Hostname: page-component-669899f699-7tmb6 Total loading time: 0 Render date: 2025-04-26T14:50:42.668Z Has data issue: false hasContentIssue false
  • English
  • Français

The Role of Mindfulness in Reducing Depression During COVID-19 At-home Treatment

Published online by Cambridge University Press:  16 April 2025

Geurim Go ,
Su Young Lee ,
Chan-Hyung Kim  and
Jhin Goo Chang
Geurim Go
Affiliation:
Department of Psychiatry, Myongji Hospital, Hanyang University College of Medicine, Goyang-Si, Gyeonggi-Do, Korea
Su Young Lee
Affiliation:
Department of Psychiatry, Yonsei Forest Mental Health Clinic, Seoul, Korea
Chan-Hyung Kim
Affiliation:
Department of Psychiatry, Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Korea
Jhin Goo Chang*
Affiliation:
Department of Psychiatry, Yonsei Forest Mental Health Clinic, Seoul, Korea
*
Corresponding author: Jhin Goo Chang; Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Mindfulness is a promising psychological resource that can alleviate dysfunctional fear responses and promote mental health. We investigated how mindfulness affects fear and depression in isolated patients with coronavirus disease 2019 (COVID-19), and whether it acts as a mediator.

Methods

We conducted an online survey of COVID-19 patients undergoing at-home treatment from February to April 2022. The survey included a questionnaire on fear of COVID-19 (measured by the Fear of COVID-19 Scale), mindfulness (measured by the Mindful Attention Awareness Scale), and depression (measured by the Patient Health Questionnaire). A total of 380 participants completed the questionnaire. We analyzed the correlation between each variable and performed a mediation analysis using hierarchical regression and bootstrapping to verify the statistical significance of the mediating effects.

Results

Each variable was significantly correlated. Hierarchical regression analysis showed that the association between the fear of COVID-19 and depression decreased from 0.377-0.255, suggesting that mindfulness partially mediates the relationship between fear of COVID-19 and depression. Bootstrapping analysis showed that the indirect effect of the mediating variable (mindfulness) is 0.121, which accounts for 32.3% of the total effect.

Conclusions

Interventions that promote mindfulness in patients with acute COVID-19 may be beneficial for their mental health.

Keywords

fear of COVID-19mindfulnessdepressionisolationstress
Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 19 , 2025 , e97
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of Society for Disaster Medicine and Public Health, Inc

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

Footnotes

Geurim Go; Current affiliation: Graduate School, Counseling Psychology Interdisciplinary Program, Sogang University, Seoul, Korea

References

Cruz, MP, Santos, E, Cervantes, MV, et al. COVID-19, a worldwide public health emergency. Revista Clínica Española (English Edition). 2021;221(1):55–61.CrossRefGoogle Scholar
Rogers, JP, Chesney, E, Oliver, D, et al. Psychiatric and neuropsychiatric presentations associated with severe coronavirus infections: a systematic review and meta-analysis with comparison to the COVID-19 pandemic. Lancet Psychiatry. 2020;7(7):611–627.CrossRefGoogle ScholarPubMed
Badenoch, JB, Rengasamy, ER, Watson, C, et al. Persistent neuropsychiatric symptoms after COVID-19: a systematic review and meta-analysis. Brain Commun. 2022;4(1):fcab297.CrossRefGoogle ScholarPubMed
Lorant, V, Smith, P, Van den Broeck, K, et al. Psychological distress associated with the COVID-19 pandemic and suppression measures during the first wave in Belgium. BMC Psychiatry. 2021;21:1–10.CrossRefGoogle ScholarPubMed
Moseholm, E, Midtgaard, J, Bollerup, S, et al. Psychological distress among hospitalized COVID-19 patients in Denmark during the first 12 months of the pandemic. Int J Environ Res Public Health. 2022;19(16):10097.CrossRefGoogle ScholarPubMed
Nishimi, K, Neylan, TC, Bertenthal, D, et al. Post-traumatic stress disorder and risk for hospitalization and death following COVID-19 infection. Transl Psychiatry. 2022;12(1):482.CrossRefGoogle ScholarPubMed
Farooq, S, Tunmore, J, Ali, MW, Ayub, M. Suicide, self-harm and suicidal ideation during COVID-19: a systematic review. Psychiatry Res. 2021;306:114228.CrossRefGoogle ScholarPubMed
Tang, W, Hu, T, Hu, B, et al. Prevalence and correlates of PTSD and depressive symptoms one month after the outbreak of the COVID-19 epidemic in a sample of home-quarantined Chinese university students. J Affect Disord. 2020;274:1–7.CrossRefGoogle Scholar
Cheng, C, CSk, Tang. The psychology behind the masks: psychological responses to the severe acute respiratory syndrome outbreak in different regions. Asian J Soc Psychol. 2004;7(1):3–7.CrossRefGoogle Scholar
Pappas, G, Kiriaze, I, Giannakis, P, Falagas, M. Psychosocial consequences of infectious diseases. Clin Microbiol Infect. 2009;15(8):743–747.CrossRefGoogle ScholarPubMed
Person, B, Sy, F, Holton, K, et al. Fear and stigma: the epidemic within the SARS outbreak. Emer Infect Dis. 2004;10(2):358.CrossRefGoogle ScholarPubMed
Seo, M. Amplifying panic and facilitating prevention: multifaceted effects of traditional and social media use during the 2015 MERS crisis in South Korea. J Mass Commun Q. 2021;98(1):221–240.Google Scholar
Rahman, MA, Hoque, N, Alif, SM, et al. Factors associated with psychological distress, fear and coping strategies during the COVID-19 pandemic in Australia. Glob Health. 2020;16(1):95.CrossRefGoogle ScholarPubMed
Stanton, R, To, QG, Khalesi, S, et al. Depression, anxiety and stress during COVID-19: associations with changes in physical activity, sleep, tobacco and alcohol use in Australian adults. Int J Environ Res Public Health. 2020;17(11):4065.CrossRefGoogle ScholarPubMed
Li, R. Fear of COVID-19: what causes fear and how individuals cope with it. Health Commun. 2022;37(13):1563–1572.CrossRefGoogle ScholarPubMed
Hasratian, AM, Nordberg, HO, Meuret, AE, et al. Fear and coping in students during the early stages of the COVID-19 pandemic: a combined cross-sectional and longitudinal study. Int J Environ Res Public Health. 2021;18(12):6551.CrossRefGoogle ScholarPubMed
Sakib, N, Akter, T, Zohra, F, et al. Fear of COVID-19 and depression: a comparative study among the general population and healthcare professionals during COVID-19 pandemic crisis in Bangladesh. Int J Mental Health Addict. 2021:1–17.Google ScholarPubMed
Şimşir, Z, Koç, H, Seki, T, et al. The relationship between fear of COVID-19 and mental health problems: a meta-analysis. Death Stud. 2022;46(3):515–523.CrossRefGoogle ScholarPubMed
Sharif-Esfahani, P, Hoteit, R, El Morr, C, Tamim, H. Fear of COVID-19 and depression, anxiety, stress, and PTSD among Syrian refugee parents in Canada. J Migr Health. 2022;5:100081.CrossRefGoogle ScholarPubMed
Khantzian, EJ. The self-medication hypothesis of substance use disorders: a reconsideration and recent applications. Harvard Rev Psychiatry. 1997;4(5):231–244.CrossRefGoogle ScholarPubMed
Rodriguez, LM, Litt, DM, Stewart, SH. Drinking to cope with the pandemic: the unique associations of COVID-19-related perceived threat and psychological distress to drinking behaviors in American men and women. Addict Behav. 2020;110:106532.CrossRefGoogle ScholarPubMed
Rehm, J, Kilian, C, Ferreira‐Borges, C, et al. Alcohol use in times of the COVID 19: implications for monitoring and policy. Drug Alcohol Rev. 2020;39(4):301–304.CrossRefGoogle ScholarPubMed
Elsayed, M, Schönfeldt-Lecuona, C, Welte, XA, et al. Psychological distress, fear and coping strategies during the second and third waves of the COVID-19 pandemic in Southern Germany. Front Psychiatry. 2022:696.Google ScholarPubMed
Yach, D. Tobacco use patterns in five countries during the COVID-19 lockdown. Nicotine Tob Res. 2020;22(9):1671–1672.CrossRefGoogle ScholarPubMed
Balakrishnan, V, Ng, KS, Kaur, W, et al. COVID-19 depression and its risk factors in Asia Pacific–a systematic review and meta-analysis. J Affect Disord. 2022;298:47–56.CrossRefGoogle Scholar
Knell, G, Robertson, MC, Dooley, EE, Burford, K, Mendez, KS. Health behavior changes during COVID-19 pandemic and subsequent “stay-at-home” orders. Int J Environ Res Public Health. 2020;17(17):6268.CrossRefGoogle ScholarPubMed
Kabat-Zinn, J. Mindfulness-based interventions in context: past, present, and future. 2003;CrossRefGoogle Scholar
Grossman, P, Niemann, L, Schmidt, S, Walach, H. Mindfulness-based stress reduction and health benefits: A meta-analysis. J Psychosom Res. 2004;57(1):35–43.CrossRefGoogle ScholarPubMed
Gu, J, Strauss, C, Bond, R, et al. How do mindfulness-based cognitive therapy and mindfulness-based stress reduction improve mental health and wellbeing? A systematic review and meta-analysis of mediation studies. Clin Psychol Rev. 2015;37:1–12.CrossRefGoogle ScholarPubMed
Boettcher, J, Åström, V, Påhlsson, D, et al. Internet-based mindfulness treatment for anxiety disorders: a randomized controlled trial. Behav Ther. 2014;45(2):241–253.CrossRefGoogle ScholarPubMed
Hawley, LL, Schwartz, D, Bieling, PJ, et al. Mindfulness practice, rumination and clinical outcome in mindfulness-based treatment. Cog Ther Res. 2014;38(1):1–9.CrossRefGoogle Scholar
McCracken, LM, Keogh, E. Acceptance, mindfulness, and values-based action may counteract fear and avoidance of emotions in chronic pain: an analysis of anxiety sensitivity. J Pain. 2009;10(4):408–415.CrossRefGoogle ScholarPubMed
Xu, F, Zhu, W, Chen, Q, et al. The relationship between mindfulness, anxiety and depression during the COVID-19 pandemic: a meta-analysis of correlational studies. Front Psychol. 2023;14:994205.CrossRefGoogle ScholarPubMed
Duarte, DFB, Libório, JR, Cavalcante, GME, et al. The effects of mindfulness-based interventions in COVID-19 times: a systematic review. J Human Growth Dev. 2022;32(2):315–326.CrossRefGoogle Scholar
Weis, R, Ray, SD, Cohen, TA. Mindfulness as a way to cope with COVID‐19‐related stress and anxiety. Couns Psychother Res. 2021;21(1):8–18.CrossRefGoogle Scholar
Zhu, JL, Schülke, R, Vatansever, D, et al. Mindfulness practice for protecting mental health during the COVID-19 pandemic. Transl Psychiatry. 2021;11(1):1–11.CrossRefGoogle ScholarPubMed
Wei, N, Huang, B-c, Lu, S-J, et al. Efficacy of internet-based integrated intervention on depression and anxiety symptoms in patients with COVID-19. Journal of Zhejiang University-SCIENCE B. 2020;21(5):400–404.CrossRefGoogle ScholarPubMed
Shaygan, M, Yazdani, Z, Valibeygi, A. The effect of online multimedia psychoeducational interventions on the resilience and perceived stress of hospitalized patients with COVID-19: a pilot cluster randomized parallel-controlled trial. BMC Psychiatry. 2021;21(1):1–12.CrossRefGoogle ScholarPubMed
Greeson, J, Brantley, J. Mindfulness and anxiety disorders: developing a wise relationship with the inner experience of fear. In: Clinical Handbook of Mindfulness. Springer; 2009:171–188.CrossRefGoogle Scholar
Belen, H. Fear of COVID-19 and mental health: the role of mindfulness in during times of crisis. Int J Mental Health Addict. 2022;20(1):607–618.CrossRefGoogle ScholarPubMed
Vos, LM, Habibović, M, Nyklíček, I, et al. Optimism, mindfulness, and resilience as potential protective factors for the mental health consequences of fear of the coronavirus. Psychiatry Res. 2021;300:113927.CrossRefGoogle ScholarPubMed
Korea Centers for Disease Control and Prevention. Release form isolation. Published Accessed 3 March, 2023. https://ncv.kdca.go.kr/menu.es?mid=a30402000000Google Scholar
Ahorsu, DK, Lin, C-Y, Imani, V, Saffari, M, Griffiths, MD, Pakpour, AH. The fear of COVID-19 scale: development and initial validation. Int J Mental Health Addict. 2020:1–9.Google ScholarPubMed
Hwang, K-S, Choi, H-J, Yang, C-M, et al. The Korean version of Fear of COVID-19 Scale: psychometric validation in the Korean population. Psychiatry Investig. 2021;18(4):332.CrossRefGoogle ScholarPubMed
Bitan, DT, Grossman-Giron, A, Bloch, Y, et al. Fear of COVID-19 scale: psychometric characteristics, reliability and validity in the Israeli population. Psychiatry Res. 2020;289:113100.CrossRefGoogle Scholar
Brown, KW, Ryan, RM. The benefits of being present: mindfulness and its role in psychological well-being. J Pers Soc Psychol. 2003;84(4):822.CrossRefGoogle ScholarPubMed
J-h, Jeon, W-K, Lee, S-J, Lee, et al. A pilot study of reliability and validity of the Korean version of Mindful Attention Awareness Scale. Korean J Clin Psychol. 2007;26(1):201–212.Google Scholar
Kroenke, K, Spitzer, RL, Williams, JB. The PHQ‐9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–613.CrossRefGoogle ScholarPubMed
Kroenke, K, Strine, TW, Spitzer, RL, et al. The PHQ-8 as a measure of current depression in the general population. J Affect Disord. 2009;114(1-3):163–173.CrossRefGoogle ScholarPubMed
Park, S-J, Choi, H-R, Choi, J-H, et al. Reliability and validity of the Korean version of the Parient Health Questionnaire-9 (PHQ-9). Anxiety and Mood. 2010;6(2):119–124.Google Scholar
Edition, F. Diagnostic and statistical manual of mental disorders. Am Psychiatric Assoc. 2013;21(21):591–643.Google Scholar
Baron, RM, Kenny, DA. The moderator–mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. J Pers Soc Psychol. 1986;51(6):1173.CrossRefGoogle ScholarPubMed
Hayes, AF. Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach. Guilford Publications; 2017.Google Scholar
Tsang, S, Avery, AR, Duncan, GE. Fear and depression linked to COVID-19 exposure: a study of adult twins during the COVID-19 pandemic. Psychiatry Res. 2021;296:113699.CrossRefGoogle ScholarPubMed
Rodríguez-Hidalgo, AJ, Pantaleón, Y, Dios, I, Falla, D. Fear of COVID-19, stress, and anxiety in university undergraduate students: a predictive model for depression. Front Psychol. 2020;11:591797.CrossRefGoogle Scholar
Bakioğlu, F, Korkmaz, O, Ercan, H. Fear of COVID-19 and positivity: mediating role of intolerance of uncertainty, depression, anxiety, and stress. Int J Mental Health Addict. 2021;19(6):2369–2382.CrossRefGoogle ScholarPubMed
Hidayati, I, Tan, W, Yamu, C. How gender differences and perceptions of safety shape urban mobility in Southeast Asia. Transportation Research Part F: Traffic Psychology and Behaviour. 2020;73:155–173.CrossRefGoogle Scholar
Mukhtar, S. Psychological impact of COVID-19 on older adults. Curr Med Res Pract. 2020;10(4):201.Google ScholarPubMed
Luo, F, Ghanei Gheshlagh, R, Dalvand, S, Saedmoucheshi, S, Li, Q. Systematic review and meta-analysis of fear of COVID-19. Front Psychol. 2021;12:1311.CrossRefGoogle ScholarPubMed
Shin, C, Lee, S-H, Han, K-M, Yoon, H-K, Han, C. Comparison of the usefulness of the PHQ-8 and PHQ-9 for screening for major depressive disorder: analysis of psychiatric outpatient data. Psychiatry Investig. 2019;16(4):300.CrossRefGoogle ScholarPubMed
HEALTH, U. Omicron BA.5: What We Know About This COVID-19 Strain. Published 2023.Google Scholar
Prevention KCfDCa. At-Home Treatment. Published 2023.Google Scholar
Spijkerman, M, Pots, WTM, Bohlmeijer, E. Effectiveness of online mindfulness-based interventions in improving mental health: a review and meta-analysis of randomised controlled trials. Clin Psychol Rev.Google Scholar
Antonova, E, Schlosser, K, Pandey, R, et al. Coping with COVID-19: mindfulness-based approaches for mitigating mental health crisis. Front Psychiatry. 2021;12:563417.CrossRefGoogle ScholarPubMed
Greeson, JM. Mindfulness research update: 2008. Complement Health Pract Rev. 2009;14(1):10–18.CrossRefGoogle ScholarPubMed
Michopoulos, V, Powers, A, Gillespie, CF, et al. Inflammation in fear-and anxiety-based disorders: PTSD, GAD, and beyond. Neuropsychopharmacol. 2017;42(1):254–270.CrossRefGoogle ScholarPubMed
Black, DS, Slavich, GM. Mindfulness meditation and the immune system: a systematic review of randomized controlled trials. Ann New York Acad Sci. 2016;1373(1):13–24.CrossRefGoogle ScholarPubMed
Hayes, AM, Feldman, G. Clarifying the construct of mindfulness in the context of emotion regulation and the process of change in therapy. Clin Psychol: Sci Pract. 2004;11(3):255.Google Scholar
Chawla, N, Ostafin, B. Experiential avoidance as a functional dimensional approach to psychopathology: an empirical review. J Clin Psychol. 2007;63(9):871–890.CrossRefGoogle ScholarPubMed
Hayes, SC, Wilson, KG, Gifford, EV, et al. Experiential avoidance and behavioral disorders: a functional dimensional approach to diagnosis and treatment. J Consult Clin Psychol. 1996;64(6):1152.CrossRefGoogle ScholarPubMed
Barnhofer, T, Crane, C. Mindfulness-based cognitive therapy for depression and suicidality. In: Clinical Handbook of Mindfulness. 2009:221–243.CrossRefGoogle Scholar
Arch, JJ, Craske, MG. Mechanisms of mindfulness: emotion regulation following a focused breathing induction. Behav Res Ther. 2006;44(12):1849–1858.CrossRefGoogle ScholarPubMed
Bossi, F, Zaninotto, F, D’Arcangelo, S, et al. Mindfulness-based online intervention increases well-being and decreases stress after Covid-19 lockdown. Sci Rep. 2022;12(1):6483.CrossRefGoogle ScholarPubMed
Zhu, JL, Schülke, R, Vatansever, D, et al. Mindfulness practice for protecting mental health during the COVID-19 pandemic. Transl Psychiatry. 2021;11(1):329.CrossRefGoogle ScholarPubMed
Polizzi, CP, Sleight, FG, Aksen, DE, McDonald, CW, Lynn, SJ. Mindfulness and COVID-19-related stress: staying present during uncertain times. Mindfulness. 2023;14(5):1135–1147.CrossRefGoogle ScholarPubMed
Wald, HS. Optimizing resilience and wellbeing for healthcare professions trainees and healthcare professionals during public health crises–practical tips for an ‘integrative resilience’approach. Med Teach. 2020;42(7):744–755.CrossRefGoogle ScholarPubMed
Wen, X, Rafaï, I, Duchêne, S, et al. Did mindful people do better during the COVID-19 pandemic? Mindfulness is associated with well-being and compliance with prophylactic measures. Int J Environ Res Public Health. 2022;19(9):5051.CrossRefGoogle ScholarPubMed