Abstract
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.
Highlights
The COVID-19 pandemic has created an unprecedented crisis [1]
Our findings showed that people who had a poor self-rated health status had higher perceived risk about the outbreak as well as higher anxiety levels; a good self-rated health status was not associated with practicing protective behaviors
Our findings showed that people simultaneously presented with both high-level risk perception and anxiety across the four surveys, leading to positive prevention behavior of avoiding visiting crowded places
Summary
The first wave of the COVID-19 epidemic in China was brought under control with 3 months—from mid-January 2020 (when human-to-human transmission of COVID-19 was confirmed) to the end of March 2020 [2]. As of January 28, 2020 (when the first-round survey started), COVID-19 infection caused 5,974 cases in Mainland China. 80,026 cases have been reported in Mainland China as of March 1, 2020 (when the fourth-round survey started). 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. 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
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