The Recommended and Excessive Preventive Behaviors during the COVID-19 Pandemic: A Community-Based Online Survey in China

Characterising subgroups of people with severe COVID anxiety by latent profile analysis

BACKGROUND

People with severe COVID anxiety have had experiences of the COVID-19 pandemic which are overwhelming, and have led to patterns of behaviours that add little protective benefit but are at the expense of other priorities in life. It appears to be a complex social and psychological phenomenon, influenced by demographic and social factors. Identifying subgroups of people with severe COVID anxiety would better place clinicians to assess and support this distress where indicated.

METHODS

Measurement tools assessing depression, generalised and health anxiety, obsessive-compulsive symptoms, personality difficulty and alcohol use from 284 people living in United Kingdom with severe COVID anxiety were explored with latent profile analysis. Further analyses examined the associations of identified clusters with demographic and social factors and daily functioning, quality of life and protective behaviours.

RESULTS

A model with 4 classes provided the best fit. Distinct patterns of psychopathology emerged which were variably associated with demographic factors and COVID behaviours.

LIMITATIONS

Given the complex aetiology of COVID anxiety a number of factors which might better cluster subgroups are likely to have gone uncollected. Moreover, using data collected at a single time-point limits these results' ability to conclude whether observed relationships were the product of the pandemic or longstanding.

CONCLUSIONS

People living with severe COVID anxiety are a heterogenous group. This analysis adds to evidence that certain health behaviours and demographic factors are inextricably linked to poor mental health in people with COVID anxiety, and that targeting health behaviours with specific intervention might be beneficial.

Knowledge and behaviors of prevention of COVID-19 and the related factors in the rural population referred to the health centers: a cross-sectional study

BACKGROUND AND OBJECTIVE

Observance of preventive behaviors is one of the main ways to break the coronavirus disease 2019 (COVID-19) chain of transmission. Therefore, the present study was conducted to determine the knowledge and behaviors of prevention of COVID-19 and the related factors in the rural population of Rasht city.

METHODS

In this cross-sectional study, 344 people of the population referred to health centers in Rasht city were included through multi-stage cluster random sampling. The data were collected using a three-part researcher-made questionnaire including individual-social factors, knowledge about the prevention of COVID-19, and the preventive behaviors against COVID-19. Data analysis was performed using the Kolmogorov-Smirnov and Shapiro-Wilk tests, Spearman's correlation coefficient, and multiple logistic regression analysis, by SPSS software version 16 at a significance level < 0.05.

RESULTS

The mean total score of knowledge about COVID-19 was at a moderate level, and the preventive behaviors of COVID-19 were at a good level. There was no significant relationship between the scores of awareness and preventive behaviors of COVID-19 (rs=0.001, P = 0.998). Awareness of COVID-19 was higher in university-educated individuals and women. Also, women, individuals who had access to the Internet, those trained by health centers, and those who were visited by health workers at home had more preventive behaviors.

CONCLUSION

Despite the lack of connection between knowledge and preventive behaviors, the villagers living in the suburbs of Rasht had a moderate level of knowledge and a good level of preventive behaviors of COVID-19. Appropriate educational interventions should be carried out to increase the awareness and performance of the rural residents.

Protective and Overprotective Behaviors against COVID-19 Outbreak: Media Impact and Mediating Roles of Institutional Trust and Anxiety

This study aims to explore how pandemic-related media use relates to both protective and overprotective behaviors and to probe the underlying mechanisms. The data were collected online during the early outbreak of COVID-19 in China, and a total of 1118 valid cases, which covered the 30 provincial administrative divisions in mainland China, were collected. Results showed that official government media use was positively associated with protective behaviors and institutional trust was an important mediator. Commercial media use was also found to be positively associated with overprotective behavior, and anxiety mediated this relationship. Findings of this study suggested that different media sources could play completely different roles. Institutional trust in government institutions and medical care systems were equally critical in translating the media effect into public compliance with the preventive measures advocated by the relevant departments. Media outlets and practitioners should also be responsible in order to avoid causing unnecessary anxiety among the public so as to reduce irrational overprotective behaviors.

Effects of negative emotions and information perceived value on residents' risk perception during the COVID-19 pandemic: An empirical survey from China

Background

The COVID-19 pandemic has spread rapidly and heavily hit the globe, and the mutation and transmission speed of the coronavirus have accelerated so that the world is still in danger. Thus, this study aims to investigate the participants' risk perception and explore the associations of risk perception of COVID-19 with negative emotions, information value perception and other related dimensions.

Methods

A cross-sectional, population-based online survey was conducted from April 4 to 15, 2020, in China. A total of 3,552 participants were included in this study. A descriptive measure of demographic information was used in this study. Multiple regression models and moderating effect analysis were used to estimate the effect of potential associations of risk perceptions.

Results

Those who showed negative emotions (depressed, helplessness, loneliness) and perceived video information in social media to be useful were positively correlated with risk perception, whereas individuals who perceived experts' advice to be useful, shared risk information with friends and thought that their community made adequate emergency preparation reported lower risk perception. The moderating effect of information perceived value (β = 0.020, p < 0.001) on the relationship between negative emotion and perception of risk was significant.

Conclusions

Individual differences in risk cognition during the COVID-19 pandemic were observed in subgroups of age level. Furthermore, the role of negative emotional states, the perceived usefulness of risk information and the sense of security also contributed to improving the public's risk perception. It is crucial for authorities to focus on residents' negative emotions and to clarify misinformation in accessible and effective ways in a timely manner.

Machine-learning approaches to identify determining factors of happiness during the COVID-19 pandemic: retrospective cohort study

OBJECTIVE

To investigate determining factors of happiness during the COVID-19 pandemic.

DESIGN

Observational study.

SETTING

Large online surveys in Japan before and during the COVID-19 pandemic.

PARTICIPANTS

A random sample of 25 482 individuals who are representatives of the Japanese population.

MAIN OUTCOME MEASURE

Self-reported happiness measured using a 10-point Likert scale, where higher scores indicated higher levels of happiness. We defined participants with ≥8 on the scale as having high levels of happiness.

RESULTS

Among the 25 482 respondents, the median score of self-reported happiness was 7 (IQR 6-8), with 11 418 (45%) reporting high levels of happiness during the pandemic. The multivariable logistic regression model showed that meaning in life, having a spouse, trust in neighbours and female gender were positively associated with happiness (eg, adjusted OR (aOR) for meaning in life 4.17; 95% CI 3.92 to 4.43; p<0.001). Conversely, self-reported poor health, anxiety about future household income, psychiatric diseases except depression and feeling isolated were negatively associated with happiness (eg, aOR for self-reported poor health 0.44; 95% CI 0.39 to 0.48; p<0.001). Using machine-learning methods, we found that meaning in life and social capital (eg, having a spouse and trust in communities) were the strongest positive determinants of happiness, whereas poor health, anxiety about future household income and feeling isolated were important negative determinants of happiness. Among 6965 subjects who responded to questionnaires both before and during the COVID-19 pandemic, there was no systemic difference in the patterns as to determinants of declined happiness during the pandemic.

CONCLUSION

Using machine-learning methods on data from large online surveys in Japan, we found that interventions that have a positive impact on social capital as well as successful pandemic control and economic stimuli may effectively improve the population-level psychological well-being during the COVID-19 pandemic.

What drives people’s protective behaviors during the early stage of the COVID-19 pandemic in China

This study systematically examined people’s protective behaviors against COVID-19 in China, and particular attention was given to people’s perceived threat and information-processing strategies. This study constructed a conceptual model and used structural equation modeling to explore this issue, and a questionnaire survey was conducted to collect data involving 4,605 participants during the early stage of the COVID-19 pandemic in China. The results showed that people’s initial information acquisition played an essential role in their behavioral responses; acquiring more initial information about COVID-19 would make them perceive a higher threat and present a higher demand for information, then making them more likely to seek and process information, and subsequently motivating their protective behaviors. In addition to increasing people’s information needs, the perceived threat could also strengthen the analytical assessment and affect protective behavior positively but failed to predict the experiential assessment. Driven by information need, information seeking significantly influenced protective behavior; it also facilitated analytical assessment and decreased experiential assessment, thus predicting people’s protective behaviors. Protective behaviors were spurred by analytical assessment but negatively influenced by the experiential assessment.

Analysis of factors influencing public attention to masks during the COVID-19 epidemic-Data from Sina Weibo

As we all know, vaccination still does not protect people from novel coronavirus infections, and wearing masks remains essential. Research on mask attention is helpful to understand the public's cognition and willingness to wear masks, but there are few studies on mask attention in the existing literature. The health belief model used to study disease prevention behaviors is rarely applied to the research on mask attention, and the research on health belief models basically entails the use of a questionnaire survey. This study was purposed to establish a health belief model affecting mask attention to explore the relationship between perceived susceptibility, perceived severity, self-efficacy, perceived impairment, action cues and mask attention. On the basis of the establishment of the hypothesis model, the Baidu index of epidemic and mask attention, the number of likes and comments on Weibo, and the historical weather temperature data were retrieved by using software. Keyword extraction and manual screening were carried out for Weibo comments, and then the independent variables and dependent variables were coded. Finally, through binomial logistic regression analysis, it was concluded that perceived susceptibility, perceived severity and action cues have significant influences on mask attention, and that the accuracy rate for predicting low attention is 93.4%, and the global accuracy is 84.3%. These conclusions can also help suppliers make production decisions.

Trends and Factors Associated With Risk Perception, Anxiety, and Behavior From the Early Outbreak Period to the Controlled Period of COVID-19 Epidemic: Four Cross-Sectional Online Surveys in China in 2020

Background: The first wave of the COVID-19 epidemic in China was brought under with 3 months-from mid-January 2020 to the end of March 2020. Less studies examined dynamic psychological effect and behaviors during COVID-19 pandemic. This study aims to examine perceived risk, anxiety, and behavioral response of the general public related to the outbreak of COVID-19 in four cross-sectional surveys conducted throughout China. Methods: In 2020, four cross-sectional, population-based online survey were conducted from January 28 to February 3, from February 10 to 12, from February 20 to 22, and from March 1 to 10, respectively. Convenience sampling was used for easy recruiting survey participants under the long-term impact of the COVID-19 epidemic. The four independent online questionnaires were sent from the same approach (WeChat and MicroBlog), and anyone who receives the questionnaire on the Internet or mobile phone and meets the inclusion criteria could fill in it. The same questionnaires repeatedly used in the four surveys. Socio-demographic information and individual protective practice were collected and the state-trait anxiety inventory (STAI) was used for measuring anxiety. Propensity score matching was used to adjust for differences in baseline characteristics among the four surveys. Wilcoxon signed ranks test was used to compare people's perceived risk, anxiety and protective behaviors changes in four stages. General linear model was used to identify associations between some demographic factors and perceived risk, anxiety scores, and protective behaviors. Results: The proportion of high perceived risk has dropped from 24.7 to 4.7%. The proportion of severe anxiety has declined from 12.2 to 1.2%. The proportion of people wore masks when they went out has increased from 97.0 to 98.3%. Women were more likely to develop anxiety (OR = 1.5, 95%CI: 1.4-1.6) and more positively adopted recommended behaviors (OR = 2.1, 95%CI: 1.3-3.4) than men. People at age 30-39 years, with high-degree education, with married status, and accompanied with poor self-rated health status were prone to have higher risk perception and anxiety. Perceived risk was significantly associated with anxiety over the entire periods. Anxiety levels had stronger associations with adoption of protective behaviors (wearing mask and avoiding crowed place) in the early epidemic periods than in the late epidemic periods. Conclusions: The levels of perceived risk and anxiety showed a trend of rising first and then falling. Gradually upward trend on initiative preventive behaviors including wearing mask and avoiding visiting crowded places also was observed through scanning data at four stages. People at age 30-39 years, with high-degree education, and accompanied with poor self-rated health status were prone to have higher risk perception and anxiety. Our findings showed that people simultaneously presented both high-level risk perception and anxiety across the four wave surveys, leading to their positive self-prevention and protective behavior.

Behavioral and Mental Responses towards the COVID-19 Pandemic among Chinese Older Adults: A Cross-Sectional Study

The novel COVID-19 pandemic spread quickly and continuously influenced global societies. As a vulnerable population that accounted for the highest percentage of deaths from the pandemic, older adults have experienced huge life-altering challenges and increased risks of mental problems during the pandemic. Empirical evidence is needed to develop effective strategies to promote preventive measures and mitigate the adverse psychological impacts of the COVID-19 pandemic. This study aimed to investigate the behavioral responses (i.e., preventive behaviors, physical activity, fruit and vegetable consumption) and mental responses (i.e., depression and loneliness) towards the COVID-19 pandemic among Chinese older adults. A further aim was to identify the associations among demographics, behavioral responses, and mental responses. Using a convenience sampling approach, 516 older adults were randomly recruited from five cities of Hubei province in China. Results of the cross-sectional survey showed that 11.7% of participants did not adhere to the WHO recommended preventive measures, while 37.6% and 8.3% of participants decreased physical activity and fruit–vegetable consumption respectively. For mental responses, 30.8% and 69.2% of participants indicated significantly depressive symptoms and severe loneliness, respectively. Participants’ behavioral and mental responses differed significantly in several demographics, such as age group, living situation, marital status, education levels, household income, medical conditions, and perceived health status. Demographic correlates and behavioral responses could significantly predicate the mental response with small-to-moderate effect sizes. This is the first study to investigate the characteristics of behavioral and mental responses of Chinese older adults during the COVID-19 pandemic. Research findings may give new insights into future developments of effective interventions and policies to promote health among older adults in the fight against the pandemic.

Cross-Cultural Validation of a New Version in Spanish of Four Items of the Preventive COVID-19 Infection Behaviors Scale (PCIBS) in Twelve Latin American Countries

The invariance of the Preventive COVID-19 Infection Behaviors Scale (PCIBS) was evaluated in 12 Latin American countries (Argentina, Bolivia, Chile, Colombia, Cuba, Ecuador, El Salvador, Guatemala, Mexico, Paraguay, Peru, and Uruguay). A total of 5183 people from the aforementioned countries participated, selected using the snowball sampling method. Measurement invariance was assessed by multigroup confirmatory factor analysis (MG-CFA) and Multi-Group Factor Analysis Alignment (CFA-MIAL). In addition, item characteristics were assessed based on Item Response Theory. The results indicate that the original five-item version of the PCIBS is not adequate; whereas a four-item version of the PCIBS (PCIBS-4) showed a good fit in all countries. Thus, using the MG-CFA method, the PCIBS-4 achieved metric invariance, while the CFA-MIAL method indicated that the PCIBS-4 shows metric and scalar invariance. Likewise, the four items present increasing difficulties and high values in the discrimination parameters. The comparison of means of the PCIBS-4 reported irrelevant differences between countries; however, Mexico and Peru presented the highest frequency of preventive behaviors related to COVID-19. It is concluded that the PCIBS-4 is a unidimensional self-report measure which is reliable and invariant across the twelve participating Latin American countries. It is expected that the findings will be of interest to social and health scientists, as well as those professionals directly involved in public health decision making.

The role of online news and social media in preventive action in times of infodemic from a social capital perspective: The case of the COVID-19 pandemic in South Korea

Infodemic, the spread of false information during the COVID-19 pandemic, has been raised as one of the major concerns aggravating the confusion in the global society. In this regard, the role of media as an information channel in delivering the reliable information and motivating the active participation of citizens in complying with government's preventive actions becomes much more important. In this study, the role of online news and social media on people's preventive actions considering the role of trust in citizens and government from the perspective of social capital is investigated. For the empirical study, a structural equation modeling is employed by using survey material gathered from South Korea in the early days of the COVID-19 outbreak. South Korea was selected as its COVID-19 prevention strategy focused not only on the provision of medical support, but also on the enhancement of social trust through active engagement with people through media channels. Our results reveal that the perceived characteristics of online news and social media influence preventive actions through the trust in citizens or in government. In addition, while online news media enhances trust in both the citizens and the government, social media only influences trust in citizens. Based on our findings, the role of media in preventing the spread of COVID-19 is dicussed.

Analysis of efficacy of intervention strategies for COVID-19 transmission: A case study of Hong Kong

By the end of February 2021, COVID-19 had spread to over 230 countries, with more than 100 million confirmed cases and 2.5 million deaths. To control infection spread with the least disruption to economic and societal activities, it is crucial to implement the various interventions effectively. In this study, we developed an agent-based SEIR model, using real demographic and geographic data from Hong Kong, to analyse the efficiency of various intervention strategies in preventing infection by the SARS-CoV-2 virus. Close contact route including short-range airborne is considered as the main transmission routes for COVID-19 spread. Contact tracing is not that useful if all other interventions have been fully deployed. The number of infected individuals could be halved if people reduced their close contact rate by 25%. For reducing transmission, students should be prioritized for vaccination rather than retired older people and preschool aged children. Home isolation, and taking the nucleic acid test (NAT) as soon as possible after symptom onset, are much more effective interventions than wearing masks in public places. Temperature screening in public places only disrupted the infection spread by a small amount when other interventions have been fully implemented. Our results may be useful for other highly populated cities, when choosing their intervention strategies to prevent outbreaks of COVID-19 and similar diseases.

Identify and measure the degree of over-prevention behaviors in the post-COVID-19 era in China

Background

With the spread of vaccines, more and more countries have controlled the outbreak of the COVID-19. In this post-epidemic era, these countries began to revive their economy. However, pollution remains in the environment, and people’s physical and psychological health has been under threat due to some over-prevention behaviors. Instruments for governmental agencies to manage these behaviors are not yet available. This study aims to develop a measurement model to identify and measure the degree of over-prevention behaviors during the COVID-19 epidemic in China.

Methods

A survey online was conducted to collect cognition from 1528 Chinese people, including descriptions of various over-prevention behaviors defined by health authorities. Factor analyses were used to develop the measurement model and test its validity. Logistic regression analyses were conducted to explore demographic characteristics, indicating people who are inclined to exhibit over-prevention behaviors.

Results

Four main factors were extracted to develop the model (eigenvalue = 7.337, 3.157, 1.447, and 1.059, respectively). The overall reliability (Cronbach’s α = 0.900), the convergent (AVE > 0.5, CR > 0.8 for each factor) and discriminant validity is good. There is also a good internal consistency among these factors (Cronbach’s α = 0.906, 0.852, 0.882, and 0.763, respectively). In Factor 1, gender has a negative effect (Beta = − 0.294, P <  0.05, OR = 0.745), whereas employment has a positive effect. Workers in institutions exhibit the greatest effect (Beta = 0.855, P <  0.001, OR = 2.352). In Factor 2, employment has a negative effect, with workers in institutions exhibit the greatest role (Beta = − 0.963, P <  0.001, OR = 0.382). By contrast, education level has a positive effect (Beta = 0.430, P <  0.001, OR = 1.537). In Factor 3, age plays a negative role (Beta = − 0.128, P < 0.05, OR = 0.880).

Conclusions

People show a discrepancy in the cognition toward various over-prevention behaviors. The findings may have implications for decision-makers to reduce the contradiction between the epidemic and economic revival via managing these behaviors.

Knowledge, Attitude, and Preventive Practices Towards COVID-19 Among Students of Ethiopian Higher Education Institutions

INTRODUCTION

COVID-19 has been a global public health problem since December 2019. Higher education institutions are risky areas for the transmission of COVID-19. But, still there is insufficient information on the prevention of the disease in this setting.

OBJECTIVE

To assess knowledge, attitude, and prevention practices towards COVID-19 among students of Ethiopian higher education institutions.

METHODS

Institutin  -based cross-sectional study design was conducted from December 1 to 30, 2020 among randomly selected 407 undergraduate students from higher education institutions in Ethiopia. The outcome variables were knowledge, attitude, and practices towards COVID-19. Binary logistic regression models at 95% confidence interval (CI) were used to determine the factors affecting knowledge, attitude, and practices towards COVID-19. In multivariable analysis, variables with a p-value of less than 0.05 were considered statistically significant and independently associated with outcome variables at 95% CI.

RESULTS

About 75.9% (95% CI: 72.2-79.9%) of University students had a good knowledge, 62.4% (95% CI: 58.2-67.1%) had a positive attitude, and 56.8% (95% CI: 52.6-61.9%) had a good COVID-19 prevention practices. Students over the age of 30 (AOR=5.8; 95% CI: 1.5, 10.6), third-year students (AOR=3.1; 95% CI: 1.1, 8.9), and being health science students (AOR=4.4; 95% CI: 2.2, 8.9) were significantly associated with a good knowledge towards COVID-19. Urban residents (AOR=0.6; 95% CI: 0.3-0.9), having an average family monthly income of $75USD (AOR=3.5; 95% CI: 1.8-6.7), use of at least one type of social media (AOR=4.7; 95% CI: 1.7-12.9), and having a positive attitude (AOR=2.2; 95% CI: 1.3-3.5) were significantly associated with COVID-19 prevention practices.

CONCLUSION

Despite three-fourths of the participants had a good knowledge, the attitude and prevention practices were low. Age, study year, College of study, presence of chronic illnesses, use of social media, family income, and residence were factors of knowledge, attitude, and prevention practices towards COVID-19. Hence, multiple information dissemination strategies using multiple media outlets should be implemented continuously.

Preventive behaviours and family inequalities during the COVID-19 pandemic: a cross-sectional study in China

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic is an international public health threat, and people's participation in disease-related preventive behaviours is the key to controlling infectious diseases. This study aimed to assess the differences in adopting preventive behaviours among populations to explore potential individual and household factors and inequalities within families.

METHODS

This online survey was conducted in April 2020. The directional stratified convenient sampling method was used to select 4704 participants from eight provinces in eastern, central, and western China. The questionnaire included demographic information, household variables, and five target prevention behaviours. The chi-squared test, binary multilevel model, and Mantel-Haenszel hierarchical analysis were used for data analysis in the study.

RESULTS

Approximately 71.2% of the participants had appropriate outdoor prevention, and 32.9% of the participants had indoor protection in place. Sharing behaviours (P < 0.001) and education level (P < 0.001) were positively associated with adopting preventive measures. The inhibiting effect of household crowding and stimulating effect of high household income on preventive behaviours were determined in this study. Household size was negatively associated with living area (β = -0.057, P < 0.05) and living style (β = -0.077, P < 0.05). Household income was positively associated with age (β = 0.023, P < 0.05), and relationship with friends (β = 0.053, P < 0.05). Vulnerable groups, such as older adults or women, are more likely to have inadequate preventive behaviours. Older adults (OR = 1.53, 95% CI 1.09-2.15), women (OR = 1.37, 95% CI 1.15-1.64), and those with more than 2 suspected symptoms (OR = 1.85, 95% CI 1.07-3.19) were more likely to be affected by the inhibiting effect of household crowding, while the stimulating effect of high household income was limited in these groups.

CONCLUSIONS

Inequalities in COVID-19 prevention behaviours exist between families and inadequate adoption of prevention by vulnerable groups are noteworthy. This study expands the research perspective by emphasizing the role of household factors in preventive behaviours and by focusing on family inequalities. The government should use traditional media as a platform to enhance residents' public health knowledge. Targeted additional wage subsidies, investments in affordable housing, financial support for multigenerational households, and temporary relocation policies may deserve more attention. Communities could play a critical role in COVID-19 prevention.

Influencing Factors of Psychosocial Stress among Korean Adults during the COVID-19 Outbreak

The restriction of an individual’s daily life due to the strengthening of quarantine and lockdown increases psychosocial stress. This study aimed to determine the factors that influence psychosocial stress during a period of strict quarantine and lockdown to curb the COVID-19 pandemic in Korea. A total of 338 adults participated in a cross-sectional online survey conducted from 19–25 May 2020, which measured knowledge of COVID-19, health belief, resilience, and psychosocial stress. According to the results, there was no difference between the participants’ scores from the Daegu area (with concentrated confirmed COVID-19 cases) and the non-Daegu area except for health belief. Eighty-two percent of participants constituted the high-risk group for psychosocial stress. Individual resilience was positively correlated with health belief and negatively correlated with psychosocial stress (p < 0.001). Further, the following factors affected the level of psychosocial stress: resilience, subjective health status, and monthly household income, with an explanatory power of 39.8%. Therefore, those with higher subjective health and higher monthly household income experienced higher psychosocial stress, whereas higher resilience indicated lower psychosocial stress.

Factors Influencing Depression and Mental Distress Related to COVID-19 Among University Students in China: Online Cross-sectional Mediation Study

BACKGROUND

The COVID-19 epidemic may elevate mental distress and depressive symptoms in various populations in China.

OBJECTIVE

This study investigates the levels of depression and mental distress due to COVID-19, and the associations between cognitive, behavioral, and psychosocial factors, and depression and mental distress due to COVID-19 among university students in China.

METHODS

A large-scale online cross-sectional study (16 cities in 13 provinces) was conducted among university students from February 1 to 10, 2020, in China; 23,863 valid questionnaires were returned. The Patient Health Questionnaire-9 was used to assess depression. Structural equation modeling was performed to test mediation and suppression effects.

RESULTS

Of the 23,863 participants, 47.1% (n=11,235) reported high or very high levels of one or more types of mental distress due to COVID-19; 39.1% (n=9326) showed mild to severe depression. Mental distress due to COVID-19 was positively associated with depression. All but one factor (perceived infection risks, perceived chance of controlling the epidemic, staying at home, contacted people from Wuhan, and perceived discrimination) were significantly associated with mental distress due to COVID-19 and depression. Mental distress due to COVID-19 partially mediated and suppressed the associations between some of the studied factors and depression (effect size of 6.0%-79.5%).

CONCLUSIONS

Both mental distress due to COVID-19 and depression were prevalent among university students in China; the former may have increased the prevalence of the latter. The studied cognitive, behavioral, and psychosocial factors related to COVID-19 may directly or indirectly (via mental distress due to COVID-19) affect depression. Interventions to modify such factors may reduce mental distress and depressive symptoms during the COVID-19 epidemic.

Disease Prevention Behavior During the COVID-19 Pandemic and the Role of Self-Esteem: An Extended Parallel Process Model

Objective

The COVID-19 outbreak has become a serious public health problem worldwide. The purpose of this study was to use an extended parallel process model (EPPM) to understand factors in COVID-19 prevention behaviors.

Methods

This cross-sectional and analytical study was conducted on 1012 participants in Taiwan. A structured questionnaire and an online survey were used to collect data.

Results

The EPPM revealed that the severity of the COVID-19 threat perceived by respondents directly affected the arousal of fear in the respondents (β=0.268, t=9.007, p<0.001), but perceived efficacy did not (β=−0.019, t=−0.619, p>0.05); additionally, fear arousal was significantly associated with COVID-19 prevention behaviors (β=0.119, t=4.603, p<0.001). Regarding personal characteristics, self-esteem moderated the relationship between perceived threat and fear arousal. However, the moderating effect of self-esteem was stronger in people with low self-esteem compared to those with high self-esteem (β=0.606, −0.472; t=26.303, −17.694; p<0.001, p<0.001; respectively). The results of this study also indicated that two demographic characteristics (age and gender) affect COVID-19 prevention behaviors.

Conclusion

When developing healthcare policies and community interventions for improving COVID-19 prevention behaviors during an outbreak, healthcare administrators should carefully consider the main constructs of the EPPM, particularly personal characteristics (ie, self-esteem) and demographic characteristics (ie, age and gender).

The relationship between government trust and preventive behaviors during the COVID-19 pandemic in China: Exploring the roles of knowledge and negative emotion

Government trust is known to be associated with preventive practices during pandemics, but few studies have explored the roles of knowledge and negative emotion in conditioning the relationship between trust and preventive behaviors. The aim of this study was to explore the roles of knowledge and negative emotion in conditioning the relationship between trust and preventive measures during the COVID-19 pandemic in China. Data from a cross-sectional survey of 3000 Chinese adults [mean (SD) age 36.93 (12.11) years; 52.4% male], conducted using quota-sampling method (March 2-2020 to March 23-2020), were analyzed. Overall, respondents performed recommended preventive measures more frequently (3.21 out of 4) than excessive preventive measures (2.11 out of 4). Government trust was positively associated with both officially recommended (b = 0.12; 95%CI = 0.18, 0.25) and excessive preventive behaviors (b = 0.07; 95%CI = 0.03, 0.10). The positive relationship between trust and excessive preventive behaviors was found to be statistically significant only among those with low levels of COVID-19 knowledge. Officially recommended preventive behavior is most likely to happen when there is a combination of high levels of government trust and low levels of negative emotion. Therefore, government trust increases both official and excessive (sometimes unscientific) preventive behaviors. Interventions shall aim to enhance people's COVID-19 knowledge and to reduce negative emotions.

Perceived psychosocial health and its sociodemographic correlates in times of the COVID-19 pandemic: a community-based online study in China

BACKGROUND

Coronavirus disease 2019 (COVID-19) pandemic has been affecting people's psychosocial health and well-being through various complex pathways. The present study aims to investigate the perceived psychosocial health and its sociodemographic correlates among Chinese community-dwelling residents.

METHODS

This cross-sectional survey was carried out online and using a structured questionnaire during April 2020. In total, 4788 men and women with the age range of 11-98 years from eight provinces in eastern, central and western China were included in the analysis. We adopted a tactical approach to capture three key domains of perceived psychosocial health that are more likely to occur during a pandemic including hopelessness, loneliness, and depression. Multiple regression method, binary logistic regression model and variance inflation factor (VIF) were used to conduct data analysis.

RESULTS

Respectively 34.8%, 32.5% and 44.8% of the participants expressed feeling more hopeless, lonely, and depressed during the pandemic. The percentage of all three indicators was comparatively higher among women than among men: hopelessness (50.7% vs 49.3%), loneliness (52.4% vs 47.6%), and depression (56.2% vs 43.8%). Being married was associated with lower odds of loneliness among men (odds ratio [OR] = 0.63, 95% CI: 0.45-0.90). Loneliness was negatively associated with smoking (OR = 0.67, 95% CI: 0.45-0.99) and positively associated with drinking (OR = 1.45, 95% CI: 1.04-2.02). Compared with those in the lowest income bracket (< CNY 10 000), men (OR = 0.34, 95% CI: 0.21-0.55) and women (OR = 0.36, 95% CI: 0.23-0.56) in the highest level of annually housed income (> CNY 40 000) had the lowest odds of reporting perceived hopelessness (OR = 0.35, 95% CI: 0.25-0.48). Smoking also showed negative association with depression only among men (OR = 0.63, 95% CI: 0.43-0.91).

CONCLUSIONS

More than one-third of the participants reported worsening in the experience of hopelessness and loneliness, with more than two-fifth of worsening depression during the pandemic compared with before the outbreak. Several socioeconomic and lifestyle factors were found to be associated with the outcome variables, most notably participants' marital status, household income, smoking, alcohol drinking, existing chronic conditions. These findings may be of significance to treat patients and help them recover from the pandemic.