Document Type : Original Article
Authors
Abstract
BACKGROUND: The coronavirus has caused fundamental changes in our way of life, leading to a
wave of psychological distress associated with the COVID‑19 epidemic, including stress, anxiety,
perceived threats, and fear.Considering the psychological consequences of COVID‑19, the present
study was conducted with the aim of mediating the role of compassion in the relationship between
COVID‑19 anxiety syndrome and COVID‑19 burnout.
MATERIALS AND METHODS: The design of the present study was descriptive correlation. The
present study population included all students of Ahvaz Jundishapur University of Medical Sciences
in the academic year 2020. Two hundred and fifty‑one students were selected and completed the
COVID‑19 Anxiety Syndrome Questionnaire, Compassion Scale, and COVID‑19 Burnout Scale.
Pearson correlation coefficient test and structural equation model were performed using SPSS
version 18 and LISREL 8.8.
RESULTS: The results showed that COVID‑19 burnout had a positive and significant relationship
with the overall score of anxiety syndrome (r = 0.42, P = 0.01), while it has a negative and significant
relationship with compassion (r = −0.37, P = 0.01). Compassion also has a significant negative
relationship with anxiety syndrome (r = −0.35, P = 0.01). In addition, the results of path analysis
showed that compassion plays a mediating role in the relationship between COVID‑19 anxiety
syndrome and COVID‑19 burnout.
CONCLUSION: Based on the findings of the present study, it can be said that compassion acts
as a protective factor against the negative effects of anxiety syndrome. Therefore, this factor can
be considered in the development of prevention and treatment programs for burnout caused by
COVID‑19.
Keywords
1. Yıldırım M, Geçer E, Akgül Ö. The impacts of vulnerability,
perceived risk, and fear on preventive behaviours against
COVID‑19. Psychology, health & medicine. 2021 Jan 2;26(1):35‑43.
http://doi.org/10.1080/13548506.2020.1776891.
2. Arslan G, Yıldırım M, Tanhan A, Buluş M, Allen KA. Coronavirus
stress, optimism‑pessimism, psychological inflexibility, and
psychological health: Psychometric properties of the Coronavirus
Stress Measure. International Journal of Mental Health and
Addiction. 2020 Jun 4:1‑7. doi: 10.1007/s11469‑020‑00337‑6.
3. Talaee N, Varahram M, Jamaati H, Salimi A, Attarchi M,
Kazempour Dizaji M, Sadr M, Hassani S, Farzanegan B,
Monjazebi F, Seyedmehdi SM. Stress and burnout in health
care workers during COVID‑19 pandemic: Validation of a
questionnaire. Journal of Public Health. 2020 Jan 1:1‑6. doi:
10.1007/s10389‑020‑01313‑z.
4. Yıldırım M, Solmaz F. COVID‑19 burnout, COVID‑19 stress and
resilience: Initial psychometric properties of COVID‑19 Burnout
Scale. Death Studies. 2020 Sep 10:1‑9. doi.org/10.1080/07481187
.2020.1818885.
5. Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S,
Greenberg N, et al. The psychological impact of quarantine
and how to reduce it: Rapid review of the evidence. Lancet
2020;395:912‑20. doi.org/10.1016/S0140‑6736(20)30460‑8.
6. Marčinko D, Jakovljević M, Jakšić N, Bjedov S ,
Mindoljević Drakulić A. The importance of psychodynamic
approach during COVID‑19 pandemic. Psychiatr Danub
2020;352:15‑21. doi.org/10.24869/psyd.2020.15.
7. Peterson U, Demerouti E, Bergström G, Samuelsson M, Asberg M,
Nygren A. Burnout and physical and mental health among
Swedish healthcare workers. J Adv Nurs 2008;62:84‑95. http://
doi.org/10.1111/j. 1365‑2648.20070.04580.x.
8. Cheli S, Cavalletti V, Petrocchi N. An online compassion‑focused
crisis intervention during COVID‑19 lockdown: A cases series on
patients at high risk for psychosis. Psychosis. 2020 Jul 19:1‑4. doi.
org/10.1080/17522439.2020.1786148.
9. Weiner L, Berna F, Nourry N, Severac F, Vidailhet P, Mengin AC.
Efficacy of an online cognitive behavioral therapy program
developed for healthcare workers during the COVID‑19
pandemic: The REduction of STress (REST) study protocol for
a randomized controlled trial. Trials 2020;21:870. doi: 10.1186/
s13063‑020‑04772‑7.
10. Irons C, Beaumont E. The compassionate mind workbook:
A step‑by‑step guide to developing your compassionate self.
Robinson; 2017 Sep 14.
11. Coyne LW, Gould ER, Grimaldi M, Wilson KG, Baffuto G,
Biglan A. First things first: Parent psychological flexibility and
self‑compassion during COVID‑19. Behavior analysis in practice.
2020 May 6:1‑7. doi: 10.1007/s40617‑020‑00435‑w.
12. Smith GD, Ng F, Li WH. COVID-19: Emerging compassion,
courage and resilience in the face of misinformation and adversity.
Journal of clinical nursing. 2020 May;29(9‑10):1425.
13. Mohammadpour M, Ghorbani V, Khoramnia S, Ahmadi SM,
Ghvami M, Maleki M. Anxiety, self‑compassion, gender
differences and COVID‑19: Predicting self‑care behaviors and
fear of COVID‑19 based on anxiety and self‑compassion with an
emphasis on gender differences. Iran J Psychiatry 2020;15:213‑9.
https://doi.org/10.18502/ijps.v15i3.3813.
14. Li, A.; Wang, S.; Cai, M.; Sun, R.; Liu, X. Self‑Compassion and
Life‑Satisfaction among Chinese Self‑Quarantined Residents
during COVID‑19 Pandemic: A Moderated Mediation Model of
Positive Coping and Gender. Pers. Individ. Dif. 2020,170,0457.
doi.org/10.3390/ijerph 18041474.
15. Braus M, Morton B. Art therapy in the time of COVID‑19. Psychol
Trauma 2020;12:S267‑8. 10.1037/tra0000746. Epub 2020 Jun 1.
16. Barnard LK, Curry JF. Self‑compassion: Conceptualizations,
correlates, & interventions. Rev Gen Psychol 2011;15:289‑303.
https://doi.org/10.1037/a0025754.
17. Hasking P, Boyes ME, Finlay‑Jones A, McEvoy PM, Rees CS.
Common pathways to NSSI and suicide ideation: The roles of
rumination and self‑compassion. Archives of Suicide Research.
2019 Apr 3;23(2):247‑60. doi.org/10.1080/13811118.2018.1468836.
18. Fresnics AA, Wang SB, Borders A. The unique associations
between self‑compassion and eating disorder psychopathology
and the mediating role of rumination. Psychiatry Res 2019;274:91‑7.
doi.org/10.1016/j.psychres.2019.02.019.
19. MurisP, Petrocchi N. Protection or Vulnerability? A Meta‑Analysis
of the Relations Between the Positive and Negative Components
of Self‑Compassion and Psychopathology. Clin Psychol
Psychother 2017;24:373‑83. doi.org/10.1002/cpp.2005.
20. Hofmeyer A, Taylor R, Kennedy K. Fostering compassion and
reducing burnout: How can health system leaders respond
in the Covid‑19 pandemic and beyond? Nurse Educ Today
2020;94:104502. doi: 10.1016/j.nedt.2020.104502.
21. Ruiz‑Fernández MD, Ramos‑Pichardo JD, Ibáñez‑Masero O,
Cabrera‑Troya J, Carmona‑Rega MI, Ortega‑Galán ÁM.
Compassion fatigue, burnout, compassion satisfaction and
perceived stress in healthcare professionals during the
COVID‑19 health crisis in Spain. J Clin Nurs 2020;29:4321‑30. doi.
org/10.1111/jocn.15469.
22. Sung CW, Chen CH, Fan CY, Su FY, Chang JH, Hung CC, Fu CM,
Wong L, Pei‑Chuan Huang E, Lee TS. Burnout in medical staffs
during a coronavirus disease (COVID‑19) pandemic. Available
at SSRN 3594567. 2020 May 1. doi.org/10.2139/ssrn.3594567.
23. Kline RB. Principles and Practice of Structural Equation Modeling. 4th
ed. New York: Guilford Publications; 2015.
24. Nikčević AV, SpadaMM. The COVID‑19 Anxiety Syndrome Scale:
development and psychometric properties. Psychiatry research.
2020 Oct 1;292:113322. doi.org/10.1016/j.psychres.2020.113322.
25. Pommier E, Neff KD, Tóth‑Király I. The development
and validation of the Compassion Scale. Assessment. 2020
Jan;27(1):21‑39. doi.org/10.1177/1073191119874108.
26. Hu LT, Bentler PM. Cutoff criteria for fit indexes in covariance
structure analysis: Conventional criteria versus new
alternatives. Struct Equ Model Multidiscip J. 1999;6:1–55. doi.
org/10.1080/10705519909540118.
27. Tandon T, Dubey AK, Dubey S, Arora E, Hasan MN. Effects of
COVID‑19 pandemic lockdown on medical advice seeking and
medication practices of home‑bound non‑COVID patients. J Educ
Health Promot 2021;10:28.
28. Nejhaddadgar N, Azadi H, Mehedi N, Toghroli R, Faraji A.
Teaching adults how to prevent COVID‑19 infection by health workers: The application of intervention mapping approach.
J Educ Health Promot 2021;10:24.
29. Sharma D, Sharma N, Sharma P, Subramaniam G. Review of
investigational drugs for coronavirus disease 2019. J Educ Health
Promot 2021;10:31.
30. BikdeliB, TalasazAH, RashidiF, Sharif‑KashaniB, FarrokhpourM,
Bakhshandeh H, et al. Intermediate versus standard‑dose
prophylactic anticoagulation and statin therapy versus placebo
in critically‑ill patients with COVID‑19: Rationale and design
of the INSPIRATION/INSPIRATION‑S studies. Thromb Res
2020;196:382‑94.
31. Morgantini LA, Naha U, Wang H, Francavilla S, Acar Ö, Flores JM,
Crivellaro S, Moreira D, Abern M, Eklund M, Vigneswaran HT.
Factors contributing to healthcare professional burnout during
the COVID‑19 pandemic: A rapid turnaround global survey. PloS
one. 2020 Sep 3;15(9):e0238217.
32. Qiu J, Shen B, Zhao M, Wang Z, Xie B, Xu Y. A nationwide
survey of psychological distress among Chinese people in the
COVID‑19 epidemic: Implications and policy recommendations.
Gen Psychiatr 2020;33:e100213.
33. Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, Ho RC. Immediate
psychological responses and associated factors during the
initial stage of the 2019 coronavirus disease (COVID‑19)
epidemic among the general population in China. International
journal of environmental research and public health. 2020
Jan;17(5):1729.
34. Mousavi‑Asl E, Khanjani S, Mahaki B, Mohammadian Y.
Disordered eating: The psychometric properties of the Persian
version of the eating attitudes test‑8. J Educ Health Promot
2020;9:307.
35. Khanjani S, Asmari Y, Mousavi Asl E, Ashouri A. Relationship of
non‑suicidal self‑injury behaviors with mental pain in soldiers:
The Mediating Role of Self‑Compassion. Journal of military
medicine. 2020 Apr;22(4):363‑72.
36. Mousavi Asl E, Dabaghi P, Taghva A. Screening borderline
personality disorder: The psychometric properties of the Persian
version of the McLean screening instrument for borderline
personality disorder. J Res Med Sci 2020;25:97.
37. Foroughi A, Khanjani S, Mousavi Asl E. Relationship of concern
about body dysmorphia with external shame, perfectionism, and
negative affect: The mediating role of self‑compassion. Iranian
Journal of Psychiatry and Behavioral Sciences. 2019 Jun 30;13(2).
perceived risk, and fear on preventive behaviours against
COVID‑19. Psychology, health & medicine. 2021 Jan 2;26(1):35‑43.
http://doi.org/10.1080/13548506.2020.1776891.
2. Arslan G, Yıldırım M, Tanhan A, Buluş M, Allen KA. Coronavirus
stress, optimism‑pessimism, psychological inflexibility, and
psychological health: Psychometric properties of the Coronavirus
Stress Measure. International Journal of Mental Health and
Addiction. 2020 Jun 4:1‑7. doi: 10.1007/s11469‑020‑00337‑6.
3. Talaee N, Varahram M, Jamaati H, Salimi A, Attarchi M,
Kazempour Dizaji M, Sadr M, Hassani S, Farzanegan B,
Monjazebi F, Seyedmehdi SM. Stress and burnout in health
care workers during COVID‑19 pandemic: Validation of a
questionnaire. Journal of Public Health. 2020 Jan 1:1‑6. doi:
10.1007/s10389‑020‑01313‑z.
4. Yıldırım M, Solmaz F. COVID‑19 burnout, COVID‑19 stress and
resilience: Initial psychometric properties of COVID‑19 Burnout
Scale. Death Studies. 2020 Sep 10:1‑9. doi.org/10.1080/07481187
.2020.1818885.
5. Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S,
Greenberg N, et al. The psychological impact of quarantine
and how to reduce it: Rapid review of the evidence. Lancet
2020;395:912‑20. doi.org/10.1016/S0140‑6736(20)30460‑8.
6. Marčinko D, Jakovljević M, Jakšić N, Bjedov S ,
Mindoljević Drakulić A. The importance of psychodynamic
approach during COVID‑19 pandemic. Psychiatr Danub
2020;352:15‑21. doi.org/10.24869/psyd.2020.15.
7. Peterson U, Demerouti E, Bergström G, Samuelsson M, Asberg M,
Nygren A. Burnout and physical and mental health among
Swedish healthcare workers. J Adv Nurs 2008;62:84‑95. http://
doi.org/10.1111/j. 1365‑2648.20070.04580.x.
8. Cheli S, Cavalletti V, Petrocchi N. An online compassion‑focused
crisis intervention during COVID‑19 lockdown: A cases series on
patients at high risk for psychosis. Psychosis. 2020 Jul 19:1‑4. doi.
org/10.1080/17522439.2020.1786148.
9. Weiner L, Berna F, Nourry N, Severac F, Vidailhet P, Mengin AC.
Efficacy of an online cognitive behavioral therapy program
developed for healthcare workers during the COVID‑19
pandemic: The REduction of STress (REST) study protocol for
a randomized controlled trial. Trials 2020;21:870. doi: 10.1186/
s13063‑020‑04772‑7.
10. Irons C, Beaumont E. The compassionate mind workbook:
A step‑by‑step guide to developing your compassionate self.
Robinson; 2017 Sep 14.
11. Coyne LW, Gould ER, Grimaldi M, Wilson KG, Baffuto G,
Biglan A. First things first: Parent psychological flexibility and
self‑compassion during COVID‑19. Behavior analysis in practice.
2020 May 6:1‑7. doi: 10.1007/s40617‑020‑00435‑w.
12. Smith GD, Ng F, Li WH. COVID-19: Emerging compassion,
courage and resilience in the face of misinformation and adversity.
Journal of clinical nursing. 2020 May;29(9‑10):1425.
13. Mohammadpour M, Ghorbani V, Khoramnia S, Ahmadi SM,
Ghvami M, Maleki M. Anxiety, self‑compassion, gender
differences and COVID‑19: Predicting self‑care behaviors and
fear of COVID‑19 based on anxiety and self‑compassion with an
emphasis on gender differences. Iran J Psychiatry 2020;15:213‑9.
https://doi.org/10.18502/ijps.v15i3.3813.
14. Li, A.; Wang, S.; Cai, M.; Sun, R.; Liu, X. Self‑Compassion and
Life‑Satisfaction among Chinese Self‑Quarantined Residents
during COVID‑19 Pandemic: A Moderated Mediation Model of
Positive Coping and Gender. Pers. Individ. Dif. 2020,170,0457.
doi.org/10.3390/ijerph 18041474.
15. Braus M, Morton B. Art therapy in the time of COVID‑19. Psychol
Trauma 2020;12:S267‑8. 10.1037/tra0000746. Epub 2020 Jun 1.
16. Barnard LK, Curry JF. Self‑compassion: Conceptualizations,
correlates, & interventions. Rev Gen Psychol 2011;15:289‑303.
https://doi.org/10.1037/a0025754.
17. Hasking P, Boyes ME, Finlay‑Jones A, McEvoy PM, Rees CS.
Common pathways to NSSI and suicide ideation: The roles of
rumination and self‑compassion. Archives of Suicide Research.
2019 Apr 3;23(2):247‑60. doi.org/10.1080/13811118.2018.1468836.
18. Fresnics AA, Wang SB, Borders A. The unique associations
between self‑compassion and eating disorder psychopathology
and the mediating role of rumination. Psychiatry Res 2019;274:91‑7.
doi.org/10.1016/j.psychres.2019.02.019.
19. MurisP, Petrocchi N. Protection or Vulnerability? A Meta‑Analysis
of the Relations Between the Positive and Negative Components
of Self‑Compassion and Psychopathology. Clin Psychol
Psychother 2017;24:373‑83. doi.org/10.1002/cpp.2005.
20. Hofmeyer A, Taylor R, Kennedy K. Fostering compassion and
reducing burnout: How can health system leaders respond
in the Covid‑19 pandemic and beyond? Nurse Educ Today
2020;94:104502. doi: 10.1016/j.nedt.2020.104502.
21. Ruiz‑Fernández MD, Ramos‑Pichardo JD, Ibáñez‑Masero O,
Cabrera‑Troya J, Carmona‑Rega MI, Ortega‑Galán ÁM.
Compassion fatigue, burnout, compassion satisfaction and
perceived stress in healthcare professionals during the
COVID‑19 health crisis in Spain. J Clin Nurs 2020;29:4321‑30. doi.
org/10.1111/jocn.15469.
22. Sung CW, Chen CH, Fan CY, Su FY, Chang JH, Hung CC, Fu CM,
Wong L, Pei‑Chuan Huang E, Lee TS. Burnout in medical staffs
during a coronavirus disease (COVID‑19) pandemic. Available
at SSRN 3594567. 2020 May 1. doi.org/10.2139/ssrn.3594567.
23. Kline RB. Principles and Practice of Structural Equation Modeling. 4th
ed. New York: Guilford Publications; 2015.
24. Nikčević AV, SpadaMM. The COVID‑19 Anxiety Syndrome Scale:
development and psychometric properties. Psychiatry research.
2020 Oct 1;292:113322. doi.org/10.1016/j.psychres.2020.113322.
25. Pommier E, Neff KD, Tóth‑Király I. The development
and validation of the Compassion Scale. Assessment. 2020
Jan;27(1):21‑39. doi.org/10.1177/1073191119874108.
26. Hu LT, Bentler PM. Cutoff criteria for fit indexes in covariance
structure analysis: Conventional criteria versus new
alternatives. Struct Equ Model Multidiscip J. 1999;6:1–55. doi.
org/10.1080/10705519909540118.
27. Tandon T, Dubey AK, Dubey S, Arora E, Hasan MN. Effects of
COVID‑19 pandemic lockdown on medical advice seeking and
medication practices of home‑bound non‑COVID patients. J Educ
Health Promot 2021;10:28.
28. Nejhaddadgar N, Azadi H, Mehedi N, Toghroli R, Faraji A.
Teaching adults how to prevent COVID‑19 infection by health workers: The application of intervention mapping approach.
J Educ Health Promot 2021;10:24.
29. Sharma D, Sharma N, Sharma P, Subramaniam G. Review of
investigational drugs for coronavirus disease 2019. J Educ Health
Promot 2021;10:31.
30. BikdeliB, TalasazAH, RashidiF, Sharif‑KashaniB, FarrokhpourM,
Bakhshandeh H, et al. Intermediate versus standard‑dose
prophylactic anticoagulation and statin therapy versus placebo
in critically‑ill patients with COVID‑19: Rationale and design
of the INSPIRATION/INSPIRATION‑S studies. Thromb Res
2020;196:382‑94.
31. Morgantini LA, Naha U, Wang H, Francavilla S, Acar Ö, Flores JM,
Crivellaro S, Moreira D, Abern M, Eklund M, Vigneswaran HT.
Factors contributing to healthcare professional burnout during
the COVID‑19 pandemic: A rapid turnaround global survey. PloS
one. 2020 Sep 3;15(9):e0238217.
32. Qiu J, Shen B, Zhao M, Wang Z, Xie B, Xu Y. A nationwide
survey of psychological distress among Chinese people in the
COVID‑19 epidemic: Implications and policy recommendations.
Gen Psychiatr 2020;33:e100213.
33. Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, Ho RC. Immediate
psychological responses and associated factors during the
initial stage of the 2019 coronavirus disease (COVID‑19)
epidemic among the general population in China. International
journal of environmental research and public health. 2020
Jan;17(5):1729.
34. Mousavi‑Asl E, Khanjani S, Mahaki B, Mohammadian Y.
Disordered eating: The psychometric properties of the Persian
version of the eating attitudes test‑8. J Educ Health Promot
2020;9:307.
35. Khanjani S, Asmari Y, Mousavi Asl E, Ashouri A. Relationship of
non‑suicidal self‑injury behaviors with mental pain in soldiers:
The Mediating Role of Self‑Compassion. Journal of military
medicine. 2020 Apr;22(4):363‑72.
36. Mousavi Asl E, Dabaghi P, Taghva A. Screening borderline
personality disorder: The psychometric properties of the Persian
version of the McLean screening instrument for borderline
personality disorder. J Res Med Sci 2020;25:97.
37. Foroughi A, Khanjani S, Mousavi Asl E. Relationship of concern
about body dysmorphia with external shame, perfectionism, and
negative affect: The mediating role of self‑compassion. Iranian
Journal of Psychiatry and Behavioral Sciences. 2019 Jun 30;13(2).
)