Functional Fear Predicts Public Health Compliance in the COVID-19 Pandemic

Hygiene and social distancing as distinct public health related behaviours among university students during the COVID-19 pandemic

Prevailing research on individuals’ compliance with public health related behaviours during the COVID-19 pandemic tends to study composite measures of multiple types of behaviours, without distinguishing between different types of behaviours. However, measures taken by governments involve adjustments concerning a range of different daily behaviours. In this study, we seek to explain students’ public health related compliance behaviours during the COVID-19 pandemic by examining the underlying components of such behaviours. Subsequently, we investigate how these components relate to individual attitudes towards public health measures, descriptive norms among friends and family, and key demographics. We surveyed 7,403 university students in ten countries regarding these behaviours. Principal Components Analysis reveals that compliance related to hygiene (hand washing, coughing behaviours) is uniformly distinct from compliance related to social distancing behaviours. Regression analyses predicting Social Distancing and Hygiene lead to differences in explained variance and type of predictors. Our study shows that treating public health compliance as a sole construct obfuscates the dimensionality of compliance behaviours, which risks poorer prediction of individuals’ compliance behaviours and problems in generating valid public health recommendations. Affecting these distinct behaviours may require different types of interventions.

Psychosocial variables and quality of life during the COVID-19 lockdown: a correlational study on a convenience sample of young Italians

BACKGROUND

In 2020, to limit the spread of Coronavirus (COVID-19), many countries, including Italy, have issued a lengthy quarantine period for the entire population. For this reason lifestyle has changed, bringing inevitable repercussions to the Quality of Life (QoL). The present study aims to identify which psychosocial variables predict behaviors capable of affecting the QoL during the lockdown period, potentially highlighting factors that might promote well-being and health in the Italian population during the epidemic.

METHODS

Between 27 April 2020 and 11 May 2020, we administered a web-survey to a sample of young Italian people (age M = 21.2; SD = 3.5; female = 57.7% of the sample). Employing variance-based structural equation modeling, we attempted to identify whether social connectedness, social support, and loneliness were variables predictive of the QoL of young Italians. We also sought to identify specific psychological factors, such as symbolic threat, realistic threat, and the threat from potentially contaminated objects, was correlated to COVID-19 fear and whether engaging in particular behaviors was likely to improve the QoL.

RESULTS

Our results suggest that social connectedness and loneliness are significant predictors of QoL, while social support did not have a significant effect on QoL. Furthermore, we observed that symbolic and realistic threats and the threat from potentially contaminated objects are significant and positive predictors of COVID-19 fear. Moreover, COVID-19 fear had significant and positive relationships with the carrying out of specific behaviors, such as creative activities during the isolation period and that this related to affirming individuals' country-specific identity. Finally, COVID-19 fear is a significant predictor of behavioral factors related to the adherence to public health advice in line with national guidance regarding the containment of COVID-19; this factor, however, did not correlate with QoL.

CONCLUSION

Our results suggest the importance of social context and psychological factors to help devise intervention strategies to improve the QoL during lockdown from epidemic events and, in particular, support the importance of promoting social communication and accurate information about the transmission of the virus.

Prevention for oneself or others? Psychological and social factors that explain social distancing during the COVID-19 pandemic

Identifying the underlying psychological and social factors of social distancing is crucial to foster preventive behavior during a pandemic effectively. We investigated the relative contribution of self-focused factors (fear of infection, fear of punishment) and other-focused factors (moral judgment, moral identity, empathy for unspecific others, empathy for loved ones) in an online study in Germany (N = 246) while COVID-19 was climaxing. Importantly, other-oriented factors were related to social distancing behavior beyond self-oriented factors. Moral judgment and empathy for loved ones remained the dominant factors while controlling for all aspects. These findings underline the relevance of interpersonal considerations when engaging in preventive behavior.

Resilience, Hope, and Subjective Happiness Among the Turkish Population: Fear of COVID-19 as a Mediator

Psychology deals with not only mental disorders but also psychological strengths within individuals. Psychological strengths will play an important role in struggling with the global novel coronavirus 2019 (COVID-19) pandemic. The present study tested a model concerning the relationship between resilience, hope, and subjective happiness using structural equation modeling to identify the mediating role of fear of COVID-19. A cross-sectional survey was conducted among a convenience sample of 971 Turkish individuals (aged 18 to 74 years) from 75 of 81 cities in Turkey. The survey included the Subjective Happiness Scale, Fear of COVID-19 Scale, Brief Resilience Scale, and the Dispositional Hope Scale, and data were analyzed using structural equation modeling (SEM). The SEM demonstrated an association between resilience-hope and subjective happiness was mediated by fear of COVID-19 (CMIN/df = 2.664, CFI = 0.994, NFI = 0.984, TLI = 0.984, GFI = 0.994, RMSEA = 0.044, SRMR = 0.024, AIC = 81.334, ECVI = 0.084). Resilience had a direct effect and an indirect effect on subjective happiness via fear of COVID-19. Hope also had a direct effect and an indirect effect on subjective happiness via fear of COVID-19. Consequently, in the fight against COVID-19, individuals who are resistant to stress and have a belief that they can find a way to cope can help prevent the fear of COVID-19 and so enhance good mental health.

Hand Hygiene Behaviors in a Representative Sample of Polish Adolescents in Regions Stratified by COVID-19 Morbidity and by Confounding Variables (PLACE-19 Study): Is There Any Association?

The hand hygiene may possibly influence the course of the COVID-19 pandemic, but the multifactorial influence on hand hygiene knowledge and behaviors is proven. The aim of the study was to analyze hand hygiene behaviors in a national representative sample of Polish adolescents in regions stratified by COVID-19 morbidity, while taking socioeconomic status of the region, as well rural or urban environment, into account as possible interfering factors. The study was conducted Polish Adolescents’ COVID-19 Experience (PLACE-19) Study population (n = 2323) that was recruited based on a random sampling of schools, while the pair-matching procedure was applied within schools and age, in order to obtain adequate number of boys and girls, representative for the general Polish population (n = 1222). The participants were asked about their handwashing habits while using Handwashing Habits Questionnaire (HHQ) and about applied procedure of washing hands. The results were compared in subgroups that were stratified by region for COVID-19 morbidity, socioeconomic status of the region, and rural/urban environment. In regions of low COVID-19 morbidity, a higher share of adolescents, than in regions of high morbidity, declared washing their hands before meals (p = 0.0196), after meals (p = 0.0041), after preparing meals (p = 0.0297), before using the restroom (p = 0.0068), after using the restroom (p = 0.0014), after combing their hair (p = 0.0298), after handshaking (p = 0.0373), after touching animals (p = 0.0007), after contacting babies (p = 0.0278), after blowing nose (p = 0.0435), after touching sick people (p = 0.0351), and after cleaning home (p = 0.0234). For the assessed steps of the handwashing procedure, in regions of low COVID-19 morbidity, a higher share of adolescents included them to their daily handwashing, than in regions of high morbidity, that was stated for removing watch and bracelets (p = 0.0052), removing rings (p = 0.0318), and drying hands with towel (p = 0.0031). For the comparison in regions stratified by Gross Domestic Product, the differences were only minor and inconsistent. For the comparison in place of residence stratified by number of residents in city, there were some minor differences indicating better hand hygiene behaviors in the case of villages and small towns when compared with medium and large cities (p < 0.05). It may be concluded that, in a population-based sample of Polish adolescents, individuals from regions of low COVID-19 morbidity presented more beneficial hand hygiene habits than those from regions of high COVID-19 morbidity.

The Impact of the COVID-19 Pandemic on Ophthalmic Care at an Eye-Specific Emergency Department in an Outbreak Hotspot

PURPOSE

During the COVID-19 pandemic, there is growing concern that patients are forgoing necessary care. Emergency departments (ED) represent an important site of eye care. We analyzed patterns of ED visits at an eye-specific ED since the declaration of the public health crisis.

MATERIALS AND METHODS

In this retrospective, cross-sectional single center study, medical records of 6744 patients who presented to the Massachusetts Eye and Ear ED between March 1st and April 30th in 2018, 2019, and 2020 were studied. The primary outcome measures were total volume of ED visits, proportion of urgent ED visits, and proportion of surgical visits.

RESULTS

Overall, the median number of daily visits to the ED decreased by 18 visits per day since the declaration of public health guidelines (interquartile range, 9-24, p < 0.001). This accounted for a 32% decrease in the total volume of ED visits in 2020 compared to prior years during the study period (p < 0.001). There was a 9% increase in the proportion of primary diagnoses considered urgent (p = 0.002). The proportion of visits requiring urgent surgery increased by 39% (p = 0.004).

CONCLUSION

The total number of eye-specific ED visits dropped compared to prior years while the proportion of urgent visits increased. Patients were likely more reluctant to seek eye care, deferring less urgent evaluation.

Factors related to preventive COVID-19 infection behaviors among people with mental illness

BACKGROUND/PURPOSE

Because of the spread of novel coronavirus disease 2019 (COVID-2019), preventive COVID-19 infection behaviors become important for individuals, especially those who are vulnerable. The present study proposes a model to explain the preventive COVID-19 infection behaviors among people with mental illness in Taiwan.

METHODS

A cross-sectional design was carried out and 414 patients with mental illness (230 males [55.6%]; mean age = 46.32 [SD = 10.86]) agreed to participate in the study. All the participants completed the Preventive COVID-19 Infection Behaviors Scale, Self-Stigma Scale-Short, Believing COVID-19 Information Scale, Fear of COVID-19 Scale, and Depression Anxiety Stress Scale-21. Regression models and structural equation modeling (SEM) were applied to examine the factors associated with preventive COVID-19 infection behaviors.

RESULTS

Both regression models and SEM showed that trust in COVID-19 information sources (standardized coefficient [β] = 0.211 in regression; β = 0.194 in SEM) and fear of COVID-19 (β = -0.128 in regression; β = -0.223 in SEM) significantly explained preventive behaviors among individuals with mental illness. The SEM further showed that fear of COVID-19 was significantly explained by trust in COVID-19 information sources (β = 0.220) and self-stigma (β = 0.454).

CONCLUSION

Based on the results, healthcare providers should help individuals with mental illness reduce self-stigma and fear of COVID-19 which would consequently improve their preventive COVID-19 infection behaviors. Moreover, improving trust in COVID-19 information sources for individuals with mental illness may be another method to improve their preventive behaviors.

COVID-19 and Parent Intention to Vaccinate Their Children Against Influenza

OBJECTIVES

Evaluate if the coronavirus disease 2019 (COVID-19) pandemic influences parents' intentions to have their children receive the 2020-2021 seasonal influenza vaccination.

METHODS

In May 2020, we recruited 2164 US parents and guardians of children ages 6 months to 5 years to complete a brief online survey that examined parental behavior and decision-making in response to experimental stimuli and real-world events. We estimated a multivariate multinomial logistic regression (controlling for key demographics) to assess the relationship between a child's 2019-2020 influenza vaccination status and the COVID-19 pandemic's influence on a parent's intentions for their child's 2020-2021 influenza vaccination.

RESULTS

Changes in vaccination intentions significantly differed between parents whose children received the 2019-2020 influenza vaccine compared with those whose children did not (P < .001). Specifically, among parents whose children did not receive the 2019-2020 vaccine, 34% (95% confidence interval [CI]: 30%-37%) reported that the COVID-19 pandemic made them less likely to have their child receive the 2020-2021 vaccine. Among those whose children did receive the 2019-2020 vaccine, this figure was just 24% (95% CI: 22%-27%). Conversely, only 21% (95% CI: 18%-24%) of parents whose children did not receive the 2019-2020 vaccine reported that the COVID-19 pandemic made them more likely to have their child receive the 2020-2021 vaccine, compared with 39% (95% CI: 36%-41%) of parents whose children did receive the 2019-2020 vaccine.

CONCLUSIONS

The COVID-19 pandemic alone does not appear sufficient to encourage the uptake of pediatric seasonal influenza vaccination. Instead, the COVID-19 pandemic may exacerbate polarity in vaccination uptake.

The Relationship Between Demographic, Socioeconomic, and Health-Related Parameters and the Impact of COVID-19 on 24 Regions in India: Exploratory Cross-Sectional Study

BACKGROUND

The impact of the COVID-19 pandemic has varied widely across nations and even in different regions of the same nation. Some of this variability may be due to the interplay of pre-existing demographic, socioeconomic, and health-related factors in a given population.

OBJECTIVE

The aim of this study was to examine the statistical associations between the statewise prevalence, mortality rate, and case fatality rate of COVID-19 in 24 regions in India (23 states and Delhi), as well as key demographic, socioeconomic, and health-related indices.

METHODS

Data on disease prevalence, crude mortality, and case fatality were obtained from statistics provided by the Government of India for 24 regions, as of June 30, 2020. The relationship between these parameters and the demographic, socioeconomic, and health-related indices of the regions under study was examined using both bivariate and multivariate analyses.

RESULTS

COVID-19 prevalence was negatively associated with male-to-female sex ratio (defined as the number of females per 1000 male population) and positively associated with the presence of an international airport in a particular state. The crude mortality rate for COVID-19 was negatively associated with sex ratio and the statewise burden of diarrheal disease, and positively associated with the statewise burden of ischemic heart disease. Multivariate analyses demonstrated that the COVID-19 crude mortality rate was significantly and negatively associated with sex ratio.

CONCLUSIONS

These results suggest that the transmission and impact of COVID-19 in a given population may be influenced by a number of variables, with demographic factors showing the most consistent association.

Behavioral Immune System Responses to Coronavirus: A Reinforcement Sensitivity Theory Explanation of Conformity, Warmth Toward Others and Attitudes Toward Lockdown

Behavioral immune system (BIS) describes psychological mechanisms that detect cues to infectious pathogens in the immediate environment, trigger disease-relevant responses and facilitate behavioral avoidance/escape. BIS activation elicits a perceived vulnerability to disease (PVD) which can result in conformity with social norms. However, a response to superficial cues can result in aversive responses to people that pose no actual threat, leading to an aversion to unfamiliar others, and likelihood of prejudice. Pathogen-neutralizing behaviors, therefore, have implications for social interaction as well as illness behaviors and responses to health communications. In this study, we investigate how PVD influences conformity, attitudes to other people and to lockdown regulations through the lens of the Reinforcement Sensitivity Theory (RST). RST describes personality in terms of biologically-driven approach and avoidance motivations which support personal goals. Participants from the United Kingdom public (N = 605) completed an RST personality questionnaire and then read either (a) coronavirus morbidity-mortality statistics and current United Kingdom government lifestyle regulations, (b) just the regulations (as presented in most government publicity materials), or (c) no information at all. They all completed the Perceived Vulnerability to Disease scale to assess BIS-relevant Germ Aversion and Perceived Infectability, followed by questions measuring social conformity, warmth toward others and attitudes toward lockdown measures. Significantly lower PVD scores were observed in the no-information condition, with the other conditions showing no difference. In terms of RST, approach behaviors related to goal-drive persistence work alongside fear in explaining conformity to social norms. Reward related approach behaviors partially explained warmth toward others, indicating that social rewards gained through interaction continue to be strong drivers of behavior. We found no role for RST traits in attitudes toward lockdown. Overall, coronavirus-related behavior is not driven purely by fear, but also by social and/or protection goals regulated by approach motivation. This study presents new insights into public perceptions of coronavirus and government regulated lifestyle restrictions, helping to explain social behaviors in terms of biologically driven mechanisms. Such understanding is vital if we are to successfully motivate public behavior to constrain spread of the virus.

A person-centered approach in studying coronavirus pandemic response: The role of HEXACO-PI-R and PANAS dimensions

The main aim of this study was to explore reactions to the COVID-19 pandemic and their relationship with personality traits using a person-centered approach. Sample of 471 Serbian citizens was collected during the first 7 weeks of the pandemic. Cluster analysis revealed three clusters based on reactions to the pandemic: Adapted, Antagonized, and Passive. Adaptive type is characterized by stable emotional reactions and adherence to behavioral guidelines. Antagonized cluster is characterized by lowered adherence to behavioral guidelines, while Passive cluster is characterized by increased fear and boredom. Clusters differed significantly on HEXACO and PANAS traits. Similarity of obtained clusters with prototypes that commonly emerge using personality traits for classification, stresses the importance of basic individual differences in pandemic-induced behavior.

Adaptation and Validation of the Brazilian Version of the Fear of COVID-19 Scale

The pandemic caused by COVID-19 has generated psychological impacts, such as fear of this disease. The authors developed the Fear of COVID-19 Scale (FCV-19S), which aims to assess the fear of COVID-19 in the general population. Adapt and validate the FCV-19S for the Portuguese language in the Brazilian context. Four main initial steps were performed: translation, back-translation, semantic validation, and experimental application. Snowball sampling corresponded to 354 Brazilian participants. Psychometric tests were performed to investigate the validity and reliability of the test, such as confirmatory factor analysis (CFA). Analysis of the data showed satisfactory internal consistency (α = 0.88), and CFA (factor loads from 0.57 to 0.86) confirmed the unidimensional structure. The Brazilian version of FCV-19S is considered valid, reliable, and appropriate for application among the general Brazilian population and may contribute to the prevention, treatments, and mental health programs, resulting from the pandemic of COVID-19.

COVID-19 Related Knowledge and Mental Health: Case of Croatia

Background and Aims: The COVID-19 pandemic has led to radical and unexpected changes in everyday life, and it is plausible that people's psychophysical health has been affected. This study examined the relationship between COVID-19 related knowledge and mental health in a Croatian sample of participants.

METHODS

An online survey was conducted from March 18 until March 23, 2020, and a total of 1244 participant responses were collected (85.5% were women and 58.4% completed secondary education). Measures included eight questions regarding biological features of the virus, symptoms, and prevention, the Hospital Anxiety and Depression Scale, and Optimism-Pessimism Scale. According to the answers given on the questions on COVID-19 related knowledge, participants were divided in two groups: (1) informed and (2) uninformed on each question. They were then compared in the expressed levels of anxiety, depression, pessimism, and optimism. Full vs. partial mediation models with optimism/pessimism as a mediator in the relationship between anxiety/depression and the accuracy of responses for questions about handwashing and ways of transmission were estimated.

RESULTS

Participants who responded correctly on the question about handwashing had higher levels of anxiety, depression, and pessimism than those participants whose answer was incorrect, while participants who answered correctly on the question about the percentage of patients who develop serious breathing problems had higher levels of depression than those who answered incorrectly. Lower levels of anxiety and pessimism were observed in the participants who answered correctly about ways of transmission. Higher levels of pessimism were found in participants who scored incorrectly on questions about the efficiency of antibiotics, most common symptoms, and the possibility of being infected by asymptomatic carriers. Higher levels of knowledge about handwashing were predicted by higher levels of anxiety and pessimism. Higher levels of knowledge about ways of transmission were predicted by lower levels of anxiety and lower levels of pessimism. The examined relationships between anxiety/depression and knowledge were mediated by pessimism.

CONCLUSION

The findings of this study suggest that knowledge about COVID-19 may be useful to reduce anxiety and depression, but it must be directed to the promotion of health behaviors and to the recognition of fake news.

The impacts of knowledge, risk perception, emotion and information on citizens' protective behaviors during the outbreak of COVID-19: a cross-sectional study in China

BACKGROUND

Individual protective behaviors play an important role in the control of the spread of infectious diseases. This study aimed to investigate the adoption of protective behaviors by Chinese citizens amid the COVID-19 outbreak and its associated factors.

METHODS

An online cross-sectional survey was conducted from 22 January to 14 February 2020 through Wenjuanxing platform, measuring their knowledge, risk perception, negative emotion, response to official communication, and protective behaviors in relation to COVID-19. A total of 3008 people completed the questionnaire, of which 2845 were valid questionnaires.

RESULTS

On average, 71% of respondents embraced protective behaviors. Those who made no error in the knowledge test (AOR = 1.77, p < 0.001) perceived the high severity of the epidemic (AOR = 1.90, p < 0.001), had high negative emotion (AOR = 1.36, p = 0.005), reported good health (AOR = 1.94, p < 0.001), paid high attention to the governmental media (AOR = 4.16, p < 0.001) and trusted the governmental media (AOR = 1.97, p < 0.001) were more likely to embrace protective behaviors after adjustments for variations in potential confounding factors. Women and older people were also more likely to embrace protective behaviors. No regional or educational differences were found in the adoption of protective behaviors.

CONCLUSION

The majority of Chinese citizens embraced protective behaviors. Higher levels of protective behaviors are associated with higher knowledge, perceived severity, negative emotion, and attention to and trust in the official governmental media. Official governmental communication is the largest single predictor of protective behaviors.

Changing health compliance through message repetition based on the extended parallel process model in the COVID-19 pandemic

When people are confronted with health proposals during the coronavirus disease 2019 (COVID-19) pandemic, it has been suggested that fear of COVID-19 can serve protective functions and ensure public health compliance. However, health proposal repetition and its perceived efficacy also influence the behavior intention toward the proposal, which has not yet been confirmed in the COVID-19 context. The present study aims to examine whether the extended parallel process model (EPPM) can be generalized to a naturalistic context like the COVID-19 pandemic. Additionally, we will explore how repetition of a health proposal is involved with the EPPM. In this study, two groups of participants are exposed to the same health proposal related to COVID-19, where one group is exposed once and another group twice. They then fill out a questionnaire consisting of items concerning behavior intention and adapted from the Risk Behavior Diagnosis Scale. Structural equation modeling will be used to determine the multivariate associations between the variables. We predict that repetition of the health proposal will associate with response efficacy (i.e., a belief about the effectiveness of the health proposal in deterring the threat) and perceived susceptibility (i.e., a belief about the risk of experiencing the threat). It is also predicted that following the EPPM, behavior intention will associate with both perceived efficacy of the health proposal, which will underlie response efficacy, and perceived threat of COVID-19, which will underlie perceived susceptibility. We will discuss the process, based on the model, where health message repetition affects behavior intention during the COVID-19 pandemic.

How fear and collectivism influence public's preventive intention towards COVID-19 infection: a study based on big data from the social media

BACKGROUND

Despite worldwide calls for precautionary measures to combat COVID-19, the public's preventive intention still varies significantly among different regions. Exploring the influencing factors of the public's preventive intention is very important to curtail the spread of COVID-19. Previous studies have found that fear can effectively improve the public's preventive intention, but they ignore the impact of differences in cultural values. The present study examines the combined effect of fear and collectivism on the public's preventive intention towards COVID-19 through the analysis of social media big data.

METHODS

The Sina microblog posts of 108,914 active users from Chinese mainland 31 provinces were downloaded. The data was retrieved from January 11 to February 21, 2020. Afterwards, we conducted a province-level analysis of the contents of downloaded posts. Three lexicons were applied to automatically recognise the scores of fear, collectivism, and preventive intention of 31 provinces. After that, a multiple regression model was established to examine the combined effect of fear and collectivism on the public's preventive intention towards COVID-19. The simple slope test and the Johnson-Neyman technique were used to test the interaction of fear and collectivism on preventive intention.

RESULTS

The study reveals that: (a) both fear and collectivism can positively predict people's preventive intention and (b) there is an interaction of fear and collectivism on people's preventive intention, where fear and collectivism reduce each other's positive influence on people's preventive intention.

CONCLUSION

The promotion of fear on people's preventive intention may be limited and conditional, and values of collectivism can well compensate for the promotion of fear on preventive intention. These results provide scientific inspiration on how to enhance the public's preventive intention towards COVID-19 effectively.

Perceived Risk and Mental Health Problems among Healthcare Professionals during COVID-19 Pandemic: Exploring the Mediating Effects of Resilience and Coronavirus Fear

During coronavirus (COVID-19) pandemic, healthcare professionals were particularly at high-risk of developing symptoms of mental health problems due to being on the frontline in the battle against COVID-19. This study examined the mediating roles of resilience and coronavirus fear in the relationship between perceived risk and mental health problems among healthcare professionals including doctors and nurses who were actively treating patients confirmed with COVID-19. We recruited 204 healthcare professionals (50% females) with a mean age of 32.92 years (SD = 7.01). Results showed that perceived risk and coronavirus fear positively predicted depression, anxiety, and stress while resilience negatively predicted those mental health problems. Coronavirus fear mediated the relationship between perceived risk and resilience, depression, anxiety, and stress. Additionally, resilience mitigated the effect of coronavirus fear on depression, anxiety, and stress. This study is among the first indicating the importance of resilience and fear as a critical mechanism that explains the relationship between perceived risk and mental health problems among health professionals directly caring for COVID-19 patients.

How fear and collectivism influence public's preventive intention towards COVID-19 infection: a study based on big data from the social media

BACKGROUND

Despite worldwide calls for precautionary measures to combat COVID-19, the public's preventive intention still varies significantly among different regions. Exploring the influencing factors of the public's preventive intention is very important to curtail the spread of COVID-19. Previous studies have found that fear can effectively improve the public's preventive intention, but they ignore the impact of differences in cultural values. The present study examines the combined effect of fear and collectivism on the public's preventive intention towards COVID-19 through the analysis of social media big data.

METHODS

The Sina microblog posts of 108,914 active users from Chinese mainland 31 provinces were downloaded. The data was retrieved from January 11 to February 21, 2020. Afterwards, we conducted a province-level analysis of the contents of downloaded posts. Three lexicons were applied to automatically recognise the scores of fear, collectivism, and preventive intention of 31 provinces. After that, a multiple regression model was established to examine the combined effect of fear and collectivism on the public's preventive intention towards COVID-19. The simple slope test and the Johnson-Neyman technique were used to test the interaction of fear and collectivism on preventive intention.

RESULTS

The study reveals that: (a) both fear and collectivism can positively predict people's preventive intention and (b) there is an interaction of fear and collectivism on people's preventive intention, where fear and collectivism reduce each other's positive influence on people's preventive intention.

CONCLUSION

The promotion of fear on people's preventive intention may be limited and conditional, and values of collectivism can well compensate for the promotion of fear on preventive intention. These results provide scientific inspiration on how to enhance the public's preventive intention towards COVID-19 effectively.

COVID-19: A review of the effectiveness of non-pharmacological interventions

COVID-19, a highly infectious disease, caused by a novel virus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has brought about an unprecedented threat to global health. First reported in Wuhan, China, in December 2019, it has now spread to all continents of the world becoming a pandemic. There is no known treatment or vaccine for it although many candidate drugs and vaccines are in various clinical trial phases. For now, non-pharmacological interventions (NPIs) have become the mainstay of response for COVID-19 and are being used across the world to flatten the epidemiologic curve with some success. This review focussed on identifying which NPIs have been effective. NPIs that are effective include isolation and quarantine, physical distancing, use of face masks and hand hygiene. These measures are best used in combination and simultaneously. The evidence is that they should be instituted early in the pandemic and for sustained periods. They should also be implemented in the context of the cultural and socioeconomic conditions of the populace. Ineffective NPIs include ultraviolet irradiation and spraying of outdoor spaces and individuals. We recommend that decision makers weigh the evidence carefully, as it applies to the local setting to inform public health decisions.

Mental Health Screening for COVID-19: a Proposed Cutoff Score for the Greek Version of the Fear of COVID-19 Scale (FCV-19S)

The COVID-19 pandemic elicited fear. The Fear of COVID-19 Scale (FCV-19S) is a newly developed self-reported measure, originally developed in Persian to assess COVID-19-related fear. To date, the scale has been translated and validated in 19 other languages, among which Greek. This study, conducted through an online survey, aimed to further explore the validity of the Greek FCV-19S version, as well as to identify appropriate cutoff scores. A total of 538 respondents completed the sociodemographic data sheet, the Generalized Anxiety Disorder 7-item scale, the Short Health Anxiety Inventory, and the Posttraumatic Stress Disorder-8 inventory. According to the results, a cutoff point score of 16.5 or higher revealed a significant predictive power for anxiety, health anxiety, and posttraumatic stress symptoms. Altogether, although the cutoff scores of the Greek FCV-19S version were explored to further evaluate the scale's validity, they may facilitate discrimination of adults with extreme COVID-19-related fear from those with normal fear reactions.

The Anxiety-Buffer Hypothesis in the Time of COVID-19: When Self-Esteem Protects From the Impact of Loneliness and Fear on Anxiety and Depression

INTRODUCTION

The coronavirus (COVID-19) disease has spread worldwide, generating intense fear of infection and death that may lead to enduring anxiety. At the same time, quarantine and physical isolation can intensify feelings of dispositional loneliness that, by focusing on thoughts of disconnection from others, can trigger intense anxiety. Anxiety, generated by both fear of COVID-19 and dispositional loneliness, can activate negative expectations and thoughts of death, potentially generating alarming depressive symptoms. However, the anxiety-buffer hypothesis suggests that self-esteem acts as a shield (buffer) against mental health threats - fear and loneliness - thus hampering anxiety and depressive symptoms.

OBJECTIVE

This study aims to test the process - triggered by COVID-19 fear and loneliness - in which self-esteem should buffer the path leading to anxiety symptoms, then to depression.

METHODS

An observational research design with structural equation models was used. A sample of 1200 participants enrolled from the general population answered an online survey comprising: the fear of COVID-19 scale, the UCLA loneliness scale, the Rosenberg self-esteem scale, and the anxiety and depression scales of the Symptom Checklist-90-Revised.

RESULTS

Structural equation models showed the link between anxiety symptoms (mediator) with both the fear of COVID-19 and dispositional loneliness (predictors), as well as its association with consequent depressive symptomatology (outcome). In line with the anxiety-buffer hypothesis, self-esteem mediated the relationship between the predictors and their adverse psychological consequences.

CONCLUSION

Self-esteem represents a protective factor from the antecedents of depression. Targeted psychological interventions should be implemented to minimize the psychological burden of the disease whilst promoting adaptation and positive psychological health outcomes.

Emotion Network Analysis During COVID-19 Quarantine - A Longitudinal Study

Introduction: The coronavirus disease 2019 (COVID-19) emergency has imposed important challenges in the lives of individuals, particularly since the restriction of free movement. In Spain, this mandatory home confinement started on March 14, 2020. In this scenario, some calls have been made to better understand the exact impact of the quarantine on the emotional status of individuals across time. Materials and Methods: On the first day that the Spanish government imposed the quarantine, our team launched an online longitudinal study to monitor emotional responses to the COVID-19 emergency over time. For 2 weeks, 187 people have responded to a daily diary on emotion functioning. An emotion network analysis was performed to study the network structure of 30 mood states and its changes during the first 2 weeks of the quarantine. Results: The emotional network showed critical changes in the interactions of emotions over time. An analysis of mean emotional levels did not show statistically significant changes in mood over time. Interestingly, two different network patterns were found when the sample was divided between those with favorable responses and those with unfavorable responses. Discussion: This new approach to the study of longitudinal changes of the mood state network of the population reveals different adaptation strategies reflected on the sample's emotional network. This network approach can help identify most fragile individuals (more vulnerable to external stressors) before they develop clear and identifiable psychopathology and also help identify anti-fragile individuals (those who improve their functioning in the face of external stressors). This is one of the first studies to apply an emotional network approach to study the psychological effects of pandemics and might offer some clues to psychologists and health administrators to help people cope with and adjust to this critical situation.

On the Nature of Fear and Anxiety Triggered by COVID-19

Emergencies that occur during natural disasters, such as avalanches, earthquakes, and floods, tend to be sudden, unexpected, and ephemeral and recruit defensive responses, similar to the ones recruited when faced with dangerous animals. Defensive behaviors are triggered by activity in survival circuits that detects imminent threats and fear is the conscious emotion of that follows immediately. But this particular threat (COVID-19) is useable and mysterious, triggering anxieties much more than fear. We conducted a literature search on May 1, 2020 in Google Scholar, PsychInfo, and PubMed with search terms related to COVID-19 fears and found 28 relevant articles. We categorized the papers into six groups based on the content and implications: fear of the unknown, social isolation, hypochondriasis, disgust, information-driven fears, and compliance. Considering the nature of fear and anxiety, combined with the characteristics of the present COVID-19 situation, we contemplate that physicians and other health care workers of several specialties, as well as police officers, fire-fighters, and rescue personnel, and first responders might be more able to deal with COVID-19 if they have (a) some tolerance of the unknown, (b) low illness anxiety disorder, (c) tolerance to social isolation; (d) low levels of disgust sensitivity; (e) be granted financial support, (f) have priority if needed medical assistance (g) use caution relatively to the COVID-19 media coverage and (h) be trained to have high levels of efficacy. Possibilities for preventive and therapeutic interventions that can help both health care personnel and the general population are also discussed.

The Japanese version of the Fear of COVID-19 scale: Reliability, validity, and relation to coping behavior

COVID-19 is spreading worldwide, causing various social problems. The aim of the present study was to verify the reliability and validity of the Japanese version of the Fear of COVID-19 Scale (FCV-19S) and to ascertain FCV-19S effects on assessment of Japanese people's coping behavior. After back-translation of the scale, 450 Japanese participants were recruited from a crowdsourcing platform. These participants responded to the Japanese FCV-19S, the Japanese versions of the Hospital Anxiety and Depression scale (HADS) and the Japanese versions of the Perceived Vulnerability to Disease (PVD), which assesses coping behaviors such as stockpiling and health monitoring, reasons for coping behaviors, and socio-demographic variables. Results indicated the factor structure of the Japanese FCV-19S as including seven items and one factor that were equivalent to those of the original FCV-19S. The scale showed adequate internal reliability (α = .87; ω = .92) and concurrent validity, as indicated by significantly positive correlations with the Hospital Anxiety and Depression Scale (HADS; anxiety, r = .56; depression, r = .29) and Perceived Vulnerability to Disease (PVD; perceived infectability, r = .32; germ aversion, r = .29). Additionally, the FCV-19S not only directly increased all coping behaviors (β = .21 - .36); it also indirectly increased stockpiling through conformity reason (indirect effect, β = .04; total effect, β = .31). These results suggest that the Japanese FCV-19S psychometric scale has equal reliability and validity to those of the original FCV-19S. These findings will contribute further to the investigation of various difficulties arising from fear about COVID-19 in Japan.

Mental Well-Being During Pandemic: The Role of Cognitive Biases and Emotion Regulation Strategies in Risk Perception and Affective Response to COVID-19

Both cognitive appraisals of risks associated with the specific disease and affective response to crisis situations have been shown to shape an individual response to pandemics. COVID-19 pandemic and measures introduced to contain it present an unparalleled challenge to mental well-being worldwide. Here, we examine the relationship between self-reported cognitive biases (CB) and emotion regulation skills (ER), COVID-19 risk perception and affective response, and mental well-being (MWB). Five Hundred and Eleven individuals completed General Health Questionnaire, Emotion Regulation Questionnaire, Davos Assessment of Cognitive Biases Scale (DACOBS) as well as scales measuring COVID-19 risk perception and affective response during the initial days of the epidemic in Poland. We used path and bootstrapping analyses to examine the hypothesis that CB may shape MWB during COVID-19 pandemic both directly and indirectly by (i) decreasing ER capacity and (ii) by increasing COVID-19 risk perception and affective response. Negative effect of CB and positive effect of ER via cognitive reappraisal on MWB were observed in participants. Furthermore, in line with our hypothesis, we observed indirect effects of CB via increased COVID-19 risk perception and affective response and decreased use of reappraisal strategy, which all, in turn, were related to MWB. Finally, we found an indirect effect of CB on MWB through double mediation of suppression strategies and COVID-19 affective response. Results of the current study suggest that CB, which have been shown to be linked to a variety of mental health symptoms in non-clinical populations, may exacerbate the impact of the COVID-19 pandemic on mental health outcomes.

"#I-Am-Engaged": Conceptualization and First Implementation of a Multi-Actor Participatory, Co-designed Social Media Campaign to Raise Italians Citizens' Engagement in Preventing the Spread of COVID-19 Virus

The COVID-19 pandemic forced health authorities around the world to introduce public health measures to contain the risks of contagion. This greatly impacted on citizens' quality of life, often raising concerns and reactance. There is an ongoing urgent need to promote and sustain behavioral changes and adherence to preventive measures. Based on the theoretical framework of the Patient Health Engagement Model and a participatory co-design process, a social media campaign aimed at improving citizens' health engagement toward behavioral change for preventing the spread of COVID-19 was promoted in Italy in the early months of the pandemic. In this paper, we describe the methodological process adopted to develop the campaign, its characteristics, and the first results-in terms of audience reach and engagement in its early implementation. The discussion of this grounded-up and citizen-centered approach to social campaign development highlights key ways of promoting learning, engaging citizens, and supporting their participation in the co-production of educational interventions for behavioral change toward preventive actions.

Increased Levels of Anxiety Among Medical and Non-Medical University Students During the COVID-19 Pandemic in the United Arab Emirates

Introduction

The COVID-19 pandemic is likely to increase anxiety levels within the community and in particular medical students who are already considered psychologically vulnerable groups. Since the COVID-19 outbreak, no study has yet estimated the effect of this pandemic on university students in the UAE or its impact on the psychological well-being of medical students.

Methods and Materials

We surveyed 1485 medical (comprising medical and dental) and non-medical university students across 4 emirates within the UAE. We used an online platform to assess knowledge, sources of information, changes in hygienic behavior, perceptions of fear and worry and anxiety levels using the generalized anxiety disorder 7 (GAD-7) scale. The GAD-7 score was measured at three time points: during hospital visits for medical/dental students, before the introduction of online learning and after online learning for all students.

Results

The majority of students demonstrated high levels of knowledge and utilized reliable sources of information. Non-medical students exercised higher compliance with social restrictions, while medical students practiced better hand hygiene. Almost half of students reported anxiety levels ranging from mild to severe with females reporting higher anxiety scores during hospital visits (OR=2.02, 95% CI, 1.41 to 2.91) and medical students reporting lower anxiety levels in comparison to dental students (OR=0.61, 95% CI, 0.45 to 0.84). Medical students reported higher levels of anxiety during their clinical rotations which decreased with the introduction of online learning, yet, non-medical students’ anxiety levels increased with online learning.

Conclusion

This study provides important information on the initial response and anxiety levels in university students across the UAE during the COVID-19 pandemic. The findings from our study can be used to support the development of effective screening strategies and interventions to build psychological resilience among university students during the COVID-19 pandemic or any other public health emergencies in the future.

The fear of COVID-19 scale: Validation in spanish university students

The emergence of the COVID-19 and its consequences has led to fears, worries, and anxiety among individuals worldwide. Recently, Ahorsu et al. (2020) developed the Fear of COVID-19 Scale (FCV-19S). The present study aimed to translate and validate the FCV-19S in Spanish university students. The sample comprised 606 Spanish´undergraduates with a mean age of 21.59 years old. We also used a six items from the State Trait Anxiety Inventory (STAI) by van Knippenberg, Duivenvoorden, Bonke & Passchiner (1990). The Fear of COVID-19 scale used for the present survey evidenced a good alpha measure of internal consistency or reliability analysis with ordinal alpha and ordinal omega. Seven items with acceptable corrected item-total correlation were retained and further confirmed by significant and strong factor loadings. Concurrent validity was supported by the six items of the State Trait Anxiety Inventory (STAI). The Fear of COVID-19 Scale, a seven-item scale, has a stable unidimensional structure with robust psychometric properties. It is reliable and valid in assessing fear of COVID-19 among the Spanish university students.

Employee norm-violations in the service encounter during the corona pandemic and their impact on customer satisfaction

In this study, an experiment was used to examine the effects of employee norm-violations in the service encounter with respect to what was considered appropriate behavior (e.g., social distancing) during the 2020 corona pandemic. The participants were exposed to a grocery store employee whose behavior was manipulated (norm-violating vs. norm-confirming). Norm-violating behavior resulted in lower perceived employee warmth, lower perceived employee competence, higher disgust, and more dehumanization of the employee. These responses mediated the impact of employee behavior on customer satisfaction, so that satisfaction was attenuated when norms were violated. The mediators, however, typically also instill a hostile, avoidance-seeking mindset for those who are subject to norm-violations, which is likely to result in problems when transgressors are to be persuaded to change their behaviors.

Anxiety as a mediator of relationships between perceptions of the threat of COVID-19 and coping behaviors during the onset of the pandemic in Poland

At the beginning of the COVID-19 pandemic (10-14 March, 2020) we conducted a survey (n = 1028) of a nationally representative sample (age, sex, and locale) in Poland. Respondents indicated how strong they thought the threat was to themselves, to Poland, and the world. They also described their emotional reactions to the pandemic, which we used to calculate three scores: Anxiety, Hopelessness, and Panic. Respondents also indicated how often they engaged in various coping behaviors and how much they supported different types of economic sacrifice. We used these responses to calculate measures that we labelled as Spread Prevention (e.g., social distancing), Self-preservation (food stockpiling), and Economic Sacrifice (e.g., fighting COVID-19 regardless of the cost). Multiple regression analyses found that perceived threat to self was the most reliable predictor (positive) of emotional reactions and of coping behaviors, and that Anxiety was the most reliable predictor (positive) of Spread prevention and Economic sacrifice. Panic predicted (positively) Self-preservation. A series of mediation analyses found that Anxiety mediated relationships between threat and coping behaviors, and that Panic mediated the relationship between perceived threats and Self-preservation. In addition, we found that scores on all measures, except Panic, increased following the announcement of the first COVID-19 related fatality in Poland, which occurred on the third (middle) day of the study. The mediational relationships we found did not vary as a function of whether the data were collected before or after this announcement. The present results suggest that emotional reactions to perceived threats can serve an instrumental function by providing the motivation to engage in coping behaviors. Such a mechanism complements much research on stress that has focused on how coping mediates threat-emotion relationships.

Cognitive Network Science Reconstructs How Experts, News Outlets and Social Media Perceived the COVID-19 Pandemic

This work uses cognitive network science to reconstruct how experts, influential news outlets and social media perceived and reported the news “COVID-19 is a pandemic”. In an exploratory corpus of 1 public speech, 10 influential news media articles on the same news and 37,500 trending tweets, the same pandemic declaration elicited a wide spectrum of perceptions retrieved by automatic language processing. While the WHO adopted a narrative strategy of mitigating the pandemic by raising public concern, some news media promoted fear for economic repercussions, while others channelled trust in contagion containment through semantic associations with science. In Italy, the first country to adopt a nationwide lockdown, social discourse perceived the pandemic with anger and fear, emotions of grief elaboration, but also with trust, a useful mechanism for coping with threats. Whereas news mostly elicited individual emotions, social media promoted much richer perceptions, where negative and positive emotional states coexisted, and where trust mainly originated from politics-related jargon rather than from science. This indicates that social media linked the pandemics to institutions and their intervention policies. Since both trust and fear strongly influence people’s risk-averse behaviour and mental/physical wellbeing, identifying evidence for these emotions is key under a global health crisis. Cognitive network science opens the way to unveiling the emotional framings of massively read news in automatic ways, with relevance for better understanding how information was framed and perceived by large audiences.

The COVID-19 Own Risk Appraisal Scale (CORAS): Development and validation in two samples from the United Kingdom

Perceived risk is an important determinant of the adoption of preventive behaviours. In this article, the psychometric properties of the COVID-19 Own Risk Appraisal Scale (CORAS), including its development and validation in two samples in the United Kingdom, are described. The CORAS is a measure of perceived personal risk of contracting the disease, incorporating primarily intuitive with some analytic risk estimates. Exploratory and confirmatory factor analyses were performed on data from 470 participants in the United Kingdom who completed the CORAS, the Fear of COVID-19 Scale and the COVID-19 Preventive Behaviours Index. Results showed that a unidimensional, six-item model fits the data well, with satisfactory fit indices, internal consistency and high item loadings onto the factor. We found no statistically significant differences by age, gender or ethnicity. The CORAS correlated positively with the Fear of COVID-19 Scale and the COVID-19 Preventive Behaviours Index, suggesting good concurrent validity.

Disentangling community-level changes in crime trends during the COVID-19 pandemic in Chicago

Recent studies exploiting city-level time series have shown that, around the world, several crimes declined after COVID-19 containment policies have been put in place. Using data at the community-level in Chicago, this work aims to advance our understanding on how public interventions affected criminal activities at a finer spatial scale. The analysis relies on a two-step methodology. First, it estimates the community-wise causal impact of social distancing and shelter-in-place policies adopted in Chicago via Structural Bayesian Time-Series across four crime categories (i.e., burglary, assault, narcotics-related offenses, and robbery). Once the models detected the direction, magnitude and significance of the trend changes, Firth's Logistic Regression is used to investigate the factors associated to the statistically significant crime reduction found in the first step of the analyses. Statistical results first show that changes in crime trends differ across communities and crime types. This suggests that beyond the results of aggregate models lies a complex picture characterized by diverging patterns. Second, regression models provide mixed findings regarding the correlates associated with significant crime reduction: several relations have opposite directions across crimes with population being the only factor that is stably and positively associated with significant crime reduction.

Prevalence and predictors of early COVID-19 behavioral intentions in the United States

Despite early warnings and calls for action, COVID-19 infection rates continue to climb in many areas of the United States. The current study examined participants’ reported likelihood of engaging in eight behaviors designated by the Centers for Disease Control and Prevention as critical for the prevention of COVID-19 at the outset of the epidemic. Self-efficacy, perceived threat, and internal and external health locus of control were explored as potential predictors of those behaviors. In addition, demographic and contextual factors, such as age, gender, political identity, and whether or not participants were currently living under a quarantine advisory, were recorded for analysis. Overall, participants reported high engagement with the prevention behaviors. Higher levels of self-efficacy, perceived severity of the illness, and external locus of control in regard to medical professionals were all positively associated with plans to take the recommended precautions. Based on the results, it appears that messaging regarding COVID-19 prevention may be particularly effective when it focuses on the high risk of the illness, the ease with which the prevention behaviors can be taken, and a reassurance that the medical establishment has individuals’ best health in mind when it makes its specific recommendations.

While numerous countries have succeeded in reducing the spread of COVID-19, the number of new cases in the United States remains high, even relative to other populations also heavily impacted by the disease [1]. Although it would be difficult to pinpoint a single cause or explanation for the epidemic’s course in the USA, at the heart of its spread, like the spread of all infectious diseases, is noncompliance with preventative measures. The current research served as a preliminary exploration of the prevalence and predictors of eight COVID-19 prevention behaviors. A brief survey was sent out at the end of March 2020 to 350 U.S. residents in order to assess the likelihood of their engaging in various prevention behaviors recommended at that time and several related psychosocial factors. The psychological factors assessed included health locus of control (HLOC) beliefs, self-efficacy, and perceived threat. In addition, a handful of demographic and contextual factors, such as age, gender, political identity, and whether or not they were working outside the home or were currently living under a quarantine advisory, were recorded for examination.

"Acute Myocardial Infarction in the Time of COVID-19": A Review of Biological, Environmental, and Psychosocial Contributors

Coronavirus disease 2019 (COVID-19) has quickly become a worldwide health crisis.Although respiratory disease remains the main cause of morbidity and mortality in COVID patients,myocardial damage is a common finding. Many possible biological pathways may explain therelationship between COVID-19 and acute myocardial infarction (AMI). Increased immune andinflammatory responses, and procoagulant profile have characterized COVID patients. All theseresponses may induce endothelial dysfunction, myocardial injury, plaque instability, and AMI.Disease severity and mortality are increased by cardiovascular comorbidities. Moreover, COVID-19has been associated with air pollution, which may also represent an AMI risk factor. Nonetheless,a significant reduction in patient admissions following containment initiatives has been observed,including for AMI. The reasons for this phenomenon are largely unknown, although a real decreasein the incidence of cardiac events seems highly improbable. Instead, patients likely may presentdelayed time from symptoms onset and subsequent referral to emergency departments because offear of possible in-hospital infection, and as such, may present more complications. Here, we aim todiscuss available evidence about all these factors in the complex relationship between COVID-19and AMI, with particular focus on psychological distress and the need to increase awareness ofischemic symptoms.

Personality regulation of decisions on physical distancing: Cross-cultural comparison (Russia, Azerbaijan, China)

The present study investigated cross-cultural comparison of the personality variables (rationality, risk readiness, empathy, Dark Triad traits, implicit theories of emotions) in predicting decisions on physical distancing during the COVID-19 pandemic.

The sample included 1077 participants from Russia, Azerbaijan, and China. After reporting if they trust the media, participants chose from different reasons why they wear or don't wear a mask: care for self vs others, risk for oneself vs others, autonomy for oneself vs others, risk estimation, law-abidingness; then participants completed questionnaires.

We expected people from collectivistic countries to make decisions based on care for others and people from more individualistic countries – on care for self and autonomy. The results revealed a different trend: participants from all countries chose care for self more frequently than other reasons. This was most prevalent in China, less – in Azerbaijan and less so – in Russia.

Rationality and empathy were positive predictors of decisions to wear a mask, risk readiness and psychopathy were negative predictors, the role of narcissism depended on the country. Implicit theories of emotions correlated with empathy in China and Azerbaijan. These two measures predicted the choice of “care for others” over “care for self” in all countries.

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Development of verbal tasks that model situations of choice on physical distancing for various reasons

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Rationality and empathy are positive predictors of a decision to wear a mask during the pandemic.

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Risk readiness and psychopathy are negative predictors, the role of narcissism depends on the country.

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IT of emotions and empathy predict “care for others” over “care for self” in Russia, Azerbaijan and China.

Correlates of Health-Protective Behavior During the Initial Days of the COVID-19 Outbreak in Norway

The coronavirus outbreak manifested in Norway in March 2020. It was met with a combination of mandatory changes (closing of public institutions) and recommended changes (hygiene behavior, physical distancing). It has been emphasized that health-protective behavior such as increased hygiene or physical distancing are able to slow the spread of infections and flatten the curve. Drawing on previous health-psychological studies during the outbreak of various pandemics, we investigated psychological and demographic factors predicting the adoption and engagement in health-protective behavior and changes in such behavior, attitudes, and emotions over time. We recruited a non-representative sample of Norwegians (n = 8676) during a 15-day period (March 12–26 2020) at the beginning of the COVID-19 outbreak in Norway. Employing both traditional methods and exploratory machine learning, we replicated earlier findings that engagement in health-protective behavior is associated with specific demographic characteristics. Further, we observed that increased media exposure, perceiving measures as effective, and perceiving the outbreak as serious was positively related to engagement in health-protective behavior. We also found indications that hygiene and physical distancing behaviors were related to somewhat different psychological and demographic factors. Over the sampling period, reported engagement in physical distancing increased, while experienced concern or fear declined. Contrary to previous studies, we found no or only small positive predictions by confidence in authorities, knowledge about the outbreak, and perceived individual risk, while all of those variables were rather high. These findings provide guidance for health communications or interventions targeting the adoption of health-protective behaviors in order to diminish the spread of COVID-19.

Beach Tourism in Times of COVID-19 Pandemic: Critical Issues, Knowledge Gaps and Research Opportunities

The strict quarantine measures employed as a response to the COVID-19 pandemic have led the global tourism industry to a complete halt, disrupting the livelihoods of millions. The economic importance of beach tourism for many destinations has led many governments to reopen tourist beaches, as soon as the number of infection cases decreased. The objective of this paper is to provide a scientific basis for understanding the key issues for beach tourism management in these circumstances. These issues include risk perception, environmental considerations directly related to beaches and COVID-19, and management strategies designed to limit the risk of contagion on the beach. The contribution of this paper lies in its interdisciplinary approach to delivering the findings from the latest studies, highly relevant for beach tourism, in psychology, health science, and environmental science (often in preprint and in press format). Particular attention was given to identifying the knowledge gaps evident in the areas of COVID-19 risk perception, with the drivers explaining the risk-taking behavior and the protective strategies employed by beachgoers. Gaps were also found in areas such as the presence of SARS-CoV-2 in bathing waters and the sand, the potential of contaminated sand being a viable route of transmission, and the impact of the use of chemical disinfectants on the marine environment and on bathers. The paper identifies research prospects in these areas, additionally pointing out other questions such as new carrying capacity methods, the opportunity given by COVID-19 in estimation of the impacts of visitation and beach-litter.

Death of a neonate with suspected coronavirus disease 2019 born to a mother with coronavirus disease 2019 in Iran: a case report

INTRODUCTION

A novel coronavirus named severe acute respiratory syndrome coronavirus 2, was first reported in Wuhan, China, in December 2019. The virus, known as COVID-19, is recognized as a potentially life-threatening disease by causing severe respiratory disease. Since this virus has not previously been detected in humans, there is a paucity of information regarding its effects on humans. In addition, only limited or no information exists about its impact during pregnancy.

CASE PRESENTATION

In the present case study, we report the death of a neonate born to a 32-year-old mother with coronavirus disease 2019 in Ilam, Iran, with Kurdish ethnicity. We report the infection and death of a neonate in Iran with a chest X-ray (CXR) marked abnormality 2 hours after birth demonstrating coronavirus disease 2019 disease. The neonate was born by elective cesarean section, the fetal health was assessed using fetal heart rate and a non-stress test before the birth, and there was no evidence of fetal distress. All the above-mentioned facts and radiographic abnormalities suggested that coronavirus disease 2019 is involved.

CONCLUSIONS

In this case study, we report the death of a neonate born to a mother with coronavirus disease 2019, 11 hours after birth. There is a paucity of data on the vertical transmission and the adverse maternal-fetal consequences of this disease, so vertical transmission from mother to child remains to be confirmed.

Obstetric Healthcare Workers' Adherence to Hand Hygiene Recommendations during the COVID-19 Pandemic: Observations and Social-Cognitive Determinants

Background

Hand hygiene is crucial to avoid healthcare‐associated infections and the transmission of COVID‐19. Although the WHO has issued global hand hygiene recommendations for healthcare, adherence remains challenging. Considering social‐cognitive theories such as the health action process approach (HAPA) can help to improve healthcare workers’ adherence. This study aimed to observe adherence and to assess determinants in obstetric hospitals during and after the onset of the COVID‐19 pandemic.

Methods

In all, 267 observations of behaviour were conducted in two German obstetric university hospitals over three time periods (pre‐COVID‐19 pandemic, heightened awareness, and strict precautions). In addition, 115 healthcare workers answered questionnaires regarding social‐cognitive determinants of hand hygiene behaviour. Multiple regression and multiple mediation analyses were used to analyse associations.

Results

Adherence to hand hygiene recommendations increased from 47 per cent pre‐COVID‐19 pandemic to 95 per cent just before lockdown while simple measures against the pandemic were taken. Self‐efficacy was associated with the intention to sanitise hands (β = .397, p < .001). Coping self‐efficacy mediated the association of intention with hand hygiene adherence.

Conclusions

Obstetric healthcare workers seem to adapt their hand hygiene behaviour to prevent infections facing the global COVID‐19 pandemic. To further improve interventions, social‐cognitive determinants should be considered, especially intention and (coping) self‐efficacy.

Adherence to COVID-19 Precautionary Measures: Applying the Health Belief Model and Generalised Social Beliefs to a Probability Community Sample

Background

In the face of the global pandemic of coronavirus disease‐2019 (COVID‐19), people’s adherence to precautionary behavioral measures (e.g. social distancing) largely influences the effectiveness of those measures in containing the spread of the coronavirus. The present study aims at testing the applicability of the health belief model (HBM) and generalised social beliefs (i.e. social axioms) to explore strategies for promoting adherence to COVID‐19 precautionary measures.

Methods

We conducted a telephone survey with a two‐step stratified random sampling method and obtained a probability sample of 616 adults in Macao, China (18–87 years old; 60.9% women) in April 2020.

Results

Our participants showed stronger adherence to some COVID‐19 precautionary measures (e.g. face mask wearing; 96.4%) but not others (e.g. social distancing; 42.3%). Their adherence to those measures was found to be significantly associated with four HBM factors and two social axioms, after controlling for gender, age, and years of education.

Conclusions

The HBM and the generalised social beliefs of social cynicism and reward for application can be applied to understanding adherence to precautionary measures against COVID‐19. Strategies based on beliefs were proposed to facilitate the promotion of precautionary measures.

Intervention Delivery Matters: What Mothers at High Risk for Type 2 Diabetes Want in a Diabetes Prevention Program-Results from a Comparative Effectiveness Trial

Participants in the ENCOURAGE Healthy Families Study, a family-focused, modified Diabetes Prevention Program, reported challenges to and preferences for engaging in a diabetes prevention program. Challenges with flexible intervention delivery, accessibility, the traditional group-based format, and Coronavirus Disease 2019 (COVID-19) exposure risk can be mitigated by participant preferences for one-on-one, virtual/online intervention delivery.Trial Registration: ClinicalTrials.gov identifier, NCT01823367.

The prospective influence of COVID-19 affective risk assessments and intolerance of uncertainty on later dimensions of health anxiety

The COVID-19 pandemic is likely to increase risk for the development of health anxiety. Given that elevated health anxiety can contribute to maladaptive health behaviors, there is a need to identify individual difference factors that may increase health anxiety risk. This study examined the unique and interactive relations of COVID-19 affective risk assessments (worry about risk for contracting/dying from COVID-19) and intolerance of uncertainty to later health anxiety dimensions. A U.S. community sample of 364 participants completed online self-report measures at a baseline assessment (Time 1) and one month later (Time 2). Time 1 intolerance of uncertainty was uniquely associated with the Time 2 health anxiety dimension of body vigilance. Time 1 affective risk assessments and intolerance of uncertainty were uniquely associated with later perceived likelihood that an illness would be acquired and anticipated negative consequences of an illness. The latter finding was qualified by a significant interaction, such that affective risk assessments were positively associated with anticipated negative consequences of having an illness only among participants with mean and low levels of intolerance of uncertainty. Results speak to the relevance of different risk factors for health anxiety during the COVID-19 pandemic and highlight targets for reducing health anxiety risk.

Awareness, Risk Perception, and Stress during the COVID-19 Pandemic in Communities of Tamil Nadu, India

The health and economic consequences of the COVID-19 pandemic is expected to disproportionately impact residents of lower-middle income countries. Understanding the psychological impact of the pandemic is important to guide outreach interventions. In this study, we examined people's awareness of COVID-19 symptoms, risk perception, and changes in behaviors and stress levels during the lockdown in peri-urban Tamil Nadu India. Field workers conducted phone call surveys (included n = 2044) in 26 communities from 20-25 May 2020. The majority perceived no (60%) or low (23%) level of risk of personally contracting coronavirus. Common fears were related to health and economic concerns, including loss of income (62%), inability to travel freely (46%), and becoming sick (46%). Residents were well aware of the common symptoms of COVID-19, such as fever (66%) and dry cough (57%), but not the asymptomatic transmission (24%). The majority experienced increased stress about finance (79%) and the lockdown (51%). Our findings emphasize the need to develop context-adequate education and communication programs to raise vigilance about asymptomatic transmission and to sustain preventative behaviors. The evidence on fear and changes in stress levels could inform designing coping strategies and programs focused on mental well-being.

Behavior change due to COVID-19 among dental academics-The theory of planned behavior: Stresses, worries, training, and pandemic severity

OBJECTIVE

COVID-19 pandemic led to major life changes. We assessed the psychological impact of COVID-19 on dental academics globally and on changes in their behaviors.

METHODS

We invited dental academics to complete a cross-sectional, online survey from March to May 2020. The survey was based on the Theory of Planned Behavior (TPB). The survey collected data on participants' stress levels (using the Impact of Event Scale), attitude (fears, and worries because of COVID-19 extracted by Principal Component Analysis (PCA), perceived control (resulting from training on public health emergencies), norms (country-level COVID-19 fatality rate), and personal and professional backgrounds. We used multilevel regression models to assess the association between the study outcome variables (frequent handwashing and avoidance of crowded places) and explanatory variables (stress, attitude, perceived control and norms).

RESULTS

1862 academics from 28 countries participated in the survey (response rate = 11.3%). Of those, 53.4% were female, 32.9% were <46 years old and 9.9% had severe stress. PCA extracted three main factors: fear of infection, worries because of professional responsibilities, and worries because of restricted mobility. These factors had significant dose-dependent association with stress and were significantly associated with more frequent handwashing by dental academics (B = 0.56, 0.33, and 0.34) and avoiding crowded places (B = 0.55, 0.30, and 0.28). Low country fatality rates were significantly associated with more handwashing (B = -2.82) and avoiding crowded places (B = -6.61). Training on public health emergencies was not significantly associated with behavior change (B = -0.01 and -0.11).

CONCLUSIONS

COVID-19 had a considerable psychological impact on dental academics. There was a direct, dose-dependent association between change in behaviors and worries but no association between these changes and training on public health emergencies. More change in behaviors was associated with lower country COVID-19 fatality rates. Fears and stresses were associated with greater adoption of preventive measures against the pandemic.

Meaning in Life and Self-Control Buffer Stress in Times of COVID-19: Moderating and Mediating Effects With Regard to Mental Distress

BACKGROUND

As evidenced by several studies, mental distress increased substantially during the COVID-19 pandemic. In this period, citizens were asked to exercise a high degree of self-control with regard to personal and social health behavior. At the same time, we witnessed an increase of prosocial acts and shared creative expressions, which are known to serve as sources of meaning. Meaning in life and self-control are acknowledged psychological resources. Especially in times of crisis, meaning in life has been shown to be a crucial factor for resilience and coping. However, threatening and stressful situations can also jeopardize existential security and trigger crises of meaning. The present study aimed to document levels of acute COVID-19 stress and general mental distress in Germany and Austria during the lockdown and in the weeks thereafter. In order to identify potential risk factors related to demographics and living conditions, their associations with COVID-19 stress were analyzed exploratively. The primary objective of the study, however, was to investigate the buffering effect of two psychological resources-meaningfulness and self-control-with regard to the relation between acute COVID-19 stress and general mental distress. Finally, a potential aggravation of mental distress due to the occurrence of crises of meaning was examined.

METHOD

A cross-sectional survey was conducted online during lockdown (survey group 1) and the subsequent weeks characterized by eased restrictions (survey group 2). A total of N = 1,538 German-speaking participants completed a questionnaire battery including a novel measure of acute COVID-19 stress, meaningfulness and crisis of meaning (SoMe), self-control (SCS-KD), and a screening of general mental distress, measured by core symptoms of depression and anxiety (PHQ-4). In a first step, associations between living conditions, demographics, and COVID-19 stress were explored. Second, a moderation and a mediation model were tested. Meaningfulness, a measure of presence of meaning in life, as well as self-control were proposed to serve as buffers in a time of crisis, thus moderating the relation between acute COVID-19 stress and general mental distress (double moderation). Crisis of meaning, operationalizing an experienced lack of meaning in life, was proposed to mediate the relationship between acute COVID-19 stress and general mental distress, with an assumed moderation of the association between COVID-19 stress and crisis of meaning by survey group (lockdown versus eased restrictions after lockdown), and a hypothesized moderation of the link between crisis of meaning and general mental distress by self-control (dual moderated mediation).

RESULTS

COVID-19 stress was slightly right-skewed. Scores were higher during lockdown than in the weeks thereafter. The rate of clinically significant general mental distress was high, exceeding prevalence rates from both the general population and clinical samples of the time before the pandemic. In the weeks following the lockdown (group 2), general mental distress and crisis of meaning were significantly higher than during lockdown (group 1), whereas meaningfulness and self-control were significantly lower. Demographically, age had the strongest association with COVID-19 stress, with older participants perceiving less acute stress (r = -.21). People who were partnered or married suffered less from COVID-19 stress (η2 = .01). Living alone (η2 = .006), living in a room versus a flat or house (η2 = .008), and being unemployed due to the pandemic (η2 = .008) were related to higher experience of COVID-19 stress. COVID-19 stress and general mental distress were strongly related (r = .53). Both meaningfulness and self-control were negatively associated with general mental distress (r = -.40 and -.36, respectively). They also moderated the relationship between COVID-19 stress and general mental distress: When meaningfulness was high, high COVID-19 stress was related to substantially lower PHQ-4 scores than when meaningfulness was low. The same held for self-control: High scores of self-control were associated with lower PHQ-4 scores especially when COVID-19 stress was high. Crisis of meaning mediated the relationship between COVID-19 stress and PHQ-4. There was a higher likelihood of crises of meaning occurring when COVID-19 stress was high; crisis of meaning, in turn, was associated with general mental distress. Survey group moderated the first path of this mediation, i.e., the relationship between COVID-19 stress and crisis of meaning: High scores of COVID-19 stress were associated more strongly with crisis of meaning in the second survey group (after the lockdown). Self-control moderated the second path, i.e., the relationship between crisis of meaning and PHQ-4: When a crisis of meaning was present, self-control could buffer its effect on general mental distress.

CONCLUSIONS

Also in the present study among German-speaking participants, general mental distress was high. Scores were higher after than during the lockdown, indicating an ongoing destabilization for a significant part of the population. People who saw a meaning in their lives and who were capable of self-control reported substantially less mental distress. Meaningfulness and self-control also served as buffers between COVID-19 stress and general mental distress: When COVID-19 stress was high, the presence of meaningfulness and self-control accounted for lower general mental distress. Moreover, people who suffered strongly from COVID-19 stress were more likely to develop a crisis of meaning which, in turn, was associated with higher general mental distress. This suggests that ongoing anxiety and depression might (also) be based on existential struggles. Again here, self-control buffered the impact of crisis of meaning on general mental health. We conclude from these findings that public health policies can support citizens in coping with large-scale crises by enabling experiences of meaningfulness, e.g., through transparent and reliable modes of communicating goals and necessary intermediate steps. Moreover, health professionals are well advised to invite individuals to confront existential questions and struggles, and to encourage them to exercise self-control. The latter can be boosted by keeping higher-order goals salient-which again is inherently linked to an understanding of their meaning.

"Do I have enough food?" How need for cognitive closure and gender impact stockpiling and food waste during the COVID-19 pandemic: A cross-national study in India and the United States of America

Food waste is considered to be one of the biggest issues affecting individuals around the globe. The COVID-19 pandemic, with the consequent lockdown processes, has recently triggered individuals to stockpile foodstuffs. Recent data shows, however, that individuals have not consumed a good proportion of the stockpiled food, resulting in increasing amounts of products ending up wasted. Using a cross-national survey conducted in the United States and India, we investigate how individuals' levels of need for cognitive closure (NFC) relate to food stockpiling and waste during the COVID-19 pandemic. Through a sequential mediation model, we show how individuals high in NFC did not perceive to have enough food at home, ending up buying more food than usual and, eventually, wasting more. Individuals' gender and country of residence moderate such phenomenon, with the effect being more pronounced among Indian (rather than American) women. We discuss how gender roles in different countries can correlate with the stockpiling and food waste processes. We conclude the manuscript by suggesting how public communication and policy making could develop targeted programs to mitigate such issues.

Non-compliance with COVID-19-related public health measures among young adults in Switzerland: Insights from a longitudinal cohort study

Rationale

Adolescents and young adults were identified internationally as a group with potentially low compliance rates with public health measures aimed at curbing the spread of coronavirus disease 2019 (COVID-19). Although non-compliance research during pandemics has typically focused on concurrent correlates, less is known about how prior social and psychological risk factors are associated with non-compliance during pandemics.

Objective

This paper leverages a prospective-longitudinal cohort study with data before and during the pandemic to describe patterns of non-compliance with COVID- 19 related public health measures in young adults and to identify which characteristics increase the risk of non-compliance.

Methods

Data came from an ongoing cohort study in Zurich, Switzerland (n=737). Non-compliance with public health measures and concurrent correlates were measured at age 22. Antecedent sociodemographic, social, and psychological factors were measured at ages 15-20. Young adults generally complied with COVID-19 public health measures, although non-compliance with some measures (e.g., cleaning/disinfecting mobile phones, standing 1.5-2 meters apart) was relatively higher.

Results

Non-compliance, especially with hygiene-related measures, was more prevalent in males, and in individuals with higher education, higher SES, and a nonmigrant background. Non-compliance was higher in young adults who had previously scored high on indicators of “antisocial potential,” including low acceptance of moral rules, pre-pandemic legal cynicism, low shame/guilt, low self-control, engagement in delinquent behaviors, and association with delinquent peers. Young adults with low trust, including in the government’s measures for fighting the virus, also complied less.

Conclusions

In order to increase voluntary compliance with COVID-19 measures, public health campaigns should implement strategies that foster moral obligation and trust in authorities, or leverage trustworthy individuals in the community to disseminate information. For young adults with low self-control, self-monitoring, environmental restructuring, or nudging may increase compliance. Long-term investments into integrating youth with antisocial potential into society may decrease rule-breaking behaviors, including during pandemics when compliance saves lives.

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Swiss men were less likely to comply with COVID-19 public health measures than women.

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Pre-pandemic factors were associated with COVID-19 non-compliance.

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Factors related to “antisocial potential” were associated with non-compliance.

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Moral disengagement from COVID-19 rules was strongly associated with non-compliance.

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Low trust in Swiss authorities was associated with non-compliance.