Mental resilience, fear of COVID-19, and psychological distress: a cross-sectional study among chronic disease patients in a regional Greek catchment

Introduction The COVID-19 pandemic significantly impacted global mental health, with fear of the virus emerging as a key factor statistically linked to psychological distress. While several studies have explored these effects in the general population, chronic disease patients represent a particularly vulnerable subgroup. This study aimed to investigate the associations between fear of COVID-19, mental resilience, and psychological distress (depression, anxiety, and stress) among chronic disease patients in a regional Greek hospital serving a mixed semi-urban and rural catchment. Methods A cross-sectional study was conducted among 293 chronic disease patients at the General Hospital of Argolida, Greece. Participants were recruited using systematic random sampling. An initial missing-data screen included Little’s MCAR test; final regression models used model-wise complete cases. Fear of COVID-19 and psychological distress were assessed using the Fear of COVID-19 Scale (FCV-19S) and the Depression, Anxiety, and Stress Scale-21 (DASS-21), respectively. Resilience was assessed using the 20 CD-RISC items available in the archived participant-level dataset (items 1–20 of the parent CD-RISC-25). The resilience score was calculated as 1.25 x the sum of the 20 items and was available for participants with valid responses to all 20 items (n = 255); no item-level imputation was performed. The final regression models used model-wise complete cases (n = 233 for depression, n =243 for anxiety, and n = 238 for stress). Results Participants demonstrated moderate levels of fear of COVID-19 (Mean=16.8, SD = 6.0). Among patients with complete data on all 20 available resilience items (n=255), the mean prorated resilience score was 68.5 (SD = 16.8) on the 0–100 metric. Overall mean depression, anxiety, and stress scores fell within mild-to-normal ranges, although categorical stratification revealed severe-to-extreme symptoms in distinct subgroups (7.2% for depression, 9.9% for anxiety, and 9.6% for stress). Temporal sensitivity analysis revealed no statistically significant macro-level differences in the psychological parameters examined. Fear of COVID-19 showed a significant positive association with overall distress, while resilience was negatively associated with depression, anxiety and stress in the final regression models. Discussion During the later phases of the pandemic, no macro-level temporal shifts were detected in the psychological profiles of chronic disease patients within this cohort. This absence of a detected difference may tentatively point toward individual habituation. The results suggest that mental resilience is statistically linked to lower distress levels, highlighting its relevance for supporting patient well-being in the aftermath of infectious disease outbreaks. These findings underscore the importance of incorporating resilience-focused assessments and digital health frameworks in clinical practice to support vulnerable populations during future public health crises.