Abstract
BackgroundAlthough there are increasing concerns on mental health consequences of the COVID-19 pandemic, no large-scale population-based studies have examined the associations of risk perception of COVID-19 with emotion and subsequent mental health. MethodsThis study analysed cross-sectional and longitudinal data from the PsyCorona Survey that included 54,845 participants from 112 countries, of which 23,278 participants are representative samples of 24 countries in terms of gender and age. Specification curve analysis (SCA) was used to examine associations of risk perception of COVID-19 with emotion and self-rated mental health. This robust method considers all reasonable model specifications to avoid subjective analytical decisions while accounting for multiple testing. ResultsAll 162 multilevel linear regressions in the SCA indicated that higher risk perception of COVID-19 was significantly associated with less positive or more negative emotions (median standardised β=-0.171, median SE=0.004, P<0.001). Specifically, regressions involving economic risk perception and negative emotions revealed stronger associations. Moreover, risk perception at baseline survey was inversely associated with subsequent mental health (standardised β=-0.214, SE=0.029, P<0.001). We further used SCA to explore whether this inverse association was mediated by emotional distress. Among the 54 multilevel linear regressions of mental health on risk perception and emotion, 42 models showed a strong mediation effect, where no significant direct effect of risk perception was found after controlling for emotion (P>0.05). LimitationsReliance on self-reported data. ConclusionsRisk perception of COVID-19 was associated with emotion and ultimately mental health. Interventions on reducing excessive risk perception and managing emotional distress could promote mental health.
Highlights
COVID-19, a public health emergency of international concern as declared by the WHO, is rapidly sweeping the world and threatening human health both physically and mentally
Of the 54,845 participants included in this study, 61% are female; 47%, 45%, or 8% are aged between 18-34, 35-64, or over 65 years old; and 48%, 31%, or 21% have education level below, equivalent, or above Bachelor’s degree
The scatter plots of country-level summary statistics showed that country-level mean values of risk perception was positively correlated with mean values of negative emotion (Figure 1A; r=0.371, P=0.031), and negatively correlated with positive emotion (Figure 1B; r=-0.393, P=0.022)
Summary
COVID-19, a public health emergency of international concern as declared by the WHO, is rapidly sweeping the world and threatening human health both physically and mentally. Consistent evidence has shown that risk perception has a remarkably positive association with the feeling of stress (Lopez-Vazquez, 2001; Lopez-Vazquez and Marvan, 2003) In this case, the threat of the pandemic will induce stress, which will in turn affect people’s emotion and mental health according to the social stress theory and empirical evidence (Aneshensel, 1992; Kessler, 1997; Wu et al, 2020; Guidi et al, 2021). High risk perception of COVID-19 may reflect motivational prioritisation of the COVID-19 threat over other important life goals, needs and duties This motivational preoccupation could cause emotional fluctuations following the pandemic escalation (Kopetz, 2017). There are increasing concerns on mental health consequences of the COVID-19 pandemic, no large-scale population-based studies have examined the associations of risk perception of COVID-19 with emotion and subsequent mental health
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