Public Behavior Change, Perceptions, Depression, and Anxiety in Relation to the COVID-19 Outbreak

BACKGROUND: COVID-19 has spread rapidly and internationally, which has elicited public panic and psychological problems. Public protective behaviors and perception play crucial roles in controlling the spread of illness and psychological status. METHODS: We conducted a cross-sectional online survey in the hardest-hit Hubei province and other areas in China affected by the COVID-19 outbreak. Questions about their basic information, the perception of the COVID-19 outbreak, recent preventive or avoidance behaviors, and self-reported mental health scales including the Patient Health Questionnaire and Self-Rating Anxiety Scale were included. Binary logistic regressions were used to investigate the association between personal variables/perceptions and psychological distress. RESULTS: A total of 6261 people were included in the analysis, with 3613 (57.7%) in Hubei province (1743 in Wuhan). The majority of people have adopted preventive and avoidance behaviors. People from Hubei, with contact history, and people who were infected or whose family members were infected had a much higher prevalence of depression and anxiety. Providing truthful and sufficient information, informing the public about the severity of the disease, and perceptions that the outbreak can be controlled by protective behaviors were associated with lower prevalence of depression and anxiety. CONCLUSIONS: Assessing the public response, perception, and psychological burden during the outbreak may help improve public health recommendations and deliver timely psychological intervention. Further research may focus on the psychological status of a specialized group to identify methods of delivery of better support based on public response and psychological demand.