Medical students as the volunteer workforce during the COVID-19 pandemic: Polish experience

Multi-risk instruments for emergency response: a multi-hazard and multi-risk assessment of the European Union's Solidarity and Emergency Aid Reserve

Natural hazard-related disasters are on the rise and have significant impacts on the public and private sector. Different mechanisms and instruments exist on the pan-European level to deal with them, including the European Union Solidarity Fund (EUSF). Recently, the EUSF expanded its scope to incorporate public health emergencies and merged with the Emergency Aid Reserve to become the Solidarity and Emergency Aid Reserve. It therefore became a multi-hazard and multi-risk instrument to assist countries during the emergency phase of disasters. As different types of hazards and risks are drawing from the same fund there is concern about what capitalisation levels have to be assumed to make it sustainable. Hence, it is important to understand to which hazards and risks the fund is most exposed and whether there are regional differences within Europe. To address these issues, this paper takes a risk-based approach and estimates the capitalisation levels needed for major hazards and risks, noting regional differences across Europe.

Do first responders and populations perceive risks similarly? A comparative study of seven countries

Introduction

Risk perception illustrates the subjective evaluation of individuals concerning the characteristics, severity, and capacity to cope with potential hazards. Risk perception influences attitudes and actions individuals take to protect themselves from future threats. Risk perceptions might change among different stakeholder groups such as society and first responders. Identifying risk perceptions of stakeholders is essential to establish effective protective measures.

Method

This study investigated the commonalities and diversities in risk perception among first responders and the public, within and between seven European and beyond countries. A self-administered questionnaire was used to gather data from both first responders and civilians. They were asked to assess their risk perception level for five categories of risks (Extreme weather-related events, nature-related events, social disruptions, critical services dependencies, and pandemics).

Results

Using Univariate Analysis of Variance showed disparity concerning both the levels of risk perception between the public and first responders, as well as their relative ranking. For example, concerning extreme weather-related and nature-related events, risk perception levels of the first responders is higher than that of the population in six out of the seven studied countries. In contrast, the population's risk perception is higher compared to the first responders in six out of the seven countries, concerning critical infrastructure dependencies and pandemics.

Discussion

The relative gaps between the first responders versus the population, within each country, vary considerably. Norway for example presents significant differences between the two internal populations concerning all risks (except for extreme weather), while in Sweden, no significant gaps were identified, concerning all five risks.

The COVID-19 related stress and social network addiction among Chinese college students: A moderated mediation model

Based on social cognitive theory and gender differences, this study verified a moderated mediation model to explore the relationship between the COVID-19 related stress (CRS) and social network addiction (SNA) and evaluate the mediating role of fear of missing out (FoMO) and the moderating role of gender. A questionnaire survey was conducted, including 702 Chinese university students.This study used PROCESS to test the hypothesis model.The results showed that the CRS significantly and positively affected the SNA of college students and FoMO played a complementary mediating role. Moreover, the analysis of the moderated mediation model showed that gender moderated the relationship between FoMO and SNA; the effect of FoMO was stronger on the SNA of male college students than that of females. The results not only enhanced our understanding of the internal influencing mechanism of the relationship between CRS and SNA but also considered gender differences. In addition, some suggestions were proposed.

Exploring senior managers' experiences preparedness to respond to COVID-19: a qualitative study in Iran

BACKGROUND

Epidemics caused by emerging respiratory viruses are challenging for the health system of most societies, and preparedness of the health system in responding to such epidemics is important. Therefore, the aim of this study was identifying different fields and key issues of the senior managers' experiences preparedness to respond to the COVID-19 epidemic from the Iranian senior managers' point of view.

METHODS

This is a qualitative descriptive study. Eighteen in-depth and semi-structured individual interviews were conducted for data collection. For this purpose, 18 senior managers with work experience in managing the COVID-19 crisis were enrolled in the study using purposive sampling. The collected data were analyzed according to Graneheim and Lundman's approach.

RESULTS

Analysis of the data resulted in the emergence of five themes and twelve sub-themes. The main themes and sub-themes included: (1) capacity improvement consisting of performance improvement and logistic improvement; (2) resource and infrastructure management including supply and support of human resources, infrastructure improvement, and supply of equipment; (3) an increase in epidemiology capacity including epidemiology improvement and emerging disease surveillance; (4) application of the principles of disaster and emergency management including intra- and extra-organizational interaction management, disaster risk management, and data management; and (5) society resilience increase including improving adaptation skill and maintaining health and social participation.

CONCLUSION

The results of this study present the key issues for the management of future emergency situations. Health system managers and policymakers in Iran and other countries should be aware of these key issues and apply them in practice to prepare the health systems to respond to next outbreaks. Indeed, the study results can help policymakers and health system managers to plan to achieve acceptable preparedness for the management of such outbreaks.

"The Yo-Yo Effect": U.S. Department of Veterans Affairs Social Workers' Experiences with Job Flexibility during the Pandemic

Social work turnover from the emotional overload of providing care during the pandemic has created staff shortages and exposed many gaps in service delivery. Those social workers who sustained employment during this pandemic are asked to take on flexible/additional roles to fill in those gaps in services to their most vulnerable clients. This qualitative study (N = 12) of U.S. Department of Veterans Affairs (VA) inpatient social workers at two sites across the country assesses their experiences of taking on additional roles at their respective VA facility. Three research questions were addressed to the participants: (1) Describe your roles and responsibilities during the COVID-19 pandemic? (2) How did those responsibilities change/evolve over time? and (3) Did you receive training for your new roles or tasks? Thematic analysis revealed six themes that would facilitate effectiveness and continuity of care: (1) recognizing insufficient training to handle a pandemic, (2) meeting the demand for care, (3) responding to unexpected aspects of flexibility, (4) adjusting to new roles over time, (5) adaptation and support, and (6) additional resources to simplify efforts. With COVID rates stabilizing across much of the United States, now is the time to implement trainings and education about job flexibility in the future instance of a pandemic.

Natural multi-hazard risk perception and educational insights among Geography and Tourism students and graduates amid the Covid-19 pandemic

Multi-hazard risk perception is an emerging research topic that has been gaining more and more interest since the beginning of the Covid-19 pandemic, due to the unprecedented interactions between the management practices of the pandemic and of other co-occurring natural hazards, and to the compounded impact of these multi-hazards. This paper aims to investigate the specialization and study level-dependent differences concerning multi-hazard risk perception and hazard-related education insights of future potential specialists in natural hazard-induced risk management and tourism reconstruction. These differences were explored by applying a multi-layer questionnaire on 547 Geography and Tourism students and graduates from two universities in Iași City (Romania) and Novi Sad (Serbia), and performing descriptive and differential statistical analyses. The statistically significant differences that emerged refer to estimations of the impact level of the Covid-19 pandemic and of other natural hazards at different spatial scales and on different socio-economic activities, on the training/career of the respondents, and to the hazard-related education improvements. Up to date, none of the papers in the existing literature integrate both the Covid-19 pandemic and the co-occurrent natural hazards as objects of students' perception, which makes the present study a starting point for such research endeavours.

Learning from the COVID-19 pandemic in Italy to advance multi-hazard disaster risk management

COVID-19 challenged all national emergency management systems worldwide overlapping with other natural hazards. We framed a 'parallel phases' Disaster Risk Management (DRM) model to overcome the limitations of the existing models when dealing with complex multi-hazard risk conditions. We supported the limitations analysing Italian Red Cross data on past and ongoing emergencies including COVID-19 and we outlined three guidelines for advancing multi-hazard DRM: (i) exploiting the low emergency intensity of slow-onset hazards for preparedness actions; (ii) increasing the internal resources and making them available for international support; (iii) implementing multi-hazard seasonal impact-based forecasts to foster the planning of anticipatory actions.

COVID-19 vaccine hesitancy in Malaysia: Exploring factors and identifying highly vulnerable groups

Vaccine hesitancy is a global health challenge in controlling the virulence of pandemics. The prevalence of vaccine hesitancy will put highly vulnerable groups, such as the elderly or groups with pre-existing health conditions, at a higher risk, as seen with the outbreak of the pandemic Covid-19. Based on the trends of vaccine hesitancy in the state of Sabah, located in East Malaysia, this study seeks to identify several variables that contribute to vaccine hesitancy. In addition to this, this study also determines which groups are affected by vaccine hesitancy based on their demographics. This study is based on a sampling of 1,024 Sabahan population aged 18 and above through an online and face-to-face questionnaire. The raw data was analysed using the K-Means Clustering Analysis, Principal Component Analysis (PCA), Mann-Whitney U Test, Kruskal-Wallis Test, and frequency. The K-Means Clustering found that more than half of the total number of respondents (Cluster 2 = 51.9%) tend to demonstrate vaccine hesitancy. Based on the PCA analysis, six main factors were found to cause vaccine hesitancy in Sabah: confidence (var(X) = 21.6%), the influence of local authority (var(X) = 12.1%), ineffectiveness of mainstream media (var(X) = 8.4%), complacency (var(X) = 7.4%), social media (var(X) = 6.4%), and convenience issues (var(X) = 5.8%). Findings from both Mann-Whitney U and Kruskal-Wallis tests demonstrate that several factors of group demographics, such as employment status, level of education, religion, gender, and marital status, may explain the indicator of vaccine hesitancy. In particular, specific groups tend to become vaccine hesitancy such as, unemployed, self-employed, students, male, single, level of education, and Muslim. Findings from this empirical study are crucial to inform the relevant local authorities on the level of vulnerability among certain groups in facing the hazards of COVID-19. The main contribution of this study is that it seeks to analyse the factors behind vaccine hesitancy and identifies which groups more likely hesitant toward vaccines based on their demographics.

Communicating COVID-19 risk changes: Signalling with words, phrases, and messages

During COVID-19, governments issued messages to trigger action, encourage sustained behaviours (e.g., social distancing, hand hygiene), and manage system wide risk. This study examines messages issued across two stages established by the World Health Organization (WHO): (a) pre-pandemic early intervention stage and (b) within-pandemic escalation stage. In April 2020, approximately one month after COVID-19 was declared a pandemic, an experiment using a sample of 769 Australian participants was conducted. Using a between-subject design, participants assessed the way messages (curated and then expertly attributed to the two stages) were perceived and influenced behaviours. Next, it examined the power of words and phrases, selected from the same messages, for (a) their potential to signal risk, warning, and behavioural response and (b) the extent to which they reflected pandemic stages. Results showed that between the two stages, messages were differentiated by negative affect, assertiveness, and risk. Subsequently, increased negative affect, assertiveness, and risk indication increased adaptive behavioural intentions. However, increased assertiveness also increased non-adaptive behavioural intentions, though increased risk indication reduced non-adaptive behavioural intentions. Signal words and phrases, which hold potential as iconic features for biological hazard messages, showed varying performance across message stages, indicating an opportunity to improve them. Taken together, the findings contribute to academic and policy approaches for adapting communication to changing risk.

A methodological proposal to evaluate the health hazard scenario from COVID-19 in Italy

2019 Coronavirus disease (COVID-19) had a big impact in Italy, mainly concentrated in the northern part of the Country. All this was mainly due to similarities of this area with Wuhan in Hubei Province, according to geographical, environmental and socio-economic points of view. The basic hypothesis of this research was that the presence of atmospheric pollutants can generate stress on health conditions of the population and determine pre-conditions for the development of diseases of the respiratory system and complications related to them. In most cases the attention on environmental aspects is mainly concentrated on pollution, neglecting issues such as land management which, in some way, can contribute to reducing the impact of pollution. The reduction of land take and the decrease in the loss of ecosystem services can represent an important aspect in improving environmental quality. In order to integrate policies for environmental change and human health, the main factors analyzed in this paper can be summarized in environmental, climatic and land management. The main aim of this paper was to produce three different hazard scenarios respectively related to environmental, climatic and land management-related factors. A Spatial Analytical Hierarchy Process (AHP) method has been applied over thirteen informative layers grouped in aggregation classes of environmental, climatic and land management. The results of the health hazard maps show a disparity in the distribution of territorial responses to the pandemic in Italy. The environmental components play an extremely relevant role in the definition of the red zones of hazard, with a consequent urgent need to renew sustainable development strategies. The comparison of hazard maps related to different scenarios provides decision makers with tools to orient policy choices with a different degree of priority according to a place-based approach. In particular, the geospatial representation of risks could be a tool for legitimizing the measures chosen by decision-makers, proposing a renewed approach that highlights and takes account of the differences between the spatial contexts to be considered - Regions, Provinces, Municipalities - also in terms of climatic and environmental variables.

Learning from Others' Disasters? A Comparative Study of SARS/MERS and COVID-19 Responses in Five Polities

The ability to successfully manage disasters is a function of the extent to which lessons are learned from prior experience. We focus on the extent to which lessons from SARS/MERS have been learned and implemented during the first wave of COVID-19, and the extent to which the source affects governance learning: from a polity's own experience in previous episodes of the same disaster type; from the experience of other polities with regard to the same disaster type; or by cross-hazard learning - transferring lessons learned from experience with other types of disasters. To assess which types of governance learning occurred we analyze the experience of four East Asian polities that were previously affected by SARS/MERS: South Korea, Taiwan, Singapore and Hong-Kong. Their experience is compared with that of Israel. Having faced other emergencies but not a pandemic, Israel could have potentially learned from its experience with other emergencies, or from the experience of others with regard to pandemics before the onset of COVID-19. We find that governance learning occurred in the polities that experienced either SARS or MERS, but not cross-hazard or cross-polity learning. The consequences in the 5 polities at the end of the first six months of Covid-19, reflected by the numbers of infected and deaths, on one hand, and by the level of disruption to normal life, on the other, verifies these findings. Research insights point to the importance of modifying governance structures to establish effective emergency institutions and necessary legislation as critical preparation for future unknown emergencies.

A multi-country comparative analysis of the impact of COVID-19 and natural hazards in India, Japan, the Philippines, and USA

Several countries have been affected by natural hazards during the COVID-19 pandemic. The combination of the pandemic and natural hazards has led to serious challenges that include financial losses and psychosocial stress. Additionally, this compound disaster affected evacuation decision making, where to evacuate, volunteer participation in mitigation and recovery, volunteer support acceptance, and interest in other hazard risks. This study investigated the impact of COVID-19 on disaster response and recovery from various types of hazards, with regard to preparedness, evacuation, volunteering, early recovery, awareness and knowledge of different types of hazards, and preparedness capacity development. This study targets hazards such as Cyclone Amphan in India, the Kumamoto flood in Japan, Typhoon Rolly in the Philippines, and the California wildfires in the U.S. This study made several recommendations, such as the fact that mental health support must be taken into consideration during COVID-19 recovery. It is necessary to improve the genral condition of evacuation centers in order to encourage people to act immediately. A pandemic situation necessitates a strong communication strategy and campaign with particular regard to the safety of evacuation centers, the necessity of a lockdown, and the duration required for it to reduce the psychological impact. Both national and local governments are expected to strengthen their disaster risk reduction (DRR) capacity, which calls for the multi-hazard management of disaster risk at all levels and across all sectors.

Mutual Impacts of the COVID-19 Pandemic and the Recent Earthquakes: A Scoping Review of the Lessons Learned

OBJECTIVE

The aim of this study was to review the articles dealing with the mutual impacts of the coronavirus disease 2019 (COVID-19) pandemic and the recent earthquakes to elicit the various scopes of the lessons learned including the challenges, the successful measures, and the recommendations.

METHODS

To detect the relevant studies published between February 1, 2020, and June 9, 2021, PubMed, Web of Science, Scopus, and Google Scholar were searched. Having considered specific inclusion/exclusion criteria, 18 studies were included.

RESULTS

Seven major earthquakes have occurred concurrently or before the pandemic era in Albania, Croatia, Haiti, Great East Japan, Mexico, Nepal, and Utah. Thematic analysis revealed 5 themes for the "challenges" (management inefficiency, increased life-threatening, economic, socially related, and dual psychological challenges); 4 themes for the "efficient response measures" (health-care services measures, government measures, community-based cooperative activities, and disaster management response); and 3 major themes with 7 sub-themes for the "recommendations" including "the mitigation phase" (identifying probable natural disasters), "the preparedness phase" (preparing necessary equipment), and "the response phase" (mental care response measures, health-care-related COVID-19 measures, economic improvement measures, recognizing community-based capabilities, and government-related boosting measures).

CONCLUSIONS

It is suggested that these scopes of the mutual impacts of the COVID-19 pandemic and the earthquakes be studied in systematic reviews.

The Geographical Distribution and Influencing Factors of COVID-19 in China

The study of the spatial differentiation of COVID-19 in cities and its driving mechanism is helpful to reveal the spatial distribution pattern, transmission mechanism and diffusion model, and evolution mechanism of the epidemic and can lay the foundation for constructing the spatial dynamics model of the epidemic and provide theoretical basis for the policy design, spatial planning and implementation of epidemic prevention and control and social governance. Geodetector (Origin version, Beijing, China) is a great tool for analysis of spatial differentiation and its influencing factors, and it provides decision support for differentiated policy design and its implementation in executing the city-specific policies. Using factor detection and interaction analysis of Geodetector, 15 indicators of economic, social, ecological, and environmental dimensions were integrated, and 143 cities were selected for the empirical research in China. The research shows that, first of all, risks of both infection and death show positive spatial autocorrelation, but the geographical distribution of local spatial autocorrelation differs significantly between the two. Secondly, the inequalities in urban economic, social, and residential environments interact with COVID-19 spatial heterogeneity, with stronger explanatory power especially when multidimensional inequalities are superimposed. Thirdly, the spatial distribution and spread of COVID-19 are highly spatially heterogeneous and correlated due to the complex influence of multiple factors, with factors such as Area of Urban Construction Land, GDP, Industrial Smoke and Dust Emission, and Expenditure having the strongest influence, the factors such as Area of Green, Number of Hospital Beds and Parks, and Industrial NOx Emissions having unignorable influence, while the factors such as Number of Free Parks and Industrial Enterprises, Per-GDP, and Population Density play an indirect role mainly by means of interaction. Fourthly, the factor interaction effect from the infected person’s perspective mainly shows a nonlinear enhancement effect, that is, the joint influence of the two factors is greater than the sum of their direct influences; but from the perspective of the dead, it mainly shows a two-factor enhancement effect, that is, the joint influence of the two factors is greater than the maximum of their direct influences but less than their sum. Fifthly, some suggestions are put forward from the perspectives of building a healthy, resilient, safe, and smart city, providing valuable reference and decision basis for city governments to carry out differentiated policy design.

Risk Perception of Natural and Human-Made Disasters-Cross Sectional Study in Eight Countries in Europe and Beyond

Each year, emergency and disaster situations claim a heavy toll in human lives and economic loss. Civilian populations that are more aware and prepared for emergencies are more resilient. The aim of this study was to explore similarities and differences in risk perception of emergencies and disasters across different societies and its association with individual resilience. A cross sectional study that explored attitudinal factors, as expressed by diverse samples of target countries across Europe and beyond, took place during the months of January-February 2021. Diverse samples (N ≥ 500) of adults from 8 countries (Italy, Romania, Spain, France, Sweden, Norway, Israel, and Japan) were engaged in this study. This study used the Pictorial Representation of Illness and Self-Measure (iPRISM) tool to assess risk perception. The results suggest that for the overall sample (N = 4,013), pandemics were the risk of which participants showed the highest concern, followed by critical infrastructure fail, social disturbance, natural hazards, and extreme weather events. It was found that religiosity is associated with risk perception, with highly religious and non-religious reporting elevated risk perception (F = 5.735, df = 2, p = 0.003), however country-specific analysis revealed that this finding varies depending on local contexts. The analysis also revealed differences in risk perception depending on age and type of risk. The results of this study present that there are commonalities and differences between societies across Europe and beyond concerning societal resilience at large, including risk perception. The dependency of risk perception on local context suggests that a regional-based approach for disaster risk reduction may be called for to adapt and adjust to local socio-cultural characteristics of each population.

What shapes people's willingness to wear a face mask at the beginning of a public health disaster? A qualitative study based on COVID-19 in China

COVID-19 should not be the world's last public health disaster, so there is an urgent need to learn from COVID-19 to prepare better for the next public health disaster. This study aims to understand the factors that make people wear a face mask at the beginning of an outbreak of public health disaster. Semi-structured interviews were conducted during April 2020 in China, one month after the COVID-19 was declared a pandemic. The respondents were members of the public living in China, covering two age groups: young adults and older adults. They were recruited using a convenient sample and snowball sampling strategy. The results were analysed using content analysis. Seventeen subjects were recruited, among which nine were young adults (average age = 26.4; SD = 10.5), and eight were older adults (average age = 60.4; SD = 12.1). This study found that environmental factors, personal factors, factors concerning wearing masks, specific circumstances, and development of the pandemic were the common factors considered by both young adults and older adults. This study should help the authority formulate prevention policies better to reduce the risk of an outbreak if there is a new virus outbreak in the future, unfortunately.

50 Years of Mass-Fatality Terrorist Attacks: A Retrospective Study of Target Demographics, Modalities, and Injury Patterns to Better Inform Future Counter-Terrorism Medicine Preparedness and Response

BACKGROUND

Terrorism-related deaths have fallen year after year since peaking in 2014, and whilst the coronavirus disease 2019 (COVID-19) pandemic has disrupted terrorist organizations capacity to conduct attacks and limited their potential targets, counter-terrorism experts believe this is a short-term phenomenon with serious concerns of an escalation of violence and events in the near future. This study aims to provide an epidemiological analysis of all terrorism-related mass-fatality events (>100 fatalities) sustained between 1970-2019, including historical attack strategies, modalities used, and target selection, to better inform health care responders on the injury types they are likely to encounter.

METHODS

The Global Terrorism Database (GTD) was searched for all attacks between the years 1970-2019. Attacks met inclusion criteria if they fulfilled the three terrorism-related criteria as set by the GTD codebook. Ambiguous events were excluded. State-sponsored terrorist events do not meet the codebook's definition, and as such, are excluded from the study. Data analysis and subsequent discussions were focused on events causing 100+ fatal injuries (FI).

RESULTS

In total, 168,003 events were recorded between the years 1970-2019. Of these, 85,225 (50.73%) events recorded no FI; 67,356 (40.10%) events recorded 1-10 FI; 5,791 (3.45%) events recorded 11-50 FI; 405 (0.24%) events recorded 51-100 FI; 149 (0.09%) events recorded over 100 FI; and 9,077 (5.40%) events recorded unknown number of FI.Also, 96,905 events recorded no non-fatal injuries (NFI); 47,425 events recorded 1-10 NFI; 8,313 events recorded 11-50 NFI; 867 events recorded 51-100 NFI; 360 events recorded over 100 NFI; and 14,130 events recorded unknown number of NFI. Private citizens and property were the primary targets in 67 of the 149 high-FI events (100+ FI). Of the 149 events recording 100+ FI, 46 (30.87%) were attributed to bombings/explosions as the primary attack modality, 43 (28.86%) were armed assaults, 23 (15.44%) hostage incidents, two (1.34%) were facility/infrastructure attacks (incendiary), one (0.67%) was an unarmed assault, seven (4.70%) had unknown modalities, and 27 (18.12%) were mixed modality attacks.

CONCLUSIONS

The most common attack modality causing 100+ FI was the use of bombs and explosions (30.87%), followed by armed assaults (28.86%). Private citizens and properties (44.97%) were most commonly targeted, followed by government (6.04%), businesses (5.37%), police (4.70%), and airports and aircrafts (4.70%). These data will be useful for the development of training programs in Counter-Terrorism Medicine (CTM), a rapidly emerging Disaster Medicine sub-specialty.

The structural characteristics and influential factors of psychological stress of urban residents in Jiangxi province during the COVID-19 pandemic: cross sectional study

AIMS

To explore the structural characteristics and influential factors of psychological stress of urban residents in Jiangxi province during the COVID-19 pandemic through a survey of psychological stress, personality traits, family function and life satisfaction.

METHODS

By the convenient sampling, 1422 urban residents from Jiangxi province were assessed with Eysenck Personality Questionnaire Short Scale (EPQ-RSC), Psychological Questionnaires for Emergent Events of Public Health (PQEEPH), Family APGAR Scale (APGAR) and Satisfaction With Life Scale (SWLS). The relation among personality traits, psychological stress, family function and life satisfaction during the COVID-19 pandemic was analyzed by using the canonical correlation analysis and the serial mediation model.

RESULTS

(1) Among the estimated correlation coefficients, the first two pairs were significant (P < 0.001 in each). (2) In the first pair of canonical variables, the loadings of neuroticism and neurasthenia were the higher (0.94, 0.70). (3) Neuroticism and life satisfaction mediated the relationship between family function and neurasthenia (β neuroticism = -0.174; 95%CI:-0.224, -0.134; β life satisfaction = -0.034, 95%CI:-0.012, -0.062), respectively. In addition, serial mediation analyses indicated that the association of family function and neurasthenia is mediated by neuroticism and life satisfaction in a sequential manner (β = -0.010; 95%CI:-0.020, -0.004).

CONCLUSIONS

During the COVID-19 pandemic, neuroticism was closely related to psychological stress of urban residents, especially neurasthenia. In addition, the serial mediating effect of neuroticism and life satisfaction played an important role in the process of family function influencing neurasthenia. These findings contributed to a more comprehensive understanding of the influential factors for psychological stress of urban residents during the COVID-19 pandemic.