PANDEMIC-INDUCED STRESS ESCALATION AMONG WOMEN IN NORTH MACEDONIA
Abstract
The COVID-19 pandemic, officially declared by the World Health Organization on 11/03/2020, when the SARS-CoV-2 virus had spread to 114 countries with >118,000 cases, prompted significant changes in daily life and potentially increased stress levels. This study aimed to investigate the difference in stress levels among women in North Macedonia, both before and during the COVID-19 pandemic. A cross-sectional study was conducted using a questionnaire, which incorporated the Perceived Stress Scale (PSS) to assess stress levels pre- and mid-pandemic. More than 500 women aged 18 to 45, who sought examinations at the University Gynaecology and Obstetrics Clinic from March 2022 to March 2023, were invited to participate; 206 women accepted the invitation. The findings indicated that the participants' stress level scores were significantly higher post-March 2020 compared to pre-March 2020 (Z = 8.13, p < 0.001). These results suggest that the COVID-19 pandemic has substantially affected the stress levels experienced by women in North Macedonia. This is aligned with previous studies indicating increased stress levels during the pandemic, primarily attributed to health concerns, financial difficulties, and social isolation. This study provides substantial evidence of the significant impact of the COVID-19 pandemic on women's stress levels in North Macedonia. Future research should focus on identifying factors contributing to heightened stress levels among women during the pandemic. This will help formulate effective interventions to counteract the negative impact of the pandemic on this population's mental health.
Key words: stress, women, COVID-19, pandemics, Perceived Stress Scale (PSS).
References
1. Gorbalenya AE, Baker SC, Baric RS, de Groot RJ, Drosten C, Gulyaeva AA, Haagmans BL, Lauber C, Leontovich AM, Neuman BW, Penzar D. The species Severe acute respiratory syndrome-related coronavirus: classifying 2019- nCoV and naming it SARS-CoV-2. Nature microbiology. 2020 Apr 1;5(4):536-44.
2. Cucinotta D, Vanelli M. WHO declares COVID-19 a pandemic. Acta bio medica : Atenei parmensis . 2020;91(1):157.
3. Xiong J, Lipsitz O, Nasri F, Lui LM, Gill H, Phan L, Chen-Li D, Iacobucci M, Ho R, Majeed A, McIntyre RS. Impact of the COVID-19 pandemic on mental health in the general population: A systematic review. Journal of affective disorders. 2020 Dec 1;277:55-64.
4. Ruzungunde VS, Zhou S. Work-life balance in the face of COVID-19: The gendered impact. Gender and Behaviour. 2021 Jun 1;19(2):18098-106.
5. Matulevicius SA, Kho KA, Reisch J, Yin H. Academic medicine faculty perceptions of work-life balance before and since the COVID-19 pandemic. JAMA network open. 2021 Jun 1;4(6):e2113539-.
6. O'Connor DB, Thayer JF, Vedhara K. Stress and health: A review of psychobiological processes. Annual review of psychology. 2021 Jan 4;72:663-88.
7. Liu, Y., Gold, EB, Lasley , BL, & Johnson, WO (2017). Factors affecting menstrual cycle characteristics. American Journal of Epidemiology, 146(2), 131-140.
8. Bae J, Park S, Kwon JW. Factors associated with menstrual cycle irregularity and menopause. BMC women's health. 2018 Dec;18(1):1-1.
9. Kim T, Nam GE, Han B, Cho SJ, Kim J, Eum DH, Lee SW, Min SH, Lee W, Han K, Park YG. Associations of mental health and sleep duration with menstrual cycle irregularity: a population-based study. Archives of Women's Mental Health. 2018 Dec;21:619-26.
10. Kowal, M., Sorokowski , P., Sorokowska , A., Dobrowolska , M., Pisanski , K., Oleszkiewicz , A., . . . Zupan_ci_c , M. Reasons for Facebook usage: Data from 46 countries. Frontiers in Psychology, 2020 ; 11, 711. https://doi.org/10.3389/fpsyg.2020.00711 .
11. Jacob, L., Haro , JM, & Koyanagi , A. Relationship between living alone and
common mental disorders in the 1993, 2000 and 2007 National Psychiatric Morbidity
Surveys. PloS ONE , 2019; 14(5), e0215182. https://doi.org/10.1371/journal.pone.0215182 .
12. Kowal M, Collâ€MartÃn T, Ikizer G, Rasmussen J, Eichel K, StudziÅ„ska A, KoszaÅ‚kowska K, Karwowski M, Najmussaqib A, Pankowski D, Lieberoth A. Who is the most stressed during the COVIDâ€19 pandemic ? Data from 26 countries and areas. Applied Psychology: Health and Wellâ€Being, 2020; 12(4):946-66.
13. Gao, W., Ping, S., & Liu, X. Gender differences in depression, anxiety, and stress among college students: A longitudinal study from China. Journal of Affective Disorders, 2019; 263, 292–300. https://doi.org/10.1016/j.jad.2019.11.121 .
14. Limcaoco , RSG, Mateos , ME, Fernandez, MJ, & Roncero , C. Anxiety, worry and perceived stress in the world due to the COVID-19 pandemic . medRxiv . 2020; doi :
https://doi.org/10.1101/2020.04.03.20043992 .
15. Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., Ho, CS, & Ho, RC Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. International Journal of Environmental Research and Public Health, 2020; 17(5), 1729. https://doi.org/10.3390/ijerph17051729 .
16. Minello A. The pandemic and the female academic. Nature. 2020 Apr 17;17(1).
17. World Health Organization. Coronavirus disease (COVID-2019) situation reports. 2020; Available at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports. Accessed on: 14.02.2023
18. Oarga , C., Stavrova , O., & Fetchenhauer , D. When and why is helping others good for well-being? The role of belief in reciprocity and conformity to society's expectations. European Journal of Social Psychology, 2015; 45(2), 242–254. https://doi.org/10.1002/ejsp.2092.
19. Mondal, H., Mondal, S., Ghosal, T., & Mondal, S. Using Google Forms for Medical Survey: A Technical Note. International Journal of Clinical and Experimental Physiology , 2019; 5 (4), 216–218. Available at: https://doi.org/10.5530/ijcep.2018.5.4.26 ; Accessed on: 21.02.2021.
20. Lohengramm , R. von. 7 steps to create surveys using Google Forms Questionnaire. Re: Starting Life in Google World above the Cloud, 2019; Available at: https://digital-transformation.media/en/g-suite/google-forms/questionnaire/ ; Accessed on: 01.02.2021
21. Chan SF, and La Greca AM. Perceived stress scale (PSS). InEncyclopedia of Behavioral Medicine 2020 Oct 20 (pp. 1646-1648). Cham: Springer International Publishing.
22. Sumner JA, Kubzansky LD, Elkind MS, Roberts AL, Agnew- Blais J, Chen Q, Cerdá M, Rexrode KM, Rich-Edwards JW, Spiegelman D, Suglia SF. Trauma exposure and posttraumatic stress disorder symptoms predict onset of cardiovascular events in women. Circulation. 2015 Jul 28;132(4):251-9.
23. HÃ¥kansson C, Ahlborg Jr G. Occupations, perceived stress, and stress-related disorders among women and men in the public sector in Sweden. Scandinavian journal of occupational therapy. 2017 Jan 2;24(1):10-7.
24. Albert MA, Durazo EM, Slopen N, Zaslavsky AM, Buring JE, Silva T, Chasman D, Williams DR. Cumulative psychological stress and cardiovascular disease risk in middle-aged and older women: Rationale, design, and baseline characteristics. American heart journal. 2017 Oct 1;192:1-2.
25. Staneva A, Bogossian F, Pritchard M, Wittkowski A. The effects of maternal depression, anxiety, and perceived stress during pregnancy on preterm birth: A systematic review. Women and birth. 2015 Sep 1;28(3):179-93.
26. Alvarenga P, Frizzo GB. Stressful Life Events and Women's Mental Health During Pregnancy and Postpartum Period1. Paidéia ( Ribeirão Preto). 2017 Jan;27:51-9.
27. Gold KJ, Leon I, Boggs ME, Sen A. Depression and posttraumatic stress symptoms after perinatal loss in a population-based sample. Journal of women's health. 2016 Mar 1;25(3):263-9.
28. Caputo J, Pavalko EK, Hardy MA. The long-term effects of caregiving on women's health and mortality. Journal of Marriage and Family. 2016 Oct;78(5):1382-98.
29. Zeqiri J, Kareva V, Alija S, Bach MP. Challenges and opportunities for higher education in North Macedonia during the COVID-19 pandemic: a survey of student satisfaction and gender-related anxiety. International Journal of Technology Enhanced Learning. 2022;14(2):163-79.
30. Mancevska S, Gligoroska JP, Velickovska LA. Levels of anxiety and depression in second year medical students during the COVID-19 pandemic spring lockdown in Skopje, North Macedonia. Research in Physical Education, Sport and Health. 2020.
31. Nikoloski D, Pechijareski L. The unemployed workers' perceptions of stress and employment prospects in Macedonia: The role of alternative adjustment mechanisms. South East European Journal of Economics and Business. 2017 Apr 1;12(1):68-79.
32. Nicola M, Alsafi Z, Sohrabi C, Kerwan A, Al-Jabir A, Iosifidis C, Agha M, Agha R. The socio-economic implications of the coronavirus pandemic (COVID-19): A review. International journal of surgery. 2020 Jun 1;78:185-93.
33. Dang HA, Nguyen CV. Gender inequality during the COVID-19 pandemic: Income, expenditure, savings, and job loss. World Development. 2021 Apr 1;140:105296.
34. Ristevska-Dimitrovska G, Batic DP 863 The impact of COVID-19 on mental health of healthcare workers and police/army forces in the Republic of North Macedonia. European neuropsychopharmacology. 2020 Nov;40:S479.
35. Almeida M, Shrestha AD, Stojanac D, Miller LJ. The impact of the COVID-19 pandemic on women's mental health. Archives of women's mental health. 2020 Dec;23:741-8.
36. Connor J, Madhavan S, Mokashi M, Amanuel H, Johnson NR, Pace LE, Bartz D. Health risks and outcomes that disproportionately affect women during the Covid-19 pandemic: A review. Social science & medicine. 2020 Dec 1;266:113364.
37. Alon, T., Doepke , M., Olmstead-Rumsey, J., Tertilt , M., 2020. The impact of Covid-19 on gender equality. NBER Work. Pap. https://doi.org/10.3386/w26947, 2020:w26947.
38. North, A., 2020, March 26. When Home Isn't Safe: what the Coronavirus Pandemic Means for Domestic Violence Survivors. Vox. https://www.vox.com/2020/3/2 6/21193814/coronavirus-domestic-violence-shelters-covid-19-abuse.
39. Davies, SE, Bennett, B. A gendered human rights analysis of Ebola and Zika: locating gender in global health emergencies. Int. Aff . 2016; 92 (5), 1041–1060. https:// doi.org/10.1111/1468-2346.12704.
40. Liu, N., Zhang, F., Wei, C., Jia, Y., Shang, Z., Sun, L., Wu, L., Sun, Z., Zhou, Y., Wang, Y., Liu, W. Prevalence and predictors of PTSS during Covid-19 outbreak in China hardest-hit areas: gender differences matter. Psychiatr . Res. 2020; 287, 112921. https://doi.org/10.1016/j.psychres.2020.112921.
2. Cucinotta D, Vanelli M. WHO declares COVID-19 a pandemic. Acta bio medica : Atenei parmensis . 2020;91(1):157.
3. Xiong J, Lipsitz O, Nasri F, Lui LM, Gill H, Phan L, Chen-Li D, Iacobucci M, Ho R, Majeed A, McIntyre RS. Impact of the COVID-19 pandemic on mental health in the general population: A systematic review. Journal of affective disorders. 2020 Dec 1;277:55-64.
4. Ruzungunde VS, Zhou S. Work-life balance in the face of COVID-19: The gendered impact. Gender and Behaviour. 2021 Jun 1;19(2):18098-106.
5. Matulevicius SA, Kho KA, Reisch J, Yin H. Academic medicine faculty perceptions of work-life balance before and since the COVID-19 pandemic. JAMA network open. 2021 Jun 1;4(6):e2113539-.
6. O'Connor DB, Thayer JF, Vedhara K. Stress and health: A review of psychobiological processes. Annual review of psychology. 2021 Jan 4;72:663-88.
7. Liu, Y., Gold, EB, Lasley , BL, & Johnson, WO (2017). Factors affecting menstrual cycle characteristics. American Journal of Epidemiology, 146(2), 131-140.
8. Bae J, Park S, Kwon JW. Factors associated with menstrual cycle irregularity and menopause. BMC women's health. 2018 Dec;18(1):1-1.
9. Kim T, Nam GE, Han B, Cho SJ, Kim J, Eum DH, Lee SW, Min SH, Lee W, Han K, Park YG. Associations of mental health and sleep duration with menstrual cycle irregularity: a population-based study. Archives of Women's Mental Health. 2018 Dec;21:619-26.
10. Kowal, M., Sorokowski , P., Sorokowska , A., Dobrowolska , M., Pisanski , K., Oleszkiewicz , A., . . . Zupan_ci_c , M. Reasons for Facebook usage: Data from 46 countries. Frontiers in Psychology, 2020 ; 11, 711. https://doi.org/10.3389/fpsyg.2020.00711 .
11. Jacob, L., Haro , JM, & Koyanagi , A. Relationship between living alone and
common mental disorders in the 1993, 2000 and 2007 National Psychiatric Morbidity
Surveys. PloS ONE , 2019; 14(5), e0215182. https://doi.org/10.1371/journal.pone.0215182 .
12. Kowal M, Collâ€MartÃn T, Ikizer G, Rasmussen J, Eichel K, StudziÅ„ska A, KoszaÅ‚kowska K, Karwowski M, Najmussaqib A, Pankowski D, Lieberoth A. Who is the most stressed during the COVIDâ€19 pandemic ? Data from 26 countries and areas. Applied Psychology: Health and Wellâ€Being, 2020; 12(4):946-66.
13. Gao, W., Ping, S., & Liu, X. Gender differences in depression, anxiety, and stress among college students: A longitudinal study from China. Journal of Affective Disorders, 2019; 263, 292–300. https://doi.org/10.1016/j.jad.2019.11.121 .
14. Limcaoco , RSG, Mateos , ME, Fernandez, MJ, & Roncero , C. Anxiety, worry and perceived stress in the world due to the COVID-19 pandemic . medRxiv . 2020; doi :
https://doi.org/10.1101/2020.04.03.20043992 .
15. Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., Ho, CS, & Ho, RC Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. International Journal of Environmental Research and Public Health, 2020; 17(5), 1729. https://doi.org/10.3390/ijerph17051729 .
16. Minello A. The pandemic and the female academic. Nature. 2020 Apr 17;17(1).
17. World Health Organization. Coronavirus disease (COVID-2019) situation reports. 2020; Available at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports. Accessed on: 14.02.2023
18. Oarga , C., Stavrova , O., & Fetchenhauer , D. When and why is helping others good for well-being? The role of belief in reciprocity and conformity to society's expectations. European Journal of Social Psychology, 2015; 45(2), 242–254. https://doi.org/10.1002/ejsp.2092.
19. Mondal, H., Mondal, S., Ghosal, T., & Mondal, S. Using Google Forms for Medical Survey: A Technical Note. International Journal of Clinical and Experimental Physiology , 2019; 5 (4), 216–218. Available at: https://doi.org/10.5530/ijcep.2018.5.4.26 ; Accessed on: 21.02.2021.
20. Lohengramm , R. von. 7 steps to create surveys using Google Forms Questionnaire. Re: Starting Life in Google World above the Cloud, 2019; Available at: https://digital-transformation.media/en/g-suite/google-forms/questionnaire/ ; Accessed on: 01.02.2021
21. Chan SF, and La Greca AM. Perceived stress scale (PSS). InEncyclopedia of Behavioral Medicine 2020 Oct 20 (pp. 1646-1648). Cham: Springer International Publishing.
22. Sumner JA, Kubzansky LD, Elkind MS, Roberts AL, Agnew- Blais J, Chen Q, Cerdá M, Rexrode KM, Rich-Edwards JW, Spiegelman D, Suglia SF. Trauma exposure and posttraumatic stress disorder symptoms predict onset of cardiovascular events in women. Circulation. 2015 Jul 28;132(4):251-9.
23. HÃ¥kansson C, Ahlborg Jr G. Occupations, perceived stress, and stress-related disorders among women and men in the public sector in Sweden. Scandinavian journal of occupational therapy. 2017 Jan 2;24(1):10-7.
24. Albert MA, Durazo EM, Slopen N, Zaslavsky AM, Buring JE, Silva T, Chasman D, Williams DR. Cumulative psychological stress and cardiovascular disease risk in middle-aged and older women: Rationale, design, and baseline characteristics. American heart journal. 2017 Oct 1;192:1-2.
25. Staneva A, Bogossian F, Pritchard M, Wittkowski A. The effects of maternal depression, anxiety, and perceived stress during pregnancy on preterm birth: A systematic review. Women and birth. 2015 Sep 1;28(3):179-93.
26. Alvarenga P, Frizzo GB. Stressful Life Events and Women's Mental Health During Pregnancy and Postpartum Period1. Paidéia ( Ribeirão Preto). 2017 Jan;27:51-9.
27. Gold KJ, Leon I, Boggs ME, Sen A. Depression and posttraumatic stress symptoms after perinatal loss in a population-based sample. Journal of women's health. 2016 Mar 1;25(3):263-9.
28. Caputo J, Pavalko EK, Hardy MA. The long-term effects of caregiving on women's health and mortality. Journal of Marriage and Family. 2016 Oct;78(5):1382-98.
29. Zeqiri J, Kareva V, Alija S, Bach MP. Challenges and opportunities for higher education in North Macedonia during the COVID-19 pandemic: a survey of student satisfaction and gender-related anxiety. International Journal of Technology Enhanced Learning. 2022;14(2):163-79.
30. Mancevska S, Gligoroska JP, Velickovska LA. Levels of anxiety and depression in second year medical students during the COVID-19 pandemic spring lockdown in Skopje, North Macedonia. Research in Physical Education, Sport and Health. 2020.
31. Nikoloski D, Pechijareski L. The unemployed workers' perceptions of stress and employment prospects in Macedonia: The role of alternative adjustment mechanisms. South East European Journal of Economics and Business. 2017 Apr 1;12(1):68-79.
32. Nicola M, Alsafi Z, Sohrabi C, Kerwan A, Al-Jabir A, Iosifidis C, Agha M, Agha R. The socio-economic implications of the coronavirus pandemic (COVID-19): A review. International journal of surgery. 2020 Jun 1;78:185-93.
33. Dang HA, Nguyen CV. Gender inequality during the COVID-19 pandemic: Income, expenditure, savings, and job loss. World Development. 2021 Apr 1;140:105296.
34. Ristevska-Dimitrovska G, Batic DP 863 The impact of COVID-19 on mental health of healthcare workers and police/army forces in the Republic of North Macedonia. European neuropsychopharmacology. 2020 Nov;40:S479.
35. Almeida M, Shrestha AD, Stojanac D, Miller LJ. The impact of the COVID-19 pandemic on women's mental health. Archives of women's mental health. 2020 Dec;23:741-8.
36. Connor J, Madhavan S, Mokashi M, Amanuel H, Johnson NR, Pace LE, Bartz D. Health risks and outcomes that disproportionately affect women during the Covid-19 pandemic: A review. Social science & medicine. 2020 Dec 1;266:113364.
37. Alon, T., Doepke , M., Olmstead-Rumsey, J., Tertilt , M., 2020. The impact of Covid-19 on gender equality. NBER Work. Pap. https://doi.org/10.3386/w26947, 2020:w26947.
38. North, A., 2020, March 26. When Home Isn't Safe: what the Coronavirus Pandemic Means for Domestic Violence Survivors. Vox. https://www.vox.com/2020/3/2 6/21193814/coronavirus-domestic-violence-shelters-covid-19-abuse.
39. Davies, SE, Bennett, B. A gendered human rights analysis of Ebola and Zika: locating gender in global health emergencies. Int. Aff . 2016; 92 (5), 1041–1060. https:// doi.org/10.1111/1468-2346.12704.
40. Liu, N., Zhang, F., Wei, C., Jia, Y., Shang, Z., Sun, L., Wu, L., Sun, Z., Zhou, Y., Wang, Y., Liu, W. Prevalence and predictors of PTSS during Covid-19 outbreak in China hardest-hit areas: gender differences matter. Psychiatr . Res. 2020; 287, 112921. https://doi.org/10.1016/j.psychres.2020.112921.
Published
2023-11-05
How to Cite
ILIEVA, Natasha et al.
PANDEMIC-INDUCED STRESS ESCALATION AMONG WOMEN IN NORTH MACEDONIA.
Journal of Morphological Sciences, [S.l.], v. 6, n. 2, p. 147-156, nov. 2023.
ISSN 2545-4706.
Available at: <https://jms.mk/jms/article/view/vol6no2-20>. Date accessed: 11 mar. 2025.
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