Introduction

The novel coronavirus (COVID-19), first discovered in 2019, was declared a pandemic and drastically affected the everyday lives of millions of people around the world. World Health Organization data confirmed about 612 million cases and 6.5 million deaths worldwide (WHO, 2022). In response to the outbreak, countries implemented extreme public health measures to slow infection rates, such as nationwide lockdowns, social distancing measures, closure of schools and businesses, and restrictions on movement. It was evident that the pandemic was a stressful and challenging event that resulted in economic, political, environmental and psychosocial upheaval. This study is focused on Grenada, a small, English-speaking, island nation which sits in the Lesser Antilles near the South American continent. Its rich, sociocultural history is shaped by several revolutions, and a blend of Indigenous, African, French, and British influences.

COVID-19, Stress and Anxiety

Following remedial efforts for the psychosocial effects of COVID-19, there has been a growing concern about the mental health impact of the pandemic on individuals (Cook et al., 2022; Mahamid & Bdier, 2021; Milner & Jumbe, 2020). Intervening variables such as domestic violence, substance abuse and economic stability have been examined in the context of COVID-19 (Boserup et al., 2020; Czeisler et al., 2020). Research emerging from the pandemic indicated that populations across the globe have experienced increases in symptoms of stress, anxiety, and depression (Alzueta et al., 2021; Czeisler et al., 2020; Wechsle et al., 2022; Xiong et al., 2020). Additionally, several meta-analyses have shown that COVID-related anxiety can negatively affect individuals’ overall health and well-being (Metin, 2022).

A study in six European countries and Australia reported high prevalence estimates of anxiety symptoms (Gemes et al., 2022). In Kwong et al. (2021) longitudinal analysis of anxiety in the UK, the authors observed a doubling of anxiety during the pandemic as compared to pre-pandemic levels. Similarly, a study in Macao showed a strong relationship between the pandemic and varying levels of anxiety among the residents who experienced serious anxiety symptoms (Bai et al., 2022). A web-based survey was conducted in the USA in 2020, and the results showed that about 40.9% of the respondents experienced adverse mental health disorders conditions, such as anxiety disorders (Czeisler et al., 2020). Furthermore, it was seen that specific populations were more adversely affected. One study showed that females were more affected by mental health disorders and that persons under 40 exhibited adverse psychological symptoms during the pandemic (Xiong et al., 2020). In another study, Czeisler et al. (2020) found that the prevalence of anxiety disorders decreased progressively with the age of the participants.

During crises, it is important to explore not only risk factors but also protective factors. Religious/spiritual coping is one such protective factor. Religion and spirituality are very important to Caribbean people and used as coping strategies during stressful times (Superville, 2014). Religious coping is religiously framed cognitive, emotional, or behavioral responses to stress and includes both positive and negative dimensions. It may serve many purposes, including achieving meaning in life, closeness to God, hope, peace, connection to others, self-development, and personal restraint (Pargament, 1997). Religious coping is aimed at achieving feelings of acceptance and has been effective with persons in whose lives spirituality or religion plays an important role (Carver, 2011). This topic has not been explored in Grenada, and it is important to understand the coping mechanisms that are being used to provide meaningful support to individuals facing stress or crisis.

Theoretical Framework

Lazarus and Folkman’s Transactional Model of Stress and Coping

Stress is a complex construct with interweaving dimensions that may be exhibited across physical, emotional, and psychological characteristics. Much of the psychological literature has sought to better understand the experience of stress and its related attributes (Richard et al., 2018; McLean et al., 2022; Yu et al., 2021) with several theoretical propositions that aim to explain the phenomenon (Amirkhan, 2021; Biggs et al., 2017; Lazarus & Folkman, 1984). Biggs et al. (2017) assert that these theoretical perspectives can be broadly classified according to how the stress experience is conceptualized: “stress as an external stimulus; stress as a response; stress as an individual/environmental interaction; and stress as an individual/environmental transaction” (p. 351). One of the most prominent and extensively empirically driven and supported models is Lazarus and Folkman’s transactional model of psychological stress and coping (TMSC). From its original conception, the theorists define stress as “a particular relationship between the person and the environment that is appraised by the person as taxing or exceeding his or her resources and endangering his or her well-being” (Lazarus & Folkman, 1984, p. 19). The two main constructs that ground the transactional model are cognitive appraisal and coping.

Lazarus and Folkman (1984) define cognitive appraisal as the “process of categorizing an encounter, and its various facets, with respect to its significance for well-being” (p. 31), which occurs on primary and secondary levels. Primary appraisal entails making an initial assessment of an experience to determine if it is a potential stressful event, which can be categorized as a loss, threat, or challenge. If a situation is deemed threatening and potentially stressful, secondary appraisal takes place. Biggs et al. (2017) strongly emphasize that primary and secondary appraisal should not be viewed as concretely sequential nor mutually exclusive; rather, both are dynamic processes that rely on continuous exchanges between primary and secondary appraisals. Lazarus and Folkman asserted that primary and secondary appraisal processes result in the initiation of coping. The theorists define coping as “constantly changing cognitive and behavioral efforts to manage external and/or internal demands that are appraised as taxing or exceeding the resources of a person” (p. 141). The transactional model assumes an iterative, cyclical process that results in cognitive reappraisal until the stressor has been successfully managed. One such profound method of coping is religion and spirituality.

Religious Coping

Although stress and anxiety are two distinct phenomena, they share physical and emotional responses, such as irritability, insomnia, muscle tension, and difficulty concentrating (Rogowska et al., 2020). As such, being anxious or stressed forces people to implement coping mechanisms to protect themselves and reduce stressful and/or anxious responses. There are various coping mechanisms, both pharmaceutical and non-pharmaceutical, that persons may employ to deal with stress or anxiety. An overwhelming number of articles point to religious-based beliefs to deal with life’s stressful events and experiences (Bakır et al., 2021; Mirzaee et al., 2022; Verhoeff-Korpershoek et al., 2023). According to Aflakseir and Mahdiyar (2016), religious coping involves using religious beliefs or practices to deal with situations that induce stress. Several scholars suggested that religious coping is associated with lower anxiety levels and improved mental health (Algahtani et al. (2022); Chow et al. (2021); Francis et al. (2019). Ab Rahman et al. (2020) further distinguish between positive religious coping and negative religious coping, with positive religious coping representative of a secure attachment and reliance on a higher being in times of distress and negative religious coping indicative of less reliance on and a tenuous relationship with a higher being.

The literature on religion and spirituality as a coping mechanism is expansive, with specific empirical investigations related to how it mediates COVID-19 responses. In Lee et al.’s (2021) review on religious coping and COVID-19, the researchers describe religion as a “double-edged sword,” in that religion has played a role in both detrimental effects of COVID-19 transmission as well as in mediating effects. Nonetheless, the authors found 71.9% of articles related to the benefits of religion in their review analysis. Dobrakowski et al. (2021) investigated the relationship between religious coping and life satisfaction during the pandemic, from which the researchers found greater life satisfaction associated with positive religious coping mechanisms. Fatima et al. (2022) cross-national analysis demonstrated the significant reliance on religious activities as a coping strategy during the pandemic among Indian and Nigerian natives. Mahamid and Bdier’s (2021) cross-sectional analysis also found negative correlations between positive religious coping and perceived stress among Palestinian adults.

The pandemic impacted various countries differently. In the context of the Caribbean, much work related to the effects of the pandemic among nations has focused on racial and ethnic inequalities and disparities (Milner & Jumbe, 2020; Nafilyan et al., 2021) and vaccine hesitancy (Cook et al., 2022; Woolf et al., 2021). However, to date, no studies have been conducted to explore the effects of religion and spirituality as a coping mechanism for COVID-related anxiety experienced in this region, reflecting a gap in the literature. To address this gap, the current study utilized quantitative methodology to investigate coping and anxiety related to COVID-19 in Grenada. The researchers hypothesized that: (1) There is a correlation between coronavirus anxiety and religious (positive and negative) coping; (2) there is a negative correlation between coronavirus anxiety and positive religious coping; and (3) age, gender, and religion are predictors of religious (positive and negative) coping and coronavirus anxiety.

Research Questions and Hypotheses:

  1. 1.

    Is there a correlation between coronavirus anxiety and religious coping?

    1. a.

      H1: There is a correlation between coronavirus anxiety and religious coping.

    2. b.

      H2: There is a negative correlation between coronavirus anxiety and positive religious coping.

  2. 2.

    Does age, gender, and religion predict coronavirus anxiety?

    1. a.

      H3: There is a predictive relationship between age, gender, religion, and coronavirus anxiety.

  3. 3.

    Does age, gender and religion predict religious coping?

    1. a.

      H4: There is a predictive relationship between age, gender, religion, and religious coping.

Study Design and Procedures

Study Design

This was a quantitative study used to investigate relationships between age, gender, religion, coronavirus anxiety and religious coping. The study was approved by the St. George’s University Institutional Review Board (reference #20,013) and was not funded. Based on G*Power 3.1.9.4 calculation, the sample size of 215 participants was sufficient for a viable study (Faul, Erdfelder, Buchner, & Lang, 2009). Participants were solicited using convenience sampling (surveys sent to various denominations) and snowball sampling (distributing the survey link to known churchgoers and asking them to pass on the link to their friends and family). There was no compensation for completing the study, and informed consent was obtained before the start of the survey. As a part of the informed consent process, participants were given the choice to request debriefing.

Measures

Participants were asked to complete a 22-item survey which consists of the Brief RCOPE (14-items); the Coronavirus Anxiety Scale (CAS; 5-items); and a demographic section that captures age range, gender, and religious affiliation (3-items).

Brief RCOPE

The Pargament et al. (2011) Brief RCOPE is a 14-item measure of religious coping with major life stressors. As one of the most commonly used measures of religious coping in the literature, it has helped contribute to the growth of knowledge about the roles that religion serves in the process of dealing with crisis, trauma, and transition. The items themselves were generated through interviews with people experiencing major life stressors. This measure is recommended as an uncontaminated scale of religion, spirituality, and health (Koenig & Carey, 2024). Positive religious coping methods reflect a secure relationship with a transcendent force, a sense of spiritual connectedness with others, and a benevolent world view. Negative religious coping methods reflect underlying spiritual tensions and struggles within oneself, with others, and with the divine. An example of an item from the positive religious coping subscale is “Looked for a stronger connection with God,” and an example from the negative religious coping subscale is “Wondered what I did for God to punish me.” Mean scores for positive religious coping range from 17 to 21; and 8 to 14 for negative religious coping (Pargament et al., 2011). The Brief RCOPE has been validated cross-culturally, and psychometric properties include Cronbach’s alpha ranging from 0.70 to 0.86 (Al-Hadethe Hunt et al., 2016; Nelda & Valmi, 2011). Within our sample, the Brief RCOPE showed strong levels of reliability (α = 0.88).

Coronavirus Anxiety Scale

The Lee (2020) Coronavirus Anxiety Scale (CAS) is a 5-item measure that was developed as a brief mental health screener to identify generalized anxiety associated with the COVID-19 pandemic. The CAS discriminates well between persons with and without dysfunctional anxiety, and initial results support its use as an efficient and valid tool for clinical practice and research with satisfactory levels of sensitivity (90%) and specificity (85%). An example of an item is “I felt dizzy, lightheaded, or faint, when I read or listened to news about coronavirus.” A CAS total high score ≥ 9 may indicate dysfunctional anxiety for the individual. Within our sample, the CAS showed strong levels of reliability (α = 0.87).

Statistical Analysis

Statistical analyses were performed using SPSS 28. Descriptive statistical analyses were used to characterize the study population. The categorical variables are presented in percentages and frequencies, while the continuous variables as means and standard deviation. Pearson correlation was calculated to determine the correlation between coronavirus anxiety and religious (positive and negative) coping. A regression analysis was performed to test the relationship between age, gender, religion, and coronavirus anxiety and the relationship between age, gender, religion, and religious (positive and negative) coping.

Results

Participants

Table 1 outlines the sociodemographic information of the study participants. There was a total of 215 participants, ranging from 18 to 84 years old, with the majority between 18 and 24 years. Most participants were female (n = 156, 72.6%) and Protestant (non-Roman Catholic (n = 153, 72.1%). Overall, the participants scored in the average range on the positive religious coping scale (M = 18.87, SD = 5.98), slightly below average on the negative religious coping scale (M = 7.03, SD = 4.48), and obtained low scores on the coronavirus anxiety scale (M = 4.16, SD = 3.41) as outlined in Table 2.

Table 1 Participant demographic characteristics
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Table 2 Means and standard deviations for research variables (n = 215)
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We predicted a correlation between coronavirus anxiety and religious coping. The data confirmed Hypothesis 1. The Pearson product correlation, as shown in Table 3, demonstrated a statistically significant, moderate, positive correlation between coronavirus anxiety and both negative religious coping (r = 0.569, p < 0.001) and positive religious coping.

Table 3 Pearson correlation between religious coping and coronavirus anxiety
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(r = 0.463, p < 0.001). This suggests that participants experiencing higher levels of coronavirus anxiety utilized both negative and positive coping strategies. However, the results did not support Hypothesis 2 as we predicted a negative correlation between coronavirus anxiety and positive religious coping.

The results confirmed Hypothesis 3. The regression analysis for predicting coronavirus anxiety, as shown in Table 4, shows that the overall regression model was able to significantly predict coronavirus anxiety, F(3, 211) = 15.123, p < 0.001. Gender (β = −0.172, p = 0.006) and Age (β = −0.386, p < 0.001) were statistically significant. However, religion did not add statistical significance to the prediction.

Table 4 Regression analysis to predict coronavirus anxiety
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Based on the data, Hypothesis 4 was also confirmed. Results shown in Table 5 show that the overall regression model was able to significantly predict both positive religious coping (F(3,211) = 8.519, p < 0.001, R2 = 0.108) and negative religious coping (F(3,211) = 18.248, p < 0.001, R2 = 0.206), and Age (β = −0.326, p =  < 0.001; β = −0.456, p =  < 0.001) was statistically significant and negative, respectively.

Table 5 Regression analysis to predict religious coping
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Discussion

This study explored whether religious coping was being used to manage coronavirus anxiety; and whether age, gender, and religion were predictors of religious coping and coronavirus anxiety in Grenada during the pandemic. It is a useful contribution to filling the gap in the literature in the Caribbean where very few studies of its kind exist.

Religious Coping and Coronavirus Anxiety

As expected, we found that religious coping was strongly correlated with coronavirus anxiety which supported our first hypothesis. However, we did not expect a positive relationship between coronavirus anxiety and both types of religious coping. We predicted a negative association between positive religious coping and coronavirus anxiety, in that the use of positive strategies would result in a decrease in coronavirus anxiety. This would reflect the way many Caribbean populations use these strategies when dealing with stressful situations (Chatters et al., 2008; Superville, 2014). In fact, there is significant support in the literature which shows that during the COVID-19 pandemic, persons managed feelings of anxiety with religious coping. Researchers have repeatedly found that religious coping is an effective mechanism for many who find that their relationship with their higher power provides strength and calm in times of distress (Chatters et al., 2008; Chow et al., 2021; Francis et al., 2019).

Additionally, we found that as the level of coronavirus anxiety increased, negative religious coping behaviors also increased. Current research supported this finding and indicated that negative religious coping has a positive association with coronavirus anxiety (Bryan et al., 2016; DeRossett et al., 2021). Possible explanations include that although individuals might have resorted to faith as a way to cope with coronavirus anxiety, the potential adverse effects of using negative religious coping surpassed the potential advantages of employing positive religious coping strategies. This suggests that persons may have struggled with confidence in their higher power and feelings of abandonment and engaged in questioning whether this crisis was punishment for misdeeds (DeRossett et al., 2021; Pargament et al., 2011).

It is important to note that Grenada is largely a Christian state (~ 82% of participants identified with a Christian denomination) and many Christian faiths believe that God punishes wrong-doing (Lee et al., 2021). During the height of the COVID-19 pandemic in 2020, Grenada instituted a lockdown period from March to July 2020, with subsequent curfews and restricted movement. Churches were closed and were unable to provide online services for their congregations (this technology came later). For the congregants, going to church means being able to get spiritual guidance to navigate life, nurturing social relationships and connections. The feelings of isolation and uncertainty that resulted from “shelter-in-place” and “work from home” were exacerbated by not being able to assemble in churches and other places of worship. Being unable to assemble may have further reinforced beliefs and feelings about abandonment from their higher power.

Gender, Age, and Coronavirus Anxiety

As hypothesized, there is a predictive relationship between gender, age and coronavirus anxiety. Specifically, we found that males experienced less coronavirus anxiety than females; and an increase in age decreased the likelihood of experiencing coronavirus anxiety.

First, the gender-related finding is consistent with other studies that show females experienced higher rates of anxiety and stress during the pandemic (Algahtani et al., 2022; Lelek-Kratiuk & Szczygiel, 2022). Further, a cross-sectional study spanning 59 countries showed that during the pandemic, when compared to males, females reported elevated levels of trauma-associated distress, a diminished capacity for relaxation, exhibited a greater number of symptoms associated with anxiety, stress, and depression, experienced poorer sleep quality, and demonstrated reduced tolerance for frustration (Kolakowsky-Hayner et al., 2021). Possible explanations are that during the pandemic women were burdened with childcare, care of elderly parents, home-schooling, and online work, which negatively affected their ability to cope and increased their chances of experiencing stress and anxiety (Laufer & Shechory Bitton, 2021). A significant number of frontline workers were female as well and the exposure to the rapid and devastating effects of COVID-19 and isolation from family predisposed them to greater levels of anxiety (Spagnolo et al., 2020). Additionally, a significant number of women reported increased distress and concerns about their reproductive health during the pandemic, and lockdown conditions created an increase in relationship conflicts and gender violence (Kolakowsky-Hayner et al., 2021).

Second, the age-related finding that increased age is correlated with decreased experience of coronavirus anxiety was an unexpected and interesting result. We assumed that given the high mortality risk among this demographic, they would have experienced higher levels of anxiety. However, several studies corroborated our finding and reported that older adults experienced less anxiety during the pandemic (Best et al., 2023; McCleskey & Gruda, 2021; Nwachukwu et al., 2020). One possible explanation is that older adults have prior major life experiences (e.g., epidemics, natural disasters) and may have used similar coping strategies during the pandemic (Best et al., 2023). Researchers found that they reported more problem-focused coping strategies than younger adults and less negative strategies, such as rumination and catastrophizing (Best et al., 2023; McCleskey & Gruda, 2021).

From the literature, it would seem that older adults not only utilized effective coping strategies but also demonstrated effective emotional regulation and reduced the impact of pandemic-related stressors (Best et al., 2023; Nwachukwu et al., 2020). Further, this ability to downregulate arousal is considered a characteristic of getting older (Gross et al., 1997). These explanations are in alignment with the tenets of the TMSC which posits that effective coping efforts are aimed at problem management and emotional regulation. Another possible explanation is that older adults tapped into their social network more during the pandemic to share concerns about the pandemic and reminisce on life experiences. In fact, they reported closer connections with friends during this time which may have influenced their positive emotional experiences and acted as a buffer against poor mood symptoms (Cavallini et al., 2021).

Age and Religious Coping

We found that age had a negative effect on religious coping which means that as age increased, religious coping decreased. This was also an unexpected result in that we assumed that older persons would lean more on their religion as a way to manage psychological distress during difficult times (Algahtani et al., 2022; Ghoncheh et al., 2021; Vasigh et al., 2018). However, other studies have supported our findings including that death anxiety among older adults dramatically increased with the pandemic (Bryne & Morgan, 2020; Rababa et al., 2021; Vancappel et al., 2023).

Several explanations may account for this phenomenon including that during stressful events, older adults may experience religious doubt (Rababa et al., 2021); and a decreased sense of life satisfaction and meaning given that COVID-19 pandemic significantly adversely affected the older population (Dobrakowski et al., 2021). Death anxiety is explicably associated with decreased religious coping as persons in this demographic, especially those with comorbidities were dying at an extremely high rate. This reality coupled with the inability to assemble due to social distancing restrictions may have negatively impacted their religious coping (Rababa et al., 2021; Zhu & Upenieks, 2022).

Limitations

This study has a few limitations. First, the cross-sectional nature negates any causal relationships between variables. Second, this study did not investigate the relationship of stress—a comorbid condition to the other variables—which would have added another dimension to the study. Third, there were no comparative studies between pre-pandemic and pandemic levels of anxiety; however, we think that the results can be generalized to unique and unpredictable stressful situations. Fourth, this study did not include residents of nursing homes and assisted living facilities. Fifth, the results may not extrapolate to the Caribbean region as a whole, given the diversity of sociocultural histories, populace, and religions. Last, this study was done during the height of the pandemic in Grenada, so a longitudinal study would better explore the shifts in the severity of psychological symptoms and coping mechanisms as the pandemic waxed and waned.

Recommendations

Despite these limitations, this study provided novel information about the role of religious coping in Grenada, and the results provide an opportunity to address the following:

  1. 1.

    religious institutions can provide more support for their membership by educating on the use of more positive religious coping strategies, while addressing the adverse impact of negative religious coping (Carver, 2011); religious leaders should be included as a collaborative approach to raise awareness of effective coping among the community as a whole (Mahamid & Bdier, 2021) and;

  2. 2.

    provision of instrumental (tangible needs, such as childcare, preparation of meals) and emotional (group or person) support especially for females to address the difference in the gender experience of psychological symptoms (Liu, 2020); these services can be provided through public mental health services and churches.

Conclusion

This quantitative study demonstrated the significant associations between religious coping and coronavirus anxiety and the impact of age and gender on religious coping and coronavirus. While older adults did not report high levels of coronavirus anxiety, they did report lower levels of religious coping. Additionally, the negative dimension of religious coping is also important to explore as it includes conflict, questioning, and doubt about God and faith. As such, interventions to decrease negative religious coping are just as important as those directed at enhancing positive religious coping. Furthermore, women reported greater levels of coronavirus anxiety than men. These findings emphasize the need for churches to provide not just spiritual guidance but also instrumental and emotional support during crises.