Abstract
This study aimed to compare the mediation of psychological flexibility, prosociality and coping in the impacts of illness perceptions toward COVID-19 on mental health among seven regions. Convenience sampled online survey was conducted between April and June 2020 from 9130 citizens in 21 countries. Illness perceptions toward COVID-19, psychological flexibility, prosociality, coping and mental health, socio-demographics, lockdown-related variables and COVID-19 status were assessed. Results showed that psychological flexibility was the only significant mediator in the relationship between illness perceptions toward COVID-19 and mental health across all regions (all ps = 0.001–0.021). Seeking social support was the significant mediator across subgroups (all ps range = <0.001–0.005) except from the Hong Kong sample (p = 0.06) and the North and South American sample (p = 0.53). No mediation was found for problem-solving (except from the Northern European sample, p = 0.009). Prosociality was the significant mediator in the Hong Kong sample (p = 0.016) and the Eastern European sample (p = 0.008). These findings indicate that fostering psychological flexibility may help to mitigate the adverse mental impacts of COVID-19 across regions. Roles of seeking social support, problem-solving and prosociality vary across regions.
Highlights
The rapid spread of coronavirus 2019 (COVID-19) caused by SARS-Co-V-2 amplified by forced quarantine and national lockdowns across countries have been shown to impose profound impacts on public mental health
By conducting multi-group analyses, we found that despite differences in pandemic situations, social and health care contexts of the geographical regions, psychological flexibility remained as the only robust resilience factor against the adverse mental health impacts arising from COVID-19
In our study, we found that avoidance showed a significant mediating role between illness perceptions toward COVID-19 and mental health, but it should not be considered as the inverse of psychological flexibility
Summary
The rapid spread of coronavirus 2019 (COVID-19) caused by SARS-Co-V-2 amplified by forced quarantine and national lockdowns across countries have been shown to impose profound impacts on public mental health. Several meta-analyses have highlighted that at least one-third of the populations worldwide have reported symptoms of depression, anxiety, stress, and insomnia during the early stage of the COVID-19 pandemic [1,2] These symptoms are more severe among people with pre-existing mental health problems [3], quarantined persons [2], COVID-19 patients [2,4], and health care professionals [5,6,7]. In the United States, the existing public health federalism allows flexibility for the State government officials to customize pandemic responses in accordance to the unique characteristics of state populations [8] This creates complications in centralizing and coordinating manpower and resources across the states for implementing timely responses to address the pandemic [9]. Countries with similar infection trends such as Germany, Austria and Switzerland, who share similar federalism systems, were able to leverage state resources to implement protective policies efficiently [10]
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