Understanding the Impacts of Lockdown during COVID-19 Pandemic on Financial Threat and Psychological Response among Sarawak Adults

The Malaysian government announced the lockdown measures following the Coronavirus Disease 2019 (COVID-19) outbreak in mid-March 2020. This action unavoidably led to economic instability and negative psychological effects. The present study examines perceived financial threats and psychological impacts on Sarawak adults during lockdown for the COVID-19 pandemic. Data from 336 respondents were collected from all divisions in Sarawak using an Ulum Islamiyyah Journal | Special Issue: Healthcare in Pandemic Era: “The New Norm” Vol.3 46 online self-reported questionnaire that included sociodemographic, the Financial Threat Scale (FTS), and the Depression, Anxiety, Stress Scales 21 (DASS-21). Results showed that perceived financial threat was associated with the employment sector, the number of children, and the change in income during the lockdown period. Almost half (47.9%) of the respondents perceived moderate-to-severe financial threat, particularly self-employed persons and those who had reduced income during the lockdown. Negative psychological effects were found to be associated with the employment sector, marital status, number of children, and number of liabilities. In general, people who perceived severe financial threats were significantly associated with severe levels of depression, anxiety, and stress. The study provided some insights into the urgent need to build on strategic plans to mitigate the economic and psychological crisis for the affected communities.


Introduction
Following an outbreak of pneumonia of unknown origin in Wuhan City, Hubei Province, China in late 2019, the World Health Organisation (WHO) officially announced the disease as Coronavirus Disease 2019  whilst the International Committee on Taxonomy of Viruses (ICTV) called this new pathogen as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Wang et al., 2020). Due to its unpredicted nature and the severity of the disease, the Malaysian authority had taken emergency steps in mitigating the outbreak through the implementation of the Movement Control Order (MCO) starting from 18 th March 2020 under the Prevention and Control of Infectious Disease Act 1988 and The Police Act 1967. This pandemic has adverse impacts on global economic growth (Jackson et al., 2021) and Malaysia is not an exception. The knock-on effect on Malaysian economics is from the effects of coronavirus outbreaks abroad as well as the locally implemented movement control (Cheng, 2020).
Several strict regulations were enforced including the prohibition of mass gatherings and unnecessary movement of people, discontinuation of non-essential services, closing of nurseries, schools, pre-university institutions, and public and private higher education institutions, as well as restricting foreign tourists from entering the country (Prime Minister's Office, 2020). The lockdown measures inevitably brought negative impacts on jobs, businesses with disrupted supply chains, and foreign investment, increasing the gap of inequalities, worsening poverty, and hardships for the people (Lim, 2020).
The financial threat can be defined as an intense feeling towards uncertainty with regard to one's present and future financial status (Fiksenbaum et al., 2017). Debts, economic hardship, and anxiety were found to be positively related to financial threat and could perpetuate psychological distress (Fiksenbaum et al., 2017). Given the government's uncommon public health measures during this pandemic, there was an exacerbation of emotional reactions and psychiatric illness (Brooks et al., 2020;Pfefferbaum & North, 2020). Work loss during the pandemic and financial insecurity were also noted to have increased prevalence in mental health problems (Griffiths et al., 2021).
In a nationwide study, Ahmad et al. (2020) reported that gender, religion, nature of the job, marital status, family size, and health condition were predictors of anxiety among the Indian population during the COVID-19 pandemic. Another similar study also found that perceived poorer health status and perceived poor current financial status were significantly associated with psychological distress among the Malaysian population (Wong et al., 2021). To date, the effects of the lockdown during pandemic on perceived financial threat and psychological effects are not being extensively studied in the Sarawak population. Through this study, we hope to gather this information to help policymakers formulate measures to cope with this issue.

Materials and methods
This cross-sectional study was carried out between 18 th May 2020 and 8 th August 2020. Data was collected via an online questionnaire using Google Forms. The link was disseminated through social media platforms such as WhatsApp, Facebook, Instagram, Twitter, and Telegram as well as emails. Respondents were given options to respond to the questionnaire in either English or Malay language. The inclusion criteria were the employed or self-employed adults in Sarawak. Those who were illiterate were excluded from this study as the researchers had difficulty conducting physical interviews with the implementation of social distancing measures. A pilot study was performed on 40 working adults in Kuala Lumpur and Selangor before the actual data collection to ensure the relevance and practicality of the questionnaire. Feedback from the pilot study was taken into consideration in improving the questionnaire.

Instrument
The questionnaire included socio-demographic information, assessment of the financial threat, and psychological response to COVID-19. Socio-demographic information included age, gender, race, marital status, number of children, and employment. Monthly income and expenditure, job status during MCO, the sustainability of savings, and the number of liabilities were also collected.
The Financial Threat Scale developed by Marjanovic and colleagues was used to assess perceived financial threats (Marjanovic et al., 2013). The 5-item scale was rated using a Likert Scale, in which "1" indicates "Not at all" and "5" indicates "Extreme. It covers areas of uncertainty, risk, perceived threat worry, and cognitive preoccupation with one's current personal finances. It reliably measures a unidimensional construct with a good internal consistency (α=.90). A higher summative score signifies a higher economic burden whereas a lower score suggests a low economic burden. In this study, we used the cut-off point based on the SPSS version. The score was classified into normal [less than -1 standard deviation (SD)], mild threat [(between -1 SD and mean)], moderate threat [(between mean and +1 SD)], and severe threat [(more than +1 SD)].
The Depression Anxiety Stress Scales (DASS-21), a 21-item questionnaire with statements reflecting the three subscales of depression, anxiety, and stress, was used to assess the level of psychological responses. Each item had 4 options that showed how much the statement correlates to the respondent over the past week ('0' for 'Never', '1' for 'Sometimes', '2' for 'Often', and '3' for 'Almost always'). The overall subscale score was classified into normal, mild, moderate, severe, and extremely severe. In assessing the association of these psychological effects with economic burden, both "severe" and "extremely severe" were grouped as "severe". The questionnaire was validated in the Malay language version and had good internal consistency (α=>.70) (Musa et al., 2007).

Data Entry and Analysis
All statistical analyses were performed using the Statistical Package for Social Sciences Program (SPSS) software version 23.0. The descriptive statistics were used to determine the frequency and percentages of demographic data, the financial threat, and psychological response on working adults during lockdown for the COVID-19 pandemic in Sarawak. Association between the variables and perceived financial threat as well as psychological response were analysed using the Chi-square test. A p-value of less than 0.05 is statistically significant.

Ethical approval
The study was approved by the Ethics Committee of the Faculty of Medicine and Health Sciences (FMHS), Universiti Malaysia Sarawak [UNIMAS/NC-21.02/03 Jld.4(60)]. The respondents were provided information about the study and required to fill the consent form before answering the questionnaire. Participation in this study was voluntary. In ensuring privacy, anonymity, and confidentiality, and data quality, the participant's identification data such as name and e-mail were not obtained.

Results
A total of 336 respondents participated in this study. 81.5% of the respondents were employed. Almost half of them were below the age of 30 years old. A large majority of the respondents were female (62.5%) and 61.0% were non-Dayak ethnicity. The majority of the respondents (72.9%) were still working during the MCO and 82.1% of all the respondents did not experience any change in income during the study period. 14.0% of the respondents did not have any savings whilst only about a quarter (21.3%) had savings that could sustain for over 4 months. As for the number of liabilities, 91.7% of the respondents had one or more liabilities.

Association between the sociodemographic characteristics of the respondents and financial threat during the lockdown
More than half of the self-employed respondents (72.6%) experienced moderate to severe financial threat whereas only 42.3% of the employed respondents had a moderate-to-severe financial threat. 54.6% of those with no children, 42.1% of those with 1 to 3 children, and 40.9% that have 4 or more children were found to be significantly associated with a moderate-to-severe financial threat. In addition, 60.0% of the respondents who had a decrease in their income during the lockdown and 45.3% with unchanged income perceived moderate-to-severe financial threat.

Association between the sociodemographic characteristic and psychological response during lockdown for the COVID-19 pandemic
Self-employed respondents were more affected psychologically as compared to the employed respondents. 48.4% of the respondents experienced depression, 51.6% had anxiety, and half of them suffered from stress. 46.2 % of the divorced or widowed respondents showed that they had depression. Other than that, respondents without children showed a higher level of psychological effect in which 43.6% of them underwent depression and stress, while 59.2% of them suffered from anxiety. 33.1% of respondents with 1 or 2 liabilities experienced depression and 63.6% of the respondent with 5 to 6 liabilities had anxiety.

Association between perceived financial threat and psychological response
38.0% of the respondents with severe financial threat experienced severe levels of depression. Among those who experienced a severe level of anxiety, 30.6% perceived moderate and 40.0% perceived severe financial burden. In terms of stress level, 26.0% of those with severe financial threat were found to have a severe level of stress.

Discussion
In this study, self-employed persons perceived moderate-to-severe financial threat. Lemoine et al. (2016) reported that people tend to focus on the direct negative consequences such as unemployment and other indirect financial difficulties during an economic crisis, contributing to a higher level of financial threat. During a pandemic, there is an increasing sense of job insecurity, uncertainties and difficulty to sustain income among the self-employed population, affecting their mental health (Gevaert et al., 2020). In a recent report, the most affected areas of businesses among small and medium-sized enterprises were sales, human resources, and marketing and the majority of subjects (68.9%) in a recent study stated MCO posed negative impacts on their businesses (Lim, 2020). Businesses that were labelled as non-essential services such as agriculture, food service, arts and entertainment were among the industries that were most affected (DOSM, 2020;Lim, 2020).
Among those who were employed, many of the low-skilled workers had a higher tendency to lose their jobs, and increasing their financial burden (Lim, 2020). It is worthwhile to note that about 80% of people in this study had only less than 3 months of savings. Lim (2020) revealed a worse situation in his survey in which 71.4% of the self-employed persons had only sufficient savings for less than a month. In an online survey carried out by the Department of Statistics, Malaysia (DOSM, 2020) immediately after the commencement of MCO in March 2020 involving 168,182 subjects, 81.9% self-employed persons and 71.3% employers stated that they were not financially ready if the MCO was extended. Lacking saving awareness among Malaysians implied that they were not financially ready for the unexpected events such as the current pandemic (DOSM, 2020;New Straits Times, 2020). This explains the increasing probability of this particular population having negative psychological responses.
We also observed that single persons and widowed or divorced persons had increased vulnerability suffering from the depressive condition during the lockdown period. Although not statistically significant, the widowed or divorced population had reported a relatively high level of moderate-to-severe financial threat. This could be contributed by the loss of sustainable income due to the death of the husband and the reduction of assets over years (Sevak et al. 2003). In these populations, they tend to be lonely and socially isolate themselves, thereby increasing the risk of developing depression (Matthews et al., 2016).
Having no children was noted to have a significant association with severe financial threats and negative psychological states. Social support from children especially for older people could serve as a crucial personal resource in facing economic turmoil (Alcover et al., 2020). Viseu et al. (2019) also described that having adequate social support could help one to cope with stress better, thus reducing the severity of the financial threats and negative psychological outcomes. However, in countries with a higher prevalence of poverty like India or Africa (Ahmad et al., 2020;Mcloyd, 1990), the increasing family size may mean an increasing burden due to disproportionation between financial resources and expenditure or economic loss. Parents may experience higher stress and anxiety, especially when they have children of younger age (Skreden et al., 2012) as they need more attention and intense care.
People with more liabilities in this study had reported a higher level of anxiety and stress amid the pandemic. A nationwide study in England that comprised 7461 subjects revealed that adults in debt were three times more likely to develop common mental disorders (Meltzer et al., 2012). Another recent systematic review also provided evidence of an increased likelihood to experience depression, anxiety, stress, and even suicidal ideations among the Asian population when they were in debt (Amit et al., 2020).
The financial threat has been strongly associated with negative psychological outcomes. The higher the financial threat, the more severe the psychological distress, as presented in a few previous studies (Fiksenbaum et al., 2017;Griffiths et al., 2021). The economic crisis during the lockdown created more room for poverty and unemployment, leading people to feel hopeless about the present and future. These could be a rippling effect on the increasing suicide events over the globe (Thakur & Jain, 2020).
The present study should be interpreted with care as there are several limitations. First is the lack of generalisability of this study as not all people could be reached through the online survey.
Internet access was also limited in remote and suburban areas. It is also difficult to determine the temporal relationship between the causes and effects using a cross-sectional study design. For future research, it is recommended that the questionnaire should be distributed through both online and physical forms. Qualitative studies are also suggested to understand the temporal relationship between perceived financial threats, psychological responses, and predictors for more comprehensive views of the people.

Conclusion
We have found several factors in this study that could have associations with the level of perceived financial threats and the severity of the psychological distress for working adults in Sarawak during the lockdown for the COVID-19 pandemic. Self-employed persons and the vulnerable population with less social support such as single, divorced or widowed and people with no children are among those who were found to be associated with high financial threats and a greater level of psychological distress. Given the current findings, the government should focus on providing more financial resources and alternatives to address the needs of the self-employed as well as offering mental health assistance to those who are more susceptible to negative psychological outcomes during a pandemic.

Acknowledgement
We sincerely thank Prof Dr. Md Mizanur Rahman from Universiti Malaysia Sarawak (UNIMAS) for his contribution in assisting us with the data analysis.