Mental health of Brazilian students during the COVID-19 pandemic: the role of gratitude, optimism, and hope in reducing anxiety

Abstract Objective To investigate the role of optimism, hope, and gratitude as psychosocial factors for healthy development, especially with regard to anxiety in college students in the context of coronavirus disease 2019 (COVID-19). Methods This is a quantitative, descriptive cross-sectional study. A sociodemographic questionnaire, the Brazilian Gratitude Scale (Escala Brasileira de Gratidão [B-GRAT]), and the Brazilian versions of an anxiety subscale, the Revised Life Orientation Test (LOT-R), Hope Index Scale, and BIG-FIVE were administered. Data were analyzed using the Mann-Whitney U test, the Kruskal-Wallis test, Spearman correlations, and hierarchical linear regression. Results A total of 297 students were assessed. The relationship between gratitude and anxiety became positive in the hierarchical linear analysis, contradicting the initial negative association between these variables according to the Spearman coefficients. This contradiction may be a result of the suppression effect. When gratitude was added to the model, these three variables together accounted for 38% of the variance in anxiety. This indicates that optimism, hope, and gratitude together are significant predictors, although optimism alone accounts for the greater part of the variance in decreased anxiety. Conclusion The data confirm that family and religiosity are protective factors against mental illness, specifically non-adaptive anxiety. Furthermore, developing optimism as a protective factor makes it possible to experience less anxiety while hope has the potential to provide the individual with multiple pathways to healthy development. This study highlights that gratitude plays a dual role in these relationships as it has the potential to be associated with anxious feelings with likely negative outcomes while at the same time it can drive positive psychosocial factors of optimism and hope, decreasing anxiety.


Introduction
Higher education students' mental health is being studied in many different countries.There has been a high prevalence of mental disorders, 1 psychological stress (26.2%), 2,3 depression (17.3%), suicidal ideation, and self-injurious behavior (15.3%). 4In the European context, the World Health Organization (WHO) 5 reported an increase in mental illnesses in 11% of the population, reaching 10 to 20% of young adults.
Research has shown that the coronavirus disease 2019 (COVID-19) pandemic has caused psychological illnesses, such as depression and anxiety, 6,7 generating fear, or coronaphobia. 8Current studies demonstrate considerably increased anxiety in students during the COVID-19 pandemic.A relationship was detected between anxiety and cognitive functioning before and during COVID-19. 9,10[13] Anxiety is characterized by fear or extreme tension that exceeds healthy levels and brings harm and illness.
Since university is a new environment that requires emotional and social adaptation, feelings, sensations, and insecurities can emerge, which have the potential to compromise students' learning and their relationship with professors, colleagues, and the university itself.
Difficulties arise with reconciling study schedules, internships, exams, and personal, professional, and family life. 14,15n a study with 257 college students, it was found that students' positive perception of their life also reflects positively on their physical, psychological, social relationship, and environment domains, increasing the frequency of positive affect and reducing adverse effects. 16In this regard, the positive psychology movement aims to (re)build positive qualities and foster and nurture the best in subjects, focusing on healthy factors, virtues, and personal strengths as protective and preventative agents of mental illness. 17,18[21] Hope is defined as a positive emotional state present in a triad formed by objective (the search for something), route (the possibility of a path to reach the goal), and agency (the motivation to trace the route and achieve the objective). 22Magaletta and Oliver 23 found that agency is a better predictor of subjective well-being.For Merolla and Peterson, 24 hope was negatively associated with the amount of daily interpersonal conflict, positively related to constructive conflict management when a battle occurred, and negatively related to everyday challenges in maintaining relationships.
Moreover, some studies show that higher levels of hope were associated with greater well-being and perceived emotional control, as well as with lower levels of perceived COVID-19 anxiety and stress. 25Also, hope could decrease students' focus and insecurity during COVID-19 20 and help them to reduce procrastination in the educational process by creating new routes when faced with adversity, 19 yielding higher intellectual satisfaction and engagement. 26Shellstrom, 27 reflects on the lessons from remote learning, including the importance of adaptability during the pandemic and appreciation of little things crucial for better academic well-being, especially in critical moments.Algoe 28 emphasizes that gratitude is also aimed at the individual's awareness of their life experiences, realizing their positive side.
Based on evidence from the Brazilian population, Vazquez et al. 29 defined gratitude as a positive mental state of gratitude for life experiences, even if adverse or risky, linked to affective memories that enhance subjective well-being.The researchers found that gratitude is positively associated with hope, explaining 38% of variance, and indicated that gratitude is a protective and preventive factor against anxiety and depression.
Moreover, in an experiment with students during the pandemic, 30 Puente-Diáz and Cavazos-Arroyoin showed that bringing to mind memories of special moments has a positive influence on gratitude and mediates the positive relationship between recalling a special event and optimism.These findings showed that these constructs might help people see a brighter future under the prevailing difficult conditions of prolonged lockdowns.
Evidence has shown that optimism promotes positive mental strategies.Optimistic individuals employ self-confidence and more significant effort and persistence to achieve their goals using thought control and logical analysis of adversity or perceived risk. 31rthermore, researchers identified that coronavirus stress was negatively associated with college students' sense of hope and optimism.These mitigated the adverse impacts of tension on mental health during the pandemic.It was concluded that being hopeful and optimistic are the potential resources that explain how coronavirus stress is related to subjective well-being. 32 the present study, we consider that hope has the potential to provide students with multiple routes of positive development, even in the face of anxiety and difficulties. 24Thus, hope has a negative association with anxiety levels (hypothesis 1).Also, gratitude can promote reflection and elaboration of negative feelings and increase students' well-being by experiencing positive feelings, even in adverse situations or when the routes followed do not suit their initial expectations. 29erefore, gratitude is negatively related to anxiety, acting as a psychosocial protective factor (hypothesis 2).
Moreover, optimism can provide a positive vision of the future, even in adversity, and optimistic students will be successful in their actions, achieving the goals they aspire to. 32Thus, optimism is negatively related to anxiety levels (hypothesis 3).In our view, the complexity of this process will enable the student to achieve the growth necessary for their personal and professional development in a healthy way.Therefore, optimism will act as the main protective factor in decreasing anxiety in comparison with hope and gratitude (hypothesis 4). Given

Brazilian version of the Revised Life Orientation Test
(LOT-R) 33 The LOT-R contains 10 items with a Likert response scale (ranging from strongly disagree = 1 to agree strongly = 5) and has an adequate reliability index (α = 0.79).In the present study, reliability (α = 0.97) and LOT-R indexes were satisfactory (χ² = 13.9, degrees of Brazilian Gratitude Scale (B-GRAT) 29 The B-GRAT consists of seven items, five items measuring gratitude towards external sources, i.e.

Data analysis procedures
The Statistical Package for the Social Sciences (SPSS) version 25 was used for data analysis.Analysis of missing data was conducted and participants who did not complete all four scales were excluded.Outliers were later analyzed using the procedure suggested by Hair et al. 36 1).
The comparison between sociodemographic variables, anxiety, optimism, hope, and gratitude demonstrated that females had higher levels of anxiety and gratitude than males.Regarding marital status, those who had no spouse had a higher level of anxiety, lower optimism, and lower hope than those who did have a spouse.Moreover, participants who endorsed no religious practice had higher levels of anxiety and lower levels of optimism, hope, and gratitude than those who did not.On the other hand, students who did observe religious practice had lower anxiety levels and increased optimism, hope, and gratitude.Finally, participants who had children had lower levels of anxiety and higher levels of optimism and gratitude than those who did not have children (Table 1).
In relation to academic level, undergraduates had higher levels of anxiety, followed by students studying for master's degrees, doctorates, and postgraduate certificates.On the other hand, postgraduate certificate students had higher levels of optimism, followed by master's, undergraduates, and, finally, doctorate students (Table 1).
Spearman coefficients were calculated to identify correlations between the study variables.First, the correlation analysis showed that sex was negatively related to anxiety and gratitude.Also, age was negatively correlated with anxiety and there were positive correlations between age and optimism, hope, and gratitude, which means that younger people had higher anxiety levels and less optimism, hope, and gratitude than older adults (Table 2).
University level was negatively related to anxiety and positively significant with regard to hope, which means that people with lower educational levels could be less anxious and more hopeful.Marital status was negatively related to anxiety and positively related to optimism, hope, and gratitude.Finally, religious practice and having children were both negatively related to anxiety and positively related to optimism, hope, and gratitude.In other words, people who are religious, people who are in romantic relationships, and those who have children are less anxious than those that are not (Table 2).
Moreover, it can be observed that anxiety was negatively related to optimism, hope, and gratitude.
Optimism showed the strongest negative association with anxiety (-0.594, p < 0.001), followed by hope (-0.375, p < 0.001), and then gratitude (-0.214, p < 0.001).Hope and optimism had the strongest positive relationship with each other (0.542, p < 0.001) and gratitude was strongly related to hope and optimism (0.526, 0.502, p < 0.001, respectively).These findings are shown in Table 2.  Hierarchical regression was performed to investigate the contribution of optimism, hope, and gratitude to explaining anxiety levels.However, this analysis entails certain assumptions.The Durbin-Watson value calculated for this study is 2.081.Based on this value, there is no problem with multicollinearity or autocorrelation among these variables.
It was found that all predictor variables added to the model significantly predicted less anxiety and, according to the hierarchical regression analysis results, just two of the models were significant.According to this, the variables most associated with decreasing anxiety were optimism, hope, and gratitude, in that order.According to the hierarchical regression analysis results from the first model, optimism alone predicted 34% of anxiety decrease.Adding the variable hope to the model, these two variables together accounted for 35% of the variance in anxiety, although this model was not significant.Furthermore, when gratitude was added, these three variables together accounted for 38% of the variance in anxiety.This indicates that together optimism, hope, and gratitude are significant predictors, but that optimism alone accounts for the greater part of the variance in decreased anxiety (Table 3).

Discussion
Sociodemographic data indicated that people in a romantic relationship have lower anxiety scores and higher levels of optimism and hope.Moreover, it was observed that people who engage in religious practice had lower anxiety levels and higher levels of optimism, hope, and gratitude.Having children was also associated with lower anxiety scores and increased levels of optimism and gratitude.The data confirm that family and religiosity are protective factors against mental illness, specifically in this research into nonadaptive anxiety. 40e highest levels of anxiety were observed in undergraduate and master's students.Studies carried out in university settings have corroborated this evidence.In a meta-analysis, Chang et al. 41 noted a high prevalence of anxiety among college students during the COVID-19 pandemic.Moreover, Ibrahim et al. 42 demonstrated that the high rates of anxiety and depression in students, especially in the first years at university, are even higher than those found in the general population.On the other hand, undergraduate and master's students demonstrated low levels of optimism.][43] Moreover, optimism and hope were negatively associated with anxiety confirming hypotheses 1 and 3. Also, optimism acted as the main protective factor in decreasing anxiety in comparison with hope and gratitude, as predicted by the fourth hypothesis.A negative correlation between anxiety and optimism was demonstrated in findings reported by Hutz and Nunes 34 and by Bastianello et al. 33 Furthermore, a negative association with hope was found in studies by Gadosey et al. 44 and Long and Gallager. 45In the correlation data, it is possible to observe that optimism, hope, and gratitude are positively related to each other, confirming the findings of Witvliet et al., 46 Kardas et al., 47 Vazquez et al., 29 and Biber et al. 48wever, it was notable that the relationship between gratitude and anxiety becomes positive in the hierarchical linear analysis, contradicting these variables' negative association indicated by the Spearman coefficients.These contradictory results in the analysis may be a result of the suppression effect, 49 showing that the Spearman correlation analysis of the indirect effects of gratitude, optimism, hope, and anxiety hinders the direct effect of gratitude on anxiety.
Importantly, the direct effect is more informative than the indirect effect because it considers the relationship between variables, considering the different influences on this relationship. 49 is important to consider that these data were collected during the first 2 months of the pandemic in Brazil, since this initial period saw a notable increase in anxiety levels. 7,8,50Based on our evidence, we observed that in COVID-19 times, students experienced fear of loss of things they were grateful for, such as health, family members, and study.That is, the more gratitude they had for things and people, the greater their fear of losing them.Thus, gratitude seems to exert a toxic effect in times of adversity and possible loss, being positively associated with anxiety.
Our findings corroborate those of Davis et al., 51 Jans-Beken et al., 52 and Cregg and Cheavens, 53 who found no negative correlations between gratitude and anxiety.Other studies have found that gratitude increases well-being and decreases anxiety.In this sense, it can be seen that gratitude acts with a positive effect on hope and optimism, significantly increasing the explanatory power of the model.Gratitude, hope, and optimism are constructs primarily studied in the positive psychology field, which shows evidence that their development as predictors of mental health favors individual strengthening and emotional balance, thus increasing the capacity to respond more satisfactorily to the challenges and adversities faced in life. 29,48,54e scientific literature presents robust findings showing that even in difficult times development of optimism as a protective factor makes it possible to experience less anxiety, 33,55 while hope has the potential to provide individuals with multiple routes of healthy development, even when facing anxiety and other difficulties. 23,56In our study, we highlight evidence that gratitude plays a dual role in these relationships, since it has the potential to be associated with anxiogenic feelings with likely negative outcomes while it can also boost positive psychosocial factors of optimism and hope, decreasing anxiety.

Conclusions
The pandemic in Brazil has been linked with evidence of many psychological illnesses, such as anxiety and depression.The aim of this research was therefore to evaluate the roles of gratitude, optimism, and hope, as psychosocial protective factors for reducing anxiety, and thus in improving the mental health of college students during the COVID-19 pandemic.The hypotheses that hope and optimism would correlate negatively with anxiety and that optimism would play a major role compared to the other variables were both proven.
However, in relation to gratitude, a positive association with anxiety was observed in the hierarchical analysis, making it impossible to confirm hypothesis 2 that gratitude would decrease anxiety.Nevertheless, an indirect action was attributed, via hope and optimism, decreasing anxiety.In pandemic or high adversity situations, development of optimism associated with hope and gratitude will have more protective effects on people's well-being and also be more effective in reducing anxiety.This paper aims to contribute current data to enable greater understanding of these constructs, realizing that they also have limitations and adverse effects when they do not confirm the importance of psychosocial protective factors such as hope, gratitude, and optimism, as well as family and religious practice, to encourage students to improve their mental health and well-being, in line with what is proposed by positive psychology regarding optimal functioning to reduce anxiety in order to maintain adequate adaptive levels in adverse contexts.These data can also be used to support practitioners, teachers, and universities thinking about better strategies to improve students' mental health and to create effective interventions based on findings from this pandemic context.Some limitations of the present research include the predominance of undergraduate females in the sample.Also, data were collected during a pandemic situation and a majority of the sample was from Brazil's southern region.However, it is important to study how these variables interact in males and in master's and doctorate students.Moreover, research in nonpandemic situations and longitudinal study designs would help understand how these variables interact in other contexts.It is suggested that further studies be carried out to analyze the effects of optimism, hope, and gratitude on factors such as anxiety and depression, as well as positive factors related to proactivity.Furthermore, replicating this research in a non-pandemic situation would be of great value for better understanding of the constructs.It is also suggested that interventions based on the findings of this study could be implemented to verify the results in practical experiences.

Table 1 -
Sociodemographic data d = d de Cohen; M = mean; SD = standard deviation; Z = score z. * Correlation is significant at the 0.01 level.†Correlation is significant at the 0.05 level.