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Graduate Student Journal of Psychology
2023, Vol. 21

Copyright 2023 by the Department of Counseling and Clinical Psychology
Teachers College, Columbia University

Anxiety Symptoms in a Community During the 
COVID-19 Pandemic: A Self-Reported Study

The coronavirus (COVID-19) pandemic has affected many aspects of people’s lives, including their men-
tal health. To better understand its impact, the current study looked at how demographic features and beliefs 
about the pandemic influenced anxiety during this time. Participants included 221 residents of Michigan who 
predominantly identified as female and White. They completed the Adaptation to Social Stress Questionnaire, 
a 105-item self-report questionnaire developed to assess participant characteristics, ability to adapt to stress and 
opinions, beliefs, and experiences related to the COVID-19 pandemic, and two measures of anxiety (the State-
Trait Anxiety Inventory and the Generalized Anxiety Disorder scale). Pearson product-moment correlations 
and independent samples t-tests were used to determine the relationship between anxiety and other study vari-
ables. Results show that religious affiliation and older age were associated with lower anxiety scores while liv-
ing in the subjects’ close environment as an infected individual was associated with increased anxiety. Interest-
ingly, thinking someone was to blame for the pandemic, being angered by official message regulations, and not 
thinking lockdown measures were sufficient increased anxiety. This latter finding implies that consistent with 
clinical theory, our beliefs about events are connected with our emotional experiences. Recommendations 
for clinical practice are noted as it is imperative for clinicians to be consistent and direct regarding any proto-
col changes that may help minimize client anxiety. Lastly, considerations regarding transparent communication 
from leaders of organizations that are adjusting their policies due to the COVID-19 pandemic are discussed. 
 Keywords: COVID-19, anxiety, Michigan, pandemic beliefs, social stress adaptation

Paige S. Erickson1, Kathryn R. Forche1, Emily A. Dowgwillo1, Carol Cronin Weisfeld1, Marina L. Butovskaya2, and Valentina 
N. Burkova2,

1Department of Psychology, University of Detroit Mercy, Detroit, Michigan  
2Center of Cross-Cultural Psychology and Human Ethology, Institute of Ethnology and Anthropology, Russian Academy 

of Sciences, Moskva, Russia

 While pandemics have caused great human 
suffering over many centuries (Turner, 2020), the 
COVID-19 pandemic may be the most carefully doc-
umented worldwide epidemic in history because of 
advances in healthcare and in worldwide communica-
tions. Greater attention to mental health issues has been 
one theme of research on the COVID-19 pandemic, 
and this report attempts to contribute to the literature 
on mental health effects within the United States, with 
a particular focus on the state of Michigan. The re-
search reported  here was conducted in the spring and 
summer of 2020, when Americans were between two 
peaks in disease/death rates, with vaccines only aspira-
tional. By the fall of 2020, the U.S.A. had approximate-
ly 12 million COVID-19 cases, compared to about 58 
million cases worldwide (John Hopkins University of 
Medicine, 2020). This was almost three million more 
cases than India, a country whose population is more 
than four times the population of the United States. 
 As COVID-19 spread, states varied widely in 
terms of their response to the epidemic. In response to 
the pandemic Michigan’s Governor, Gretchen Whit-
mer, issued executive orders restricting commerce 
and public activity, while the state legislature (con-
trolled by the other political party) opposed her and 
encouraged citizens to rebel (Jaffe & Marley, 2022). 

Michigan received a great deal of news coverage, not 
because of particularly high COVID-19 case numbers 
or death rates in 2020, but because of the strong reac-
tions against the restrictions placed on Michiganders 
by Governor Whitmer and her Public Health officials. 
 One of the objections to health restrictions (e.g., 
mask-wearing, the closing of bars and gyms, discour-
aging large gatherings, moving schools to online teach-
ing) is that they may protect against infection but 
create unwanted side effects such as increased levels 
of domestic abuse, child neglect, anxiety, depression, 
and other types of mental illness. This assertion is 
supported by a recent meta-analysis that included 
15 studies (11 related to COVID-19 and four relat-
ed to SARS and Influenza pandemics) on the effects 
of pandemics on the mental health of people with 
pre-existing mental illnesses (Neelam et al., 2021). 
All 15 studies found that people with mental illness 
experienced more psychiatric symptoms during pan-
demics compared to control groups (Neelam et al., 
2021). The primary symptoms identified included 
increased anxiety, depression, and insomnia. Re-
searchers hypothesized that the lack of social inter-
action and difficulty in maintaining a daily routine 
contributed to these findings (Neelam et al., 2021). 
Similarly, Marroquín and colleagues (2020) found  



107

that the stay-at-home orders that were implemented 
in March 2020 were associated with more symptoms 
of depression, generalized anxiety, acute stress, and 
insomnia (Marroquín et al., 2020). These symptoms 
remained despite individuals’ levels of perceived so-
cial support, which suggests that known protective 
factors (e.g., social interaction) did not eliminate the 
impact of social distancing (Marroquín et al., 2020). 
Anxiety and Predictors of Anxiety
Research has shown that women are significantly 
more likely than men to develop an anxiety disorder at 
some point during their lifespan (Kessler et al., 1994; 
Pigott, 2003; Jalnapurkar et al., 2018). The National 
Comorbidity Survey (NCS) conducted from 1990 
to 1992 found that lifetime prevalence rates for any 
anxiety disorder were 30.5% for women and 19.2% 
for men (Kessler et al., 1994). Various factors are hy-
pothesized to be responsible for the sex differences 
reported in anxiety disorders, including genetic, neu-
rodevelopmental, environmental, and neurobiological 
factors (Jalnapurkar et al., 2018). More specifically, 
fluctuations in estrogen and progesterone levels can 
substantially influence the severity of anxiety disor-
ders (Jalnapurkar et al., 2018). Furthermore, women 
have lower gastric acidity, lower body weight, greater 
percentage of body fat, and lower blood volume com-
pared with men, factors that can affect the absorp-
tion and distribution of medications (Pigott, 2003).
 Across cultures, the prevalence of Generalized 
Anxiety Disorder (GAD) is higher in females than 
in males, at approximately a 1.5 to 1 ratio (Macki-
naw-Koons & Vasey, 2000). In the United States, spe-
cifically, the US National Comorbidity Survey Repli-
cation found prevalence rates of 3.6% for men and 6.6% 
for women (Kessler et al., 2005). Importantly, these 
prevalence rates depend partly on age: the sex differ-
ence in prevalence rates for GAD is highest in adoles-
cence and declines with age at a faster rate for men than 
it does for women (Mackinaw-Koons & Vasey, 2000).
 Research suggests that age itself is also an import-
ant predictor of anxiety, with findings generally point-
ing to decreasing levels of anxiety as people get older. 
A literature review by Baxter et al. (2013), for exam-
ple, found that, globally, adults over age 54 were sig-
nificantly less likely to be diagnosed with anxiety than 
adults aged 18-54. Additionally, anxiety seemed to rise 
dramatically for younger adults (18-25 years of age) in 
the USA between the years 2008-2018; for adults 50 

years of age and older, it remained steady (Goodwin 
et al., 2020). The researchers hypothesized that poor 
job prospects and student loan debt contributed to the 
rise in anxiety for young (emerging) adults. There is 
cross-    sectional research evidence, however, that sug-
gests that these findings may occur because older co-
horts are less accurate at identifying and labeling symp-
toms of anxiety and depression (Wetherell et al., 2009). 
 Other predictors that have been associated 
with anxiety include spending increased time on-
line (Weinstein et al., 2015), living in a European 
or North American country, and living in a devel-
oped rather than a developing country (Baxter et 
al., 2013). Conversely, religiosity is associated with 
lower anxiety, although results suggest that intrinsic 
religious orientation is more efficacious than sim-
ple religious affiliation (Shreve-Neiger & Edelstein, 
2004). Volunteerism or helping others (Waite et 
al., 1998) and being the recipient of social support 
(Berkman & Syme, 1979) also predict lower anxiety.
Unique Anxiety Findings under Pandemic Con-
ditions
 Although it is difficult to separate anxiety reac-
tions to government restrictions from anxiety reac-
tions to the virus itself, this article attempts to better 
understand the characteristics, behaviors, and beliefs 
that were associated with anxiety symptoms early in 
the pandemic. Other research has found gender and 
age to be predictors of anxiety during the pandemic 
(Marroquín et al., 2020; Solomou & Constantinidou 
2020). Marroquín and colleagues (2020) found that 
younger adults, women, individuals with minimal 
social support, and those who reported being un-
der a stay-at-home order had higher levels of GAD 
symptoms compared to older adults, males, individu-
als who identified as having social support, and any-
one not under a stay-at-home order (Marroquín et 
al., 2020). Similarly, Solomou and Constantinidou 
(2020) found women of younger age (18-29), stu-
dent status, unemployment status, prior psychiat-
ric history, and those reporting a greater negative 
impact of the pandemic on their quality of life were 
at higher risk for increased anxiety and depression. 
 Large-scale studies have yielded similar results; re-
searchers have found increases in anxiety in younger 
adults in response to the conditions imposed by the 
COVID-19 pandemic (Burkova et al., 2021; Kowal 
et al., 2020). A survey done in June 2020 for the US 

ANXIETY SYMPTOMS IN THE COVID-19 PANDEMIC



108

Center for Disease Control and Prevention (Czeisler 
et al., 2020, p. 1049) reported “considerably elevated” 
anxiety and depression, along with suicide ideation, in 
young adults aged 18 to 24. Moreover, the impact of 
one’s social support during pandemic conditions may 
be complex; for example, Kowal and colleagues (2020) 
found that under the physical isolation mandates of 
COVID-19, anxiety was worse for people living alone 
and for people forced to live in overcrowded conditions.  
Anxiety Findings in the State of Michigan (USA)
 The current authors participated in one of the 
international studies cited above (Burkova et al., 
2021), contributing data from across the USA that 
were pooled with other samples to form the USA 
sample for that 2021 publication. It was serendip-
itous that several hundred of the volunteers came 
from the state of Michigan. Because, as mentioned 
above, each state had such a different strategy for 
managing the pandemic, the authors realized that it 
might be worthwhile to analyze the Michigan data 
separately, paying more attention to some of the 
demographic data that had already been gathered, 
in order to better understand contextual factors.
Hypotheses
 The aim of this cross-sectional study was to ex-
amine the characteristics, behaviors, and beliefs asso-
ciated with increased anxiety during the COVID-19 
pandemic. We had six hypotheses and six exploratory 
goals. Under pandemic conditions, the first hypothesis 
was that our sample would have higher anxiety levels 
on the Generalized Anxiety Disorder Scale (GAD-7) 
and the State-Trait Anxiety Inventory (STAI) com-
pared to normative community samples. Secondly, we 
hypothesized that anxiety levels would be higher in old-
er individuals because of their increased risk for severe 
COVID-19-related illness. Similarly, the third hypoth-
esis was that anxiety levels would be higher in people 
with chronic diseases because of their increased risk for 
severe COVID-19-related illness. The fourth hypothe-
sis was that higher anxiety was expected in people who 
identified others in their close environment who were 
diagnosed with COVID-19. Next, our fifth hypothe-
sis was that anxiety would also be positively associat-
ed with the female gender. Lastly, our sixth hypoth-
esis was that anxiety would be positively associated 
with an absence of religious affiliation. This research 
also had several exploratory goals in mind: to assess if 
higher anxiety was associated with living alone, having 

children, experiencing changes in financial well-being 
or lifestyle habits, social networking online, or hold-
ing certain beliefs about government officials respon-
sible for providing leadership during the pandemic.

Method
Procedure
 The data analyzed below are part of a large 
cross-cultural study that examined possible factors 
that may be associated with self-reported levels of 
anxiety during the first wave of the COVID-19 pan-
demic (Burkova et al., 2021). The larger sample in-
cluded 15,375 participants from 23 countries which 
was conceptualized by a team of researchers in Rus-
sia. They hypothesized the spread of the pandemic, 
isolation measures, and restrictions would result in 
increased depression symptoms and would exacer-
bate the psychological well-being of people worldwide 
during the first wave of the COVID-19 lockdown 
(Burkova et al., 2021). All co-authors of this larg-
er study collected data from their home countries. 
 Participants in each country were recruited from 
various university listservs and social networking sites. 
As stated above, a significant portion of the sample 
was from Michigan. Thus, the current authors chose 
to perform a separate analysis on the Michigan sample      
to better understand the impact of context. Informa-
tion relevant to the current study is presented below. 
Approval for all procedures was provided by the uni-
versity’s Institutional Review Board.  Data were collect-
ed from May 19, 2020, through September 16, 2020.
Participants
 Participants were members of the communi-
ty recruited via convenience sampling methods (e.g. 
local postings on university and faculty email list-
servs, Facebook, Instagram, NextDoor, and word of 
mouth). Postings provided a brief description of the 
study and a link to the survey hosted on Qualtrics. 
Participants provided informed consent on the on-
line survey form. There were no incentives given for 
participation.  Participants were included in the cur-
rent study if they resided in Michigan, were over the 
age of 18, completed all of the items in the General-
ized Anxiety Disorder 7 (N = 217) and/or the State-
Trait Anxiety Inventory (N = 200) questionnaire, 
and provided at least 50% responses to the other sur-
vey questions. Based on these inclusion criteria, a to-
tal of 221 participants were retained in the analyses. 
 Of these participants, 27.1% were male and 72.4% 

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were female. Regarding ethnicity, 84.2% of the sample 
identified as White, 5% as African American or Black, 
3.2% as Hispanic or Latino, and 1.4% as Asian. Partici-
pants ranged in age from 22 to 80 years (M = 45.60, SD 
= 16.28). Regarding relationship status, 68.3% report-
ed being married or in a committed relationship, while 
31.2% reported being single, divorced, or widowed. Re-
garding religious affiliation, 25.3% identified as Catho-
lic, 33.5% as Christian, 5.9% as Jewish, .9% as Muslim 
and 30.8% as not religious. On average, participants 
completed the survey 13.71 (SD = 4.17) weeks after 
the Michigan stay-at-home order (March 23, 2020). 
Measures
Generalized Anxiety Disorder-7 (GAD-7; Spitzer, 
Kroenke, Williams, & Lowe, 2006)
 The GAD-7 is a seven-item self-report question-
naire that assesses the frequency of anxiety symptoms 
over the past two weeks.  Responses were recorded 
on a 4-point Likert scale from 0 to 3, where 0 is “not 
at all” and 3 is “nearly every day.”  A Cronbach’s al-
pha coefficient of 0.89 was found in a community 
sample in Germany (Löwe et al., 2008). Construct 
validity was supported by the relationship between 
the GAD-7 and the PHQ-2 depression scale, the 
Rosenberg Self-Esteem Scale, the Questionnaire on 
Life Satisfaction, and the Resilience Scale (Löwe et 
al., 2008).  Participants’ scores were then summed 
to produce a total GAD-7 score for each partici-
pant.  Internal consistency was excellent (α = .910).
State-Trait Anxiety Inventory (STAI; Spielberg-
er, 1983)
 The STAI is a 40-item self-report questionnaire 
comprised of 20 items assessing state anxiety and 
20 items assessing trait anxiety.  For the purposes of 
this study, the 20 items that measure state anxiety 
were used to assess participants’ anxiety at the time 
of the survey.  Responses were recorded on a 4-point 
Likert scale from 1 (not at all) to 4 (very much so). 
Participants’ scores were summed to produce a to-
tal score for each participant. A Cronbach’s alpha 
coefficient of 0.87 was found in a community sam-
ple (Balsamo et al., 2013). Construct validity was 
supported by the relationship between the STAI 
and the Beck Anxiety Inventory (Balsamo et al., 
2013). Internal consistency was excellent (α = .952).
Adaptation to Social Stress Questionnaire 
(ASSQ; Butovskaya & Burkova, 2021)
  The ASSQ is a 105-item self-report questionnaire 

assessing individuals’ demographic features, ability to 
adapt to stress and opinions, beliefs, and experiences re-
lated to the COVID-19 pandemic (Burkova et al., 2021; 
Butovskaya et al., 2021; Burkova et al., 2022).  Table 1 
contains the relevant questions and response options 
for the current study. This ASSQ was designed specifi-
cally for the larger cross-cultural study that the authors 
participated in  at the beginning of the COVID-19 pan-
demic. All author participants had the opportunity to 
critique the questionnaire, after which the agreed-up-
on questionnaire was translated into the local lan-
guage for each country. The ASSQ included standard 
demographic questions (e.g., age, gender, occupation, 
etc.). As of this writing, three articles have been pub-
lished using the ASSQ (Burkova et al., 2021, 2022; Bu-
tovskaya et al., 2021), and more studies are in progress. 
More information about the testing properties of the 
ASSQ will be forthcoming in future research reports. 
Data Analysis
 Because the current study was conducted in re-
sponse to the global COVID-19 pandemic, it was not 
feasible to collect data from a control group. Howev-
er, to provide a sense of the magnitude of the anxiety 
present in the current sample, single-sample t-tests 
were used to compare mean GAD-7 and STAI scores 
in the current sample with mean scores on the GAD-
7 and STAI from comparable community samples 
published in the research literature (Löwe et al., 2008; 
Spielberger, 1983). To better understand the relation-
ship between anxiety scores and a range of demograph-
ic, behavioral, and belief variables, bivariate analyses 
were conducted. Pearson product-moment correla-
tions were used to determine the relationship between 
anxiety scores and continuous criterion variables like 
age and number of weeks into the stay-at-home or-
der. Independent samples t-tests were used to examine 
the relationship between anxiety scores and dichot-
omous criterion variables assessed with the ASSQ. 

Results
Hypothesis One
  In order to assess the magnitude of anxiety in our 
sample and the inability to have a control group, we 
compared scores from our sample to scores from previ-
ously published community samples. The current sam-
ple had significantly higher GAD-7 scores (M=6.41) 
than both a German sample (M=2.95; Löwe et al., 
2008) and a United States pandemic sample (M=5.66;  

ANXIETY SYMPTOMS IN THE COVID-19 PANDEMIC



110

Marroquín et al., 2020) and significantly higher STAI 
scores (M=41.79) than a community sample of work-
ing adults in the United States (M= 35.72; Spielberger, 
1983).   Importantly, scores on the GAD-7 were sig-
nificantly and positively associated with scores on the 
STAI (r = .760, p <.001) in the current sample, suggest-
ing substantial convergence across anxiety measures. 
Thus, regardless of measure, this Michigan sample was 
more anxious than comparable community samples. 
Hypotheses Two, Three, and Five
 To better understand these elevated anxiety scores, 
we examined their relationship with important demo-
graphic and behavioral criterion variables.  Regarding 
demographics for our second hypothesis, both GAD-7 
and STAI scores were significantly and negatively cor-
related with age, (r = -.330, p < .001) and (r = -.311, p 
< .001) for GAD-7 and STAI respectively. Thus, as age 
increased, anxiety scores decreased. Additionally, our 
third and fifth hypotheses were not supported in that 
having a chronic illness diagnosis and biological sex      
were not associated with GAD-7 or STAI anxiety scores. 
Hypotheses Four and Six
 Our fourth hypothesis was supported in that hav-
ing infected people living in your environment (t(214) 
= -2.53, p = .012) was associated with higher GAD-7 
scores. Our sixth hypothesis was supported by the find-
ing that those who identified as religious reported sig-
nificantly lower GAD-7 scores (t(209) = 2.12, p = .035).
Exploratory Goals
  In terms of the exploratory goals regarding be-
liefs, thinking there was someone to blame (GAD-7: 
t(213) = -2.794, p = .00; STAI: t(194) = -2.735, p = 
.007), feeling angry in response to official message 
regulations (GAD-7: t(214) = -2.81, p = .024; STAI: 
t(193) = -2.55, p = .012), and believing that lock-
down measures were insufficient  (GAD-7: t(209) = 
2.03, p = .044; STAI: t(192) = 2.66, p = .008)  were 
associated with significantly higher anxiety scores.  
Other Findings
 Lastly, having a history of volunteering prior to the 
pandemic (t(213) = -2.16, p = .032) were associated with 
higher GAD-7 scores. Conversely, those who changed 
their daily lifestyle habits and believed that virtual so-
cial networking was a valuable opportunity to connect 
with others reported significantly lower GAD-7 scores, 
t(211) = -2.13, p = .035, and t(200) = 2.40, p = .017 
respectively.  Having children, living alone, and experi-
encing a change in household income were not associ-

ated with GAD-7 or STAI anxiety scores. Additionally, 
anxiety was not significantly associated with the num-
ber of weeks since the stay-at-home order, suggesting 
that when participants took the survey, it did not have 
an effect on their scores. A summary of these findings 
associated with the GAD-7 can be found in Table 2.

   Discussion 
 As hypothesized, average GAD-7 and STAI scores 
were higher in the current sample than comparable 
scores from community samples prior to (Löwe et al., 
2008; Spielberger & Gorsuch, 1983) and during (Mar-
roquín et al., 2020) the COVID-19 pandemic. How-
ever, it is worth noting that the current sample had 
approximately 20% more females than the compared 
community samples. Thus, it is possible that gender 
played a role in the observed effects in the current sam-
ple. The STAI average score exceeded an established 
clinical cutoff of 40 (Emons et al., 2019), suggesting 
that state anxiety was elevated to a clinically significant 
degree. These findings are consistent with the increas-
es in anxiety (Bareket-Bojmel et al., 2020; Hyland et 
al., 2020; Moghanibashi-Mansourieh, 2020) and other 
mental health problems found in the current pandemic 
(Hwang, 2020; Roy et al., 2020; Spoorthy et al., 2020). 
 To better understand this pattern of findings, 
we examined the association between sample char-
acteristics, behaviors, and experiences with anxiety. 
In particular, hypotheses related to variables that in-
creased the likelihood of COVID-19 infection and 
severe illness (Centers for Disease Control and Pre-
vention, n.d.) were partially supported. Specifically, 
having infected people living in your environment 
was significantly associated with higher state and trait 
anxiety.  Research suggests that people experience a 
fear of contamination related to COVID-19 that is 
similar to the fear of contamination for other virus-
es, such as Ebola or H1N1 Influenza (Helleringer et 
al., 2015; Cheung, 2015; Kim et al., 2015; Knowles 
& Olatunji, 2021). Therefore, it is possible that those 
with infected people living in their environment 
were not only concerned with the well-being of their 
loved ones but also anxious about contracting the 
virus themselves. Interestingly, there was not a signif-
icant relationship between anxiety and living alone.  
 Contrary to our hypothesis, however, a num-
ber of factors associated with increased vulnerabil-
ity to COVID-19 were not associated with anxiety 

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as expected. In particular, age was negatively rather 
than positively associated with anxiety.  Although 
unexpected, this finding is consistent with a broader 
literature that finds that as people age, their levels of 
neuroticism and negative affectivity tend to decrease 
(Kessler & Staudinger, 2010; Masten & Wright, 2010; 
Yeung & Fung, 2007; Yeung et al., 2020).  Thus, age 
continues to be a strong protective factor even when 
facing a virus that disproportionately affects older 
adults. Similarly, chronic illness was not significant-
ly associated with anxiety. Although past research 
has found associations between pre-existing condi-
tions and negative mental health outcomes during 
public health crises (Gayer-Anderson et al., 2020), it 
is possible that the shift to working from home that 
occurred in the early months of COVID-19 mitigat-
ed many of these negative outcomes.   Not only are 
individuals with disabilities more likely to work from 
home (which allows them to flexibly attend recurring 
medical appointments and have access to medical 
equipment), but working from home itself has be-
come easier and less stigmatized as many workplaces 
were forced to broaden their views on accommoda-
tions for workers in the early months of the pandem-
ic (Schur et al., 2020).  Thus, increased flexibility and 
acceptance of working from home may have contrib-
uted to the nonsignificant finding for chronic illness. 
 Identifying as religious was associated with low-
er anxiety in the current sample, consistent with our 
hypothesis. Given that the COVID-19 environment is 
one in which we are physically and socially disconnect-
ed from each other, belief in a higher power might help 
people remain connected to others through communi-
ty-specific religious activities and events and through 
an awareness that one is part of something bigger than      
oneself. This is consistent with the larger literature, 
which has identified religion and pro-social behavior 
as protective factors against psychopathology broad-
ly and anxiety specifically (Gearing & Lizardi, 2009; 
Greenfield & Marks, 2004; Levin, 2009; Peteet 2020; 
Smith et al., 2003). Interestingly, individuals who re-
ported a history of volunteering prior to the pandemic 
endorsed significantly more anxiety than participants 
who had not volunteered in the past.  Although altru-
ism as a whole tends to be negatively associated with 
anxiety (Elphick, 2020), research suggests that changes 
in daily lifestyle habits and identity roles can lead to 
a loss in well-being and the presence of psychologi-

cal symptoms (Giuntella, Hyde, Saccardo, & Sadoff, 
2021; Greenfield & Marks, 2004) and this is true for 
altruistic behaviors specifically (Feng et al., 2020). Giv-
en a stay-at-home order was put in place shortly before 
the data was collected, many altruistic individuals may 
not have been able to volunteer as they usually would. 
This may have changed their daily lifestyle, separated 
them from sources of social support, and had implica-
tions for their identity as a volunteer, leading to anxiety. 
 Perhaps the most intriguing pattern of results may 
be seen in the three questions that inquire about the 
perception of failures in leadership. People who en-
dorsed blaming someone “for the current situation 
in your country” reported higher anxiety scores on 
both measures. Of the 62% of respondents who felt 
there was someone to blame, the vast majority iden-
tified an entity in national leadership (the CDC, Pres-
ident Trump, Congress, etc.) who they believed was 
to blame. Further, about half of the sample endorsed 
feeling angry about official messaging, and 34.7% said 
that self-isolation measures imposed by authorities 
were not sufficient.  These beliefs similarly predicted 
higher anxiety. Together, these results are consistent 
with broader research on organizational leadership. 
In a meta-analysis by Costello and colleagues (2019), 
researchers found that the perception of poor lead-
ership within an organization leads to higher stress; 
the findings were particularly striking in a dementia 
care home (Vogel et al., 2017), and in nursing homes 
(Willemse et al., 2012). Similarly, a study of industri-
al workers (Schmidt et al., 2014) found that leader-
ship perceived as less supportive was associated with 
higher stress and lower self-perceived health among 
employees. These findings have been replicated across 
many occupations, from teaching to the military, in 
many different countries. As Gabriel (2014) wrote: 
 We expect our leaders to lead the way, to show mor-
al courage and to embody and  articulate values beyond 
that of efficiency.  We expect leaders to talk to us, to ad-
dress our concerns and to listen to us….Sometimes, we 
expect our leaders to see clearly, to possess a certain con-
viction and resoluteness represented by that overused 
and abused word, vision….We expect our leaders to care 
– not just in an impersonal manner ‘about’ a project or 
‘about’ the bottom line, but ‘for’ the organization and 
its people, indeed for each and every follower. (p. 319)     
Importantly, these results are consistent with recent 
work by Dhanani and Franz (2020), who directly 

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112

examined trust in governmental leadership during 
March, 2020 of the pandemic. Their findings suggest 
that, at that time, there was a significantly higher lev-
el of trust in the Center for Disease Control (CDC) 
than in President Trump. Moreover, trust in President 
Trump was significantly correlated with misinforma-
tion about transmission and symptoms of the virus, as 
well as angry feelings towards people of Asian descent. 
Thus, contrary to prior research identifying mistrust 
in the government as a barrier to good health behav-
iors, Dhanani and Franz (2020) concluded that their 
findings “suggest that trust in governmental leadership 
can be a hindrance to health literacy when the messages 
issued by governmental leaders are at odds with those 
from public health organizations and emerging evi-
dence-based practices…messaging from governmental 
leaders in the United States may be impeding effective 
public health responses to COVID-19” (Dhanani & 
Franz, 2020, p. 10). Together these findings suggest 
that the absence of clear and consistent messaging 
from leadership not only makes it more difficult to 
discern the appropriate course of action but can also 
directly increase anxiety and mental health symptoms.   
Clinical Implications
 These results have a number of implications for 
clinical theory and treatment. First, this study high-
lights that our beliefs about the COVID-19 pandemic 
can impact our emotional response and well-being. 
This is consistent with a major premise of cogni-
tive-behavioral therapy: our thoughts occupy a posi-
tion of central importance and largely determine our 
emotions, behaviors, and experiences (Beck Institute, 
2021). Transference-focused psychotherapy, a psycho-
dynamic approach, similarly acknowledges that the 
way an individual views themselves and others influ-
ences their interpretation of their experience and con-
tributes to the development of distressing symptoms 
(Frank Yeomans, 2021). Thus, existing therapeutic 
approaches are well-positioned to address mental 
health difficulties related to this novel coronavirus. 
 The findings also suggest a number of specific 
therapy recommendations in the current setting. First, 
being consistent and transparent about changes to pro-
tocol and expectations during the pandemic may help 
minimize client anxiety.  This may be particularly true 
if providers are navigating a shift to telehealth practice 
or a return to in-person services. Given that clinicians 
are often viewed as an authority, clear communication 

and consistent information can have a profound im-
pact on clients. Additionally, asking about the impact 
COVID-19 has had on patient’s various identities can 
provide important context for understanding their 
symptoms. If certain parts of a client’s identity have 
been lost during the pandemic, processing that loss in 
therapy may be an important part of addressing patient 
symptoms. Additionally, the results suggest that the 
associations between symptoms and vulnerabilities to 
COVID-19 may be more complex than predicted and 
should be understood from the patient’s perspective 
rather than assumed. Thus, approaching patients with 
a curious, caring, and empathetic attitude is likely to 
not only strengthen the alliance between the therapist 
and patient but also provide important contextual in-
formation for understanding the patient’s symptoms.  
 Not only can these recommendations be helpful 
in a therapeutic setting, but they can also be imple-
mented across all workplace environments. As many 
companies transitioned to remote work and are now 
contemplating returning to in-person, specific health 
and safety guidelines should be enacted. For example, 
guidelines regarding the requirement of in-person ver-
sus remote work, the (dis)use of masks, COVID-19 test-
ing onsite, COVID-19 screeners, etc., should be clearly 
delineated for all employees. Furthermore, it would be 
in leadership’s best interest to facilitate feedback from 
their employees to ascertain their level of comfort re-
garding the potential return to in-office work. The 
findings from this study clearly demonstrate the im-
portance of transparent communication from leaders.
Limitations and Future Directions
 The current study has several limitations. In 
particular, the current sample consisted primarily of 
Caucasian women from Michigan who were recruit-
ed through a convenience sampling approach.  While 
this provides insight into a specific demographic, it 
lacks a holistic view of the population of Michigan, 
which includes diverse racial, ethnic, and socioeco-
nomic backgrounds. Consequently, the results from 
this study are not generalizable to the whole popu-
lation of Michigan.  Furthermore, the study did not 
control for potential confounding variables. Captur-
ing information regarding psychiatric history could 
have provided further information regarding the 
pandemic’s influence on individuals’ anxiety levels. 
 While the political unrest and worsening 
COVID-19 numbers in Michigan at the time of data 

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113

collection provide an interesting sample for study, 
findings might not be generalizable to other parts of 
the country where COVID-19 numbers and poli-
cies differed or to other stages of the pandemic. That 
said, findings from the current study are largely con-
sistent with prior research on anxiety and mental 
health during COVID-19. Another limitation is that 
this is not an experimental study but, rather, a nat-
uralistic field study. It documents what is happen-
ing in the real world, which is a great opportunity 
for understanding human behavior; however, lack-
ing experimental controls, it provides less evidence 
of cause-and-effect relationships (Miller, 2017). 
 Additionally, the current study is part of a larger, 
global study involving 23 countries. Other countries 
used either Qualtrics or Google for their online sur-
veys. An attempt was made to get cross-sectional data 
(different age groups) and diverse populations as much 
as possible. Readers who wish to learn more about the 
findings from other countries may read the already 
published articles from this study (Burkova et al., 2021, 
2022; Butovskaya et al., 2021). Future research exam-
ining these findings in the international sample could 
help to clarify the generalizability of these findings.  
 Further, this study was developed early in the 
pandemic, when researchers and respondents were 
unaware of how long the pandemic would last and 
how costly it would be. Consequently, the findings 
presented are only applicable to the first phase of the 
pandemic as the results do not capture the perspec-
tives of individuals as the pandemic progressed. To 
address this limitation, future work should examine 
whether findings persist over the course of the pan-
demic. To that end, a second round of data collection 
is being conducted. Questions about epidemiological 
experience, vaccination, personality characteristics, 
and unexpected consequences of the pandemic will 
be examined in the second wave of data collection.  
Conclusions
 Our study revealed factors associated with higher 
levels of anxiety in a sample of Michigan adults. As to be 
expected, those who lived with someone infected with 
COVID-19 had higher state and trait anxiety. Consis-
tent with prior research on anxiety during pandemics, 
older age and having a religious affiliation were demon-
strated to be protective factors against anxiety. Further-
more, those who identified as having volunteered prior 
to the pandemic denied social networking as a valuable 

means to connect with loved ones and had changes to 
their daily lifestyle habits reported higher rates of anx-
iety. A possible explanation is that older adults’ rou-
tines may not have been as affected by the pandemic as 
younger adults due to their retirement status. Those 
who were already communicating with friends online 
(e.g., social media) may have noticed a smaller shift in 
their social lives as they still connect with friends, al-
beit in a slightly different context. However, for those 
who volunteer, consistent face-to-face contact may 
have been a primary form of social interaction and/or 
become ingrained in their routine; thus, the inability 
to volunteer restricted their means of communication. 
 The findings presented here were from the ear-
lier stages of the pandemic, at a point when no one 
knew the duration of the stay-at-home orders, thus no 
shifts to virtual connection were yet established. But 
as the pandemic continued, more companies, univer-
sities, social circles, etc. had to make the adjustment 
to solely connecting virtually. Therefore, it is possible 
that had the data been collected at a later time in the 
pandemic, some may have adjusted to the “new nor-
mal,” and, consequently, these factors would not have 
contributed to higher reporting of anxiety symptoms. 
 The results of this study should be interpreted 
within the context of certain limitations. One import-
ant limitation of the current study includes but is not 
limited to, the lack of representation from diverse ra-
cial, ethnic, and socioeconomic backgrounds. Accord-
ingly, the results are not generalizable to the whole 
population of Michigan. This study, along with prior 
studies, demonstrates the negative impact pandemics 
have on individuals’ mental health. The effects of the 
COVID-19 pandemic are far-reaching and will likely 
take time to fully understand. The current study adds 
to the conversation of the mental health sequela result-
ing from COVID-19 and highlights important impli-
cations for organizational leaders and clinical practice. 

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Table 1

Frequency of Adaptation to Social Stress Responses and Mean Anxiety Symptom Ratings by Group     

Note. M = mean, SD = standard deviation. 

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Table 2

Group Differences in GAD-7 and STAI Anxiety Scores 

Note. *p <.05, **p <.01, ***p <.001

ANXIETY SYMPTOMS IN THE COVID-19 PANDEMIC




