Family support as a protective factor for attitudes toward social distancing and in preserving positive mental health during the COVID-19 pandemic

Abstract

We examined the role of family support in influencing attitudes about social distancing and positive mental health during the COVID-19 pandemic among 1547 Chinese people. The results showed that after the effects of demographic variables were controlled, perceived support from family members made unique contributions to their attitudes about social distancing and positive mental health both directly and indirectly (via buffering loneliness). These results suggest that strong support from family plays an important role in improving individuals’ attitudes about social distancing and maintaining positive mental health during the epidemic.

Keywords

COVID-19 family support loneliness social distancing positive mental health

Introduction

In December 2019, a novel coronavirus disease (COVID-19) was detected in Wuhan, Hubei (Health Commission of Wuhan, 2019). The initial symptoms of COVID-19 were similar to those of the common cold. Patients presented a fever, headache, cough, and other symptoms, later causing severe acute respiratory distress syndrome leading to death (Chen et al., 2020; Huang et al., 2020). Evidence shows that COVID-19 is mainly transmitted through respiratory droplets, airborne transmission, and direct contact (Chan et al., 2020); thus, it is extremely contagious. On March 12, 2020, the World Health Organization (WHO) defined COVID-19 as a pandemic (WHO, 2020). As of August 2020, more than 20 million people worldwide have been diagnosed with the infection, and more than 800,000 people have died (Johns Hopkins University & Medicine, 2020). Effectively controlling the spread of the COVID-19 contagion has become the most pressing public health concern facing the world today (Li et al., 2020).

Until vaccination and other effective medical interventions become available, social distancing remains an effective measure for combating an unknown infectious disease, as it restricts close person-to-person contact. For example, based on the case data from the CDC and health commissions of China, a study analyzed the speed of COVID-19 containment for 58 cities in China, showing that the propagation rate declined by an average of 54.3% after the implementation of social distancing measures (Du et al., 2020). However, due to the inherent costs (e.g. sacrifice freedom and endure loneliness) associated with social distancing, not all people are likely to fully comply with the social distancing recommendations (Gupta and Dhamija, 2020). Some recent studies revealed that some demographic variables (e.g. age and educational levels; Wirz et al., 2020) and cognitive skills (e.g. working memory; Xie et al., 2020) influenced compliance and attitudes about social distancing during the COVID-19 pandemic. Due to the close relationship between social distancing and social isolation (Gupta and Dhamija, 2020), the present study examined the effect of social support from family on attitudes toward social distancing and in maintaining positive mental health during the epidemic.

Social support is typically conceptualized as the emotional, informational, and instrumental assistance received from social networks (House and Kahn 1995; Thoits, 2011). During the past decades, numerous studies have indicated that social support is an effective resource in coping with stress, and buffers the harmful physical and mental health impacts of stress exposure (Andrews et al., 1978; Cohen and Wills, 1985; Ell, 1996; Kim et al., 2010). Particularly, as compared to the actual available or received support, perceived social support may more closely relate to positive coping mechanisms and psychological well-being (Lakey and Orehek, 2011).

During the COVID-19 pandemic, governments across the globe implemented social distancing measures as an important strategy to curb the spread of infection. However, a potential drawback of social distancing is social isolation, the removal of social interactions, connection, and support with others and the outside world (Gupta and Dhamija, 2020; Razai et al., 2020). Stay-at-home, family become the most available source for meaningful, face-to-face social interactions and connections. Close ties with family could provide an important support for people dealing with crises by increasing the sense of belonging, security, and self-worth. These positive psychological states may directly benefit mental health by increasing the motivation of healthy behaviors and positive coping strategies (Greenglass, 1993; Leserman et al., 1992). Therefore, support from family could play a crucial role in helping people cope with the stress and difficulties caused by the epidemic and subsequent isolation. For example, several recent studies have emphasized family support as a key principle in maintaining “social distancing” to tackle COVID-19 (Bavel et al., 2020; Gupta and Dhamija, 2020; Razai et al., 2020). However, to our knowledge, no previous study has examined the relationship between family support and attitudes about social distancing. Thus, the present study examines and attempts to provide direct evidence for the effect of family support on attitudes toward social distancing during an epidemic.

In addition to affecting attitudes about social distancing, family support may also play an important role in the maintenance of positive mental health during the epidemic. During the past decades, the relationships between social support and mental health have been well documented (Cohen and Janicki-Deverts, 2010; Uchino, 2006). Perceived social support can defy negative psychological impacts under stressful situations, like depression (Lakey and Cronin, 2008), anxiety (Xu et al., 2019), and posttraumatic stress disorder (Kaniasty and Norris, 2010). Additionally, it can also be helpful in maintaining positive mental health aspects like positive affect (Finch et al., 1999), life satisfaction (Kong et al., 2015; Wang et al., 2020), and subjective well-being (Kong et al., 2013). Recent studies have shown that the COVID-19 pandemic and its implications will cause widespread emotional distress and increase mental health issues (Daly et al., 2020; Pfefferbaum and North, 2020; Torales et al., 2020). Social support may mitigate the increased stressful impacts for both medical staff (Xiao et al., 2020) and the general population (Cao et al., 2020; El-Zoghby et al., 2020) during the COVID-19 pandemic. However, studies on positive side of mental health and its correlates are scare as compared to those on mental problems. Thus, the present study also examined the role of family support in preserving positive mental health during the COVID-19 pandemic among the general population.

Loneliness refers to the negative subjective experience of a mismatch between the desired and the achieved personal network of relationships (Cacioppo and Patrick, 2009). Because loneliness is characterized by a deficiency of social relations, social support deficits were found to be an important predictor of loneliness (Prince et al., 1997; Segrin and Passalacqua, 2010). As a result, loneliness is also comorbid with a host of psychological problems and health related behaviors, including depression and anxiety (Beutel et al., 2017; Wang et al., 2018), lower levels of subjective well-being (Kong and You, 2013), as well as negative coping strategies (Cacioppo et al, 2003). Thus, loneliness was found to be an important mediator between social support and mental health or subjective well-being (Kong and You, 2013; Segrin and Passalacqua, 2010). Therefore, in the present study, we also examined the possible mediating effect of loneliness between social support from family members and attitudes about social distancing and positive mental health. We hypothesized that in addition to the direct effect, support from family could also preserve people’s positive mental health and facilitate positive coping strategies by reducing loneliness caused by social isolation during the pandemic (Msw and Volicer, 2020).

Methods

Participants

We conducted an online survey using the snowball sampling technique with different social media resources (e.g. WeChat, QQ, and Weibo). From March 5 to March 9, 2020, 1547 people (age range = 12–60 years, Mage = 24.32 years, SD = 8.62; 33.7% female; 43.7% living in rural) from around 31 provinces and autonomous regions of China completed the online survey through Wenjuanxing, an online survey system. All obtained responses were anonymous and we obtained informed consent from all participants at the beginning of the questionnaire. For participants under the age of 18 years, parental informed consent was also obtained. Ethical approval was granted from the local institutional board. All participants were compensated with a red packet after completing the questionnaire.

Measures

At the beginning of the online survey, we collected socio-demographic information (including age, sex, rural or urban residential setting, and educational levels) and assessed educational levels on a seven-point Likert scale: 1 = primary school or below, 2 = middle school, 3 = high school, 4 = 3-year college, 5 = 4-year university, and 6 = postgraduate.

We assessed their social support from family members, using the family support subscale of the Multidimensional Scale of Perceived Social Support (MSPSS; Zimet et al., 1990). The MSPSS assesses individual perceived social support from family, friends, and others. It consisted of 12 items in total and 4 items for each subscale. All items were rated on a five-point Likert scale (1 = strongly disagree, 5 = strongly agree). The sum of scores of the 4 items on each subscale were the ﬁnal score of the levels of perceived social support from various sources. The revised Chinese version of the MSPSS has been proven to have good reliability and validity (Jiang, 2001). The internal consistency reliability coefficient (Cronbach’s α) of the family support subscale was 0.85 in the present study.

We assessed loneliness in the present study using a three-item short-form UCLA loneliness scale (Hughes et al., 2004). The three items were as follows: (1) “How often do you feel that you lack companionship?” (2) “How often do you feel left out?” (3) “How often do you feel isolated from others?” We asked participants to rate on a three-point Likert scale (1 = hardly ever, 2 = some of the time, and 3 = often). The original UCLA loneliness scale was developed by Russell et al. (1978, 1980), and was widely used to assess loneliness caused by social isolation. The translated Chinese version of the UCLA loneliness scale has proven to have good validity and reliability (Wang, 1995). The internal consistency reliability coefficient (Cronbach’s α) of the short-form UCLA was 0.73 in the present study.

We assessed attitudes about social distancing using a self-report questionnaire. The questions were as follows: “During the past month, cities across China implemented stringent social distancing measures in order to effectively control the rapid spread of COVID-19 (such as staying at home, avoiding mass gathering, self-isolation, etc.); (1) To what extent do you agree with the implementation of these measures? (2) To what extent are you willing to comply with the following social distancing measures? (3) Social distancing plays a very important role in preserving people’s lives during the pandemic. (4) The implementation of these social distancing measures is an important factor for the definitive control of the epidemic in China.” Participants were asked to rate these questions on a five-point Likert scale (1 = strongly disagree/unwilling, 5 = strongly agree/willing). The internal consistency reliability coefficient (Cronbach’s α) of the attitudes about social distancing was 0.79 in the present study.

Positive mental health was assessed with the Mental Health Continuum Short-Form (MHC-SF; Keyes et al., 2008; Yin and He, 2012). MHC conceptualizes mental health as a syndrome of positive feelings and positive functioning in life (Keyes, 2002). The MHC-SF includes 14 items and assesses subjective well-being on three dimensions, including emotional, psychological, and social (Keyes et al., 2008). All items were rated on a five-point Likert scale (1 = strongly disagree, 5 = strongly agree), and the final score was the mean score of all items. The Chinese version of the MHC-SF has proven to have good reliability and validity (Yin and He, 2012). The internal consistency reliability coefficient (Cronbach’s α) of the MHC-SF was 0.93 in the present study.

Data analysis

First, descriptive analyses, including mean score, standard deviations, and score range were computed for various variables used in the present study. Then, we calculated Pearson correlations to analyze the relationship between variables. Finally, we used multiple regression and the SPSS macro PROCESS program (Hayes, 2013) to examine the roles of family support for attitudes about social distancing and in preserving positive mental health, and the possible mediating effect of loneliness. We tested the indirect effect using a bootstrapping method with 5000 bootstrap resamples (Preacher and Hayes, 2008). If the 95% CI of the indirect effect did not overlap with zero, the significance of the mediating effects was accepted. We evaluated all statistical tests at the p < 0.05 significance level.

Data sharing statement

The current article includes the complete raw data set collected in the study, including the participants’ data set, syntax file, and log files for analysis.

Results

Common method bias test

In this study, we used Harman’s single factor test to test the possible common method bias of all variables in this study. Common method bias exists if a single factor is identified, and the first factor explains the majority of the variance in the variables (Podsakoff et al., 2003). The results of the exploratory factor analysis identified five factors with eigenvalues greater than one, and the first factor accounted for 35.07% of the total variance without rotation and 18.03% of the total variance after rotation. Therefore, there was no significant common method bias in the measurements.

Descriptive statistics and intercorrelations

Table 1 shows the means, standard deviations, ranges, and intercorrelations of all measures in this study. As Table 1 shows, age positively correlated with family support and positive mental health, and negatively correlated with loneliness. The females in our sample population exhibited more positive attitudes toward social distancing than males did. Educational levels positively correlated with positive attitudes toward social distancing and positive mental health. Family support positively correlated with attitudes toward social distancing and positive mental health, while loneliness negatively correlated with attitudes about social distancing and positive mental health. In addition, family support and loneliness were significantly correlated, and attitudes toward social distancing and positive mental health were significantly correlated.

Table 1.

Means, standard deviations (SD), ranges, and intercorrelations of all measures.

Variable	1	2	3	4	5	6	7	8
1. Age	1.00
2. Sex	−.18^**	1.00
3. RUS	−.20^**	.01	1.00
4. Educational levels	−.04	.10^**	−.18^**	1.00
5. Family support	.13^**	.01	−.04	.05	1.00
6. Loneliness	−.07^**	−.01	.03	−.04	−.32^**	1.00
7. ASD	.03	.08^**	−.05	.15^**	.32^**	−.16^**	1.00
8. Positive mental health	.08^**	−.01	−.03	.07^**	.57^**	−.33^**	.33^**	1.00
Means	24.32	–	–	4.46	22.54	4.01	18.30	3.60
SD	8.62	–	–	1.12	4.31	1.33	2.04	.68
Ranges	12–60	–	–	1–6	4–20	3–9	4–28	1–5

N = 1547.

ASD: attitudes about social distancing; RUS: rural or urban residential setting.

p < 0.001.

Regression

First, we conducted two hierarchical regressions to examine the roles of family support and loneliness, in attitudes toward social distancing and positive mental health (Table 2). In the first step, we entered various socio–demographic variables (including age, sex, rural or urban residential setting, and educational levels). At the second step, we entered family support and loneliness; all predictors explained 12.9% variance of attitudes about social distancing, and 35.1% variance of positive mental health. As shown in the table, among all the variables, sex, educational levels, family support, and loneliness were the significant predictors for attitudes toward social distancing, while educational levels, family support, and loneliness were significant predictors of positive mental health.

Table 2.

Hierarchical regression in predicting attitudes about social distancing and positive mental health.

		ASD		Positive mental health
		β	t	β	t
Step 1:	Age	−.01	−.20	.01	.21
	Sex	.06	2.58^*	−.01	−.59
	RUS	−.01	−.48	.01	.47
	Educational levels	.12	5.02^***	.04	2.03^*
Step 2:	Family support	.30	11.68^***	.52	23.68^***
	Loneliness	−.06	−2.42^*	−.17	−7.66^***

N = 1547.

RUS: rural or urban residential setting; ASD: attitudes about social distancing.

*p < 0.05, ^***p < 0.0001.

We then tested the possible mediating effect of loneliness between family support and attitudes about social distancing and in preserving positive mental health using the SPSS macro PROCESS program (Hayes, 2013). As shown in Figure 1, we controlled for the effects of age, sex, rural or urban residential setting, and educational levels. In addition to the direct effects on attitudes about social distancing and positive in preserving positive mental health, family support also works on attitudes about social distancing (point estimate = 0.02, 95% CI = 0.01–0.03) and positive mental health (point estimate = 0.05, 95% CI = 0.03–0.07) via loneliness.

Figure1.

Mediating effect of loneliness between family support and attitudes about social distancing (a)/positive mental health (b). ^*p < 0.05, ^***p < 0.0001.

Discussion

During the COVID-19 pandemic, governments across the world implemented social distancing measures to control the spread of the disease. To accompany these, they initiated a series of interventions to promote adherence to social distancing guidelines, which included education, persuasion, and restriction. In the present study, we examined the role of social support on attitudes toward social distancing and in preserving positive mental health during the COVID-19 pandemic. Results showed that perceived social support from family had a significant influence on attitudes toward social distancing and positive mental health both directly and indirectly (via buffering loneliness).

Previous research has shown that a high level of social support facilitates positive coping strategies to deal with stressful situations (Greenglass, 1993; Leserman et al., 1992). The present study extended the previous literature by demonstrating that social support from family also contributed to more positive attitudes about social distancing. This result was in agreement with the prediction of the main effect model of social support; integrating oneself in a social network may produce a sense of purpose and belonging, which in turn promotes good health. Similarly, a recent study showed that if people learned that their social distancing would help their families and their peers, it would promote the engagement in and positive attitudes toward social distancing (Wirz et al., 2020).

In addition to the signiﬁcant direct effect of family support on the attitudes toward social distancing, family support also works on this attitude by mitigating loneliness. During the pandemic, social distancing policies would cut off meaningful social interactions and connections from the outside world, and increase social isolation and relationship difficulties (Brooks et al., 2020). Family support at home would be a powerful resource in tackling the adverse consequences of social isolation and loneliness. A study showed that people’s inability to tolerate social isolation and loneliness was one of the barriers discouraging them from practicing social distancing (Wirz et al., 2020). Interventions targeting social support would attenuate loneliness caused by social isolation (Winningham and Pike, 2007). Therefore, social support reduces loneliness caused by social distance, which in turn promotes more positive attitudes about social distancing.

Consistent with the findings on the attitudes about social distancing, our results also showed that family support contributed to positive mental health both directly and indirectly via reducing loneliness during the pandemic. This ﬁnding is aligned with previous studies on the relationship between social support and mental health or subjective well-being (Kong and You, 2013; Lechner et al., 2020; Xu et al., 2019), and suggests that social support benefits an individual’s ability to cope with stress by providing various psychological and material resources, or mitigating the adverse consequences of harmful events (Barrera, 1986; Cohen and Wills, 1985; Thoits, 2011).

Furthermore, our results showed that the female respondents exhibited more positive attitudes toward social distancing. This was in line with previous studies that indicated that the female population exhibited an increased compliance regarding medical advice and health care (Solomon et al., 2005). Meanwhile, consistent with the finding of a recent study (Wirz et al., 2020), our results revealed that people with a higher level of education had more positive attitudes about social distancing and likely to comply with social distancing recommendations.

Finally, some limitations of the current study should be acknowledged. First, the cross-sectional design of the current study naturally led to the correlation of present observations. Thus, the causal inference on the relationship between family support and attitude toward social distancing and in preserving positive mental health needs to be tested in future longitudinal or interventional studies. Second, although all the data were collected anonymously, social approval may still have influenced the responses of the subjects, especially in China, where collectivism is emphasized. Third, in the present study, we measured the attitudes about social distancing using self-report measures, but not actual behaviors regarding social distancing. Attitude and behaviors are usually highly correlated (Shrigley, 1990), and changes in attitude are often accompanied by corresponding behavioral changes over time (Ajzen and Fishbein, 1977). Future studies are needed to examine the relationships between social support and actual behaviors regarding social distancing directly.

Conclusion

The present study provides evidence that a high level of social support from family is associated with more positive attitudes toward social distancing and preserving positive mental health during the COVID-19 pandemic. Social support contributed to attitudes about social distancing and preserving positive mental health both directly and indirectly via buffering loneliness. In addition, the males in our sample population, as well as the less educated individuals, did not see social distancing as effective and were less likely to fully comply with social distancing guidelines. These results have important implications for promoting the compliance of social distancing guidelines and in preserving positive mental health during the COVID-19 pandemic.

Research Data

data-family_support – Research Data for Family support as a protective factor for attitudes toward social distancing and in preserving positive mental health during the COVID-19 pandemic

Research Data, data-family_support for Family support as a protective factor for attitudes toward social distancing and in preserving positive mental health during the COVID-19 pandemic by Shifeng Li and Qingying Xu in Journal of Health Psychology

This article is distributed under the terms of the Creative Commons Attribution 4.0 License (http://www.creativecommons.org/licenses/by/4.0/) which permits any use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).

Footnotes

Acknowledgements

We would like to thank all participants for their efforts and participation in this study.

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.

ORCID iD

Shifeng Li

Data sharing statement

The current article includes the complete raw data-set collected in the study including the participants’ data set, syntax file, and log files for analysis.

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