Mediated Pathways from Death Anxiety and Fear of COVID-19 to Adjustment Disorder via Social Support and Resilience

Agarwal, M., Sharma, P., Goswami, A., & Mittal, R. (2024). A 2023 nationwide study on adjustment disorder among first-year MBBS students in India. Bioinformation, 20(2), 190–195. https://doi.org/10.6026/973206300200190

Ahorsu, D. K., Lin, C. Y., Imani, V., Saffari, M., Griffiths, M. D., & Pakpour, A. H. (2022). The Fear of COVID-19 Scale: Development and Initial Validation. International journal of mental health and addiction, 20(3), 1537–1545. https://doi.org/10.1007/s11469-020-00270-8

Bambrah, V., Wyman, A., Friedman, E., & Eastwood, J. D. (2022). Examining the Longitudinal Associations between Adjustment Disorder Symptoms and Boredom during COVID-19. Behavioral sciences (Basel, Switzerland), 12(9), 311. https://doi.org/10.3390/bs12090311

Beck, E., & Daniels, J. (2023). Intolerance of uncertainty, fear of contamination and perceived social support as predictors of psychological distress in NHS healthcare workers during the COVID-19 pandemic. Psychology, health & medicine, 28(2), 447–459. https://doi.org/10.1080/13548506.2022.2092762

Bibi, A., & Khalid, M. A. (2020). Death anxiety, perceived social support, and demographic correlates of patients with breast cancer in Pakistan. Death studies, 44(12), 787–792. https://doi.org/10.1080/07481187.2019.1614108

Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely, S., Greenberg, N., & Rubin, G. J. (2020). The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet (London, England), 395(10227), 912–920. https://doi.org/10.1016/S0140-6736(20)30460-8

Connor, K. M., & Davidson, J. R. (2003). Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC). Depression and anxiety, 18(2), 76–82. https://doi.org/10.1002/da.10113

Dour, H. J., Wiley, J. F., Roy-Byrne, P., Stein, M. B., Sullivan, G., Sherbourne, C. D., … , & Craske, M. G. (2014). Perceived social support mediates anxiety and depressive symptom changes following primary care intervention. Depression and anxiety, 31(5), 436–442. https://doi.org/10.1002/da.22216

 Dragan, M., Grajewski, P., & Shevlin, M. (2021). Adjustment disorder, traumatic stress, depression and anxiety in Poland during an early phase of the COVID-19 pandemic. European journal of psychotraumatology, 12(1), 1860356. https://doi.org/10.1080/20008198.2020.1860356

Fathi Dooki, A., Fathi Dooki, E., Hassannia, L. and Hassannia, H. (2023). Psychological consequences of coronavirus (COVID-19) in students: A systematic review study. Health Psychology, 12(47), 105-117. https://doi.org/10.30473/hpj.2024.62958.5484

Feyzbabaie, M., Rajai, N., Alizadeh, A., & Azizi, M. (2025). Psychological distress among nursing students during the COVID-19 pandemic: a hybrid concept analysis. BMC psychology, 13(1), 218. https://doi.org/10.1186/s40359-025-02562-x

Gundogan S. (2021). The mediator role of the fear of COVID-19 in the relationship between psychological resilience and life satisfaction. Current psychology (New Brunswick, N.J.), 40(12), 6291–6299. https://doi.org/10.1007/s12144-021-01525-w

Hashemi, L., & Jokar, B. (2011). Study of relationship between spiritual transcendence and resilience. Journal of educational psychology studies, 8(13), 123-142. [Persian]

Kamkari, K. & Eskandari, M. (2022). Survey of Psychopathological Profile in Cured Patients of COVID-19 Disease. Iranian Journal of Health Psychology, 5(2), 63-70. https://doi.org/10.30473/ijohp.2022.56478.1152

Kazlauskas, E., Gelezelyte, O., Nomeikaite, A., & Zelviene, P. (2021). Posttraumatic Stress Disorder and Adjustment Disorder in Lithuanian Healthcare in 2018-2020: A Nation-Wide Cohort Study of the Effects of COVID-19 Pandemic. Healthcare (Basel, Switzerland), 9(11), 1422. https://doi.org/10.3390/healthcare9111422

Kuriyama, A., Shikino, K., Moriya, M., Sadohara, M., Nonaka, S., Nagasaki, K., … , & Makiishi, T. (2022). Burnout, depression, anxiety, and insomnia of internists and primary care physicians during the COVID-19 pandemic in Japan: A cross-sectional survey. Asian journal of psychiatry, 68, 102956. https://doi.org/10.1016/j.ajp.2021.102956

Kurose, S., Funayama, M., Takata, T., Shimizu, Y., Mimura, Y., Kudo, S., … , & Mimura, M. (2022). Symptom changes in patients with pre-existing psychiatric disorders in the initial phase of the COVID-19 pandemic: Vulnerability of female patients and patients with mood disorders. Asian journal of psychiatry, 68, 102966. https://doi.org/10.1016/j.ajp.2021.102966

Lenferink, L., Mouthaan, J., Fritz, A. M., Soydas, S., Eidhof, M., van Hoof, M. J., …, & Mooren, T. (2022). Predicting transitions between longitudinal classes of post-traumatic stress disorder, adjustment disorder and well-being during the COVID-19 pandemic: protocol of a latent transition model in a general Dutch sample. BMJ open, 12(1), e055696. https://doi.org/10.1136/bmjopen-2021-055696

Lotzin, A., Krause, L., Acquarini, E., Ajdukovic, D., Ardino, V., Arnberg, F., … & Adjust Study Consortium (2021). Risk and protective factors, stressors, and symptoms of adjustment disorder during the COVID-19 pandemic - First results of the ESTSS COVID-19 pan-European ADJUST study. European journal of psychotraumatology, 12(1), 1964197. https://doi.org/10.1080/20008198.2021.1964197

Mahat-Shamir, M., Pitcho-Prelorentzos, S., Kagan, M., Kestler-Peleg, M., & Lavenda, O. (2023). Adjustment Disorder in the Face of COVID-19 Outbreak: The Impact of Death Anxiety, Media Exposure, Fear of Contagion and Hypochondriasis Symptoms. Omega (Westport), 87(4),1189-1206. https://doi.org/10.1177/00302228211034372.

Makki, N., Alrehaili, D. A., Alrehaili, R. K., Sedaqir, R., & Alahmadi, W. T. (2024). Prevalence of Adjustment Disorder and Its Predictors Among First- and Second-Year Medical Students in Madinah, Saudi Arabia. Cureus, 16(1), e52028. https://doi.org/10.7759/cureus.52028

Mao, Z., Qin, T., Fan, L., Li, N., & Wang, Y. (2024). Factors associated with psychological distress among college students under COVID-19 pandemic: The moderating role of coping styles and social support. Current Psychology, 43(19), 17771–17786. https://doi.org/10.1007/s12144-023-05156-1

Mohammadi, F., Masoumi, Z., Oshvandi, K., Khazaei, S., & Bijani, M. (2022). Death anxiety, moral courage, and resilience in nursing students who care for COVID-19 patients: a cross-sectional study. BMC nursing, 21(1), 150. https://doi.org/10.1186/s12912-022-00931-0

Nasri, E., Yousefi, Sh., & Ashouri, A. (2025). Investigating the Psychometric Properties of the Persian Version of the International Adjustment Disorder Questionnaire Among University Students in Tehran City, Iran. Iranian Journal of Psychiatry and Clinical Psychology. 2025; 31:E4696.2. http://dx.doi.org/10.32598/ijpcp.31.4996.2

Noriega, C., Sánchez-Cabaco, A., López, J., Pérez-Rojo, G., Sitges, E., & Bonete-López, B. (2024). Protective and vulnerability factors of posttraumatic growth during the COVID-19 pandemic. Current Psychology, 43(19), 17740–17750. https://doi.org/10.1007/s12144-023-05058-2

Rahimian-Boogar, I., Talepasand, S., & Jabari, M. (2018). Psychosocial and Medical Determinants of Health-related Quality of Life in Patients with Relapsing-Remitting Multiple Sclerosis. Noro psikiyatri arsivi, 55(1), 29–35. https://doi.org/10.29399/npa.16983

Rajabi, Gh, & Bahrani, M. (2002). Item factor analysis of the Death Anxiety Scale. Iranian Association Psychology, 20(5), 331-44. [Persian]

Rayatpisheh, F., Torabizadeh, C., Najafi Kalyani, M., & Farsi, Z. (2023). Relationship between resilience and death anxiety of the older adults during the coronavirus disease 2019 (COVID-19) pandemic. BMC geriatrics, 23(1), 367. https://doi.org/10.1186/s12877-023-04086-8

Razgulin, J., Argustaitė-Zailskienė, G., Petrolienė, R., & Šmigelskas, K. (2024). Sociocultural adjustment and social support as predictors for international medical sciences students' anxiety during COVID-19. BMC medical education, 24(1), 395. https://doi.org/10.1186/s12909-024-05379-1

Rossi, R., Socci, V., Pacitti, F., Mensi, S., Di Marco, A., Siracusano, A., & Di Lorenzo, G. (2020). Mental Health Outcomes Among Healthcare Workers and the General Population During the COVID-19 in Italy. Frontiers in psychology, 11, 608986. https://doi.org/10.3389/fpsyg.2020.608986

Saha, I., Majumder, J., Bagepally, B. S., Ray, S., Saha, A., & Chakrabarti, A. (2023). Burden of mental health disorders and synthesis of community-based mental health intervention measures among adolescents during COVID-19 pandemic in low middle-income countries: A systematic review and meta-analysis. Asian journal of psychiatry, 89, 103790. https://doi.org/10.1016/j.ajp.2023.103790

Seçer, İ., Ulaş, S., & Karaman-Özlü, Z. (2020). The Effect of the Fear of COVID-19 on Healthcare Professionals' Psychological Adjustment Skills: Mediating Role of Experiential Avoidance and Psychological Resilience. Frontiers in psychology, 11, 561536. https://doi.org/10.3389/fpsyg.2020.561536

Seo, E. H., Kim, S. G., Lee, J. H., Dickey, C. C., Kim, M. Y., Ghumman, R. K., & Yoon, H. J. (2023). Psychosocial Factors Influencing Quality of Life Among Medical Students. Psychiatry investigation, 20(11), 1077–1085. https://doi.org/10.30773/pi.2023.0161

Shevlin, M., Hyland, P., Ben-Ezra, M., Karatzias, T., Cloitre, M., Vallières, F., … , & Maercker, A. (2020). Measuring ICD-11 adjustment disorder: the development and initial validation of the International Adjustment Disorder Questionnaire. Acta psychiatrica Scandinavica, 141(3), 265–274. https://doi.org/10.1111/acps.13126

Shi, J., Ma, G., Liu, X., & Jin, Y. (2024). Social isolation and adolescents’ psychological wellbeing during the COVID-19 epidemic: The mediating effect of loneliness and the moderating effect of resilience. Current Psychology, 43(19), 17163–17174. https://doi.org/10.1007/s12144-024-05637-x

Shokri, O., Kormi Nouri, R., Farahani, M.N., & Moradi A. (2016). The Quality of College Life from Viewpoint of Native and Non-Native Students of Tehran’s Public Universities. Journal of Iranian Cultural Research, 9(2), 75-100. [Persian]

Soleimani, M. A., Bahrami, N., Yaghoobzadeh, A., Banihashemi, H., Nia, H. S., & Haghdoost, A. A. (2016). Validity and reliability of the persian version of templer death anxiety scale in family caregivers of cancer patients. Iranian journal of nursing and midwifery research, 21(3), 284–290. https://doi.org/10.4103/1735-9066.180390

Tabachnick, B. G., & Fidell, L. S. (2014). Using Multivariate Statistics (6th ed.). Harlow: Pearson Education.

Templer, D. I. (1970). The construction and validation of a death anxiety scale. Journal of General Psychology, 82(2), 165–177. https://doi.org/10.1080/00221309.1970.9920634

Wen, Y., Zhang, Q. X., Liu, Y., He, X. H., & Gong, Y. W. (2025). Relationship between death anxiety and coping with death competence among Chinese oncology nurses: A chain mediation model. World journal of psychiatry, 15(7), 107416. https://doi.org/10.5498/wjp.v15.i7.107416

Woo, B. F. Y., Ang, W. H. D., Rogers, M., & Zhou, W. (2025). Factors associated with resilience, spiritual and mental well-being of advanced practice nurses: Implications for role integration. International nursing review, 72(1), e70015. https://doi.org/10.1111/inr.70015

Xiao, W., Liu, X., Wang, H., Huang, Y., Dai, Z., Si, M., … , & Su, X. (2023). Mediating role of resilience in the relationship between COVID-19 related stigma and mental health among COVID-19 survivors: a cross-sectional study. Infectious diseases of poverty, 12(1), 27. https://doi.org/10.1186/s40249-023-01074-3

Zapata-Ospina, J. P., Rodríguez, N., Rodríguez, A. M., García-Valencia, J., Jiménez-Benítez, M., Martínez-Ramos, N., … , & Aguirre-Acevedo, D. C. (2025). Development and validation of the "Adjustment Disorder Scale for Medically Ill Patients - ETAM". Frontiers in psychiatry, 16, 1482888. https://doi.org/10.3389/fpsyt.2025.1482888

Zhang, L., Jiang, M., Wang, L., Zheng, J., & Wang, W. (2023). The Mediating Effect of Perceived Social Support and Medical Coping Modes Between Psychological Resilience and Meaning in Life in COVID-19 Patients. Patient preference and adherence, 17, 571–582. https://doi.org/10.2147/PPA.S391014

Zimet, G. D., Dahlem, N. W., Zimet, S. G., & Farley, G. K. (1988). The Multidimensional Scale of Perceived Social Support. Journal of Personality Assessment, 52(1), 30–41. https://doi.org/10.1207/s15327752jpa5201_2