were completed by 266 participants (aged 17 to 78, 51.5% female) who had recovered from COVID-19. The serial mediation analysis showed that the relationship of threat appraisal and resilience with health behaviors was mediated by problem-focused coping, meaning-focused coping, and meaning-making, but not by emotion-focused coping. These results suggest that associations among threat perception, resilience, and health behavior depend to some extent on the interplay of coping and meaning-making, which reveals their unique role in the process of recovery from COVID-19, with potential implications for health interventions.

1. Introduction

The outbreak of the COVID-19 pandemic, caused by the Severe Acute Respiratory Syndrome Coronavirus-2, has led to 6,833,388 deaths and affected more than 755,385,709 people worldwide, as of February 2023 [1]. According to statistics released by the Polish Ministry of Health, within the same period, 118,779 patients died in Poland due to COVID-19, and more than 6,389,572 recovered from this disease [2].
In many ways, the pandemic has left most people confused and unprepared to deal with the unpredictability of the disease and its consequences [3]. Moreover, there is substantial evidence that the coronavirus has had significant lasting and emergent side effects in recovered patients [4,5]. Systematic psychological reviews and meta-analyses of current studies show that COVID-19, besides having economic (e.g., lockdown, loss of work) and social consequences (e.g., quarantine, social distancing, isolation, loneliness), has had detrimental ramifications on mental health [6]. Infected people display higher levels of emotional difficulties [7], anxiety or depression [8,9,10], post-traumatic stress symptoms [10], sleep disturbances [9], chronic fatigue, and pain [11].
Still, little research has investigated the functional coping strategies and meaning-making processes that modified both negative and positive reactions to the pandemic [12,13]. Therefore, the aim of this study was to examine how threat appraisal and resilience relate to health behaviors in recovered COVID-19 patients in terms of coping and meaning-making. The identification of pathways (coping strategies and comprehension of challenging life events) through which assessment of the COVID-19 pandemic affects the health practices of recovered patients may contribute to further understanding the indirect relationships between disease-related appraisal and health behaviors.

1.1. Threat Appraisal, Resilience, and Health Behaviors

Health behavior is the fluctuating response to stressful events [12], and depends on several factors [14]. Research shows that people differ in their sensitivity to threats and resilience, assigning various meanings to life challenges [15].
Threat appraisal, which is defined as the subjective interpretation of the likelihood, acuteness, and vulnerability regarding a difficult situation [16,17], motivates people to action [18]. Some research conducted during the COVID-19 outbreak confirmed that threat appraisal is related to the implementation of preventive behaviors [19,20]. People who display increased threat and coping appraisal are likely to perceive health distress as manageable [21], employ effective strategies, and generate adaptive solutions [22]. Resilience, conceptualized as “a dynamic process wherein individuals display positive adaptation despite [or after] experiences of significant adversity or trauma” ([23], p. 858), can play a similar role. Recent evidence demonstrated that people who present higher levels of resilience are likely to show a lower degree of trait catastrophizing [24] and psychological distress [25], higher hope, optimism, happiness, life satisfaction [26,27], and better mental health [25] and emotional adjustment [28]. They are also more prompt in recovering from difficult situations to recuperate psychological balance. Thus, based on prior literature and assorted studies, we assumed the following:
H1. 
Threat appraisal regarding a difficult situation, and a resilient ability to ‘bounce back’ from adversity [29], positively correlate with those behaviors that promote well-being, such as proper eating habits, preventive behaviors, health practices, and positive mental attitude.

1.2. Coping Strategies and Other Variables

There is an internal connection between coping strategies and other variables considered in the current study. Coping, perceived as a conscious response to stress, is one potential reaction to threat [30] that affects physical and psychological health [31]. People who face stressful events attempt to manage or reduce the negative experience by taking direct action, behaving emotionally, or giving meaning to what is difficult [30]. Problem-, emotion-, and meaning-coping strategies are positively connected to psychological well-being [32]. A series of meta-analyses [33] demonstrated that problem-focused coping is positively associated with health, indicating that efforts to solve the problem characterize individuals who report adaptive health behaviors. It has been found that active forms of coping have a positive effect on people’s health, whereas avoidance has the opposite effect [34,35]. Likewise, highly resilient people tend to engage in active solutions [36], and largely choose problem-focused coping [37]. Stronger resilience was related to lower levels of anxiety during the COVID-19 pandemic [38]. Emotional coping is often considered less adaptive [39]. However, it seems that this form of strategy, depending on the circumstances, can also play a functional role. Indeed, it has been confirmed that emotion-focused strategies are associated with more growth [12]. Adaptive and functional emotional coping (e.g., emotional support) enables people to deal with stress correctly. Conversely, non-adaptive emotional coping (e.g., rumination) results in dysfunctional responses to difficult events [40]. Meaning-focused coping is an important regulation strategy during particularly stressful events [41], which helps to re-establish personal resources over a relatively long time as a result of meaning reappraisal [42]. It also predicts better adjustment, reflecting psychological resilience [43]. Hence, we hypothesized the following:
H2. 
Problem-, emotion-, and meaning-focused coping correlate positively with threat appraisal, resilience, and healthy behavior.

1.3. Coping Strategies and Meaning-Making as Mediators

While the direct relationship between threat appraisal/resilience and healthy behavior is empirically quite well documented, knowledge about the mechanisms behind this association is far less clear. Since sustaining health behavior can be difficult for recovered COVID-19 patients due to psychological distress and physical consequences [44], it seems crucial to identify patients’ resources which may play a protective role in maintaining well-being. Therefore, considering that the analysis of the mediation effects is crucial for explaining the outcomes [45], we investigated whether coping strategies and meaning-making could act as potential intermediary variables between threat appraisal/resilience and healthy behavior.
The main rationale for this choice was that both coping and meaning-making could serve as protective factors against unhealthy behaviors. Indeed, coping strategies have been found to be mediators between antecedent difficult situations and outcomes, such as different dimensions of health [30], or between personality and adjustment [46]. However, specific coping strategies can have different mediating functions. In a sample of healthcare personnel, problem- and meaning-focused coping, but not emotion-focused coping, mediated the relationship between risk perception of COVID-19 and psychological well-being, and between meaning-based resources and psychological well-being [32]. Likewise, meaning-making has recently been identified as a mediator between perception of COVID-19 and benevolent orientation toward others [47].
The mediational relationship between threat appraisal/resilience, coping strategies, meaning-making, and healthy behavior can be better grasped on the theoretical grounds of protection motivation theory (PMT) [48]. When people face fears related to a difficult situation or event (e.g., COVID-19), they act based on two cognitive processes: threat identification and evaluation, and the ability to cope with it. Depending on how individuals assess a threat, how resilient they are in facing it, what coping strategies they adopt, and what meaning they give to difficult events, they implement adaptive or maladaptive behavioral responses. This means that healthy behaviors are not only affected by threat appraisal/resilience, but mediating factors may also influence the association between these variables. Empirical research shows that coping with stressful events is regarded as the intermediate process that can alter the relationship between a stressful situation and health [45]. The alternating function of coping strategies may consist of facilitating or impeding mental and physical health [30]. For example, emotion-oriented and task-oriented coping acted as mediators between temperamental traits and occupational burnout [49], different types of perfectionism and perceived stress [50], resilience and post-traumatic stress disorder [51], and the motivational states of engagement and burnout [52]. Moreover, meaning-making mediated the relationship between self-efficacy and life satisfaction among healthcare workers during the first COVID-19 lockdown [48]. Likewise, the presence of meaning mediated the association between social support and post-traumatic growth [53]. Therefore, it can be concluded that identification of a threat and the ability to deal with it can enable people to give it appropriate meaning and adopt healthy behaviors. Based on theoretical considerations and empirical findings, we assumed the following:
H3. 
Coping strategies and meaning-making are serial mediators in the relationship between threat appraisal/resilience and healthy behaviors.

2. Materials and Methods

2.1. Participants and Procedure

Eligible participants were people who had recovered from COVID-19. We set the following inclusion criteria: (1) confirmed diagnosis of COVID-19 during illness; (2) cognitive abilities to complete the questionnaire; and (3) recovery from the symptoms of COVID-19. The exclusion criteria were the following: (1) serious medical conditions that would distort the person’s responses (cancer, cardiovascular disease, obstructive pulmonary diseases, diabetes); and (2) lack of ability to fill in the questionnaire due to cognitive impairment, disability, or severe distress. COVID-19 was confirmed by two main types of viral tests: nucleic acid amplification tests (NAATs) and antigen tests. Our study was cross-sectional in design.

2.2. Procedure

A purposive sampling method was used to select participants who were COVID-19 survivors. The study was conducted from 1 November 2021 to 31 March 2022 in southern parts of Poland (Opole, Wroclaw, and Katowice), both privately by individuals in their homes, and in outpatient clinics. Initially, 325 people were approached for the study: 31 declined to participate, and 28 turned out to be ineligible due to the inclusion vs. exclusion criteria. Finally, 266 people agreed to participate (the participation ratio was 81.84%). The participants were approached by study assistants who informed them about the study and handed them the questionnaire and written informed consent. The questionnaires had to be filled in at home and given back to the assistant. Debriefing was provided after the study, along with answers to potential questions. The University Ethics Board approved the research material and procedure.

2.3. Measures

The following questionnaires were used to assess five outcomes: threat appraisal, resilience, health behaviors, coping, and meaning-making.
Threat appraisal was assessed using the Perceived Threat of COVID-19 Scale [32], a six-item instrument using ratings from 1 (strongly disagree) to 5 (strongly agree). The scale evaluates the perceived threat severity of COVID-19 that reflects the person’s negative personal, societal, and economic consequences related to the pandemic. The Cronbach’s reliability for the present study was 0.82.
Resilience was measured using the Brief Resilience Scale (BRS), which is a reliable tool to quantify respondents’ resilience, understood as one’s ability to recover from stress [46]. The scale contains six items which are evaluated on a five-point Likert scale, ranging from 1 (strongly disagree) to 5 (strongly agree); higher scores indicate higher resilience. The Cronbach’s reliability for the present study was 0.84.
Health behaviors were measured with the Health Behavior Inventory [54]. This is a 24-item scale that measures individuals’ health practices which are conducive to health. Each item is answered on a five-point Likert scale, ranging from 1 (almost never) to 5 (almost always). The instrument measures four categories of pro-health behaviors: proper eating habits, including the type of food primarily consumed; preventive behaviors, referring to following health recommendations and seeking knowledge and information about health and disease; health practices, including daily habits related to sleep, recreation, or exercise; and positive mental attitude, comprising psychological factors in health behavior such as avoidance of high stress, emotions, tension, and depressing situations. The sum of the scores from all four scales indicates the overall health behavior score. Higher scores represent healthier behaviors. The inventory has demonstrated good reliability and validity in clinical and non-clinical groups [54]. The Cronbach’s coefficients for the present study were 0.85 for the total result, and from 0.75 to 0.86 for the subscales.
Coping was assessed using the Coping Questionnaire [55], which measures three coping strategies: problem-focused coping, emotion-focused coping, and meaning-focused coping. The questionnaire comprises 37 items scored on a five-point Likert scale, ranging from 1 (not at all) to 5 (very much). Higher scores represent greater use of the coping strategies. The Cronbach’s coefficients for the present study were 0.83 (problem-focused coping), 0.84 (emotion-focused coping), and 0.86 (meaning-focused coping).
Meaning-making was measured using the Meaning-Making Questionnaire [56], which assesses one’s cognitive ability to comprehend and integrate challenging life events into a coherent set of personal meaning, beliefs, and goals. It contains six items scored on a five-point Likert scale, ranging from 1 (never) to 5 (very often). Higher scores reflect a stronger and more dynamic process of meaning-making. The Cronbach’s reliability for the present study was 0.86.

2.4. Data Analysis

Statistical analyses were conducted using Statistica, version 13, and Amos, version 21. A priori power analysis G* showed that a sample size of 250 participants is sufficient (f = 0.10, α = 0.05) to obtain a required 90 percent power in our analysis [57]. Firstly, as part of the preliminary analyses, multicollinearity through VIF and tolerance were checked: the value of the variance inflation factor (VIF) collinearity test2 was 1.43, while the value of the tolerance coefficient was 0.67, which indicate an acceptable degree of correlation of the predictors entered for the analysis conducted. Secondly, bivariate correlation analyses were calculated among all variables. Thirdly, we decided to test the serial mediation effects using SEM analysis. The covariance matrix and maximum likelihood estimation were applied, and model fit was evaluated. Thirdly, the bootstrapping procedure (95% bias-corrected confidence intervals, 5000 bootstrap resamples) was applied to test direct and indirect effects between the variables [58]. The procedure examined the serial mediation effects of coping and meaning-making on the relationship between threat appraisal, resilience, and health behaviors. Missing data were controlled by the case-wise mean substitution method that calculates average score from the matching subscale. All models were adjusted for age, gender, and education.

3. Results

3.1. Sample Characteristics

The participants were aged between 18 and 78 years (M = 40.31; SD = 17.19). More clinical and demographic characteristics are provided in Table 1.

3.2. Descriptive Statistics and Correlations

The correlational results showed that the time since COVID-19 was positively associated with symptom severity, resilience, problem-focused coping, preventive behaviors, and health practices (Table 2). Age was positively correlated with all variables, except for threat appraisal. Symptom severity was positively correlated with threat appraisal, resilience, problem-focused coping, emotion-focused coping, meaning-focused coping, proper eating habits, preventive behaviors, health practices, and positive mental attitude. Threat appraisal was positively associated with problem-focused coping, emotion-focused coping, meaning-focused coping, and preventive behaviors. Resilience was positively related with problem-focused coping, emotion-focused coping, meaning-focused coping, meaning-making, proper eating habits, preventive behaviors, health practices, and positive mental attitude. Problem-, emotion-, and meaning-focused coping, as well as meaning-making, were positively associated with proper eating habits, preventive behaviors, health practices, and positive mental attitude.

3.3. Serial Mediation Effects

The confirmatory factor analysis of the measurement model demonstrated that the model had a very satisfactory fit to the data: χ2 (N = 266) = 104.21; p < 0.001; NFI = 0.95; CFI = 0.96; RMSEA = 0.03; SRMR = 0.03. All the factor loadings for the indicators (proper eating habits, preventive behaviors, health practices, and positive mental attitude) on the latent factor (health behaviors) were significant (p < 0.001).
Next, our research model was tested, including directional paths between threat appraisal, resilience, problem-, emotion-, and meaning-focused coping, meaning-making, and health behaviors. However, the initial model had a rather poor fit to the data: χ2 (29) = 143.39; p < 0.001; GFI = 0.85; AGFI = 0.79; CFI = 0.43; RMSEA = 0.13 [0.10; 0.14]; Hoelter’s index = 92. Additionally, some paths were statistically non-significant (e.g., the paths from threat appraisal to health behaviors, problem-, and meaning-focused coping, or the path from emotion-focused coping to meaning-making; p > 0.05). Thus, we decided to re-test that model to improve its fit, in accordance with the recommendations of Mueller and Hancock [59]. This resulted in a final model that showed a substantial improvement and satisfactory fit to the empirical data: χ2 (23) = 55.37; p < 0.001, GFI = 0.95; AGFI = 0.91; CFI = 0.88; RMSEA = 0.07 [0.05; 0.10]; SRMR = 0.05; Hoelter’s index = 201. The final model is presented in Figure 1. Comparison of the initial model with the final one showed a better fit of the latter: Δχ2 (6) = 88.02, p < 0.001.
Finally, a bootstrapping procedure was used [60] to assess mediation effects (Table 3). Only one direct effect turned out to be statistically significant, that of resilience on health behaviors. In addition, four indirect effects were significant: threat appraisal on health behaviors through problem-focused coping, meaning-focused coping, and meaning-making; resilience on health behaviors through problem-focused coping, meaning-focused coping, and meaning-making, both of which indicate serial mediation; problem-focused coping on health behaviors through meaning-making; and meaning-focused coping on health behaviors through meaning-making. Thus, problem-focused coping, meaning-focused coping, and meaning-making were serial mediators. Finally, we conducted a multi-group analysis to check how the overall model was adjusted for age, gender, and education. The path coefficients for problem-focused coping, meaning-focused coping, and meaning-making as serial mediators proved to be insignificant across age (χ2 = 1.01, p > 0.05), gender (χ2 = 1.23, p > 0.05), and education (χ2 = 0.94, p > 0.05).

4. Discussion

The first purpose of the study was to examine relationships among threat appraisal, resilience, coping strategies, meaning-making, and health behaviors. The second aim was to verify serial mediation roles of coping strategies and meaning-making in the relationship of threat appraisal and resilience with health behaviors. Our findings mostly confirm the hypothesized associations. They also extend previous research on the application of PMT with the results of people who have already experienced COVID-19 infections [61]. To our knowledge, this is the first study to reveal indirect associations among threat appraisal, resilience, and health behaviors that occurred through coping and meaning-making in recovered COVID-19 patients.
The positive correlations that were found between threat appraisal and health behaviors (H1) are in line with PMT [62,63]. People who assess a situation to be threatening intensify behaviors that serve health. Other research has also shown that people who are confronted with a risk of being infected with COVID-19 tend to engage in behaviors that are protective against that risk, such as travel avoidance [64] or reduced use of public transport [65]. This shows that through the assessment of perceived severity and vulnerability, and taking into account the benefits of modified behavior, people decide to undertake behavioral changes by implementing a healthier mental and physical lifestyle.
Positive associations between psychological resilience and all of the dimensions of health behaviors (H1) corroborate results obtained in prior studies, and confirm a role of resilience as a personal resource in dealing with adversity. This finding aligns with the outcomes of a study in a multiple-phase-change single-case experimental design run by Jeste et al. [66], showing that even remotely administered resilience-focused behavioral intervention during the COVID-19 pandemic led to a reduction in perceived stress and an increase in happiness in a senior group. In other disease contexts, patients with high resilience were more likely to understand their adverse situation [67], achieve treatment response [68], cope with the ongoing demands of their illness [69], and effectively adapt to challenging conditions [70]. Such optimal adaptations, despite or after disease, are likely to occur because resilient patients are characterized by a strong and integrated sense of personal identity [71]. Moreover, resilience helps patients overcome distress and make sense of complex adaptation processes [72].
Problem-, emotion-, and meaning-focused coping correlate positively with threat appraisal and healthy behavior (H2) [73]. Empirical evidence shows that threat appraisal and coping are related in different domains. Elkayal et al. [74] showed that psychological distress is positively connected to problem- and emotion-focused coping. It has been also observed that problem-focused coping [75], emotion-focused coping [12], and meaning [76] are associated with less distress. Moreover, problem- and emotion-focused coping correlated positively with threat appraisal and more post-traumatic growth among university students in their psychological response to COVID-19 [77]. A positive association of problem-focused coping with threat appraisal and healthy behavior was also obtained by Wu et al. [64]. Their research showed that COVID-19-specific protective behaviors, which specifically address the infection risks, were positively connected with perceived threat avoidability of COVID-19, and led to reduced psychic anxiety. In a longitudinal study by Szczuka et al. [77], perceived COVID-19 illness severity (for the higher general anxiety group) at T1 predicted higher perceived illness severity at T3, which led to higher intentional handwashing and handwashing adherence at T3. Our study also demonstrated that meaning-focused coping positively correlated with behaviors that promote well-being. This result is in line with those of previous studies, in which meaning-focused coping was positively associated with positive affect (including pain control) over time in somatic patients [55], and meaningful attitudes to transcendence were associated with a lower level of psychological distress during the COVID-19 pandemic [78]. Similarly, Ziółkowska et al. [79] showed that meaning-focused coping (measured as positive reappraisal) was a predictor of positive emotions in children diagnosed with cancer.
The positive correlations found between resilience and problem-, emotion-, and meaning-focused coping (H2) are also in line with those of previous studies which showed that individuals with higher levels of resilience tend to deal effectively with life problems [80,81], regulate emotions [80], and give meaning to stressful situations. Therefore, resilience enables individuals to use several protective strategies [82], assuming active coping, self-regulation, and making sense of life events [52]. Our findings are understandable if we take into account that, in the face of distress, resilient people possess a wide range of resources to deal with difficult events.
In difficult times, such as the pandemic and recovery from the disease, resilience can be optimized by finding meaning in life [83]. Meaning-centered activities were also associated with problem- and emotion-focused strategies [84], which may suggest that people who give meaning to difficult experiences are more inclined to adopt task- and emotion-centered coping. Finally, Eisenbeck et al. [84] confirmed that meaning-centered coping was a significant predictor of psychological and physical health during the COVID-19 pandemic.
Both coping strategies and meaning-making were found to be mediators in the relationship between threat appraisal and healthy behaviors (H3), and between resilience and healthy behaviors. These findings are very interesting, as they suggest that when people who recovered from COVID-19 assess the risk of the disease or its consequences with a resilient ability, they are able to adopt active coping, effectively deal with hardships and uncertainty, and modify the problem. They also make sense of the disease, since the restoration of the meaning hidden in every disruptive condition is the main goal of coping [85]. Our findings extend previous research on meaning in life and quality of life [86] by demonstrating that meaning-centered activities (i.e., meaning-focused coping and meaning-making) play a significant role in shaping healthy behaviors that are part of overall quality of life. Meaning-making helps reframe negative experiences and make sense of them [87], leading people to undertake healthy behaviors. In addition, threat appraisal and resilience necessitate the use of coping strategies which facilitate cognitive processes, and help identify positive meanings [88] for healthy behaviors.

5. Limitations

Although our study provides a better understanding of the relationships among threat appraisal, resilience, and healthy behaviors within the mediating effect of coping strategies and meaning-making processes, it also has some limitations. Firstly, the most important weakness is the lack of random group selection and inclusion criteria that were too general. In the case of purposive selection, we may have missed people who experienced the disease in a more severe way. Therefore, future studies should include more detailed data on the severity of COVID-19 (e.g., presence of life-threatening course of the disease, presence of comorbidities, use of oxygen therapy, etc.), which could prove to be moderating factors of the aforementioned relationships. Another important limitation of our study is its cross-sectional nature, which prevented us from deducing any causal associations among all the variables considered. Mediating relationships and their directionality, although supported by sound theory, are no substitute for a longitudinal study. A prospective study could examine the stability of the studied traits over time, while controlling for their baseline levels. In future studies, it would be constructive to undertake an experimental approach to confirm causal relationships and the role of variables. Another limitation is that only those who had contracted COVID-19 were studied, with no reference group. Future research could test the existence of the described relationships in people who did not become ill, since the imagined possibility of passing on the disease could activate similar coping resources, and through them, appropriate health-oriented behaviors. Another interesting direction for future research would be to examine the existential resources used by the respondents (e.g., philosophy of life, religiousness, values) in the process of meaning-making. Moreover, we did not consider any confounder variables. Given that the research group was diverse in terms of age, it can be assumed that age-related variables, such as general health, economic conditions, and satisfaction with interpersonal relationships, could have affected the overall mediation results.

6. Conclusions

Thus far, the present study is one of few studies that has explored the relationships among threat appraisal, resilience, and health behaviors within a mediational role of coping strategies and meaning-making. Two coping strategies—problem- and meaning-focused coping and meaning-making—were serial mediators in the relationship between threat appraisal and health behaviors. Our findings also showed that problem- and meaning-focused coping and meaning-making were serial mediators in the relationship between resilience and health behaviors, which, despite the threats related to COVID-19, provide opportunities to develop healthy behaviors through meaning-making processes. Finally, the study showed that in the process of treatment and therapy, as well as in the promotion of health, it is essential to emphasize the promotion of personal resources (e.g., religiosity, attentiveness, insight), which can enhance meaning-making processes.

Author Contributions

Conceptualization, D.K., E.T., M.S. and A.F.; methodology, D.K., E.T., M.S. and A.F.; formal analysis, D.K., E.T., M.S. and A.F.; investigation, D.K., E.T. and M.S.; data curation, D.K. and E.T.; writing—original draft, D.K., E.T., M.S. and A.F.; writing—review and editing, D.K., E.T., M.S. and A.F.; project administration, D.K.; funding acquisition, D.K., E.T., M.S. and A.F. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Ethics Committee of University of Opole, KEBN nr 4/2021.

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The data presented in this study are available on request from the corresponding author.

Acknowledgments

We confirm that all individuals included in this section have consented to the acknowledgement.

Conflicts of Interest

The authors declare no conflict of interest.

References

  1. WHO Coronavirus (COVID-19) Dashboard. Available online: https://covid19.who.int/ (accessed on 11 February 2023).
  2. Raport zakażeń koronawirusem (SARS-CoV-2). Available online: https://www.gov.pl/web/koronawirus/wykaz-zarazen-koronawirusem-sars-cov-2 (accessed on 11 February 2023).
  3. Gashi, D.; Gallopeni, F.; Imeri, G.; Shahini, M.; Bahtiri, S. The relationship between Big Five personality traits, coping strategies, and emotional problems through the COVID-19 pandemic. Curr. Psychol 2022. ahead of print. [Google Scholar] [CrossRef] [PubMed]
  4. Groff, D.; Sun, A.; Ssentongo, A.E.; Ba, D.; Parsons, N.; Poudel, G.R.; Lekoubou, A.; Oh, J.S.; Ericson, J.E.; Ssentongo, P.; et al. Short-term and long-term rates of postacute sequelae of SARS-CoV-2 infection: A systematic review. Infect. Dis. 2021, 4, e2128568. [Google Scholar] [CrossRef] [PubMed]
  5. Poudel, A.N.; Zhu, S.; Cooper, N.; Roderick, P.; Alwan, N.; Tarrant, C.; Ziauddeen, N.; Yao, G.L. Impact of COVID-19 on health-related quality of life of patients: A structured review. PLoS ONE. 2021, 16, e0259164. [Google Scholar] [CrossRef] [PubMed]
  6. Salari, N.; Hosseinian-Far, A.; Jalali, R.; Vaisi-Raygani, A.; Rasoulpoor, S.; Mohammadi, M.; Rasoulpoor, S.; Khaledi-Paveh, B. Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: A systematic review and meta-analysis. Glob. Health 2020, 16, 57. [Google Scholar] [CrossRef] [PubMed]
  7. Pei, F.; Wang, Y.; McCloskey, R.J.; Liu, Q. Experiences, life changes, and support systems of recovered COVID-19 patients from practitioners’ perspectives: A qualitative study. Qual. Soc. Work. 2022, 9, 14733250221119440. [Google Scholar] [CrossRef]
  8. Deng, J.; Zhou, F.; Hou, W.; Silver, Z.; Wong, C.Y.; Chang, O.; Drakos, A.; Zuo, Q.K.; Huang, E. The prevalence of depressive symptoms, anxiety symptoms and sleep disturbance in higher education students during the COVID-19 pandemic: A systematic review and meta-analysis. Psychiatry Res. 2021, 301, 113863. [Google Scholar] [CrossRef]
  9. Pappa, S.; Ntella, V.; Giannakas, T.; Giannakoulis, V.G.; Papoutsi, E.; Katsaounou, P. Prevalence of depression, anxiety, and insomnia among healthcare workers during the COVID-19 pandemic: A systematic review and meta-analysis. Brain Behav. Immun. 2020, 88, 901–907. [Google Scholar] [CrossRef]
  10. Vindegaard, N.; Benros, M.E. COVID-19 Pandemic and Mental Health Consequences: Systematic Review of the Current Evidence. Brain Behav. Immun. 2020, 89, 531–542. [Google Scholar] [CrossRef]
  11. Higgins, V.; Sohaei, D.; Diamandis, E.P.; Prassas, I. COVID-19: From an Acute to Chronic Disease? Potential Long-Term Health Consequences. Crit. Rev. Clin. Lab. Sci. 2021, 58, 297–310. [Google Scholar] [CrossRef] [PubMed]
  12. Chu, G.M.; Goger, P.; Malaktaris, A.; Lang, A.J. The role of threat appraisal and coping style in psychological response to the COVID-19 pandemic among university students. J. Affect. Disord. Rep. 2022, 8, 100325. [Google Scholar] [CrossRef]
  13. Shamblaw, A.L.; Rumas, R.L.; Best, M.W. Coping during the COVID-19 pandemic: Relations with mental health and quality of life. Can. Psychol. 2021, 62, 92–100. [Google Scholar] [CrossRef]
  14. Yoshitake, N.; Omori, M.; Sugawara, M.; Akishinonomiya, K.; Shimada, S. Do health beliefs, personality traits, and interpersonal concerns predict TB prevention behavior among Japanese adults? PLoS ONE. 2019, 14, e0211728. [Google Scholar] [CrossRef] [Green Version]
  15. Pan, J.Y. A resilience-based and meaning-oriented model of acculturation: A sample of mainland Chinese postgraduate students in Hong Kong. Int. J. Intercult. Relat. 2011, 35, 592–603. [Google Scholar] [CrossRef]
  16. Constant, A.; Conserve, D.F.; Gallopel-Morvan, K.; Raude, J. Socio-cognitive factors associated with lifestyle changes in response to the COVID-19 epidemic in the general population: Results from a cross-sectional study in France. Front. Psychol. 2020, 11, 579460. [Google Scholar] [CrossRef] [PubMed]
  17. Lahiri, A.; Iha, S.S.; Chakraborty, A.; Dobe, M.; Dey, A. Role of threat and coping appraisal in protection motivation for adoption of preventive behavior during COVID-19 pandemic. Front. Public Health. 2021, 9, 678566. [Google Scholar] [CrossRef]
  18. Maloney, E.K.; Lapinski, M.K.; Witte, K. Fear appeals and persuasion: A review and update of extended parallel process model. Soc. Personal. Psychol. Compass. 2011, 5, 206–219. [Google Scholar] [CrossRef]
  19. Al-Rasheed, M. Protective behavior against COVID-19 among the public in Kuwait: An examination of the Protection Motivation Theory, trust in government, and sociodemographic factors. Soc. Work Public Health. 2020, 35, 546–556. [Google Scholar] [CrossRef] [PubMed]
  20. Šuriņa, S.; Martinsone, K.; Perepjolkina, V.; Kolesnikova, J.; Vainik, U.; Ruža, A.; Vrublevska, J.; Smirnova, D.; Fountoulakis, K.N.; Rancans, E. Factors related to COVID-19 preventive behaviors: A structural equation model. Front. Psychol. 2021, 12, 676521. [Google Scholar] [CrossRef] [PubMed]
  21. McGinty, H.L.; Goldenberg, J.L.; Jacobsen, P.B. Relationship of threat appraisal with coping appraisal to fear of cancer recurrence in breast cancer survivors. Psycho-Oncology 2012, 21, 203–210. [Google Scholar] [CrossRef]
  22. Ireland, J.L. The importance of comping, threat appraisal, and beliefs in understanding and responding to fear of victimization: Applications to a male prisoner sample. Law Hum. Behav. 2011, 35, 306–315. [Google Scholar] [CrossRef]
  23. Luthar, S.S.; Cichetti, D. The construct of resilience: Implications for interventions and social policies. Dev. Psychoaptol. 2000, 12, 857–885. [Google Scholar] [CrossRef] [Green Version]
  24. Sturgeon, J.A.; Zautra, A.J. Resilience: A new paradigm for adaptation to chronic pain. Curr. Pain Headache Rep. 2010, 14, 105–112. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  25. Kermott, C.A.; Johnoson, R.E.; Sood, R.; Jenkins, S.M.; Sood, A. Is higher resilience predictive of lower stress and better mental health among corporate executives? PLoS ONE. 2019, 14, e0218092. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  26. Gao, J.; Zheng, P.; Jia, Y.; Chen, H.; Mao, Y.; Chen, S.; Wang, Y.; Fu, H.; Dai, J. Mental Health Problems and Social Media Exposure during COVID-19 Outbreak. PLoS ONE 2020, 15, e0231924. [Google Scholar] [CrossRef]
  27. Smith, J.L.; Hollinger-Smith, L. Savoring, resilience, and psychological well-being in older adults. Aging Ment. Health. 2015, 19, 192–200. [Google Scholar] [CrossRef]
  28. Markovitz, S.E.; Schrooten, W.; Amtz, A.; Peters, M.L. Resilience as a predictor for emotional response to the diagnosis and surgery in breast cancer patients. Psycho-Oncology 2015, 24, 1639–1645. [Google Scholar] [CrossRef]
  29. Smith, B.W.; Dalen, J.; Wiggins, K.; Tooley, E.; Christopher, P.; Bernard, J. The brief resilience scale: Assessing the ability to bounce back. Int. J. Behav. Med. 2008, 15, 194–200. [Google Scholar] [CrossRef] [PubMed]
  30. Endler, N.S.; Parker, J.D.A. Assessment of multidimensional coping: Task, emotion, and avoidance strategies. Psychol. Assess. 1994, 6, 50–60. [Google Scholar] [CrossRef]
  31. Doron, J.; Trouillet, R.; Maneveau, A.; Neveu, D.; Ninot, G. Coping profiles, perceived stress and health-related behaviors: A cluster analysis approach. Health Promot. Int. 2015, 30, 88–100. [Google Scholar] [CrossRef] [Green Version]
  32. Krok, D.; Zarzycka, B. Risk perception of COVID-19, meaning-based resources and psychological well-being amongst healthcare personnel: The mediating role of coping. J. Clin. Med. 2020, 9, 3225. [Google Scholar] [CrossRef]
  33. Penley, J.A.; Tomaka, J.; Wiebe, J.S. The association of coping to physical and psychological health outcomes: A meta-analystic review. J. Behav. Med. 2003, 25, 551–603. [Google Scholar] [CrossRef] [PubMed]
  34. Tinella, L.; Tinterri, A.; Dipace, A.; Ladogana, M.; Loiodice, I.; Bosco, A. Sociodemographic and digital education factors are associated to general health, coping strategies, and academic outcomes of undergraduate students during the post-pandemic period. Eur. J. Investig. Health Psychol. Educ. 2022, 12, 1334–1348. [Google Scholar] [CrossRef]
  35. Savitsky, B.; Findling, Y.; Ereli, A.; Hendel, T. Anxiety and coping strategies among nursing students during the covid-19 pandemic. Nurse Educ. Pract. 2020, 46, 102809. [Google Scholar] [CrossRef] [PubMed]
  36. Tsuno, K. Do personal resilience, coping styles, and social support prevent future psychological distress when experiencing workplace bullying? Evidence from a 1-year prospective study. BMC Psychol. 2022, 10, 310. [Google Scholar] [CrossRef] [PubMed]
  37. Wu, Y.; Yu, W.; Wu, X.; Wan, H.; Wang, Y.; Lu, G. Psychological resilience and positive coping styles among Chinese undergraduate students: A cross-sectional study. BMC Psychol. 2020, 8, 79. [Google Scholar] [CrossRef] [PubMed]
  38. Rahmat, H.; Aris, A.; Miskam, H.M.; Rajendran, K.; Mashudi, R. Students’ attitudes and coping strategies relating to online learning during the COVID-19 pandemic: A cross-sectional study. F1000Research 2022, 11, 320. [Google Scholar] [CrossRef]
  39. Shigeto, A.; Laxman, D.J.; Landy, J.F.; Scheier, L.M. Typologies of coping in young adults in the context of the COVID-19 pandemic. J. Gen. Psychol. 2021, 3, 272–304. [Google Scholar] [CrossRef]
  40. Marcía, P.; Barranco, M.; Gorbeña, S.; Álvarez-Fuentes, E.; Iraurgi, I. Resilience and coping strategies in relation to mental health outcomes in people with cancer. PLoS ONE. 2021, 16, e0252075. [Google Scholar] [CrossRef]
  41. Van den Bos, K.; Hewstone, M.; Schut, H.A.W.; de Wit, J.B.F.; Stroebe, M.S. On the scope of social psychology: An introduction. In The Scope of Social Psychology: Theory and Applications; Hewstone, M., Schut, H.A.W., de Wit, J.B.F., Van den Bos, K., Stroebe, M.S., Eds.; Psychology Press: London, UK, 2007; pp. 1–10. [Google Scholar]
  42. Folkman, S.; Moskowitz, T. Positive affect and meaning-focused coping during significant psychological stress. In The Scope of Social Psychology: Theory and Applications; Hewstone, M., Schut, H.A.W., de Wit, J.B.F., Van den Bos, K., Stroebe, M.S., Eds.; Psychology Press: London, UK, 2007; pp. 193–208. [Google Scholar]
  43. Park, C.L.; Finkelstein-Fox, L.; Russell, B.S.; Fendrich, M.; Hutchison, M.; Becker, J. Psychological resilience early in the COVID-19 pandemic: Stressors, resources, and coping strategies in a national sample of Americans. Am. Psychol. 2021, 76, 715–728. [Google Scholar] [CrossRef]
  44. Yıldırım, M.; Arslan, G.; Wong, P.T.P. Meaningful living, resilience, affective balance, and psychological health problems among Turkish young adults during coronavirus pandemic. Curr. Psychol. 2022, 41, 7812–7823. [Google Scholar] [CrossRef] [PubMed]
  45. Dardas, L.A.; Ahmad, M.M. Coping strategies as mediators and moderators between stress and quality of life among parents of children with autistic disorder. Stress Health. 2015, 31, 5–12. [Google Scholar] [CrossRef]
  46. Major, B.; Richards, C.; Cooper, M.L.; Cozzarelli, C.; Zubek, J. Personal resilience, cognitive appraisals, and coping: An integrative model of adjustment to abortion. J. Pers. Soc. Psychol. 1998, 74, 735–752. [Google Scholar] [CrossRef]
  47. Krok, D.; Zarzycka, B.; Telka, E. The Perception of COVID-19, the Light Triad, Harmony and Ethical Sensitivity in Late Adolescents: The Role of Meaning-Making and Stress. ResearchSquare 2022. in review. [Google Scholar]
  48. Krok, D.; Zarzycka, B.; Telka, E. Risk of contracting COVID-19, personal resources and subjective well-being among healthcare workers: The mediating role of stress and meaning-making. J. Clin. Med. 2021, 10, 132. [Google Scholar] [CrossRef] [PubMed]
  49. Więsyk, S.M.; Płudowska, M. The mediating role of coping styles in the relations between temperament traits and occupational buronout in bank employees. Med. Stud. 2022, 38, 59–67. [Google Scholar] [CrossRef]
  50. Ashby, J.S.; Gnilka, P.B. Multidimensional perfectionism and perceived stress: Group differences and test of a coping mediation model. Pers. Individ. Differ. 2017, 119, 106–111. [Google Scholar] [CrossRef]
  51. Thompson, N.J.; Fiorillo, D.; Rothbaum, B.O.; Ressler, K.J.; Michopoulos, V. Coping strategies as mediators in relation to resilience and posttraumatic stress disorder. J. Affect. Disord. 2018, 225, 153–159. [Google Scholar] [CrossRef] [PubMed]
  52. de la Fuente, J.; Santos, F.H.; Garzón-Umerenkova, A.; Fadda, S.; Solinas, G.; Pignata, S. Cross-sectional study of resilience, positivity and coping strategies as predictors of engagement-burnout un undergraduate students: Implications for prevention and treatment in mental well-being. Front. Psychiatry. 2021, 12, 596453. [Google Scholar] [CrossRef] [PubMed]
  53. Aliche, J.C.; Ifeagwazi, C.M.; Onyishi, I.E.; Mefoh, P.C. Presence of meaning in life mediates the relations between social support, posttraumatic growth, and resilience in young adult survivors of a terror attack. J. Loss Trauma. 2019, 24, 736–749. [Google Scholar] [CrossRef]
  54. Juczynski, Z. Narzędzia Pomiaru w Promocji i Psychologii Zdrowia [Tools for Assessment of Health in Promotion of Health and Psychology]; Polish Psychological Society: Warsaw, Poland, 2001. [Google Scholar]
  55. Gruszczyńska, E.; Knoll, N. Meaning-focused coping, pain, and affect: A diary study of hospitalized women with rheumatoid arthritis. Qual. Life Res. 2015, 24, 2873–2883. [Google Scholar] [CrossRef] [Green Version]
  56. Krok, D.; Zarzycka, B. Self-efficacy and psychological well-being in cardiac patients: Moderated mediation by affect and meaning-making. J. Psychol. 2020, 154, 411–425. [Google Scholar] [CrossRef]
  57. Faul, F.; Erdfelder, E.; Buchner, A.; Lang, A.G. Statistical power analyses using G* Power 3.1: Tests for correlation and regression analyses. Behav. Res. Methods 2009, 41, 1149–1160. [Google Scholar] [CrossRef] [Green Version]
  58. MacKinnon, D.P.; Lockwood, C.M.; Williams, J. Confidence limits for the indirect effect: Distribution of the product and resampling methods. Multivar. Behav. Res. 2004, 39, 99–128. [Google Scholar] [CrossRef] [Green Version]
  59. Mueller, R.O.; Hancock, G.R. Structural equation modeling. In The Reviewer’s Guide to Quantitative Methods in the Social Sciences; Hancock, G.R., Stapleton, L.M., Mueller, R.O., Eds.; Routledge: London, UK, 2018; pp. 445–456. [Google Scholar]
  60. Hayes, A.F. Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression Based Approach; The Guilford Press: New York, NY, USA, 2013. [Google Scholar]
  61. Acar, D.; Kıcali, Ü.Ö. An integrated approach to COVID-19 preventive behaviour intentions: Protection Motivation Theory, information acquisition, and trust. Soc. Work Public Health. 2022, 37, 419–434. [Google Scholar] [CrossRef] [PubMed]
  62. Floyd, D.L.; Prentice-Dunn, S.; Rogers, R.W. A meta-anaylsis of research on Protection Motivation Theory. J. Appl. Soc. Psychol. 2000, 30, 407–429. [Google Scholar] [CrossRef]
  63. Maddux, J.E.; Rogers, R.W. Protection motivation and self-efficacy: A revised theory of fear appeals and attitude change. J. Exp. Soc. Psychol. 1983, 19, 469–479. [Google Scholar] [CrossRef]
  64. Wu, A.Q.; Lau, V.M.C. COVID-19-induced negative emotions and the impacts on personal values and travel behaviors: A threat appraisal perspective. J. Hosp. Tour. Manag. 2022, 51, 143–155. [Google Scholar] [CrossRef]
  65. Kaplan, S.; Tchetchik, A.; Greenberg, D.; Sapir, I. Transit Use Reduction Following COVID-19: The Effect of Threat Appraisal, Proactive Coping and Institutional Trust. Transp. Res. Part A Policy Pract. 2022, 159, 338–356. [Google Scholar] [CrossRef] [PubMed]
  66. Jeste, D.V.; Glorioso, D.K.; Depp, C.A.; Lee, E.E.; Daly, R.E.; Jester, D.J.; Palmer, B.W.; Mausbach, B.T. Remotely administered resilience- and wisdom-focused intervention to reduce perceived stress and loneliness: Pilot controlled clinical trial in older adults. Am. J. Geriatr. Psychiatry. 2023, 31, 58–64. [Google Scholar] [CrossRef]
  67. Faria, D.A.P.; Revoredo, L.S.; Vilar, M.J.; Chaves, M.E.M. Resilience and treatment adhesion in patiens with systemic lupus erythematosus. Open Rheumatol. J. 2014, 8, 1–8. [Google Scholar] [CrossRef] [PubMed] [Green Version]
  68. Min, J.A.; Lee, N.B.; Lee, C.U.; Lee, C.; Chae, J.H. Low trait anxiety, high resilience, and their interaction as possible predictors for treatment response in patients with depression. J. Affect. Disord. 2012, 137, 61–69. [Google Scholar] [CrossRef] [PubMed]
  69. Seghal, P.; Ungaro, R.C.; Foltz, C.; Iacoviello, B.; Dubinsky, M.C.; Keefer, L. High levels of psychological resilience associated with less disease activity, better quality of life, and fewer surgeries in inflammatory bowel disease. Inflamm. Bowel Dis. 2021, 27, 791–796. [Google Scholar] [CrossRef]
  70. Weitzel, E.C.; Löbner, M.; Röhr, S.; Pabst, A.; Reininghaus, U.; Riedel-Heller, S.G. Prevalence of high resilience in old age and association with perceived threat of COVID-19—Results from a representative survey. Int. J. Environ. Res. Public Health. 2021, 18, 7173. [Google Scholar] [CrossRef] [PubMed]
  71. Skodol, A.E. Personality disorder classification: Stuck in neutral, how to move forward? Curr. Psychiatry Rep. 2014, 16, 480. [Google Scholar] [CrossRef] [PubMed]
  72. Krüger, M.; Albris, K. Resilience unwanted: Between control and cooperation in disaster response. Secur. Dialogue. 2021, 52, 343–360. [Google Scholar] [CrossRef]
  73. Dias, C.; Cruz, J.F.; Fonseca, A.M. The relationship between multidimensional competitive anxiety, cognitive threat appraisal, and coping strategies: A multi-sport study. Int. J. Sport Exerc. Psychol. 2012, 10, 52–65. [Google Scholar] [CrossRef] [Green Version]
  74. Elkayal, M.M.; Shahin, M.A.H.; Hussien, R.M. Psychological distress related to the emerging COVID-19 pandemic and coping strategies among general population in Egypt. J. Egypt. Public. Health. Assoc. 2022, 97, 3. [Google Scholar] [CrossRef]
  75. Taha, S.; Matheson, K.; Cronin, T.; Anisman, H. Intolerance of Uncertainty, Appraisals, Coping, and Anxiety: The Case of the 2009 H1N1 Pandemic. Br. J. Health Psychol. 2014, 19, 592–605. [Google Scholar] [CrossRef]
  76. Thompson, S.C. Finding positive meaning in stressful event and coping. Basic Appl. Soc. Psych. 1985, 6, 279–295. [Google Scholar] [CrossRef]
  77. Szczuka, Z.; Siwa, M.; Abraham, C.; Baban, A.; Brooks, S.; Cipolletta, S.; Danso, E.; Dombrowski, S.U.; Gan, Y.; Gaspar, T.; et al. Handwashing adherence during the COVID-19 pandemic: A longitudinal study based on protection motivation theory. Soc. Sci. Med. 2023, 317, 115569. [Google Scholar] [CrossRef]
  78. Upenieks, L.; Ellison, C.G. Changes in religiosity and reliance on God during the COVID-19 pandemic: A protective role under conditions of financial strain? Rev. Relig. Res 2023. ahead of print. [Google Scholar] [CrossRef] [PubMed]
  79. Ziółkowska, N.; Bargiel-Matusiewicz, K.; Gruszczyńska, E. Emotional state of parents of children diagnosed with cancer: Examining religious and meaning-focused coping. Religions 2020, 11, 132. [Google Scholar] [CrossRef] [Green Version]
  80. Liang, F.; Cao, L. Linking employee resilience with organizational resilience: The roles of coping mechanism and managerial resilience. Psychol. Res. Behav. Manag. 2021, 14, 1063–1075. [Google Scholar] [CrossRef] [PubMed]
  81. Popa-Velea, O.; Diaconescu, L.; Popescu, M.J.; Truţescu, C. Resilience and active coping style: Effects on the self-reported quality of life in cancer patients. Int. J. Psychiatry Med. 2017, 52, 124–136. [Google Scholar] [CrossRef]
  82. Tan-Kristanto, S.; Kiropoulos, L.A. Resilience, self-efficacy, coping styles and depressive and anxiety symptoms in those newly diagnosed with multiple sclerosis. Psychol. Health Med. 2015, 20, 635–645. [Google Scholar] [CrossRef]
  83. Karataş, Z.; Tagay, Ö. The relationship between resilience of the adults affected by the covid pandemic in Turkey and COVID-19 fear, meaning in life, life satisfaction, intolerance of uncertainty and hope. Pers. Individ. Dif. 2021, 172, 110592. [Google Scholar] [CrossRef]
  84. Eisenbeck, N.; Carreno, D.F.; Wong, P.T.P.; Hicks, J.A.; García María, R.R.; Puga, J.L.; Greville, J.; Testoni, I.; Biancalani, G.; Cepeda López, A.C.; et al. An international study on psychological coping during COVID-19: Towards a meaning-centered coping style. Int. J. Clin. Health Psychol. 2022, 22, 100256. [Google Scholar] [CrossRef]
  85. Wiener, C.L.; Dodd, M.J. Coping amid uncertainty: An illness trajectory perspective. Sch. Inq. Nurs. Pract. 1993, 7, 17–31. [Google Scholar] [PubMed]
  86. Guerrero-Torrelles, M.; Monforte-Royo, C.; Rodríguez-Prat, A.; Porta-Sales, J.; Balaguer, A. Understanding meaning in life interventions in patients with advanced disease: A systematic review and realist synthesis. Palliat. Med. 2017, 9, 798–813. [Google Scholar] [CrossRef]
  87. Elemo, A.S.; Kara, E.; Rostamzadeh, M. The fear of COVID-19 and flourishing: The mediating role of search for meaning and presence of meaning. Curr. Psychol 2022. ahead of print. [Google Scholar] [CrossRef] [PubMed]
  88. Xie, C.S.; Kim, Y. Post-traumatic growth during COVID-19: The role of perceived social support, personality, and coping strategies. Healthcare 2022, 10, 224. [Google Scholar] [CrossRef] [PubMed]
Ijerph 20 03649 g001 550
Figure 1. Final model of the relationships between threat appraisal, resilience, and health behaviors: serial mediation of coping and meaning-making (standardized coefficients). * p < 0.05; *** p < 0.001.
Figure 1. Final model of the relationships between threat appraisal, resilience, and health behaviors: serial mediation of coping and meaning-making (standardized coefficients). * p < 0.05; *** p < 0.001.
Ijerph 20 03649 g001
Table
Table 1. Clinical and demographic characteristics of recovered COVID-19 patients (N = 266).
Table 1. Clinical and demographic characteristics of recovered COVID-19 patients (N = 266).
Characteristics
AgeM
40.31		SD
17.19
Body mass index26.643.21
Symptom severity (on a scale from 1 to 10)5.782.34
Time since COVID-19 in months6.794.29
Range of the time since COVID-19from 5 days to 18 moths
N%
Sex
Male12948.5
Female13751.5
Hospitalization due to COVID-19 symptoms7829.3
Educational attainment
Basic education4015.1
Vocational education7528.3
High school education10137.9
University education5018.7
Table
Table 2. Correlations among medical factors, threat appraisal, resilience, coping, meaning-making, and health behaviors in recovered COVID-19 patients.
Table 2. Correlations among medical factors, threat appraisal, resilience, coping, meaning-making, and health behaviors in recovered COVID-19 patients.
Variables12345678910111213
1.
Age
-
2.
Time since COVID-19
0.36 ***-
3.
Symptom severity
0.59 ***0.29 ***-
4.
Threat appraisal
0.050.100.20 **-
5.
Resilience
0.46 ***0.25 ***0.30 ***0.03-
6.
Problem-focused coping
0.30 ***0.13 *0.27 ***0.17 **0.53 ***-
7.
Emotion-focused coping
0.20 **0.090.14 *0.19 **0.40 ***0.63 ***-
8.
Meaning-focused coping
0.16 **0.130.18 **0.17 **0.49 ***0.73 ***0.73 ***-
9.
Meaning-making
0.17 **0.120.040.070.46 ***0.59 ***0.43 ***0.56 ***-
10.
Proper eating habits
0.25 **0.070.16 **0.090.19 **0.28 ***0.36 ***0.29 ***0.24 ***-
11.
Preventive behaviors
0.35 ***0.16 *0.36 ***0.21 ***0.32 ***0.37 ***0.34 ***0.36 ***0.40 ***0.59 ***-
12.
Health practices
0.17 **0.18 **0.18 **0.060.48 ***0.42 ***0.41 ***0.41 ***0.43 ***0.47 ***0.59 ***-
13.
Positive mental attitude
0.110.110.22 ***0.090.33 ***0.39 ***0.36 ***0.38 ***0.39 ***0.46 ***0.61 ***0.54 ***
M40.156.805.794.203.443.863.773.853.703.473.643.67-
SD17.054.312.340.660.980.800.800.790.890.920.780.703.53
0.62
* p < 0.05; ** p < 0.01; *** p < 0.001.
Table
Table 3. Bootstrapping indirect effects (standardized) and their 95% confidence intervals.
Table 3. Bootstrapping indirect effects (standardized) and their 95% confidence intervals.
Model PathwaysEstimatesStandard Errors95% CI
LowerUpper
Threat appraisal→Problem- and Meaning-focused coping/Meaning-making→Health behaviors0.04 a0.020.010.07
Resilience→Problem- and Meaning-focused coping/Meaning-making→Health behaviors0.15 a0.070.130.23
Problem-focused coping→Meaning-making→Health behaviors0.15 a0.040.080.24
Meaning-focused coping→Meaning-making→Health behaviors0.13 a0.040.060.21
a Empirical 95% confidence interval does not overlap with zero.
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content.

Share and Cite

MDPI and ACS Style

Krok, D.; Telka, E.; Szcześniak, M.; Falewicz, A. Threat Appraisal, Resilience, and Health Behaviors in Recovered COVID-19 Patients: The Serial Mediation of Coping and Meaning-Making. Int. J. Environ. Res. Public Health 2023, 20, 3649. https://doi.org/10.3390/ijerph20043649

AMA Style

Krok D, Telka E, Szcześniak M, Falewicz A. Threat Appraisal, Resilience, and Health Behaviors in Recovered COVID-19 Patients: The Serial Mediation of Coping and Meaning-Making. International Journal of Environmental Research and Public Health. 2023; 20(4):3649. https://doi.org/10.3390/ijerph20043649

Chicago/Turabian Style

Krok, Dariusz, Ewa Telka, Małgorzata Szcześniak, and Adam Falewicz. 2023. "Threat Appraisal, Resilience, and Health Behaviors in Recovered COVID-19 Patients: The Serial Mediation of Coping and Meaning-Making" International Journal of Environmental Research and Public Health 20, no. 4: 3649. https://doi.org/10.3390/ijerph20043649

Note that from the first issue of 2016, this journal uses article numbers instead of page numbers. See further details here.

Article Metrics

Back to TopTop