Identifying the Risk and Protective Factors of Psychological Distress among Individuals in Asia during the COVID-19 Pandemic: A Systematic Literature Review

. The COVID-19 pandemic has caused a profound negative impact on individuals, manifesting in psychological distress such as depression and anxiety. Therefore, this study aimed to identify the risk and protective factors affecting psychological distress among individuals in Asia. A systematic literature review was guided by the PRISMA (Preferred Reporting Items for Systematic and Meta-analysis) protocol using Google Scholar and Science Direct databases. Furthermore, keywords such as “psychological distress”, “COVID-19”, “individual psychological distress”, and “COVID-19 Asia” were employed in the search, with articles selected based on inclusion and exclusion criteria. The results included 14 selected articles and showed that psychological distress was influenced by sociodemographic (gender, age, marital status, living in COVID-19-affected areas), stress-related (isolation, vitamin use at home, exposure to negative news on social media), internal (congenital diseases, low self-efficacy), and external factors (heavy workload, low income, lack of health protocols, inexperience in work, recently graduated or completed education). This study provided insights into the psychological distress experienced by individuals during the COVID-19 pandemic and highlights the need for further investigation, such as meta-analyses, to determine the effect size of these risk and protective factors.

According to Mirowsky and Ross (2017), psychological distress can manifest as mood symptoms such as fear, worry, and irritability for anxiety and lack of enthusiasm, sadness, and loneliness for depression.Anxiety symptoms include fainting, dizziness, and tremors, while depression symptoms are difficulty sleeping, concentrating, and losing appetite (Mirowsky & Ross, 2017).During the COVID-19 pandemic, depression and anxiety contributed to the psychological distress experienced by individuals distress (Wang et al., 2020).The factors are categorized into three groups, namely sociodemographic, stress-related, and personal resources.Meanwhile, each category contains risk and protective factors, which can lead to mental disorders and reduce the likelihood (Drapeau et al., 2012).

Sociodemographic risk factors include
early adulthood, being female, living in a specific area, and not being married or having a family (Drapeau et al., 2012;Mirowsky & Ross, 2017).(Drapeau et al., 2012).Previous studies demonstrated that psychological distress can have a negative impact on both mental and physical health.Additionally, it can increase aggressive behavior, cause sleep disturbances, and lead to drug addiction and suicidal tendencies (Bebanic et al., 2017;Gyawali et al., Identifying the Risk and Protective Factors of Psychological Distress among Individuals in Asia during the... PSIKOLOGIKA Volume 28 Nomor 1 Januari 2023 2016; Rezaei et al., 2018;Tang et al., 2018).It can also have physiological effects, including obesity, heart disease, and cancer (Almigbal et al., 2019;Jarrad et al., 2019;McLachlan & Gale, 2018).This highlights that psychological distress affects not only mental health but also physical well-being.
Studies have been conducted to examine psychological distress among individuals during the COVID-19 pandemic in Asian countries (Al-Hanawi et al., 2020;Ben-Ezra et al., 2020;Chao et al., 2020;Elhessewi et al., 2021;Hawari et al., 2021;Horesh et al., 2020;Lahav, 2020;Lee et al., 2020;Marzo et al., 2020;Qiu et al., 2020;Qodariah et al., 2020;Shahrour & Dardas, 2020;Vahedian-Azimi et al., 2020;Wang et al., 2021).These studies were conducted using quantitative methods but have not been synthesized through a systematic literature review, which is important for gathering existing knowledge (Linnenluecke et al., 2020).There are previous literature reviews on this concept in various contexts, such as refugee children (Bronstein & Montgomery, 2011), adolescents influenced by social media (Keles et al., 2020), depression and anxiety among the general population during the COVID-19 pandemic (Wang et al., 2020), overcoming psychological distress among health workers (Petzold et al., 2020), and resilience strategies to cope with distress (Heath et al., 2020).The study of psychological distress is unique because each individual responds differently to stressors (Drapeau et al., 2012).Furthermore, to the best of our knowledge, no previous review investigated the causes of individual psychological distress during the pandemic in Asian countries.An indepth study is needed to determine the causes of distress, specifically in Asia, where many countries were among the first to be exposed to the virus.A systematic literature review analysis should identify the factors causing psychological distress.
However, Vahedian-Azimi et al. (2020) found that male individuals were more susceptible to psychological distress during the COVID-19 pandemic.
Individuals in the early stage of adulthood are also prone to psychological distress (Al-Hanawi et al., 2020;Horesh et al., 2020;Lahav, 2020;Qiu et al., 2020;Qodariah et al., 2020;Shahrour & Dardas, 2020), which aligns with the findings of Mirowsky and Ross (2017), where early adulthood is a time of heightened susceptibility to depression and anxiety.This phenomenon is consistent across society and reflects the challenges of modern life (Mirowsky & Ross, 2017).Unmarried status is another sociodemographic factor that increases the risk of this distress (Horesh et al., 2020;Lahav, 2020;Vahedian-Azimi et al., 2020;Wang et al., 2021) due to the low wellbeing of individuals (Mirowsky & Ross, 2017).
However, studies also found that living with family can lead to psychological distress during the pandemic due to fear of infection (Al-Hanawi et al., 2020;Hawari et al., 2021;Qodariah et al., 2020).Stress-related factors such as isolation and reinforcing behaviors such as taking vitamins (Ben-Ezra et al., 2020), as well as negative news on social media (Chao et al., 2020), also contribute to psychological distress, as changes in life cause stress Drapeau et al. (2012).During the pandemic, regulations and protocols, such as isolation and reduced travel time, caused life changes and stress for some individuals (Djalante et al., 2020).
Protective factors in this category include having work and income, while family conflicts or job loss are stress-related risk factors.Stressrelated factors, such as life transitions such as losing a job or caring for a sick family member, can also increase the risk of psychological distress.Personal resources can be affected by internal and external factors.Internal risk factors include low self-efficacy and personality, while adequate social support is an internal protective factor.External risk factors include family problems, low income, and reduced education, while harmonious family and high income are external protective factors 19", "individual psychological distress", and "COVID-19 Asia".It was conducted from January 12 to 30, 2022.To select journals for the review, several inclusion criteria were applied, namely (1) Studies focused on the causes of psychological distress during the pandemic in Asia, (2) Used quantitative empirical analysis, (3) Published within the last two years (2020-2021), and (4) Written in English and published in a reputable international or national journal.The exclusion criteria included (1) Studies on psychological distress in a general context, not specific to the COVID-19 pandemic, (2) Performed outside of Asia, and (3) Conducted as a literature study or meta-analysis.
Figure 1 Article Search Flowchart The quantitative survey study byHawari et al. (2021),Al-Hanawi et al. (2020),Lee et al. (2020),Shahrour and Dardas (2020),Vahedian-Azimi et al. (2020)  focused on health worker participants.Hawari et al. (2021) analyzed 937 health workers in Jordan, whileAl-Hanawi et al. (2020) studied 3,036 medical personnel in Saudi Arabia.Furthermore, Lee et al. (2020) analyzed 270 anesthesiologists and nurses at the Singapore Medical Center.Shahrour and Dardas (2020) analyzed 448 nurses in Jordan, while Vahedian-Azimi et al. (2020) studied 886 in Iran, including 217 medical personnel, 241 members of the general public, 221 COVID-19 patients, and 207 students.In addition to medical personnel, there were several quantitative studies conducted by Ben-Ezra et al. (2020), Chao et al. (2020), Elhes s ewi et al. (2021), Horesh et al. (2020), Lahav (2020), Marzo et al. (2020), Qiu et al. (2020), Qodariah et al. (2020), and Wang et al. (2021) on public participants.Ben-Ezra et al. (2020) and Chao et al. (2020) studied participants in China, with samples of 1,134 and 976 aged 18-59 a nd 18 a bo ve, res pe c t ive ly.Elhessewi et al. (2021), Horesh et al., (2020), Lahav (2020), Marzo et al. (2020), Qiu et al. (2020), and Qodariah et al. (2020) analyzed 739, 204, 976, 407, 52,730, and 1,534 participants in Saudi Arabia, Israel, Israel, Philippines, China, and Indonesia aged 18 and over, 18 and over, 18 to 45, under 18 to over 60, and over 17 years old, respectively.Wang et al. distress during the COVID-19 pandemic.Hawari et al. (2021) reported that factors such as female gender, living with elderly individuals, limited work experience, recent education completion, working fully in COVID-19 cases, fear of infection, family suffering, as well as economic situation contribute to psychological distress.Furthermore, Al-Hanawi et al. (2020) also found similar factors affecting health workers' psychological distress in Saudi Arabia, focusing on female and young frontline workers.Lee et al. (2020) Identifying the Risk and Protective Factors of Psychological Distress among Individuals in Asia during the... PSIKOLOGIKA Volume 28 Nomor 1 Januari 2023 stated that nurses were more affected than anesthesiologists during the pandemic.Factors such as fear of infection, lack of personal protective equipment, and high workloads also contributed to the distress.Shahrour and Dardas (2020) found that female, young, low-income, and selfefficacious nurses in Jordan experience psychological distress.Vahedian-Azimi et al. (2020) stated that male and unmarried individuals, including medical workers, in Iran experience this problem, with the highest level found in the general public than medical personnel.Ben-Ezra et al. (2020) found that individuals in Hubei Province, China, who experience psychological distress engage in selfisolation and adopt additional, nonrecommended behaviors, such as taking vitamins and returning to work when offices reopen.In addition, Chao et al. (2020) found that boredom and social media use can increase psychological distress.According to Elhessewi et al., (2021), perceptions of vulnerability and severity of COVID-19, fear of job loss, and excessive advice on prevention contribute to this problem.Horesh et al. (2020) also reported that young, lonely, and diseased individuals in Israel experience psychological distress, similar to the findings of Lahav (2020), where young, single, low-income, ill, and traumatic females experience more distress.Marzo et al. (2020) found that individuals with high education and residing in the Visayas Province in the Philippines experience psychological distress.According to Qiu et al. (2020), highly educated and young female adult individuals can also experience this problem.The result is similar to Qodariah et al. (2020), where mothers in Indonesia with more children and knowledge of COVID-19 in the neighborhood experience more depression.Wang et al. (2021) found that young, highly educated, single, or divorced individuals who experience discrimination and have contact with infected people experience psychological distress, with Thailand having the highest level compared to five other countries.Discussion Studies conducted by Hawari et al. (2021), Khaled Al-Hanawi et al. (2020), Lee et al. (2020), Shahrour dan Dardas (2020), and Vahedian-Azimi et al. (2020) examined the factors of psychological distress in healthcare workers.Meanwhile, Ben-Ezra et al. (2020), Chao et al. (2020), Elhessewi et al. (2021), Horesh et al. (2020), Lahav (2020), Marzo et al. (2020), Qiu et al. (2020), Qodariah et al. (2020), and Wang et al. (2021) analyzed the problem in the general population using sociodemographic, stress-related, internal, and external factors.
et al., 2021;Horesh et al., 2020;Lahav, 2020;Shahrour & Dardas, 2020).StudiesAlmigbal et al. (2019),Jarrad et al. (2019), andMcLachlan andGale (2018) showed that physical health issues can impact psychological well-being.However, during the COVID-19 pandemic, it is not the only factor causing this problem.Individuals with pre-existing conditions may experience increased anxiety in a COVID-19 pandemic situation(Girma et al., 2021).Sociodemographic, stress-related, internal, and external factors contribute to psychological distress.Furthermore, health workers feel the effects of external factors such as a heavy workload during the pandemic(Al- Hanawi et al., 2020;Hawari et al., 2021;Lee et al., 2020).Gispert et al. (2003) reported that work could be a protective factor by fulfilling life needs and reducing distress.However, Hawari et al. (2021), Al-Hanawi et al. (2020), and Lee et al. (2020) showed that health workers with demanding workloads might experience increased psychological distress.As stated by Lahav (2020) and Shahrour and Identifying the Risk and Protective Factors of Psychological Distress among Individuals in Asia during the... PSIKOLOGIKA Volume 28 Nomor 1 Januari 2023 Dardas (2020) low income is another contributing factor.This aligns with the idea that low income leads to greater distress, according to Mirowsky and Ross (2017).Sociodemographic, internal, and external factors, such as living in areas with high virus transmission (Ben-Ezra et al., 2020; Marzo et al., 2020), low self-efficacy (Shahrour & Dardas, 2020), and limited work experience and education (Hawari et al., 2021) with lack of health protocols (Lee et al., 2020) also play a crucial role.These findings supported the concept developed by Drapeau et al. (2012) that psychological distress is determined by a complex interplay of sociodemographic, stress-related, internal, and external factors.The results of this literature review have important clinical and public health implications.First, the significant risk factors for psychological distress can identify populations at higher risk in future pandemics.Second, these findings highlight the need for mental health services and interventions to support populations at risk of psychological distress during the COVID-19 pandemic.By considering protective factors, interventions can be designed to minimize psychological stress in these situations.Conclusion This study aimed to identify risk and protective factors that impact psychological distress among individuals in the Asian region during the COVID-19 pandemic.The results showed that various sociodemographic, stress-related, internal, and external factors could contribute to this problem in individuals.Furthermore, the factors can be a single or a combination of the four.Gender, age, marital or family status, and living in highrisk COVID-19 areas are examples of sociodemographic factors affecting psychological distress.Stress-related risk factors include isolation, taking vitamins, and accessing negative news about the situation through social media.Meanwhile, internal factors such as pre-existing conditions and low self-efficacy can also increase risk.External factors, such as heavy workloads, low income, limited experience, completing education during the pandemic, and nonadherence to health protocols, are potential risks for psychological distress during the COVID-19 pandemic.Suggestion This study has limitations since the extent of influence of the identified sociodemographic, internal, and external factors for psychological distress during the COVID-19 pandemic has not been established.Further study, including metaanalysis, can provide deeper insights into this issue.This study was conducted in Asia, and future analysis could broaden the scope by examining psychological distress in other regions to make comparisons and gain a comprehensive understanding.

Table 1
Research Related to Individual Psychological Distress during the COVID-19 Pandemic Identifying the Risk and Protective Factors of Psychological Distress among Individuals in Asia during the... Identifying the Risk and Protective Factors of Psychological Distress among Individuals in Asia during the...