THE IMPACT OF LONELINESS, ANGER, AND REGULAR PHYSICAL ACTIVITY ON MENTAL HEALTH DURING THE PANDEMIC
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The Impact of Loneliness, Anger, and Regular Physical Activity on Mental Health during the Pandemic
ASEAN Journal of Psychiatry, Vol. 22(5), July 2021: 1-11
RESEARCH ARTICLE
THE IMPACT OF LONELINESS, ANGER, AND REGULAR
PHYSICAL ACTIVITY ON MENTAL HEALTH DURING THE
PANDEMIC
Hilal SEKİ ÖZ*, Didem AYHAN**, Vahit ÇİRİŞ***
*
Department of Physical Education and Sports Education, Kırşehir Ahi Evran University, Kırşehir,
Turkey
**
Department of Physical Education and Sports Education, Bandırma Onyedi Eylül University,
Bandırma, Balıkesir, Turkey
***
Department of Physical Education and Sports Education, Kırşehir Ahi Evran University, Kırşehir,
Turkey
Abstract
The Covid-19 pandemic has affected the entire world and mandatory restrictions
have increased mental health problems. This descriptive study aimed to examine the
impact of loneliness, anger, and regular physical activity on mental health and
investigate their interaction with regular physical activity. The universe of the study
was people who lived in Kırşehir, Turkey, 560 people participated via stratified
sampling. Data of the study were collected through socio-demographic information
form, General Health Questionnaire-12, UCLA Loneliness Scale-8, and Trait Anger
Scale in March 2021. In the data analysis, the seven-way mixed-factor (ANOVA)
variance analysis of such groups as regular physical activity, gender, loneliness,
anger, body mass index, and educational status was compared in terms of GHQ-12
total score and the interaction effect of physical activity with each of other six
independent variables were examined. The study found a statistically significant
difference between physical activity groups, loneliness groups, anger groups, and age
groups in terms of GHQ-12 total score, and there was no interaction effect among
these variables. According to these results, it can be said that age, loneliness, anger,
and regular physical activity are effective on mental distress, and it is suggested that
advanced studies are conducted to examine mental distress. ASEAN Journal of
Psychiatry, Vol. 22(5), July 2021: 1-11.
Keywords: Mental Distress, Regular Physical Activity, Loneliness, Anger
Introduction the studies on the impact of the pandemic on
mental health, the following countries ' reports
With the new coronavirus (Covid-19), the daily are as follows: China: high levels of depression
life routines of people all over the world and anxiety symptoms [3-5], Italy: post-traumatic
changed. The measures taken brought stress symptoms 37%, adaptation disorder
requirements that changed lifestyles decreased 22.9%, high level of stress 21.8%, anxiety
physical activity, and the time spent with others %20.8, depression 17.3%, and sleep deprivation
while preventing the spread of the virus. 7.3% [6], severe depression 7.6%, severe anxiety
Although restrictions have protective effects 9.1%, severe obsessive-compulsive
against Covid-19 infection, they can have symptoms 9.3% in Portugal [7], Brasil: mild-
negative impacts on mental health [1,2]. When moderate level of mental distress in 52% of the
1The Impact of Loneliness, Anger, and Regular Physical Activity on Mental Health during the Pandemic
ASEAN Journal of Psychiatry, Vol. 22(5), July 2021: 1-11
participants, severe mental distress in the 18.8% strategies that will guide public mental health. In
of the participants [8] and mild depression this direction, this descriptive research aimed to
18.1% and mild anxiety 11.4% in Japan [9]. examine the impact of loneliness, anger, and
Dealing with uncertainty, restrictions, increasing regular physical activity on mental health during
social, economic, and individual problems the pandemic, and to investigate the interaction
caused by the pandemic is getting harder; between them and regular physical activity.
emotions such as loneliness and anger, which can
trigger mental distress, can increase. It is Material and Method
reported that loneliness poses a significant health
problem in terms of depression, anxiety, suicide Population and Sample
thought, and avoiding health services [10]. A
study found that 43% of the participants received The universe of the study was adults aged
a loneliness score over the limit, there was a between 18-65 who lived in Kırşehir, Turkey.
positive relationship between loneliness and Kırşehir is a province located in the central part
depression and suicide thought [11]. Another of Turkey and close to the capital. As the number
study found that individuals with mental distress of universes was not known, sampling
had higher stress and anger levels compared to calculation was conducted and a table prepared
before the pandemic, and the economic, for the ''sample size for two-sample ratio test'' in
psychosocial stressors and despair increased the determination of the sample size of the study
mental distress during the pandemic [12]. In a [21]. A study conducted with adults in Turkey
study conducted in England, participants stated found the frequency of regular physical activities
that they experienced controversy, felt angry, or as 14.8% [22]. The sample size stated in the table
conflicted with others at least once [13]. by considering the 5% significance level, 95%
Strategies to cope with increasing mental distress strength rate, and regular physical activity
in the pandemic are listed as maintaining daily prevalence (15%) was found to be 311 females,
routines, positive reassessments/reframing, and 233 males, 544 people in total. Considering the
regular physical activity. possible data losses during the implementation of
the study, a number above the suggested one was
Regular physical activity is known to have taken as the sample size. Stratified sampling
positive impacts on mental health [14-16]. It can method was used to determine the sample [23].
be said that restrictions brought due to the There are 3 large parks and 5 gyms open to the
pandemic decreased physical activity, and this public, suitable for regular physical activity in
had indirect negative effects on mental health Kırşehir, Turkey. For the selection of the
[17]. It was stated that there was an stratified sample, these gyms, parks, and
approximately 12% decline in the number of neighborhoods where they are located were
steps across the USA [18], and the decline across considered as layers. From each layer, the
the world was higher [19]. It was reported that participant was reached according to their
only 26% of males and 19% of females meet the distribution, a total of 560 people who did and
physical activity instructions of the USA (US did not do regular physical activity were
Department of Health and Human Services). It contacted.
was found that physically active individuals were
more psychologically negatively affected by the Data Collection Tools
pandemic due to limited activity opportunities
[20]. Growing mental health problems around the Socio-demographic Information Form
world are becoming a serious concern along with
the pandemic. However, studies which examined This form prepared by the researchers following
changes in mental health due to pandemic-related the literature consists of fifteen questions related
public health constraints and inactive lifestyles to demographic data and regular activity.
provide very important information both in
determining the situation and in creating General Health Questionnaire-12 (GHQ-12)
2The Impact of Loneliness, Anger, and Regular Physical Activity on Mental Health during the Pandemic
ASEAN Journal of Psychiatry, Vol. 22(5), July 2021: 1-11
was 0.80. As the score from the scale increases, it
GHQ developed by Goldberg (1972), is used to shows that the level of anger is high.
research or scan mental problems. The Turkish
validity and reliability study was conducted by Data analysis
Kılıç (1996). Cronbach's Alpha internal The data of the study were evaluated in SPSS
consistency of the scale was 0.84, and the retest 21.0 program and frequency and percentage
correlation was 0.67. There are 12 questions in values were calculated for descriptive data. In the
GHQ-12. Each question questions the symptoms study, with the calculation of dependent and
of the last few weeks, and consists of 4 options independent variables' descriptive statistics and
as never, as usual, more often than usual, and GHQ-12 Cronbach's Alpha internal consistency
very often. The first two options of the answers coefficient, the comparison of groups of regular
to the survey questions are calculated on a score physical activity, gender, loneliness score, anger
of ''0'' and the other two options are calculated on score, age, body mass index, and educational
a score of ''1'', and participants can score between status (2x2x2x2x4x2x2) with seven-way mixed-
0-12. It is accepted that mental health factor (ANOVA) variance analysis was
deteriorates as the score obtained from the survey conducted in terms of GHQ-12 total score.
increases, and the possibility of psychiatric Additionally, the interaction effect of the six
problems increases. In the present study, 0-0-1-1 other independent variables of physical activity
GHQ type scoring was used. Cronbach's Alpha was examined.
internal consistency coefficient was 0.89.
Ethical declaration
Ucla Loneliness Scale-8 (ULS-8)
Approval was obtained from Kırşehir Ahi Evran
The scale developed by includes 20 items and is University Social and Humanities Ethics
4-item Likert type. The Turkish adaptation of the Committee dated 04.03.2021 and 2021/1 meeting
scale was conducted. The 8-item short form of number. Data were collected in accordance with
the scale was introduced into Turkish by [24,25]. the Declaration of Helsinki, and each participant
The internal consistency coefficient of the scale was informed and approved by a voluntary form.
was 0.96, and the reliability coefficient of the test
retest was 0.94. In this study, Cronbach's Alpha Results
internal consistency coefficient was 0.80. As the
score obtained from the scale increases, level of A total of 560 people who performed regular
loneliness increases, as well. physical activity (n=285) and did not (n=275)
participated in the study. Demographic
Trait Anger Scale (TAS) characteristics of participants shown in Table 1
include the following information: 58% female,
The scale developed by was adapted into Turkish 53.4% married, 60.3% university graduate,
by Özer in 1994. The scale consists of 10 items 46.9% had balanced income-expense, 51.4% was
and is a 4-point Likert type. The lowest score to employed, 49.1% had a sedentary lifestyle,
take from trait anger scale is 10 and the highest average height was 171.94 ± 9.03, the average
score is 40. In the validity and reliability study, weight was 74.47 ± 115.20, BMI average was
Cronbach's alpha value was 0.79. In this study, 25.10 ± 4.41, and the average age was 31.04 ±
Cronbach's Alpha internal consistency coefficient 10,56 (Table 1).
Table 1: Socio-Demographic Characteristics of Participants
n %
Male 235 42
Gender
Female 325 58
Marital status Married 299 53.4
3The Impact of Loneliness, Anger, and Regular Physical Activity on Mental Health during the Pandemic
ASEAN Journal of Psychiatry, Vol. 22(5), July 2021: 1-11
Single 261 46.6
Primary Education 35 6.3
Secondary education 106 19
Education level
University 338 60.3
Postgraduate 81 14.4
Incomeexpense 111 19.8
Yes 288 51.4
Employment Status
No 272 48.6
Regular Physical No 275 49.1
Activity status Yes 285 50.9
Less than a year 94 16.8
The time of performing 1-3 years 77 13.8
physical activity 3-5 years 41 7.3
More than 5 years 73 13
Age X±SD=31.04±10.56 min-maks=18-67
min-maks=140-
Height (cm) X±SD=171.94±9.03
200
Weight (kg) X±SD=74.47±115.20 min-maks=37-157
min-maks=15.47-
BMI X±SD=25.10±4.41
62.49
First, the participants were divided into two body mass index, and 2 groups of educational
groups considering the total score averages status; GHQ-12 total score was compared to the
obtained from UCLA Loneliness Scale-8 seven-way mixed-factor variance analysis.
(avg.=12.92) and Trait Anger Scale (avg.=20.15) According to the results, there was statistically
as those below and above both total points. Later, significant difference between the physical
as some groups had few people, merging the activity groups (F(1,654)=13,14; pThe Impact of Loneliness, Anger, and Regular Physical Activity on Mental Health during the Pandemic
ASEAN Journal of Psychiatry, Vol. 22(5), July 2021: 1-11
statistically higher than the total score average of aged 24 and below (avg.=4.02) and the 25-29 age
the anger score below average group (avg.=2.34). group (avg.=3.85), had higher GHQ-12 total
The comparison of the age groups was examined score average than 30-39 (avg.=2.70) and 40 and
by Tukey multiple comparison tests as there were above age group (avg.=2.15) (Table 2).
four groups, and it was seen that both the group
Table 2: Seven-way Mixed-Factor Variance Analysis in Terms of GHQ-12 Total Score
F p Part η2
Independent Variables
Physical Activity Groups (2) 13.14 0.00 0.02
Gender Groups (2) 1.4 0.24 0.002
Loneliness Score Groups (2) 33 0.00 0.048
Anger Score Groups (2) 35.54 0.00 0.052
Age Groups (4) 10.05 0.00 0.044
BMI Groups (2) 0.00 0.97 0.000
Educational Status Groups (2) 0.54 0.46 0.001
Interactions
Physical Activity Groups X
0.02 0.9 0.000
Gender Groups (2x2)
Physical Activity Groups X
2.58 0.11 0.004
Loneliness Score Groups (2x2)
Physical Activity Groups X
4.42 0.05 0.007
Anger Score Groups (2x2)
Physical Activity Groups X Age
1.2 0.31 0.005
Groups (2x4)
Physical Activity Groups X BMI
0.02 0.89 0.000
Groups (2x2)
Physical Activity Groups X
0.11 0.74 0.000
Educational Status Groups (2x2)
Although there was a difference in statistical score, there was no interaction effect between the
level between both physical activity groups and two variables (F(1,654)=2.58; p>0.05; part
loneliness score groups in terms of GHQ-12 total η2=0.004) (Figure 1).
5The Impact of Loneliness, Anger, and Regular Physical Activity on Mental Health during the Pandemic
ASEAN Journal of Psychiatry, Vol. 22(5), July 2021: 1-11
Figure 1: Comparison of Physical Activity and Loneliness Score Groups in Terms of GHQ-12 Total
Score
Similarly, although there was a difference in 12 total score, there was no interaction effect
statistical level between both physical activity between the two variables (F(1.654)=4.42;
groups and anger score groups in terms of GHQ- p>0.05; part η2=0.007) (Figure 2)
Figure 2: Comparison of Physical Activity and Anger Score Groups in Terms of GHQ-12 Total Score
Figure 2: Comparison of Physical Activity and Anger Score Groups in Terms of GHQ-12 Total Score
Similarly, although there was a difference in score, there was no interaction effect between the
statistical level between both physical activity two variables (F(3.654)=1.20; p>0.05; part
groups and age groups in terms of GHQ-12 total η2=0.005) (Figure 3).
Figure 3: Comparison of Physical Activity and Age Groups in Terms of GHQ-12 Total Score
In contrast, there was no statistically significant p>0,05; part η2=0.002), body mass index groups
difference between gender groups (F(1.654)=1.40; (F(1,654)=0.01; p>0.05; part η2=0.000), and
6The Impact of Loneliness, Anger, and Regular Physical Activity on Mental Health during the Pandemic
ASEAN Journal of Psychiatry, Vol. 22(5), July 2021: 1-11
educational status groups (F(1,654)=0,54; p>0,05; protective and improving effect of regular physical
part η2=0,001) in terms of GHQ-12 total score. activity on mental health was also defined in the
Additionally, there was no interaction effect in literature, and the results of the study are
significant level statistically between physical consistent with the literature. It can be said that
activity groups and gender groups (F(1,654)=0,02; regular physical activity is relaxing for individuals
p>0,05; part η2=0,000), body mass index groups both physically and mentally, it helps to cope with
(F(1,654)=0,02; p>0,05; part η2=0,000) and the high stress of the pandemic, resulting in the
educational status groups (F(1,654)=0,11; p>0,05; less psychological distress of the active group.
part η2=0,000) in terms of GHQ-12 total score.
According to this result, it is understood that In the study, the GHQ-12 score of the group with a
physical activity groups show similar score higher-than-average loneliness score was
distribution in all of the six independent variable significantly higher compared to individuals with
groups. low loneliness. The study by Wong et al. found
that there was a significant increase in the
Discussion loneliness, anxiety, and sleep deprivation levels
after the start of the Covid-19 pandemic, and being
It is known that the compulsory changes brought female, living alone, having 4 or more chronic
by the Covid-19 pandemic into daily life routines disease were associated with independently
encourage an inactive lifestyle, increasing the increasing loneliness [29]. A community-based
physical health problems as well as negatively study in England found that 29.2% of the
affecting the mental health of the community participants scored 4 or more in GHQ, and 35.86
(Ashdown-Franks et al., 2020). Additionally, the of them felt alone sometimes or often [30].
increase in loneliness due to restrictions makes it
harder for individuals to cope with the difficulties A study conducted with Slovenian adults found
they go through and contribute to the increase in that participants experienced social loneliness
psychological distress. In this study, which was rather than emotional loneliness, and demographic
conducted to examine the impact of loneliness, variables and past mental illness history were
anger, and regular physical activity on mental determinant for emotional, social, and general
health in pandemic conditions, there was a loneliness [31]. In a study conducted with Swedish
statistically significant difference between adults, individuals' having ≥ 3 in GHQ-12 and
physical activity groups, loneliness score groups, frequently perceived stress, loneliness, or sleep
anger score groups, and age groups in terms of problems were associated (Blom, et al., 2020). A
GHQ-12 total score and there was no interaction study conducted in Ghana found the loneliness
effect between these variables. prevalence as 18.1% with mental distress [32]. The
results of the present study are consistent with the
The score of the inactive group, which is one of literature and it can be said that the restrictions
the physical activity groups, was significantly high such as social distance, staying at home, decrease
compared to the active group in terms of GHQ-12 in the social interaction, which were implemented
total score. A study showed that increasing to prevent infection in the pandemic, contributed
physical activity can improve mental health. A to this situation. In pandemic conditions, the
study conducted with 20 thousand people in inability of individuals to go out on the street with
Scotland reported that doing daily physical activity complete closure prevented them from both
was associated with less psychological distress socializing and performing physical activity in
[26]. A study conducted in Singapore found a gyms or outside the home. This condition also
positive relationship between high sedentary appears to have negatively affected mental health.
behavior and psychological distress, while
physically active individuals had lower levels of In the study, the anger score was found to be
psychological distress [27]. In another study, it higher than the average group's level of
was found that when adolescents with low and psychological distress. A study found that
high physical activity in terms of GHQ-12 score participants showed increased levels of stress and
were compared, GHQ score decreased by 2.13 anger during the pandemic compared to before.
points with regular physical activity [28]. The The study, which investigated the relationship
7The Impact of Loneliness, Anger, and Regular Physical Activity on Mental Health during the Pandemic
ASEAN Journal of Psychiatry, Vol. 22(5), July 2021: 1-11
between anger and mental health in the Australian negative correlation between anger and exercise
general population, found that mood, anxiety and and healthiness [39-41]. In the study, it can be said
substance use disorder were independently that regular physical activity does not have a
associated with anger symptoms [33,34]. A study common effect with variables such as loneliness,
conducted in the Netherlands found that anger and anger, age, is related to the difficult conditions
anger attacks were linked to depression and caused by the pandemic, that individuals face
anxiety disorders [35]. It was found that mental unprepared and sudden life changes, the increase
health problems increased anger, and alcohol- in individual, social, economic stressors this
addicted individuals had higher anger expression condition affects mental health independently of
than the healthy control groups [36]. The results of the common effect of regular physical activity
the present study are consistent with the literature, with other variables.
and the stress increased due to pandemic, increase
in mental distress, and uncertainties may have Conclusion and Suggestion
increased anger, as well.
In the study, it was found that there was a
With the comparison of the age groups in the statistically significant difference between mental
study, it was found that young age group (18-29 distress and regular physical activity, loneliness,
years) had higher GHQ-12 total score than middle anger, and age variables, and there was no
and older age group. A study noted that young interaction effect between them. It can be said that
people had high general psychiatric disorders and the restrictions and measures taken to prevent
loneliness, and having a job and living with a pandemic infection led to many problems, both
partner were protective factors [36]. Additionally, physical and mental, at the social level, and that
it was found that having ≥ 3 from GHQ-12 were regular physical activity was effective in dealing
higher in young and low-educated individuals with these problems. In this direction, it is
compared to older individuals. When those who recommended to conduct advanced studies on
suffered from mental distress were examined, it mental distress in the pandemic.
was found that younger students tended to feel
more alone, anxious, and suicidal than older Limitations of Research
students. The levels of mental distress before the
pandemic and the impact of secondary results of The limitations of research can be listed as cross-
the pandemic on mental health were studied, and it sectional data, data collection based on self-
was found that young adults were more at risk for declaration, and not generalizing results to
mental distress. Although restrictions in pandemic populations with different characteristics.
conditions are more towards older individuals, it
can be said that older people can cope with the Conflict of Interest
process more efficiently and experience less
mental distress thanks to the decrease in their daily Authors declared no conflict of interest.
life stressors due to older ages, having regular
income due to being retired, calmer approach to Financial Disclosure
problems with mature point of view.
Authors declared no financial support.
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Corresponding author: Hilal SEKİ ÖZ, Kırşehir Ahi Evran University, Faculty of Health Sciences,
Department of Nursing, Kırşehir, Turkey.
E-mail: hilalseki@hotmail.com
Received date: 28 July 2021 Accepted date: 02 August 2021
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