Coping With Covid-19: Loneliness, Self-Efficacy, Social Support, Depression & Anxiety in Patients in Medical Rehab.

Background: Increased depressive symptoms and anxiety symptoms have been observed in
about 23% of all post-COVID patients, also called post-COVID depression (Huang et al.,
2021). However, what a) promotes post-COVID depression after the disease and whether it
is b) even post-Covid specific has not yet been conclusively understood and will be
investigated in this proposed research. The theoretical basis of the proposed work is
Cacioppo, Peplau, and Perlman's theory of loneliness, Bandura's self-efficacy theory, and
Schwarzer's HAPA model.

Objectives: The aim of the study is to investigate possible predictors and factors that
may be associated with the development and maintenance of mental and physical health
constrains including depression and anxiety symptomatology as well as loneliness in
hospitalized post-COVID patients and non-COVID patients in Germany. Furthermore, it will
be investigated whether psychological interventions have an effect on anxiety and
depression symptomatology, on loneliness values, self-efficacy and perceived social
support values. Specifically, the research aim is to examine the relationships between
loneliness, self-efficacy, and social support and to address the question of what factors
increase the risk of post covid depression/anxiety, and to test the buffering effect of
physical and social activities. For this purpose, a correlational study and an
experimental group comparison will be applied, in which two interventions will be
performed on post-COVID patients and non-COVID patients. These two data collections will
serve as the basis for a later longitudinal study, which is still in the planning stage,
as follow-up questions still need to be elaborated. Methods: Around 300 patients should
be included in the study. The correlation study at the first measurement point also
includes a regression analysis (moderated mediation analysis). Furthermore, an
experimental group comparison is performed. For the first group, a psychological
intervention for psychoeducational measures and psychosocial support, was designed
according to the recommendations of the DGP - Deutsche Gesellschaft für Pneumologie und
Beatmungsmedizin e.V. for the rehabilitation of COVID-19 patients (DGP, 2020). The second
intervention was designed after Cacioppo's intervention EASE, for processing loneliness.
In this experiment, the psychological interventions will be applied to both groups of
patients (non-Covid/Covid patients). The interventions start approximately two days after
data collection at T0. The second measurement time point (T1) is scheduled at the time of
patient discharge after the interventions have been implemented. Only patients who scored
8 or higher on the Hospital Anxiety and Depression Scale (HADS) at admission will
participate in the interventions. Patients will be asked to complete the questionnaire
again six months after discharge to include a third measurement point and to conduct the
aforementioned longitudinal study. Patients who refuse to participate in one of the
interventions but nevertheless agree to complete the questionnaires at the measurement
time points are treated according to the standards of the complex treatment in early
rehabilitation in which a twice psychological contact and screening by means of HADS is
obligatory. They form a third group. The following instruments will be used: Items from
the UCLA Loneliness Scale (Russel, 1980, German version), the Hospital Anxiety and
Depression Scale (Snaith & Zigmond, 2010), Perceived Social Support Questionnaire (F-SozU
K-6, Fydrich et al., 2009); SWE - General Self-Efficacy Expectancy Scale (Schwarzer et
al., 1999); various self-efficacy instruments, such as staging and Activities Against
Loneliness (Lippke, 2007, adapted from Godin & Shepard, 1985). It is expected that
self-efficacy and social support play a role as mediator variables and moderator
variables and that the symptomatology of depression and anxiety improves after an
intervention in COVID and non-COVID patients alike. The findings of this research will
contribute to a better understanding of the experience and behavior of patients with and
without an infection with COVID-19 in early rehabilitation and identify opportunities for
psychological intervention.

The ethics committee of Jacobs University Bremen, where Prof. Dr. Lippke supervises the
PhD project, has already approved the research project. Therefore, the project is already
in the recruitment phase in order to be able to use data from the third wave from the
first quarter of 2021, as this is a special situation in the pandemic and the data would
not be reproducible in this way.