Volume 23, Issue 5 (December & January - Special Issue on COVID-19 2020)                   J Arak Uni Med Sci 2020, 23(5): 698-709 | Back to browse issues page

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Fathi A, Sadeghi S, Maleki Rad A A, Rostami H, Abdolmohammadi K. Effect of Health-promoting Lifestyle and Psychological Well-being on Anxiety Induced by Coronavirus Disease 2019 in Non-medical Students. J Arak Uni Med Sci 2020; 23 (5) :698-709
URL: http://jams.arakmu.ac.ir/article-1-6279-en.html
1- Institute of Law Enforcement and Social Studies, Tehran, Iran.
2- Department of Psychology, Institute of Charkh Niloofari, Tabriz, Iran. , soli.sdgh@gmail.com
3- Department of Biology, Faculty of Scince, Payam-e-Nour University, Tehran, Iran.
4- Department of Psychology, Institute of Charkh Niloofari, Tabriz, Iran.
5- Department of Psychology, Faculty of Psychology and Educational Sciences, Payam-e-Nour University, Tehran, Iran.
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1. Introduction
nxiety is one of the clinical signs of viral diseases such as coronavirus disease 2019 (COVID-19), which can weaken the immune system and make them vulnerable to such diseases [5]. Many studies have shown that stressful life events can affect psychological well-being [12131415, 18], and consequently lifestyles of people. The aim of this study is to identify the effects of health-promoting lifestyle and psychological well-being on the COVID-19-induced anxiety in non-medical students.
2. Materials and Methods
This is an analytical study. The study population includes all undergraduate students of Islamic Azad University in Tabriz, Iran in 2020. After determining sample size using Krejcie & Morgan table, 327 non-medical students were selected voluntarily. The data collection tools were Corona Disease Anxiety Scale developed by Alipour et al. [5]. Ryff’s Scales of psychological Well- Being (SPWB) [28], (Containing six subscales of autonomy, environmental mastery, personal growth, purpose in life, positive relations with others and self-acceptance), and Health-Promoting Lifestyle Profile (HPLP) developed by Walker et al. [25] (Containing six subscales of responsibility, spiritual growth, physical activity, interpersonal relationships, nutrition, and stress management) which were completed by students online to due restrictions during the pandemic. After collecting questionnaires, 20 were excluded due to large amounts of outliers and 307 were included in the analysis. The statistical analysis was conducted in SPSS V. 16 using Stepwise regression method.
3. Results
Participants were 307 non-medical students; 256 females (83.4%) and 51 (16.6%) males with a mean age of 27 years. The stepwise regression analysis was used to evaluate the effects of SPWB dimensions on the COVID-19-induced anxiety. In the first step, the “personal growth” dimension entered the regression model, due to having the highest correlation coefficient with the dependent variable, and explained 71% of the variance in the anxiety. In the next step, the dimension of “positive relations with others” was entered into the model; this dimension together with the personal growth dimension explained 72% of the anxiety variance (Table 1). 

Other SPWB dimensions could not predict the COVID-19-induced anxiety and were then excluded from the regression model.
The stepwise regression analysis was also used to evaluate the effects of HPLP dimensions on the COVID-19-induced anxiety. In the first step, the “spiritual growth” dimension entered the regression model, due to having the highest correlation coefficient with the dependent variable, and explained 3% of the anxiety variance. In the next step, the dimension of “responsibility” was entered into the model; this dimension together with the spiritual growth dimension explained 9% of the anxiety variance (Table 2). 

Other HPLP dimensions were excluded from the regression model. 
4. Discussion and Conclusion
Findings from the present study showed that the two SPWB components of personal growth and positive relations with others together could explain 72% of the variance in the COVID-19-induced anxiety, and they had a significant negative relationship with the COVID-19-induced anxiety. This is consistent with the findings of some other studies [12131415, 18]. Personal growth means having a sense of continued development and, sense of realizing self potentials, and having more self-knowledge and effectiveness. Positive relations with others indicate having warm, satisfying, and trusting relationships with others [12]. Anxiety causes destructive effects on a person’s physical and mental condition, and this in itself creates a vicious link between anxiety and the psychological well-being of the person; i.e. anxiety endangers his/her psychological well-being [14]. Another finding of this study showed that people who had higher spiritual growth and responsibility (two HPLP components ) had less COVID-19-induced anxiety, indicating a significant negative relationship between them, which is consistent with other studies [3, 23, 26, 33]. Spiritual growth is an internal process to break old habits and ideas, misconceptions and false beliefs about life [3, 33]. Responsibility makes a person sensitive and responsible to maintain and improve self health by visiting a doctor in case of need; hence, they report less anxiety [26].

Ethical Considerations
Compliance with ethical guidelines

This study was approved by University of Tabriz (Code:IR.TABRIZU.REC.1399.018). All ethical principles are considered in this article. The participants were informed about the purpose of the research and its implementation stages. They were also assured about the confidentiality of their information and were free to leave the study whenever they wished, and if desired, the research results would be available to them. 

This research did not receive any grant from funagencies in the public, commercial, or non-profit sector.

Authors' contributions
Project design, guidance, editing theoretical foundations, statistical analysis and scientific editing of the article: Ayatollah Fathi; Compilation of proposal, writing of the introduction, statistical analysis and participation in writing theoretical foundations and articles: Solmaz Sadeghi; Participation in project design, discussion and writing of results and article: Ali Akbar Maleki Rad; Guiding and editing theoretical foundations, participation in data collection and analysis: Hossein Rostami; Participation in data collection and analysis: Karim Abdolmohammadi.

Conflicts of interest
The authors declare no conflict of interest.

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Type of Study: Original Atricle | Subject: COVID-19
Received: 2020/04/14 | Accepted: 2020/07/6

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