The Associations of COVID-19 Induced Anxiety, Related Knowledge and Protective Behavior

On the last day of 2019, 44 pneumonia cases with unknown etiology were reported to the World Health Organization (WHO) Country Office of China. This was the first cluster of what would be defined later as coronavirus disease (COVID-19). A self-administered questionnaire with multiple-choice items was created in Microsoft Forms (Microsoft Corp. Redmond, WA. 2020). A 5-point Likert scale with ten items, where “1” refers to “Totally disagree” and “5” refers to “Totally agree,” was developed to evaluate the anxiety induced by the COVID-19 outbreak highlighting the suggested sources of stress and anxious emotions, e.g., “When I or any family member go outside home during this COVID-19 outbreak I feel anxious”. A 5-point Likert scale with 14 items, where “1” refers to “Not at all like me” and “5” refers to “Just like me,” was developed to evaluate people’s protective behaviors against coronavirus infection from 3 dimensions: Routine Protective Behaviors (RPB), Post-exposure Protective Behaviors (PPB), and Post-exposure Risky Behaviors (PRB). Items in RPB are aimed to measure individuals’ protective behaviors in daily life when facing the epidemic. A multiple-choice scale of 12 items was developed to assess public awareness of COVID-19 as an emerging infectious disease. The primary objective of this work was to develop psychometrically sound scales to assess COVID-19 induced anxiety (CIAS), protective behaviors towards COVID-19 (PBCS), and COVID-19 related knowledge. The results indicated that COVID-19 induced the 6-item version of the CIAS can adequately measure anxiety level. Infectious disease outbreaks represent specific health-related crises that may impact people’s emotions in different patterns according to their emerging nature. Therefore, the CIAS was designed to cover the potential anxiety sources for the general population during the COVID-19 outbreak.
1. World Health Organization. WHO Director-General's opening remarks at the media briefing on COVID-19- March 13th 2020. Published 2020.
Accessed May 1,2020.https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-mission-briefing-on-covid-19---13-march-2020
2. Gudi SK, Tiwari KK. Preparedness and lessons learned from the novel coronavirus disease.International Journal of Occupational and Environmental Medicine.2020;11(2):108-112. doi:10.34172/ijoem.2020.1977
3. Wang C,Pan R,Wan X,et al.Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease(COVID-19) epidemic among the general population in China. International Journal of Environmental Research and Public Health.2020;17(5):1729.doi:10.3390/ijerph17051729
4. Heng V, Zigmond MJ, Smeyne RJ. Neurological effects of moving from an enriched environment to social isolation in adult mice. Society for Neuroscience Annual Meeting, San Diego. Published 2018.Accessed May 1,2020.https://www.abstractsonline.com/pp8/#!/4649/presentation/20940
5. Hu W,Su L,Qiao J,Zhu J,Zhou Y.Countrywide Quarantine Only Mildly Increased Anxiety Level during COVID-19 Outbreak in China. MedRxiv.Published online April 4, 2020:1-20. doi:10.1101/2020.04.01.20041186
6. Li W, Yang Y, Liu ZH,et al. Progression of Mental Health Services during the COVID-19 Outbreak in China. International Journal of Biological Sciences.2020;16(10):1732-1738.doi:10.7150/ijbs.45120
7. Hong X, Currier GW,Zhao X,Jiang Y,Zhou W,Wei J. Posttraumatic stress disorder in convalescent severe acute respiratory syndrome patients: a 4-year follow-up study. General Hospital Psychiatry.2009;31(6):546-554.doi:10.1016/j.genhosppsych.2009.06.008
8. Lee SM, Kang WS, Cho AR, Kim T, Park JK.Psychological impact of the 2015 MERS outbreak on hospital workers and quarantined hemodialysis patients. Comprehensive Psychiatry.2018;87:123-127.doi:10.1016/j.comppsych.2018.10.003
9. Rossi R, Socci V, Talevi D,et al. COVID-19 pandemic and lockdown measures impact on mental health among the general population in Italy. An N=18147 web-based survey. MedRxiv. Published online April 14,2020:20057802. doi:10.1101/2020.04.09.20057802
10. Crego A, Carrillo M, Armfield JM, Romero M. From public mental health to community oral health: the impact of dental anxiety and fear on dental status.Front Public Health.2014;2:16. doi:10.3389/fpubh.2014.00016
11. Di Marco F, Verga M, Santus P,et al. Close correlation between anxiety, depression, and asthma control.Respiratory Medicine.2010;104(1):22-28. doi:10.1016/j.rmed.2009.08.005
12. Wong LP, Sam IC. Behavioral responses to the influenza A(H1N1) outbreak in Malaysia. Journal of Behavioral Medicine.2011;34(1):23-31. doi:10.1007/s10865-010-9283-7
13. Oh SH, Lee SY, Han C. The Effects of Social Media Use on Preventive Behaviors during Infectious Disease Outbreaks: The Mediating Role of Self-relevant Emotions and Public Risk Perception. Health Communication. Published online 2020. doi:10.1080/10410236.2020.1724639
14. Janis IL. Effects of Fear Arousal on Attitude Change: Recent Developments in Theory and Experimental Research1. Advances in Experimental Social Psychology.1967;3(C):166-224. doi:10.1016/S0065-2601(08)60344-5
15. Lodge EK, Schatz AM, Drake Population Behavior Change in Outbreaks of Emerging Infectious Disease. BioRxiv. Published online January 28,2020:921536. doi:10.1101/2020.01.27.921536
16. Geldsetzer P. Use of rapid online surveys to assess people's perceptions during infectious disease outbreaks: A Cross-sectional Survey on COVID-19.Journal of Medical Internet Research.2020;22(4). doi:10.2196/18790
17. Hua J, Shaw R. Coronavirus(Covid-19)“infodemic” and emerging issues through a data lens:The case of china. International Journal of Environmental Research and Public Health.2020;17(7):2309. doi:10.3390/IJERPH17072309
18. Wang H yao, Xia Q, Xiong Z zhen, et al. The psychological distress and coping styles in the early stages of the 2019 coronavirus disease(COVID-19)epidemic in the general mainland Chinese population: a web-based survey. MedRxiv. Published online March 27,2020:20045807. doi:10.1101/2020.03.27.20045807
19. Zhong BL, Luo W, Li HM, et al. Knowledge,attitudes, and practices towards COVID-19 among Chinese residents during the rapid rise period of the COVID-19 outbreak: a quick online cross-sectional survey. International journal of biological sciences.2020;16(10):1745-1752. doi:10.7150/ijbs.45221
20. World Medical Association(WMA). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA- Journal of the American Medical Association.2013;310(20):2191-2194. doi:10.1001/jama.2013.281053
21. Eysenbach G. Improving the quality of web surveys: The Checklist for Reporting Results of Internet E-Surveys(CHERRIES). Journal of Medical Internet Research.2004;6(3). doi:10.2196/jmir.6.3.e34
22. Proton Technologies AG. General Data Protection Regulation(GDPR) Compliance Guidelines. HORIZON 2020- Project REP-791727-1. Published 2020.Accessed May 1,2020.https://gdpr.eu/
23. Brandler S, Roman CP. Handbook of Research Methods in Public Administration. CRC Press; 2007. doi:10.1201/9781420013276
24. Rosseel Y. Lavaan: An R package for structural equation modeling. Journal of Statistical Software.2012;48(1):1-36. doi:10.18637/jss.v048.i02
25. Ferketich S. Focus on psychometrics. Aspects of item analysis. Research in Nursing& Health.1991;14(2):165-168. doi:10.1002/nur.4770140211
26. Nugent GC,Kunz GM,Sheridan SM,Glover TA,Knoche LL. Rural Education Research in the United States: State of the Science and Emerging Directions.Springer International Publishing; 2016. doi:10.1007/978-3-319-42940-3
27. Gentina E, Tang TLP, Gu Q. Do Parents and Peers Influence Adolescents' Monetary Intelligence and Consumer Ethics? French and Chinese Adolescents and Behavioral Economics. Journal of Business Ethics.2018;151(1):115-140. doi:10.1007/s10551-016-3206-7
28. Xia Y,Yang Y.RMSEA,CFI,and TLI in structural equation modeling with ordered categorical data: The story they tell depends on the estimation methods.Behavior Research Methods.2019;51(1):409-428. doi:10.3758/s13428-018-1055-2
29. Parkinson B, Simons G. Worry spreads:Interpersonal transfer of problem-related anxiety.Cognition and Emotion.2012;26(3):462-479. doi:10.1080/02699931.2011.651101
30. Harris CR,Jenkins M,Glaser D. Gender Differences in Risk Assessment: Why do Women Take Fewer Risks than Men? Judgment and Decision Making.2006;1(1):48-63.
31. Lendrem BAD, Lendrem DW, Gray A, Isaacs JD.The Darwin awards: Sex differences in idiotic behaviour.BMJ(Online).2014;349. doi:10.1136/bmj.g 7094
32. Dobe M. Health promotion for prevention and control of non-communicable diseases: unfinished agenda. Indian journal of public health.2012;56(3):180-186. doi:10.4103/0019-557X.104199
33. Werner P. Knowledge about symptoms of Alzheimer's disease: Correlates and relationship to help-seeking behavior. International Journal of Geriatric Psychiatry.2003;18(11):1029-1036.doi:10.1002/gps.1011
34. DiClemente RJ, Forrest KA, Mickler S. College students' knowledge and attitudes about AIDS and changes in HIV-preventive behaviors. AIDS Education and Prevention. 1990;2(3):201-212.
35. Ferguson KJ,Yesalis CE, Pomrehn PR, Kirkpatrick MB. Attitudes, Knowledge, and Beliefs as Predictors of Exercise Intent and Behavior in Schoolchildren.Journal of School Health.1989;59(3):112-115.doi:10.1111/j.1746-1561.1989.tb04675.x
36. Maner JK, Richey JA, Cromer K, et al.Dispositional anxiety and risk-avoidant decision-making. Personality and Individual Differences.2007;42(4):665-675.doi:10.1016/j.paid.2006.08.016
37. Raghunathan R, Pham MT. All negative moods are not equal: Motivational influences of anxiety and sadnesson decision making. Organizational Behavior and Human Decision Processes. 1999;79(1):56-77. doi:10.1006/obhd.1999.2838
38. Barlow DH. Anxiety and Its Disorders: The Nature and Treatment of Anxiety and Panic. Guilford Press;2002.
39. Butler G, Mathews A. Anticipatory anxiety and risk perception. Cognitive Therapy and Research.1987;11(5):551-565.doi:10.1007/BF01183858
40. Auerbach RP, Abela JRZ, Ringo Ho MH.Responding to symptoms of depression and anxiety:Emotion regulation, neuroticism, and engagement in risky behaviors. Behaviour Research and Therapy.2007;45(9):2182-2191.doi:10.1016/j.brat.2006.11.002
41. Cicchetti D, Ackerman BP, Izard CE. Emotions and emotion regulation in developmental psychopathology. Development and Psychopathology.1995;7(1):1-10. doi:10.1017/S0954579400006301