Locus of control moderates the association of COVID-19 stress and general mental distress: results of a Norwegian and a German-speaking cross-sectional survey

Numerous studies found that mental distress has substantially increased during the COVID-19 pandemic, and first systematic reviews and meta-analyses reported prevalence rates ranging from 21.8 to 33.0%, from 22.0 to 33.7%, and from 34.4 to 41.1%, for clinically relevant anxiety, depression, and general mental distress, respectively [1‐8]. Researchers observed that people experienced not only mental distress but also stress that was directly related to the pandemic and its aftermath [9, 10]. Thus, several scales were developed to measure stress specifically due to the pandemic. These COVID-19 stress scales primarily assess symptoms of anxiety and fears associated with COVID-19, but also various other facets of stress experience during the pandemic, such as feeling restricted by lockdown measures, uncertainty and doubts of how to protect oneself and loved ones against infections, sleep disturbance, confusion, frustration, anger, loneliness, social isolation, and fears of the future [11, 12]. While there is ample evidence that higher COVID-19 stress is significantly related to symptoms of mental distress [12‐17], we do not know much about factors influencing this relationship. In particular, there is a need for investigations into resilience factors and resources that can buffer the effect of acute COVID-19 stress on mental distress. Research on resilience and resources will help inform public health measures and interventions to improve coping with stressful experience during the current pandemic and its aftermath, and it will provide important insights for dealing with future crises.

Until now, several factors were found to serve as resources buffering the effects of stressors, stressful experiences or risk factors on mental health or protective health promoting behaviour during the first year of the pandemic. Among these moderating factors are higher self-esteem [18], greater psychological flexibility and acceptance of difficult experience [19], higher meaning in life and self-control [12], less digital emotion contagion [20], higher age [21], male gender and lower COVID-19 stress [22], emotion regulation by cognitive reappraisal strategies [23], increased resilience [24], trust in the healthcare system [25], identifying positive over negative aspects of COVID-19 lockdown [26], as well as utilizing prenatal care services [27]. Although their stress buffering and/or resilience strengthening effects are empirically confirmed in the respective study samples, it is open to what extent the protective mechanisms of the mentioned moderators would work in other samples and across various circumstances. Research is needed to identify psychological moderators that are stable, established, and robust, so that their assumed stress-buffering effect would be less dependent on sample characteristics and regional pandemic differences.

Locus of control (LoC) is among the four most widely investigated personality traits [28]. It is a relatively stable dimension that describes the extent to which individuals are convinced to be able to control their environment and future, and to experience significant events as consequences of their own behaviour [29]. LoC covers two aspects. While external LoC refers to the belief that chance and powerful others control one’s life, internal LoC describes the belief that the outcome of events in one’s life is contingent upon one’s actions. LoC has originally been assessed with continuous internal-external scales (e. g. [29, 30]), whereas later on, separate scales for internal and external LoC were considered more appropriate (e.g. [31‐33]). Cross-sectional and longitudinal studies from various international regions found that higher internal LoC and lower external LoC were moderately associated with greater mental health, lower situational stress, and lower mental distress, like depression and anxiety [30, 34‐38]. Studies on psychosocial factors during the COVID-19 pandemic also investigated the role of LoC. In a sample of 339 participants from the United States, Berg & Lin (2020) examined predictors of the self-rated likelihood to engage in COVID-19 prevention behaviors. While internal health-related LoC did not show significant associations, external health-related LoC regarding powerful others predicted preventative behaviors [39]. Two studies examined associations of LoC and mental health. In a sample of 1723 adults from the USA and five European countries, Sigurvinsdottir et al. (2020) found significant negative correlations of internal LoC, and significant positive correlations of external LoC with depression, anxiety, and stress. Multiple regression analyses with diverse predictors showed that higher external LoC was moderately related to higher depression, anxiety and stress, while higher internal LoC was slightly related to lower depression and less stress, but not to anxiety [40]. In a sample of 667 participants from India, Alat et al. (2021) investigated the protective role of psychological resources for mental health. Higher internal LoC correlated moderately with higher positive affect and affect balance, as well as with lower negative affect and psychological distress. Using confirmatory factor analysis and path analysis, the authors found a small indirect effect indicating that affect balance mediated the association between internal LoC on psychological distress [41]. With its established validity for more than five decades, a temporal and transnational robustness, as well as replicated associations with perceived stress and mental health, LoC seems to be a promising candidate when it comes to factors that might attenuate the putative relationship between COVID-19 stress and general mental distress.

The objective of this study was therefore to investigate whether internal LoC and external LoC moderated the relation between COVID-19 stress and general mental distress during the early months of the COVID-19 pandemic. In order to assess the robustness of the assumed stress-buffering (LoC I) and stress-exacerbating (LoC E) effects, we collected data in a Norwegian and a German-speaking sample (primarily from Germany and Austria). Norway on the one hand and the central-European countries Germany and Austria on the other hand showed both differences and similarities in pandemic-relevant aspects of country and societal characteristics, as well as regarding the extent of the pandemic. Similarities existed with regard to the timing, extend, and strictness of national COVID-19 restriction guidelines [42, 43]. Differences can be seen in the following characteristics: Most importantly, population density is substantially lower in Norway, and institutional trust, as in the other Scandinavian countries, is higher than in Austria and Germany [42, 44]. According to data from the Johns Hopkins University (2021), in the first three weeks of March 2020 Norway had more cumulative confirmed COVID-19 cases per million people than Germany and Austria, but from April 1, 2020 to the end of our survey period, the number of cumulative confirmed cases per million people was always lower in Norway than in Germany and Austria [45]. The same holds for the cumulative number of confirmed COVID-19 deaths. Despite of the contextual variations, we expected that in both samples, high internal LoC would buffer, and high external LoC would exacerbate the association between COVID-19 stress and general mental distress.

This cross-sectional survey was conducted in a Norwegian sample during the weeks when the strict COVID-19 regulations were gradually eased (May, 7, 2020 to June, 4, 2020 [44]), and in a German-speaking sample during the times of strict regulations and in the weeks thereafter (Austria, Germany, April 10, 2020 to May 28, 2020 [12]). Participation was voluntary, without compensation, and could be terminated by participants anytime. Ethical approval was issued by the Review Board (Psychology) of the University of Innsbruck, No 09/2020, as well as by Personvernombudet Innlandet Hospital Trust, Norway, No 20/02104–1. All participants expressed their informed consent by explicitly agreeing to continue with the questionnaire after being informed about the study’s aims, employed data protection, participants’ rights, and contact points for questions or concerns.

Data were collected by means of convenience sampling, using online questionnaire tools. Invitations to the study were sent out via university, business, worldview-related and regional network newsletters, and posted in several newspapers and news websites.

Our findings can offer important insights into how people with certain personality characteristics are well-equipped, whereas others are particularly vulnerable in times of crisis. According to the present study, people with an external locus of control are at special risk.

Decision-makers in the field of public health can take this into account. Improving citizens’ sense of control can help prevent increased mental distress from developing into mental disorders. Experiencing a sense of control may encourage citizens to adhere to necessary restrictions of individual freedom as a possible outcome of informed personal choice, rather than simply obeying an imposed rule. Possible ways of evoking a sense of control include clear, honest, and substantiated policy communication that is based on multiple perspectives, as well as explicit invitation of citizens to participate in decision-making, e.g. by expressing questions and objections. Although critical situations may require quick decisions and the short-term suspension of democratic processes, this should be done with utmost care, transparent explanation, and the quickest possible return to political action that seriously and credibly incorporates and implements citizens’ concerns. Feelings of stress caused by the pandemic on the one hand and of one’s own lack of control on the other hand obviously feed off each other, which is reflected in a worrying level of psychological distress.