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Americans’ COVID-19 Stress, Coping, and Adherence to CDC Guidelines
Open accessAbstract
Importance Documenting Americans' stress responses to an unprecedented pandemic and their degree of adherence to CDC guidelines is essential for mental health interventions and policy-making.Objective To provide the first snapshot of immediate impact of COVID-19 on Americans' stress, coping, and guideline adherence.Design Data were collected from an online workers' platform for survey research (Amazon's Mechanical Turk) from April 7 to 9, 2020. The current data represents the baseline of a longitudinal study. Best practices for ensuring high-quality data were employed.Participants Individuals who are 18 years of age or older, living in the USA, and English-speaking were eligible for the study. Of 1086 unique responses, 1015 completed responses are included.Setting Population-based.Main outcomes Exposure to and stressfulness of COVID-19 stressors, coping strategies, and adherence to CDC guidelines.Results The sample was 53.9% women (n = 547), with an average age of 38.9 years (SD = 13.50, range = 18-88), most of whom were White (n = 836, 82.4%), non-Hispanic (n = 929, 91.5%), and straight/heterosexual (n = 895, 88.2%); 40% were currently married (n = 407), and 21.6% (n = 219) were caregivers. About half (50.5%) endorsed having at least "mostly" enough money to meet their needs. Respondents' locations across the USA ranged from 18.5% in the Northeast to 37.8% in the South. The most commonly experienced stressors were reading/hearing about the severity and contagiousness of COVID-19, uncertainty about length of quarantine and social distancing requirements, and changes to social and daily personal care routines. Financial concerns were rated most stressful. Younger age, female gender, and caregiver status increased risk for stressor exposure and greater degree of stressfulness. The most frequently reported strategies to manage stress were distraction, active coping, and seeking emotional social support. CDC guideline adherence was generally high, but several key social distancing and hygiene behaviors showed suboptimal adherence, particularly for men and younger adults.Conclusions and relevance Americans have high COVID-19 stress exposure and some demographic subgroups appear particularly vulnerable to stress effects. Subgroups less likely to adhere to CDC guidelines may benefit from targeted information campaigns. these findings may guide mental health interventions and inform policy-making regarding implications of specific public health measures.
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“Research conducted during the initial lockdown period found that American adults commonly dealt with stress through distraction, active coping, and seeking emotional support [31]”
From Gender Differences in Coping and Psychological Adaptation during the COVID-19 Pandemic (2023) · cites this paper as [31]
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Filindassi, V., Pedrini, C., Sabadini, C., Duradoni, M., & Guazzini, A. (2022) · COVID · doi:10.3390/covid2030022 · Cited by 56
“Higher levels of stress were associated with: loss of job/education [89,309], having to go out to work [187], having an acquaintance infected with COVID-19 [89,187,247], likelihood of contracting the virus [310], more hygiene behaviors [247,256,310], history of stressful situations [187], medical problems [74,187], ri…”
BackgroundResultInfluentialStockman, J. K., Wood, B. A., & Anderson, K. M. (2021) · Journal of Medical Internet Research · doi:10.2196/26296 · Cited by 50
“These differences may reflect increased uptake of prevention behaviors among women, compared to a sample of both men and women; this is consistent with findings that female gender is associated with adherence to prevention behaviors [16].”
BackgroundResultAbroshan, H., Devos, J., Poels, G., & Laermans, E. (2021) · IEEE Access · doi:10.1109/access.2021.3109091 · Cited by 61
Delgado-Gallegos, J. L., Padilla-Rivas, G. R., Zúñiga-Violante, E., Avilés-Rodríguez, G. J., Arellanos-Soto, D., Gastelum-Arias, L. J., Franco-Villareal, H., Cosío-León, M. D. L. Á., Romo-Cárdenas, G. S., Moreno‐Treviño, M. G., et al. (2021) · Frontiers in Public Health · doi:10.3389/fpubh.2021.728690 · Cited by 52
Daily Stress Processes in a Pandemic: The Effects of Worry, Age, and Affect
Nelson, N. A., & Bergeman, C. S. (2020) · The Gerontologist · doi:10.1093/geront/gnaa187 · Cited by 50
“Additionally, between individuals, the most reported COVID-19-related stressor was news exposure (Park et al., 2020; Whitehead & Torossian, 2020).”
BackgroundInfluentialLillie, H. M., Chernichky-Karcher, S. M., & Venetis, M. K. (2021) · Journal of Social and Personal Relationships · doi:10.1177/02654075211009302 · Cited by 48
“Researchers and health professionals expressed concern about the relational impacts of social distancing, particularly for couples whose marriages may be strained from being confined together (Galea et al., 2020; Park et al., 2020; Restubog et al., 2020).”
BackgroundBrain volumetric changes in the general population following the COVID-19 outbreak and lockdown
Salomon, T., Cohen, A., Barazany, D., Ben-Zvi, G., Botvinik‐Nezer, R., Gera, R., Oren, S., Roll, D., Rozic, G., Saliy, A., et al. (2021) · NeuroImage · doi:10.1016/j.neuroimage.2021.118311 · Cited by 51
Acuff, S. F., Tucker, J. A., & Murphy, J. G. (2020) · Experimental and Clinical Psychopharmacology · doi:10.1037/pha0000431 · Cited by 50
“…sources of reward such as social interaction, physical activity, leisure activities, hobbies, work and school pursuits, while simultaneously experiencing drastic increases in stress and uncertainty related to the well-being of themselves, their loved ones, and their community (Park et al., 2020).”
BackgroundThe COVID-19 pandemic in Italy: Depressive symptoms immediately before and after the first lockdown
Medda, E., Toccaceli, V., Gigantesco, A., Picardi, A., Fagnani, C., & Stazi, M. A. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.10.129 · Cited by 49
Tibubos, A. N., Otten, D., Ernst, M., & Beutel, M. E. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.712492 · Cited by 51
Manning, K. F., Eades, N. D., Kauffman, B. Y., Long, L. J., Richardson, A. L., Garey, L., Zvolensky, M. J., & Gallagher, M. W. (2021) · Cognitive Therapy and Research · doi:10.1007/s10608-021-10207-7 · Cited by 44
Young Adults Underestimate How Well Peers Adhere to COVID-19 Preventive Behavioral Guidelines
Graupensperger, S. A., Lee, C. M., & Larimer, M. E. (2021) · The Journal of Primary Prevention · doi:10.1007/s10935-021-00633-4 · Cited by 46
Masks, Gloves, and the COVID-19 Pandemic: Rapid Assessment of Public Behaviors in the United States
Khubchandani, J., Saiki, D., & Kandiah, J. (2020) · Epidemiologia · doi:10.3390/epidemiologia1010004 · Cited by 43
“Unfortunately, according to preliminary reports, men have a higher risk of mortality from COVID-19, and deaths of younger individuals are not uncommon [17,18].”
BackgroundPark, K., Chamberlain, B. C., Song, Z., Esfahani, H. N., Sheen, J., Larsen, T., Novack, V. L., Licon, C., & Christensen, K. (2021) · Transportation Research Part A Policy and Practice · doi:10.1016/j.tra.2021.12.008 · Cited by 42
“, 2020), high psychological distress (Wang et al., 2020; Park et al., 2020), financial stress (Chakraborty & Chatterjee, 2020), and depression and anxiety (Madani et al.”
Alschuler, K. N., Roberts, M. K., Herring, T. E., & Ehde, D. M. (2020) · Multiple Sclerosis and Related Disorders · doi:10.1016/j.msard.2020.102618 · Cited by 42
“, 2020) and the admission that fears of the severity and contagiousness of COVID-19 is the most common COVID-19 associated stressor in a general population sample (Park et al., 2020), it may be the case that individuals are primed to experience increased distress when evidence of the threat is more apparent.”
Noone, C., Warner, N. Z., Byrne, M., Durand, H., Lavoie, K., McGuire, B. E., McSharry, J., Meade, O., Morrissey, E. C., Molloy, G. J., et al. (2021) · Health Psychology Review · doi:10.1080/17437199.2021.1934062 · Cited by 40
Li, Y., Peng, J., & Tao, Y. (2021) · Current Psychology · doi:10.1007/s12144-021-02334-x · Cited by 44
“One American study surveyed the types of coping that 1086 Americans employed to manage stressors online in early April 2020 and encouraged frequent use of emotional support-seeking strategies (Park et al., 2020).”
BackgroundGuszkowska, M., & Dąbrowska-Zimakowska, A. (2022) · Psychology Research and Behavior Management · doi:10.2147/prbm.s345648 · Cited by 45
“the COVID-19 pandemic, American adults most often dealt with stress through distraction, active coping, and seeking emotional support.(23) Acceptance, humor, and planning were the three most common strategies used by adults in Greece.”
BackgroundFerreira, M. J., Sofia, R., Carreno, D. F., Eisenbeck, N., Jongenelen, I., & Cruz, J. F. A. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.647984 · Cited by 40
Iddi, S., Obiri‐Yeboah, D., Aboh, I. K., Quansah, R., Owusu, S. A., Enyan, N. I. E., Kodom, R. V., Nsabimana, E., Jansen, S., Ekumah, B., et al. (2021) · PLoS ONE · doi:10.1371/journal.pone.0253800 · Cited by 40
“Previous studies have shown that the concern of contracting the disease or death is a major source of concern to many people during the pandemic [13, 16].”
BackgroundJoseph, R. P., Ainsworth, B. E., Hollingshead, K. E., Todd, M. W., & Keller, C. S. (2021) · JMIR mhealth and uhealth · doi:10.2196/27383 · Cited by 37
Singh, S., Pandey, N. M., Datta, M., & Batra, S. (2021) · Clinical Epidemiology and Global Health · doi:10.1016/j.cegh.2021.100885 · Cited by 54
Work Performance, Mood and Sleep Alterations in Home Office Workers during the COVID-19 Pandemic
Costa, C., Teodoro, M., Mento, C., Giambò, F., Vitello, C., Italia, S., & Fenga, C. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19041990 · Cited by 59
“Introduction The sudden burst of the COVID-19 pandemic and the subsequent preventive measures, such as quarantine, social isolation, partial or total lockdown, not only have dramatically transformed everyday life, with a massive impact on physical, mental, social, and financial welfare of the population [1] but they h…”
BackgroundMirlashari, J., Ebrahimpour, F., & Salisu, W. J. (2020) · Journal of Pediatric Nursing · doi:10.1016/j.pedn.2020.10.024 · Cited by 39
“It seems that these concerns have gone beyond the current locality to become a global concern, creating fear and anxiety among people from all walks of life (Lin, Hu, Alias, & Wong, 2020; Park et al., 2020; Zandifar & Badrfam, 2020).”
BackgroundInfluentialde Andrade, E. G., Šimončičová, E., Carrier, M., Vecchiarelli, H. A., Robert, M.-È., & Tremblay, M. (2021) · Frontiers in Cellular Neuroscience · doi:10.3389/fncel.2021.647378 · Cited by 39
Guse, J., Weegen, A. S., Heinen, I., & Bergelt, C. (2021) · BMJ Open · doi:10.1136/bmjopen-2021-054728 · Cited by 41
Rainisch, G., Jeon, S., Pappas, D., Spencer, K. D., Fischer, L. S., Adhikari, B. B., Taylor, M. M., Greening, B., Moonan, P. K., Oeltmann, J. E., et al. (2022) · JAMA Network Open · doi:10.1001/jamanetworkopen.2022.4042 · Cited by 39
What predicts adherence to COVID-19 government guidelines? Longitudinal analyses of 51,000 UK adultsPreprint
Wright, L., Steptoe, A., & Fancourt, D. E. (2020) · medRxiv · doi:10.1101/2020.10.19.20215376 · Cited by 39
Zhang, X., Wang, Y., Lyu, H., Zhang, Y., Liu, Y., & Luo, J. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.681091 · Cited by 43
Dixon, D. L., den Daas, C., Hubbard, G., & Johnston, M. (2021) · British Journal of Health Psychology · doi:10.1111/bjhp.12533 · Cited by 41
“Overall, adherence to the three TRBs was high, confirming the findings from other studies (Coroiu et al., 2020; Park et al., 2020).”
Sexual and Gender Minority Young Adult Coping Disparities During the COVID-19 Pandemic
Krueger, E. A., Barrington‐Trimis, J. L., Unger, J. B., & Leventhal, A. M. (2021) · Journal of Adolescent Health · doi:10.1016/j.jadohealth.2021.07.021 · Cited by 37
“, increased substance use, social disengagement, decreases in exercise) [18,19].”
Short‐term impacts of COVID‐19 on family caregivers: Emotion regulation, coping, and mental health
Russell, B. S., Hutchison, M., Park, C. L., Fendrich, M., & Finkelstein‐Fox, L. (2021) · Journal of Clinical Psychology · doi:10.1002/jclp.23228 · Cited by 35
Self-citationSolnick, R. E., Chao, G. F., Ross, R. D., Kraft‐Todd, G., & Kocher, K. E. (2020) · Academic Emergency Medicine · doi:10.1111/acem.14188 · Cited by 35
“J Risk Uncertain [Internet] 1997;14(3):235–57.”
BackgroundMethodInfluentialThematic Analysis of Parent–Child Conversations About COVID-19: “Playing It Safe”
Tambling, R. R., Tomkunas, A. J., Russell, B. S., Horton, A. L., & Hutchison, M. (2021) · Journal of Child and Family Studies · doi:10.1007/s10826-020-01889-w · Cited by 34
“2020), which are felt particularly keenly for those currently caring for children in their homes (Park et al. 2020; Pew Research Center 2020; Russell et al. 2020; Tambling et al. 2020).”
BackgroundSelf-citationSutter, E. N., Francis, L. S., Francis, S. M., Lench, D. H., Nemanich, S. T., Krach, L. E., Sukal‐Moulton, T., & Gillick, B. T. (2021) · American Journal of Physical Medicine & Rehabilitation · doi:10.1097/phm.0000000000001818 · Cited by 34
“Regarding caregivers, disruptions to routines and access to supports during COVID-19 may result in additional burden and stress.(17,18) The extent of the impact of COVID-19 on access to rehabilitation therapies for children with motor impairment, and the subsequent impact on child and caregiver physical and mental hea…”
BackgroundWolfe, K., Sirota, M., & Clarke, A. D. F. (2021) · Royal Society Open Science · doi:10.1098/rsos.201445 · Cited by 35
Metadata
- Authors
- Park, C. L., Russell, B. S., Fendrich, M., Finkelstein-Fox, L., Hutchison, M., & Becker, J.
- Affiliations
- University of Connecticut (US)
- Corresponding author
- Park, Crystal L.
- Venue
- Journal of General Internal Medicine
- Published
- 2020-05-29
- Volume
- 35
- Issue
- 8
- Pages
- 2296-2303
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC7259430
- OpenAlex
- W3031875368
- Cited by
- 728
- References
- 26
- Citations by year
- 2026: 10 · 2025: 31 · 2024: 74 · 2023: 120 · 2022: 219 · 2021: 224 · 2020: 49
- FWCI
- 61.25
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of General Internal Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Alcohol Abuse and Alcoholism (1R34AA027455)
- Topics
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Social Sciences › Sociology and Political Science › COVID-19 Prevention and Impact
- Social Sciences › Communication › Communication and COVID-19 Impact
- Keywords
- COVID-19 pandemic, psychological stress, coping strategies, social distancing, hygiene practices, financial stress, caregiver burden, gender differences, age differences, social support, mental health
- MeSH terms
- Betacoronavirus, COVID-19, SARS-CoV-2, Adaptation, Psychological, Adult, Centers for Disease Control and Prevention, U.S., Female, Humans, Male, Mental Health, Pneumonia, Viral, Public Health, Surveys and Questionnaires, Stress, Psychological, United States, Guidelines as Topic, Coronavirus Infections, Disease Transmission, Infectious, Guideline Adherence, Pandemics
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