COVID-19: Psychol­­­ogical Distress, Fear, and Coping Strategies Among Community Members Across 17 Countries

Abstract

Background: The current pandemic of COVID-19 impacted the psychological wellbeing of populations globally. Our study aimed to examine the extent and associated factors to psychological distress, the level of fear of COVID-19, and coping strategies amongst a diverse range of community people in multi-country settings.Methods: A cross-sectional study across 17 countries was conducted. Psychological distress (based on the Kessler Psychological Distress Scale) was categorized into low and moderate to very high, fear of COVID-19 (based on the Fear of COVID-19 Scale) was categorized into low and high, and coping (based on the Brief Resilient Coping Scale) was categorized into low and medium to high. For country-wise comparisons, we selected the reference country based on the lowest prevalence of each outcome and examined the status for other countries. Multivariate analyses were conducted to adjust potential confounders including in-country variations; adjusted odds ratio (AOR) and 95% confidence intervals (CIs) were reported.Findings: A total of 8559 people participated in this study. Mean age (±SD) was 33 (±13) years and two-thirds (64%) were females. More than one-third (40%) self-identified as frontline or essential service workers. More than two-thirds (69%) experienced moderate to very high levels of psychological distress, which was 46% in Thailand and 91% in Egypt. A quarter (24%) had high levels of fear of COVID-19, which was as low as 9% in Libya and as high as 38% in Bangladesh. More than half (57%) exhibited medium to high resilient coping; the lowest prevalence (3%) was reported in Australia and the highest (72%) in Syria. Being female (AOR 1.31 [95% CIs 1.09-1.57]), perceived distress due to change of employment status (AOR 1.56 [1.29-1.90]), being affected by the change of financial situation, comorbidity with mental health conditions (AOR 3.02 [1.20-7.60]), unsure contact with COVID-19 patient, and use of healthcare services in the last six months were associated with moderate to very high levels of psychological distress. Doctors had higher psychological distress (AOR 1.43 [1.04-1.97]), but low levels of fear of COVID-19 (AOR 0.55 [0.41-0.76]); nurses had medium to high resilient coping (AOR 1.30 [1.03-1.65]). Participants from 10 countries (Hong Kong, Oman, Libya, Kuwait, Saudi Arabia, UAE, Jordan, Syria, Palestine and Egypt) demonstrated significantly higher psychological stress compared to the participants from Thailand. Participants from four countries (Oman, Indonesia, Hong Kong and Pakistan) exhibited higher levels of fear of COVID-19 compared to those from Libya. Participants from 12 countries (Jordan, Egypt, Saudi Arabia, Kuwait, Hong Kong, UAE, Palestine, Thailand, Oman, Nepal, Indonesia and Syria) demonstrated statistically significant medium to high resilience coping compared to those from Australia.Interpretation: Females and people with existing mental health issues were the most vulnerable groups of populations for adverse psychological impact of COVID-19 pandemic across 17 countries. While these two groups had ongoing challenges in a COVID-free world, the pandemic worsened their wellbeing. There is an urgent need to prioritise their needs. Adequate medical and social support along with specific health promotion policies should be considered within the strategic response to the ongoing pandemic and future crises.Funding Information: None.Declaration of Interests: We declare no competing interests.Ethics Approval Statement: Ethics approval was obtained from the Human Research Ethics Committee from each participating country. The survey was voluntary in nature and it was clarified in the PLIS, so that participants got the opportunity to have informed decision to participate in the study. Privacy and confidentiality of the collected data were maintained. All responses were anonymous and there was no information about the identity of the participants.