Investigating the Relationship between Needs and Life Expectancy (Maslow’s Hierarchy) among COVID-19-Recovered Patients

1. INTRODUCTION

Human life is fraught with countless incidents and events. Some happenings, such as sickness, can carry anxieties that might be the source of psychological repercussions. One such phenomenon that has affected the daily life of all human beings is COVID-19. The disease spread quickly all across the globe and caused worldwide panic because of its unknown and lethal nature. In Iran, as in other countries, the spread of this virus has caused complicated and diverse consequences in several fields: economic, cultural, social, and psychological [1-3]. People’s mental health is indeed jeopardized by a variety of factors, including the risk of illness, the fear of death, the spread of false information and gossip, the disruption of daily routines, travel restrictions or lockdowns, decreased social contact with family members, coworkers, and friends, and occupational and financial problems, to name just a few [4, 5]. Together, they can induce a wide range of symptoms, ranging from anxiety and fear to morbid stress and obsessive-compulsive disorder linked with disease [6], signs of post-traumatic stress disorder [7], increased loneliness, a decline in social support, and a lower life expectancy [8].

As mentioned, one of the psychological consequences of implementing such health policies in the community can be increased anxiety and stress, resulting in a reduction in life expectancy [9]. Marois et al. have demonstrated in their study of the potential effects of COVID-19 on life expectancy that the prevalence of the virus is negatively linked with life expectancy and that life expectancy declines as the disease prevails [10].

Life expectancy is a health indicator. It is, according to Snyder et al., a forward-looking cognitive construct. The desire for a better life results in the individual’s facilitated adaptation and adjustment. Hopeful people are more motivated to participate actively in problem-solving processes, adaptability, and flexibility because they have more potent stimuli and energy to pursue their goals [11, 12].

Life expectancy is characterized by goal-orientedness, the capacity to plan, the desire to attain goals, awareness of challenges, and the ability to overcome barriers and enhance performance [13, 14]. With higher hope, one can grasp goals better, have a stronger sense of confidence, and manage stress more effectively. Under such circumstances, individuals are well aware that they must have a precise strategy in place to deal with any type of stress. Without hope, life comes to a halt, leading to worry and anxiety. Disappointment places individuals in a position where they are unable to weigh and decide effectively. Despair renders individuals vulnerable and helpless in the face of pressure. Thus, life expectancy is seen as a critical indication of human survival and health [15, 16].

Studies indicate that life expectancy is linked with the role and position of the individual in society. Hence, people with different roles, needs, and positions will have different levels of life expectancy. One theory that classifies human needs is Abraham Maslow’s theory of human motivation [13, 17].

Maslow’s hierarchy of human needs is depicted as a five-level pyramid. This hierarchy starts with the basic needs at the bottom and progresses to more complex human needs at the top. The levels include physiological or physical needs, security needs, social needs or belonging and love needs, esteem needs, and self-actualization needs.

According to Maslow’s theory, lower-level needs are more potent, and a person can only progress to higher-level needs after their basic needs are satisfied. In this theory, human needs are divided into five categories, as described below:

1. Biological needs: Biological needs are the first building blocks of the hierarchy and have the most substantial impact on one’s behavior until they are satisfied to a certain degree. Biological needs are human survival, such as food, clothing, shelter, and reproduction. As long as the basic needs are not sufficiently satisfied, the majority of a person’s activities are likely to remain at this level, and higher-level needs will be motivated to a significantly lesser degree.

2. Security needs: These include well-being, health security, financial security, and protection from panic and violence. In other words, it includes the need to protect oneself at present and in the future.

3. Social needs or belonging and love needs: Humankind is a social being, and when social needs peak, one strives for meaningful relationships with others.

4. Esteem needs: This set of needs begins with self-respect and progresses to esteem earned via respect and acknowledgment from others. If people are unable to meet their desire for respect through constructive behavior, they may resort to destructive or reckless behavior to satisfy the need for attention.

5. Self-actualization and self-motivation need: They describe the flourishing and fulfillment of all latent talents of oneself, whatever these talents may be. As Maslow puts it: “What a man can be, he must be”.

According to Maslow, human needs are hierarchical, with the most acute needs driving one’s behavior at any given moment. When needs begin to be satisfied, a change occurs in one’s motivation. Indeed, a new level of needs replaces the fulfilled level, foregrounds, and motivates behavior. Newer needs peak likewise until they are fulfilled; subsequently, they recede to be replaced by a different set [18-20].

Understanding the life expectancy of COVID-19-recovered patients and recognizing their needs as per Maslow’s pyramid can, as fundamental research, demonstrate the efficiency of the Ministry of Health’s policies in fighting COVID-19 and supporting patients with the disease. No inquiry has yet been undertaken to determine the position of the needs of COVID-19 patients on Maslow’s pyramid and its relationship with life expectancy in these patients. Indeed, the existence of a link between these two variables, i.e., needs level and life expectancy, or the life expectancy status of COVID-19 patients, is unknown. Thus, the main objective of this study was to ascertain the link between Maslow’s hierarchy of needs and life expectancy among COVID-19-recovered patients in Khaf.

2. MATERIALS AND METHODS

This research is a descriptive-analytical, cross-sectional study intending to determine the associations between Maslow’s hierarchy of needs levels and life expectancy in COVID-19-recovered patients residing in Khaf in the second quarter of 2021. All people aged 18 to 65 who had been diagnosed with COVID-19 illness and had recovered their health were included in the statistical population. The lack of symptoms and persistent sequelae were considered improvement criteria. To be included, the participants were required to be between the ages of 18 and 65, have a history of COVID-19 with a positive PCR test, be literate and alert, have access to a smartphone and the Internet to receive the electronic questionnaire link and provide their consent to participate. Incomplete questionnaire submissions and a refusal to continue participating in the study were exclusion criteria.

As the number of individuals who recovered from the COVID-19 disease from the beginning of April 2021 to the end of June 2021 was n = 134, the sample size was estimated to be n = 100, considering Cochrane’s formula and a 5% error level. The patients included those referring to the comprehensive health service centers of Khaf City in addition to patients discharged from the 22^nd-Bahman Hospital of Khaf, which also admits residents of Khaf.

The convenience sampling method was utilized to recruit participants. The ethics committee affiliated with Mashhad University of Medical Sciences issued the code of ethics. Moreover, an introduction letter was obtained from the university’s Vice-chancellor for Research and presented to Khaf’s health network management and officials. Upon the required arrangements, the demographic characteristics of the recovered patients were collected from the Health Statistics and Information Technology Unit. The respondents were then contacted by phone and requested to complete the study’s electronic questionnaire link.

The tool used in this study included a three-part electronic questionnaire. The first part of the questionnaire addressed the demographic characteristics of participants, namely, age, gender, marital status, occupation, monthly income, history of COVID-19 vaccine injection, and time since recovery. The second part was a researcher-developed questionnaire that aimed to determine the needs of individuals according to Maslow’s hierarchy of needs. This questionnaire was designed by drawing upon Maslow’s needs assessment questionnaire [21], Jones and Pfeiffer’s Needs Questionnaire [22], and related literature [18, 23]. With 20 items, the questionnaire was designed to determine participants’ needs on Maslow’s hierarchy of needs pyramid (namely, basic or physiological needs, security needs, social needs, esteem needs, and self-actualization needs). These items were answered on a seven-point scale, as detailed below:

Strongly agree (+3), Agree (2+), Slightly agree (+1), I have no idea (0), Slightly disagree (-1), Disagree (-2), Strongly disagree (-3).

The components and associated items are:

1. Basic needs: (1-4-16-20).

2. Security needs: (2-3-9-19).

3. Social needs: (5-7-12-15).

4. Esteem needs: (6-8-14-17).

5. Self-actualization needs: (10-11-13-18).

Face validity and expert opinion from six experts were measures taken to warrant the questionnaire’s validity and items. All items demonstrated satisfactory content validity. The scores on the CVI scale ranged from 0.79 to 1, indicating that the items were adequate in terms of simplicity, relevance, and clarity. The Cronbach’s alpha coefficient of 0.88 was used to establish the instrument’s internal consistency.

Part 3, Snyder et al.’s Hope Scale (SHS): Developed by Snyder et al. in 1991, SHS intends to measure the life expectancy of adults over 15 years of age. It is a self-report scale with 12 items on two subscales of agency and pathways. Four items make up the agency subscale, 4 make up the pathways subscale, and 4 are fillers. Each item is answered on a 4-point Likert scale ranging from definitely false (scored 1) to definitely true (scored 4). Accordingly, the overall score can range between 12 and 48 [12, 24]. Many studies support the reliability and validity of this scale as a measure of hope. The internal consistency of the whole test ranges between 0.74 to 0.84, and the test-retest reliability coefficient is reported to be 0.80. The coefficient has been significantly greater in periods longer than 8 to 10 weeks. Internal consistency of the agency subscale ranges between 0.71 and 0.76, while that of the pathways subscale is from 0.63 to 0.80 [25]. In Iran, Kermani et al. have reported the instrument’s reliability using Cronbach’s alpha and test-retest methods as 0.86 and 0.81, respectively [26]. Data were analyzed using SPSS-15 statistical software. First, the normal distribution of data was evaluated using skewness and elongation coefficients. Given the normal distribution of the data, the Pearson correlation coefficient and multiple regression tests were utilized. The level of significance was set at P <0.05.

3. RESULTS

In this study, 100 COVID-19-recovered individuals were studied, most of whom were female (54%) and married (71%). The highest frequency was related to people over 40 years (47%), high school diploma holders (41%), non-healthcare employees (35%), and those with a monthly income of 5-10 million tomans (44%). Sixty percent had received the COVID-19 vaccine, and nearly half (49%) reported that it had been more than three months since they had recovered (Table 1).

Based on the results, the highest mean score from respondents concerned the basic needs level (5.50 ± 4.80), while the lowest average was related to self-actualization needs (1.85 ± 5.65). The overall score for Maslow’s needs amounted to 5.50 ± 4.80, and the mean life expectancy score was 26.21 ± 5.57. Given that the coefficients of skewness and elongation for all research variables were in the range [2], the research data exhibited a normal distribution (Table 2).

According to the Pearson correlation coefficient, life expectancy in the subjects has a significant positive relationship with Maslow’s hierarchy of needs in general (r = 0.53) and the levels of basic needs (r = 0.53), security needs (r = 0.51), social needs (r = 0.48) r), esteem needs (r = 0.46), and self-actualization needs (r = 0.42) (P <0.001). Multiple linear regression was used to examine the effects of Maslow’s hierarchical levels of needs and demographic variables on life expectancy. Moreover, duming coding was employed to integrate qualitative variables (gender, marital status, occupation, education level, monthly income level, COVID-19 vaccination, and recovery time) into the model. In addition, the levels of Maslow’s hierarchy of needs and age were quantitatively incorporated into this model.

The test results showed that life expectancy holds a significantly negative relationship with age (P = 0.04) and gender (P = 0.02). Indeed, life expectancy decreased significantly with age and was significantly higher in women than men. The results also revealed that life expectancy was significantly higher in non-healthcare employees and significantly lower in homemakers, unemployed people, and retirees. However, life expectancy did not exhibit a significant correlation with education level, monthly income level, COVID-19 vaccination, recovery time, and the levels of Maslow’s hierarchy of needs (P> 0.05) (Table 3).

4. DISCUSSION

This study explored the association between the levels of Maslow’s needs hierarchy and life expectancy in persons who recovered from COVID-19. Findings revealed that the maximum mean score of Maslow’s hierarchy of needs was associated with basic needs and the lowest mean was linked to self-actualization needs. Given the absence of a similar study, it is not feasible to compare results.

Regarding this first finding of the research, it should be postulated that COVID-19 has overshadowed all human needs at all levels, affecting social relations and activities that are the ground for the emergence and satisfaction of human needs at different levels. Fulfilling human physiological (basic) needs in the present day is meaningless without participation in society and is entirely dependent on social activities. With its widespread prevalence and forced home quarantines, COVID-19 has indeed curtailed social activities, whereby vast numbers of individuals have lost their occupations, resulting in serious financial troubles for families and disruption of basic needs.

To continue treatment at home, moreover, some patients have had to provide medications and respiratory support devices at a substantially higher cost incurred by increased sanctions and inflation. These constraints have disrupted the families’ budget and made it exceedingly difficult to satisfy their basic needs. The fact that the highest mean score of Maslow’s hierarchy of needs in patients recovered from COVID-19 concerns the level of basic needs implies that these individuals require special attention and comprehensive support to meet the basic needs of themselves and their families.

According to Maslow, human needs follow a hierarchy wherein the most extreme needs shape the behavior of individuals at specific moments. When a person’s basic requirements are met, another set of needs emerges and drives behavior and motivation. Varying needs peak and subside successively until the end of the hierarchy of needs [18-20]. This justifies the first finding of our study regarding the fact that self-actualization needs to gain the lowest mean score on Maslow’s hierarchy of needs in COVID-19-recovered patients. In explaining this finding, it can be pointed out that one’s levels of needs, according to Maslow’s pyramid, are shaped by the most severe needs. When one is involved in basic needs, there would not be the opportunity to move to higher levels of Maslow’s pyramid. Therefore, engagement at the basic needs level is one of the reasons why the lowest mean score concerned the level of self-actualization needs in COVID-19-recovered patients.

Additionally, the current study demonstrates a significant positive link between life expectancy and Maslow’s hierarchy of needs in general and all levels in COVID-19-recovered patients. Life expectancy correlated with the needs levels at varying degrees, and the intensity lowered in the following order: basic needs, security needs, social needs, esteem needs, and self-actualization needs. The current study’s findings indicate that the levels of Maslow’s pyramid have a significant, direct association with the participants’ life expectancy.

Consistent with our findings, Marois et al. demonstrated that the psychological consequences of community health policy implementation might include increased anxiety and stress and decreased life expectancy in the general population, particularly in patients with COVID-19. Additionally, they found that COVID-19 prevalence is inversely connected to life expectancy and that life expectancy declines as COVID-19 prevalence increases [10]. The findings of Doggleby, et al.’s study, also agree with ours. Their study established a relationship between life expectancy and one’s function and position in society, demonstrating that individuals with varying responsibilities, needs, and positions had varying degrees of life expectancy [13].

In this regard, one may argue that the country’s COVID-19 circumstances raised the cost of households impacted by this disease and amplified the unemployment problem during the COVID-19 period. Indeed, many families whose caregivers did not have full-time jobs or worked part-time prior to the outbreak of COVID-19 were compelled to stay at home and were harmed by the socioeconomic difficulties caused by the epidemic. One of COVID-19’s socioeconomic consequences is a rise in community poverty, which threatens individual health [27-29].

In the COVID-19 epidemic, the inability of low-income families with basic needs to pay for treatment is a typical phenomenon. When COVID-19 therapy is prohibitively expensive, this group’s vulnerability to COVID-19 grows due to the lack of comprehensive health insurance coverage in low-income groups, as a result, we will see more problems for families with basic needs. [29, 30]. Based on current research findings, it has been determined that there is a strong correlation between life expectancy and factors related to basic needs (according to Maslow's hierarchy of needs). Therefore, it can be said that people's financial problems during the covid-19 pandemic have led to people being at the level of basic needs and have affected their life expectancy.

CONCLUSION AND RECOMMENDATIONS

Currently, meeting all five levels of Maslow’s pyramid of human needs necessitates one’s presence in society and is contingent on one’s activities, relationships, and social interactions. The COVID-19 pandemic has wrought significant changes in human life, including increased adherence to health standards such as obligatory house isolation and social distancing. However, the coronavirus has entirely eclipsed and impacted all human needs at all levels. It has completely overshadowed the community, social interactions, and social activities that serve as the locus of emergence and fulfillment of basic (physiological) needs. On the other hand, the life of contemporary humankind is inconceivable without her/his presence in society.

Families’ involvement in the COVID-19 crisis at the level of basic needs has resulted in a decline in life expectancy to the point that basic needs provision has become the primary demand of those recuperating from COVID-19. As a result, health policymakers, managers, and other relevant officials are urged to prioritize fulfilling the fundamental needs of COVID-19 patients and their families in order to enhance their life expectancy.

REFERENCES