1

The mediating role of religious beliefs in the relationship between well-being and fear of

COVID-19

Phuong Thi Hang Nguyena, Van-Son Huynhb, Thanh-Thao Lyb, My-Tien Nguyen-Thib*, Kieu

Xuan Nguyen Thanhc, Gallayaporn Nantachaid, and Vinh-Long Tran-Chib,d

Correspondence: My-Tien Nguyen-Thi

700000, Vietnam

Tel + 84 898 539 896

Email [email protected]

Orcid https://orcid.org/0000-0002-4420-1395

a
Faculty of Psychology and Education, The University of Danang - University of Science and

Education, Danang City, Vietnam

City, Vietnam
d
Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand

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The mediating role of religious beliefs in the relationship between well-being and fear of

COVID-19

ABSTRACT

Religion has been one of the social entities that significantly impacted the COVID-19

pandemic. The study aims to examine the relationship between well-being and fear of

COVID-19 and to test whether religious beliefs mediate the effect of well-being on fear

of COVID-19. The sample comprised 433 participants in Vietnam. The results show that

individuals who attend religious services daily, people without chronic disease, and

younger adults have higher levels of well-being than others. Additionally, older adults

have higher levels of religious beliefs than others. Females are more likely to experience

fear of COVID-19 compared to males. The latter shows religious beliefs mediated the

effect of well-being on fear of COVID-19. Social workers and clinicians must consider

older adults and people with chronic disease as prioritized vulnerable groups for early

mental interventions and should be aware of the role of religion in psychological

treatment integration.

Keywords: religious beliefs, well-being, fear, COVID-19 pandemic, Vietnam

Introduction

COVID-19 has caused much inconvenience and significant disruption to the general

population. The Delta variant was more aggressive and highly transmissible than previously

circulating variants (Davies et al., 2021). The spread of the Delta variant has led to many

infection and death cases reported worldwide. Specifically, Vietnam has faced challenges and

difficulties in the pandemic due to a significant increase in confirmed cases, with over one

million reported from April 27, 2021 to December 19, 2021 (WHO, 2021). With the extremely

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high infection and comparatively high mortality prevalence, individuals naturally began

worrying about the coronavirus. For this reason, COVID-19 has become a main source of fear

and a major factor affecting mental health and well-being among individuals. Besides, using

religious beliefs to cope with difficult situations such as stress and anxiety caused by the

pandemic could alleviate negative mental states.

Well-being and Religious Beliefs

Religion has been generally known as a protective factor for individuals' psychological health

and many types of religious experiences are related to improved physical and mental health.

Holland et al. (1998) defined religious beliefs as an individual's system of beliefs in the

significance of religious faith in their life. Religious beliefs play a significant role in people's

understanding of themselves and the world, as well as mental health and well-being (Ellison et

al., 2001). Specifically, well-being is profoundly related to the individual's religious beliefs.

The term well-being is described as an essential dimension of mental health (Keyes & Reitzes,

2007), a multidimensional concept comprising cognitive, affective, physical and mental

components (Benevene et al., 2020) as well as social life and community involvement (Sohi et

al., 2018).

Many prior studies reported that religious attendance was linked to mental health enhancement,

including decreased depressive symptoms, reduced anxiety and increased life satisfaction

(Koenig & Vaillant, 2009; Sternthal et al., 2010). Furthermore, frequent religious attendance

might have helped prevent the development of high levels of medical illness burden and better

physical function (Koenig, 1998). Religious beliefs can help people experience feelings of

hope, optimism, peace and the release of negative emotions. People’s religious beliefs are

specifically strengthened by frequent participation in networks of people who share their

beliefs.

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Graham and Crown (2014) reported that religious activities positively affected well-being

among individuals, and the belief related to religion could be accounted for well-being.

Besides, religious activities such as prayer, meditation, listening to religious radio programs or

Bible reading were positively associated with well-being and had positive implications for the

well-being of believers (Klokgieters et al., 2019; Osei-Tutu et al., 2021). Many scholars

reported a positive relationship between the frequency of religious service attendance and

individuals' well-being (Chen et al., 2020; Greenfield & Marks, 2007). For instance, Ellison et

al. (2001) reported that church attendance positively correlated to well-being. Individuals who

regularly attend religious services may feel optimism, belonging, peacefulness, hope, and

release of negative emotions (Hill, 2006; Michaels et al., 2022).

History of chronic disease and Well-being

Several studies have investigated the relationship between well-being and individuals with

chronic diseases. Prior evidence showed that people without chronic disease had much greater

health and well-being than people with chronic disease (Westaway, 2010). Concerning the

outbreak of COVID-19, a prior study found that individuals with chronic disease had greater

levels of stress, anxiety, and depression (Ozamiz-Etxebarria et al., 2020), as well as lower

psychological well-being and higher fears and worries about the COVID-19 (Rapelli et al.,

2020) compared to individuals without the chronic disease.

Age and Well-being

Regarding emotional regulation, the literature showed that older people's emotional

experiences were more stable, positive, and a greater sense of well-being than younger people

(Burr et al., 2021; Stone et al., 2010). According to Aizpurua et al. (2021), older people have

more pronounced adaptation mechanisms to adversity, stress, and emotionally negative events

than younger ones. For instance, Carstensen et al. (2020) found that older people had higher

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emotional well-being than younger people in the pandemic. And even in facing of prolonged

stress, the elderly had better emotional well-being in the middle of the pandemic. Similarly,

Bidzan-Bluma et al. (2020) indicated that older people rated their well-being higher than young

and middle-aged. Besides, older adults experienced less pandemic-related stress, less social

isolation, less life change and lower negative relationship quality than younger adults (Birditt

et al., 2021). In other words, older adults appeared to have higher resilience and systems for

regulating their emotions and dealing effectively with adversity (Silva et al., 2019).

Age and Religious Beliefs

The most vulnerable age group to COVID-19 has been identified as older individuals (Covid

et al., 2020), and the pandemic has substantially impacted all aspects of their quality of life,

including mental health (Hall et al., 2021). Because older people are at high risk for developing

more serious complications from COVID-19, the pandemic is likely to worry them more than

younger people. Religious beliefs and practices have been shown to assist people in managing

stress and anxiety, and have been linked to less anxiety and more hope, particularly among

older adults. Older adults had higher levels of religiosity than younger adults (Bengtson et al.,

2015). Religion has been considered a crucial coping resource for many older people. Older

people found that religious strategies help them manage loneliness, purpose and meaning of

life, physical limitations and losses related to aging. It's also possible that older people have

more free time to dedicate to religious contemplation and activity than younger people.

Religious beliefs and Fear of COVID-19

COVID-19 is a global emergency that can impact both physical and mental health. The

Coronavirus disease has caused worry and fear among the general population due to its spread,

cross-industry impact, and unpredictable contagion. During the pandemic, fear has been one of

the most common psychological reactions in the general population (Bavel et al., 2020; Wang

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et al., 2020). Fear is an emotional response to a threat regarded as a functional, adaptive and

transient response to stimuli that causes physiological changes for a brief period (Adolphs,

2013; Bakioğlu et al., 2021).

Religion has been believed that it is a significant coping tool for people when confronted with

adversity (Henrich et al., 2019). Religion, prayer and other personal religious activities could

be considered common strategies for coping with the fear caused by COVID-19 for religious

believers (Bentzen, 2021). During the pandemic, however, public restrictions were

implemented, such as only going outside when an emergency, buying food or medicines and

prohibiting large public gatherings, which led religious believers to refrain from gathering and

participating in communal activities like worshipping, celebrating or Bible reading. Religious

people felt loss of engagement between fellowship and religious communities (Osei-Tutu et

al., 2021), compromised religious lifestyles and raised fear of COVID-19 (Enea et al., 2021)

due to mandatory prohibitions against praying in a church.

Gender and Fear

Gender is one of aspects that influences an individual's health and disease status. Previous

research indicated that females, as compared to males, were more susceptible to stress and, as

a result, had higher levels of fear when confronted with various life events (Tolin & Foa, 2008;

Vlassoff, 2007). Besides, females reported that had a higher affective intensity and were more

likely to experience negative emotions such as fear (Alsharawy et al., 2021).

Vietnam is a multi-religious country where thousands of religious activities occur yearly (Van

Nghia, 2015). In light of the COVID-19 pandemic, most people are considerably more open to

faith, prayer, Bible reading and worship. These religious activities give people control over the

situation, help to make it understandable, and deal with the fear of the pandemic. In the context

of COVID-19, general public religious practices were considered unnecessary, and religious

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organizations were required not to organize mass activities. These restrictions influenced the

general population's mental health. Additionally, no research has studied the relationship

between religious beliefs and well-being among the general population, particularly in the

COVID-19 pandemic in Vietnam. For that reason, our research aims to investigate the

association between well-being and fear of COVID-19, religious beliefs, and to determine if

well-being and religious beliefs predict fear of COVID-19 among the general population in

Vietnam. Accordingly, the answers to the following questions were sought:

What factors influence the fear of COVID-19 in the general population?

Do religious beliefs operate as a mediator between well-being and fear of COVID-19?

Method

Research Hypothesis

Hypothesis 1: Individuals who attend religious services daily would have higher levels of well-

being than others.

Hypothesis 2: People without chronic disease would have higher levels of well-being than

people with chronic disease.

Hypothesis 3: Older adults would have higher levels of well-being than others.

Hypothesis 4: Older adults would have higher levels of religious beliefs than others.

Hypothesis 5: Females would be more likely to experience fear of COVID-19 than males.

Hypothesis 6: Religious beliefs would negatively predict the fear of COVID-19 among the

general population.

Hypothesis 7: Religious beliefs would mediate the relationship between well-being and the fear

of COVID-19.

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Procedure

Public restrictions were still implemented as prohibiting large public gatherings, our study

selected the data based on an online survey through Google form. The data collection occurred

from November 14 to December 1, 2021. Informed consent was provided and anonymity

confidentiality terms were explained before participants took the survey. Participants were

entirely voluntary without remuneration and could withdraw at any time. The survey was

approximately 10–15 minutes to complete. Participants were advised to contact the research

team through email or phone if they had any questions during the survey.

Items from three scales were forward and back-translated in this study. The English version

was first translated into Vietnamese by a Vietnamese native speaker who is fluent in English,

then the Vietnamese version was sent and back-translated into English by a professional

translator (a native speaker of English and fluent in Vietnamese). Eventually, the research team

evaluated for content accuracy and discrepancies between the original and the two versions

(the English-translated and the Vietnamese back-translated versions).

Participants

A total of 443 questionnaires distributed, with 433 of them being valid. The study population

consisted of 264 females (61%) and 169 males (39%), with the mean age of 37.58 years (SD =

3.47) belonging to the age group 18 - 82. The participants classified their religion as

Catholicism (n = 157; 36.3%), Buddhism (n = 152; 35.1%), Protestantism (n = 12; 2.8%),

Caodaism (n = 4; 0.9%) and non religion (n = 108; 24.9%), most of respondents were not

infected with COVID-19 (n = 251; 58%). Detailed description of participants is presented in

Table 1.

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Measures

The Intrinsic Religious Motivation Scale

The short version of the Intrinsic Religious Motivation Scale (IRMS) was developed by Hoge

(1972) to evaluate diverse approaches to religion as well as the motivation through religious

activities. The measurement used a 5-point Likert scale ranging from 1 (strongly disagree) to

5 (strongly agree).

In this study, the Confirmatory Factor Analysis (CFA) indicated that the measurement was an

adequate fit, CMIN/df = 2.835 (p<.001); Goodness-of-fit index (GFI) = 0.973; Comparative

fit index (CFI) = 0.981; Tucker - Lewis Index (TLI) = 0.972; Root mean square error of

approximation (RMSEA) = 0.065; and 90% Confidence Interval (CI: 0.042, 0.089) (Joseph et

al., 2010).

The Fear of COVID-19 Scale

The Fear of COVID-19 Scale (FCV-19S) was developed by Ahorsu et al. (2020) to evaluate

the level of fear experienced by individuals during the Coronavirus pandemic. The scale used

a 5-point Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree).

In this study, the CFA indicated that the measurement was an acceptable fit, CMIN/df = 5.983

(p<.001); GFI = 0.960; CFI = 0.962; TLI = 0.920; RMSEA = 0.10; and 90% CI (0.082, 0.134)

(Joseph et al., 2010).

Mental Health Continuum–Short Form

The Mental Health Continuum–Short Form (MHC-SF) - 14-item questionnaire was developed

by Keyes et al. (2008) focusing on dimensions of well-being to assess happiness levels among

individuals. The measurement used a 6-point Likert scale from 0 (never) to 5 (every day).

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In this study, the CFA indicated that the measurement was an adequate fit, CMIN/df = 3.842

(p<.001); GFI = 0.916; CFI = 0.942; TLI = 0.929; RMSEA = 0.081 and 90% CI (0.071, 0.091)

(Joseph et al., 2010).

Research analysis

The Social Sciences Statistics Program (SPSS) version 25.0 was used for data processing.

Descriptive statistics were used to describe participants' characteristics. The one-way analysis

of variance (ANOVA) was used to examine any statistical differences between age, chronic

disease status, frequency of religious attendance and well-being, age and religious beliefs,

gender and fear of COVID-19.

The present research was conducted using a quantitative approach that applied a cross-sectional

study method with path analysis measured by partial least squares structural equation modeling

(PLS-SEM). PLS‐SEM approach was selected to validate the hypotheses of the study and was

used to analyze the effects of the independent variables on the dependent variables and examine

the mediation hypothesis.

[Table 1 near here]

Results

Descriptive analysis

A one-way ANOVA was performed to test significant differences between age, history of

chronic disease and frequency of religious attendance in terms of WB, age in terms of RB and

gender in terms of FoC, as shown in Table 2. Levene's test of equality of error variances was

used to test the assumption ANOVA that the variances for each variable are equal across the

groups. If Levene's test is significant, the homogeneity of variance assumption needed for an

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ANOVA is met. In contrast, Welch’s adjusted F ratio is employed to correct for violating the

assumption of homogeneity of variance.

The outcome of Levene’s Test showed is not significant of frequency of religious attendance

[F(5,427) = 4.269, p < 0.05], history of chronic disease [F(1,431) = 43.352, p < 0.05] and age

[F(5,427) = 9.54, p < 0.05] according to WB. Therefore, Welch’s adjusted F ratio was

employed, revealing a significant differences of frequency of religious attendance [Welch’s

F(5,156) = 8.029, p < 0.05], history of chronic disease [Welch’s F(1,431) = 37.834, p < 0.05]

and age [Welch’s F(5,122) = 6.429, p < 0.05]. The findings showed that individuals who

attended religious services daily (M = 3.47, SD = 0.81) had higher level of WB than others,

individuals without chronic disease (M = 2.95, SD = 1.09) had higher level of WB than

individuals with chronic disease (M = 2.41, SD = 0.74). While, individuals from the age of 18

- 20 (M = 3.04, SD = 1.15) had higher level of WB than others. The results suggested that the

first and second hypothesis should be accepted, the third hypothesis should be rejected.

The outcome of Levene’s Test showed is not significant of age [F(5,427) = 2.63, p < 0.05] in

terms of RB. Therefore, Welch's adjusted F ratio was employed, revealing a significant age

difference [Welch's F(5,121) = 2.642, p < 0.05]. The finding showed that individuals above 59

(M = 3.29, SD = 0.77) had higher RB than others. The results suggested that the fourth

hypothesis should be accepted.

The outcome of Levene’s Test showed that the variances between gender [F(1,431) = 0.851, p

> 0.05] in FoC, indicating that these assumptions underlying the application of ANOVA were

met. There were statistically significant effects of gender [F(1,431) = 18.92, p < 0.05] on FoC.

The finding showed that females (M = 2.94, SD = 0.79) had experienced higher level of FoC

than males (M = 2.60, SD = 0.81). The results suggested that the fifth hypothesis should be

accepted.

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[Table 2 near here]

Measurement Model

Indicator Reliability (Outer loading). In the present study, most of the outer loadings above

0.708 met the criteria for indicator reliability. The remaining indicators with loadings ranging

from 0.4 to 0.7 were accepted (Hair et al., 2021). The elimination of these indicators did not

lead to the improvement of CR and AVE, as referred in Table 3

Construct Reliability (CA; CR). The results for CA and CR are presented in Table 3 for RB

(0.874, 0.903), FoC (0.867, 0.893), WB (0.929, 0.937), respectively. this study found the

reliability values to be in a satisfactory range (Hair et al., 2021).

Convergent Validity (AVE). AVE values for RB, FoC and WB were 0.579, 0.546, 0.520,

respectively (shown in Table 3). All the values were greater than the 0.50 threshold, which was

acceptable (Hair et al., 2021).

Discriminant Validity (HTMT). Bootstrap confidence intervals can test if the HTMT is

significantly different from 1.0 (Henseler et al., 2015) or a lower threshold value, such as 0.9

or 0.85. The HTMT ratio results were lower than the 0.090 thresholds presented in Table 4.

Assessment of structural model

Collinearity statistics (VIF). The values of VIF are equal to or less than 3.30 considered biased

free (Hair et al., 2017). All VIF values were less than 3.30 concluding that the data set was not

suffered from a common bias issue in achieved data (referred to Table 5).

Coefficient of determination (R2). The R2 ranges from 0 to 1, with higher values indicating a

greater explanatory power (Hair et al., 2021). The values of R2 must be higher than 0.1 being

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considerable (Falk & Miller, 1992). In our study, the R2 value 0.127 depicts that WB and RB

together caused 12.7% variance in FoC (referred to Table 6).

Cross-validated redundancy (Q2). The Q2 values of FoC, RB, WB were 0.057, 0.220 and 0.071

respectively, indicating the predictive relevance of the present study model (Hair et al., 2014;

Henseler et al., 2009) (refer to Table 6).

The effect Sizes F2 . The effect size of F2 showed relatively small effects of RB on FoC (0.031)

and WB on RB (0.023) and there was no effect of WB on FoC (less than 0.02) (Hair et al.,

2017; Henseler et al., 2009).

[Table 3 near here]

[Table 4 near here]

[Table 5 near here]

[Table 6 near here]

Results of PLS-SEM analysis

Fig.1 shows the final PLS model. In the mediation model, WB and RB mediated the effects of

history of chronic disease, frequency of religious attendance, gender, religion on the FoC.

We found that 12.7% of the variance in the FoC was explained by RB, history of chronic

disease, gender, age and religion, while WB was no significant impact. PLS showed that 15.8%

of the variance in the WB could be explained by the regression on history of chronic disease,

frequency of religious activities and age , while 39.1% of the variance in the RB was explained

by WB, gender, frequency of religious activities and religious. Moreover, the specific indirect

effects showed that most pathways from the input to the output variables were significant. For

example, the effects of history of chronic disease, age, gender, religion and frequency of

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religious activities on the FoC were mediated by RB, WB.

The results showed that the direct effect of WB on FoC was not significant (β = -0.076, t =

1.421, p = 0.156) and the indirect effect of RB between the relationship WB and FoC was

positive and statistically significant (β = 0.024, t = 2.155, p = 0.031). The present study

signalled a full mediation effect (Nitzl et al., 2016). This result suggested that RB mediated the

effect of WB on FoC. Therefore, the sixth hypothesis should be rejected and the seventh

hypothesis should be accepted.

There were significant specific indirect effects of age on RB mediated via WB (β = - 0.034; t

= 2.278; p = 0.023). There were significant total effects of age on RB (β = -0.034; t = 2.278; p

= 0.023); on WB (β = - 0.283; t = 4.865; p < .001). There were significant specific indirect

effects of history of chronic disease on RB mediated through WB (β = 0.019; t = 1.969; p =

0.049). There were significant total effects of history of chronic disease on RB (β = 0.019; t =

1.969; p = 0.049); on WB (β =0.157; t = 2.926; p = 0.004).

There were significant specific indirect effects of gender on FoC mediated via RB (β = -0.046;

t = 2.979; p = 0.003).There were significant total effects of gender on FoC (β = 0.199; t = 4.046;

p < .001); on RB (β = 0.232; t = 5.754; p < .001). There were significant specific indirect effects

of religion on FoC mediated through RB (β = -0.061; t = 2.902; p = 0.004). There were

significant total effects of religion on FoC (β = 0.165; t = 3.109; p = 0.002); on RB (β = -0.303;

t = 6.105; p < .001).

There were significant specific indirect effects of frequency of religious activities on (a) FoC

mediated through RB (β = 0.070; t = 3.395; p = 0.001); (b) RB mediated through WB (β =

0.029; t = 2.369; p = 0.018); (c) FoC mediated by the path from WB → RB (β = 0.006; t =

2.048; p = 0.041) . There were significant total effects of frequency of religious activities on

RB (β = 0.379; t = 6.810; p < .001); on WB (β =0.239; t = 4.937; p < .001); on FoC (β = 0.058;

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t = 2.336; p = 0.020)

[Figure 1 near here]

Figure 1. Results of complete partial least squares analysis performed on 1000 bootstrap

samples. The gender, age, religion, history of chronic disease and frequency of religious

activities are input variables and fear of COVID -19 (FoC) is output variable with well-being

(WB) and religious belielfs (RB) mediating the effects of the input on the output variables.

Discussion

The current study provides existing research on mental health support that may protect against

the influence on the COVID-19 crisis by investigating relations between well-being, religious

beliefs and fear of COVID-19. Our study highlighted a few significant findings. First,

individuals who attend religious services daily, people without chronic disease, younger adults

had higher levels of well-being than others. Additionally, older adults had higher levels of

religious beliefs than others. Females were more likely to experience fear of COVID-19

compared to males. The latter shows religious beliefs mediated the effect of well-being on fear

of COVID-19.

The present research findings examine the relationship between descriptive variables and well-

being, religious beliefs, and fear of COVID-19. This finding indicates that individuals who

attend religious services daily have higher levels of well-being than others. This result is

consistent with research that reported a positive relationship between religious services

attendance and well-being (Chen et al., 2020; Greenfield & Marks, 2007). Many prior scholars

reported that attending religious services enhanced social integration, belonging, peacefulness,

hope and released negative emotions (Hill, 2006; Michaels et al., 2022).

This study shows people without chronic disease have higher levels of well-being than people

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with chronic disease. The findings in these prior analyses are similar to what we observed in

our models, individuals without chronic disease have much greater well-being than people with

chronic disease (Rapelli et al., 2020; Westaway, 2010). Immunocompromised and chronic

disease people have been considered susceptible populations under tremendous physical and

psychological stress, fear and anxiety about being infected in a public health crisis (Al-Rahimi

et al., 2021; Samlani et al., 2020). They were more at risk of contagion and the consequences

were more severe. Our data analysis reveals a difference between age and well-being, reflecting

younger adults have higher levels of well-being than others. This is a surprising finding,

contrary to what we know from previous studies (Bidzan-Bluma et al., 2020; Carstensen et al.,

2020), which have shown that older adults had higher levels of well-being than younger adults.

It can be seen that most people aged 60 or over live either alone or in couples in most high

income countries. In contrast, the majority of the elderly live in multigenerational households

in low-middle income countries, typically numbering five or more individuals (Hodgins &

Saad, 2020). Like many Asian countries, the majority of older people in Vietnam often live

with later generations in large families (Teerawichitchainan et al., 2015; Tung, 2020).

Particularly in the COVID-19 pandemic, household income declined, resulting in reduced

support from offspring and relatives to older people. Specifically, households with older people

needing medical care could temporarily fall into poverty because of COVID-19 (Vietnam,

2020). In some provinces, the national social security organization paid benefits and provided

home care programs for the elderly, which was still unusual in rural areas. Furthermore, most

older adults lived in rural areas, where income reductions were less than in urban areas. For the

aforementioned statements, older people worried that they would be unable to support their

offspring and would become a hindrance to their loved ones.

High levels of religious beliefs in older adults could be considered as an expected finding. It is

in line with the study of (Bengtson et al., 2015) showing that older adults have higher levels of

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religiosity than younger adults. During old age, the major negative influences are acute and

chronic physical health problems, the loss of roles in society and family, financial stresses, loss

of friends and family, and issues related to purpose and meaning in the face of suffering and

death. Older adults frequently have depleted personal resources to cope and tend to handle

difficulties including distance, positive reappraisal, and seeking social support. Religious

beliefs are coping strategies with aging changes, especially when there seems to be nothing

else to turn to. Many older people reported that religious beliefs help them cope with physical

health problems and life stresses, manage loneliness, purpose and meaning of life, especially

in COVID-19.

According to the findings, females are more likely to experience fear of COVID-19 than males.

Our result ties well with previous studies wherein the coronavirus pandemic causes more

psychological effects in females (Alsharawy et al., 2021; Lo Coco et al., 2021; Mahamid et al.,

2022). Gender roles, on the other hand, may be a significant influence in this finding. Females

were physically weaker and sicker more often (Overfield, 2017) they were more likely to

experience more fear of COVID-19 compared to males since they got sick more frequently.

Besides, females were more caregiver responsibilities than usual (Gausman & Langer, 2020);

more likely to perceive the pandemic as a very serious health problem and more risk-averse

than males (Galasso et al., 2020).

We find that religious beliefs positively predict the fear of COVID-19, which individuals with

high levels of religious beliefs are associated with increased fear of COVID-19. In normal

context, major religions play a role of healing the soul, and frequent religious participation is

linked to improve emotional health outcomes. It can be explained that religiosity significantly

influences how religious people perceive life, death, and suffering as well as how they react to

death and the end of life by attaching meanings to those concepts with values in corresponding

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religious teachings. Previous research showed that frequency of religious attendance improved

the mental health of religious believers (Długosz, 2021). Religious beliefs and practices were

related to the ability to cope with the disease and a positive attitude in a difficult situation

(Kowalczyk et al., 2020). However, it should be noted that the meanings of death, suffering,

and so on are highly subjective and determined by personal interpretations of religious

teachings and hence these meanings are not always positive in terms of mental health. In the

context of COVID-19, social distancing and other restrictions leading to a lack of religious

communication can prevent proper assistance and guidance from religious leaders as well as

the community, which may increase the likelihood of related misperceptions and negative

emotions (Vuong et al., 2021). Therefore, the psycho-religious mechanism can help further

explain the role of religious beliefs as presented in the current study.

Nevertheless, due to the high spread of disease, the Vietnamese government asked religious

organizations to cancel religious festivals and religious ceremonies like worshipping and

praying in a church, mosque, or pagoda to prevent virus transmission. Many religious

communities conducted online services at certain times of the week to stream live videos of

suitably modified rituals, sermons, and prayers for providing support and enhancing a sense of

connectedness in religious believers. However, believers who did not have this information

and communications technology advantage seemed to be lack of religious knowledge and

decline in interaction with fellowship and religious assembling. Some reasons have been

proposed that mandatory prohibitions against participating in communal activities

compromised the religious lifestyle and increased the anxiety and fear of individuals' religious

beliefs.

We discover that religious beliefs in fact fully mediate the effects of well-being on the fear of

COVID-19, indicating that religious beliefs act indirectly in the fear of COVID-19. The

Electronic copy available at: https://ssrn.com/abstract=4212930

dimension of religious beliefs positively and significantly mediate the relationship between

well-being and the fear of COVID-19. People who experience higher levels of well-being are

more likely to have higher levels of religious beliefs, which leads to more fear of COVID-19.

Previous models have not examined role of religious beliefs in mediating the relationship

between well-being and the fear of COVID-19, and this understanding will help develop more

targeted interventions.

Limitations

The current study has some limitations. First, the study is conducted through an online survey,

which is associated with low participation of the elderly and technologically disadvantaged

people, reducing the generalizability of the results to a representative population. Larger and

more representative groups of the population are needed to increase the accuracy of the findings

and explore more factors related to school-education, socio-economic status and employment

status, which may be considered in the future studies. Second, the recent study do not address

religious well-being or religious coping, limiting the scope of the findings. Future studies

should examine the role of religious coping and religious well-being in fear of COVID-19.

Implications

Effective positive psychological interventions and support strategies must be implemented to

enhance psychological resilience and improve the mental health of this population, especially

religious aspects. Remarkably, religious beliefs have not only assisted in spiritual attainment

of salvation, but also in physical health and temporal longevity among the elderly. Religious

strategies have been proven to support older adults in coping with loneliness, purpose, meaning

of life, physical limitations and losses.

Regarding implications for clinical practices, our results suggest that clinicians should consider

Electronic copy available at: https://ssrn.com/abstract=4212930

the role of religion into the treatment to support well-being and mental health of clients during

a public health crisis. Paterson and Francis (2017) found that people who had higher levels of

religiosity reported higher benefits from psychological therapy, specifically concerning coping

skills. Clinicians are encouraged to learn about religiously integrated psychotherapy

approaches so that they can support clients within their current transcendental beliefs systems.

According to Cognitive Behavior Therapy (CBT), religion has a role in developing ''cognitive

schemata'' and a religious framework that can operate as a generic mental model, contributing

to a consistent and adaptive assessment of situations (James & Wells, 2003). Besides,

Acceptance and Commitment Therapy (ACT) plays an important part in stimulating the third

wave of behavior therapy and be recently practiced in clinical settings (Hayes et al., 2004).

According to ACT, clients are guided to accept what cannot be changed, and adapt their

behavior in response to the problem. The goal of ACT is to assist individuals in living with

psychological suffering, clarifying and committing to personal values, like region. ACT

appears to be an appropriate method for the variety of COVID-related stress: through focusing

on the main adaptive processes that underpin psychological health and resilience (Flaxman et

al., 2010; Shepherd et al., 2022).

Online interventions developed and implemented by mental health professionals might

improve people’s ability to cope with stressors throughout adversity (Yıldırım & Güler, 2022).

Most clients tend to look for an app that can provide personalized treatments or healthcare

advices as access to physical and mental healthcare during COVID-19. Mobile Health

(mHealth) applications have appeared to be a useful approach for disease and health

management, enhancing healthcare services' effectiveness (Tran et al., 2018). Specifically,

mHealth applications can potentially help prevent the spread of contagious diseases in society

by using distance communication (Alam et al., 2022), to massively implement these

Electronic copy available at: https://ssrn.com/abstract=4212930

applications in all healthcare settings (van Dijk et al., 2020). Mental health hotlines should be

developed throughout Vietnam and provided the public with counseling and psychological

services to share strategies, recommendations, and education programs for dealing with

potential mental disorders. In response to these issues, and recognizing that many people do

not know where to turn for mental health support, "Caring for Mental Health and Wellbeing”:

A directory of services for Vietnamese communities and people living in Vietnam has been

compiled by mental health experts in Vietnam.

Conclusion

COVID-19 has already affected mental health, and some of these effects might persist. The

psychological impact of the disease is already apparent both in the general population,

specifically in the elderly and people with chronic diseases. Family support, social support,

early detection of mental distress and interventions should be implemented to alleviate mental

health issues and reduce feelings of isolation and social maladaptation. During the pandemic,

it is essential for public health services to build awareness of people's mental health needs and

concerns, as well as empower them to seek help and support. Individuals should develop coping

strategies tailored to their specific needs and enhance psychological resilience. Our study

appears that religious beliefs play a positive role during the COVID-19 outbreak among the

general population in Vietnam, contributing additional information to future similar studies

based on our findings. Clinicians and therapists should consider integrating religion into

clinical interventions and treatment to improve clients' mental health.

Disclosure Statement

The authors have no conflicts of interest to disclose in this work.

Electronic copy available at: https://ssrn.com/abstract=4212930

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