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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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Fryburg, D. A., Ureles, S. D., Myrick, J. G., Carpentier, F. R. D., & Oliver, M. B. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.591942 · Cited by 14
Brogårdh, C. B., Hammarlund, C. S., Eek, F., Stigmar, K., Lindgren, I., Trulsson, A., & Hansson, E. E. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18126234 · Cited by 16
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Luo, P., LaPalme, M. L., Cipriano, C., & Brackett, M. A. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.828076 · Cited by 26
Wright, L., Fluharty, M., Steptoe, A., & Fancourt, D. E. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.810655 · Cited by 13
“A number of studies have examined coping during the COVID-19 pandemic, using quantitative (Park et al., 2020; Agha, 2021; Fluharty and Fancourt, 2021), qualitative (Ogueji et al.”
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Christoforou, E., Barlas, P., & Otterbacher, J. (2021) · CHI Conference on Human Factors in Computing Systems · doi:10.1145/3411764.3445317 · Cited by 14
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Urbieta, D., Akin, J. L., Hamilton, W. M., Brock, W. W., & Yablonsky, A. M. (2021) · Military Medicine · doi:10.1093/milmed/usab213 · Cited by 16
Barriers to and Facilitators of COVID-19 Prevention Behaviors Among North Carolina Residents
Hill, L. M., Davis, H., Drewry, M., Shelus, V., Bartels, S. M., Combs, K. G., Ribisl, K. M., & Lazard, A. J. (2022) · Health Education & Behavior · doi:10.1177/10901981221076408 · Cited by 13
“Other studies have described adherence to prevention behaviors in the United States but have not assessed barriers to adherence (Park et al., 2020; Parsons Leigh et al., 2020).”
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“Center for Disease Control guidelines (Park et al. 2020).”
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ResultThe Effect of Stress Perceived by Adults Due to the COVID-19 Pandemic on Their Sleep Quality
Başkan, S. A., & Güneş, D. (2021) · Journal of Turkish Sleep Medicine · doi:10.4274/jtsm.galenos.2021.02996 · Cited by 13
“In parallel to our findings, the studies on the COVID-19 pandemic also indicated high levels of stress (22,23).”
Ménard, J., Foucreault, A., Leduc, H., Meunier, S., & Trépanier, S. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.620349 · Cited by 18
“Thus, most residents of countries affected by this pandemic had to make major changes to all spheres of their lives, in addition to being constantly reminded that a potentially deadly virus is present and spreading, which can lead to stress and worry (Park et al., 2020).”
BackgroundTaylor, B. K., Frenzel, M. R., Johnson, H. J., Willett, M. P., White, S. F., Badura-Brack, A. S., & Wilson, T. W. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.706120 · Cited by 13
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“Media coverage worldwide, with headlines of the COVID-19 pandemic, has had a negative effect on mental health, and the most common reasons for negative stress were reading and hearing about the contagiousness and the seriousness of the disease, the uncertainty about the time limit for quarantine, and demands for socia…”
Stress, Sources of Stress and Coping During the COVID-19 Lockdown
Fenn, J., Chacko, N., Thomas, T., Varghese, V. K., & George, S. (2021) · Indian Journal of Social Psychiatry · doi:10.4103/ijsp.ijsp_155_20 · Cited by 13
Megreya, A. M., Latzman, R. D., Al‐Ahmadi, A., & Aldosari, N. (2021) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-021-00536-9 · Cited by 13
“Further, across a number of studies, age, gender, socio-economic status, and being a parent have emerged as risk factors for adopting more maladaptive coping responses during COVID-19 pandemic (e.g., Atchison et al., 2020; Park et al., 2020).”
BackgroundTürkiye, Çin, ABD, Fransa Sağlık Sistemleri ve COVID-19 Politikaları
SARIYILDIZ, A. Y., Paşaoğlu, M. T., & YILMAZ, M. E. (2021) · Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi · doi:10.37989/gumussagbil.818483 · Cited by 13
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“Furthermore, demographic characteristics are determinant factors in society for adopting a coping response during the pandemic (Park et al., 2020).”
BackgroundChild externalising and internalising behaviour and parental wellbeing during the Covid-19 pandemic
Portnoy, J., Bedoya, A., & Wong, K. K. (2022) · UCL Open Environment · doi:10.14324/111.444/ucloe.000040 · Cited by 13
“Caregivers also reported heightened stress and increased caregiver demands related to Covid-19 [5].”
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Korzeniowski, C. (2023) · Journal of Biomedical Research & Environmental Sciences · doi:10.37871/jbres1776 · Cited by 18
“On the other hand, the daily exposure of news about mortality rates, about the rapid proliferation of the virus and the lack of appropriate therapeutic approaches, generated fear and insecurity [1-4].”
BackgroundThe Public Health Governance of the COVID-19 Pandemic: A Bibliometric Analysis
Yang, K., & Qi, H. (2022) · Healthcare · doi:10.3390/healthcare10020299 · Cited by 14
Lapierre, N., Olatona, O., Labrie, D., Gagnon, M., Raynard, E. P., Mortenson, W. B., & Routhier, F. (2022) · Health & Social Care in the Community · doi:10.1111/hsc.14050 · Cited by 14
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“Those with higher self-esteem might have been more likely to try to maintain social relationships, seek social support (Park et al., 2020), and cope better with stressors such as limited social interactions (Carver et al., 1989).”
A U.S. National Study of Family Resilience During the COVID-19 Pandemic
Perry, K. J., Penner, F., Contreras, H. T., Santos, R. P., & Sarver, D. E. (2023) · Journal of Child and Family Studies · doi:10.1007/s10826-023-02581-5 · Cited by 12
“Recent research has demonstrated that financial stress, not being married, and online schooling demands are all related to increased stress or decreased mental health among adults during the COVID-19 pandemic (Adams et al., 2021; Jace & Makridis, 2020; Park et al., 2020).”
BackgroundMeese, K. A., Boitet, L. M., Sweeney, K. L., Nassetta, L. B., Mugavero, M. J., Hidalgo, B., Reamey, R. A., & Rogers, D. A. (2023) · Journal of Medical Internet Research · doi:10.2196/47629 · Cited by 12
“A recent study reported that female gender and caregiver status were predictors of increased stress during the pandemic [5].”
van Loenhout, J. A. F., Vanderplanken, K., den Broucke, S. V., & Aujoulat, I. (2022) · BMC Public Health · doi:10.1186/s12889-022-12654-7 · Cited by 12
Nearchou, F., Flinn, C., French, A., Hennessy, E., Kerin, L., & Linehan, C. (2022) · Youth · doi:10.3390/youth2020013 · Cited by 15
Guszkowska, M., & Dąbrowska-Zimakowska, A. (2022) · Scandinavian Journal of Occupational Therapy · doi:10.1080/11038128.2022.2143892 · Cited by 13
The Psychological Impact of COVID-19 on Residents of Saudi Arabia
Rafique, N., Tufaif, F. A., Alhammali, W., Alalwan, R. E., Aljaroudi, A., AlFaraj, F., Latif, R., Asoom, L. I. A., Alsunni, A. A., Ghamdi, K. S. A., et al. (2022) · Psychology Research and Behavior Management · doi:10.2147/prbm.s360772 · Cited by 12
“Moreover, a study in the United States demonstrated other factors causing stress, including the news about the severity of how contagious the virus is, the uncertainty of the quarantine period, and changes in the social and personal care routines.(11) On the other hand, some studies suggested that the levels of stress…”
BackgroundHorton, A. L., Russell, B. S., Tambling, R. R., Britner, P. A., Hutchison, M., & Tomkunas, A. J. (2022) · Family Relations · doi:10.1111/fare.12717 · Cited by 10
“CSS—Adapted To examine parents’ stress due to changes in their children’s daily routines, seven items were added to the measure for the present study.”
BackgroundMethodResultInfluentialSelf-citationJeon, S., Rainisch, G., Harris, A., Shinabery, J., Rai, M. I., Pallavaram, A., Hilton, S., Karki, S., Moonan, P. K., Oeltmann, J. E., et al. (2023) · Emerging infectious diseases · doi:10.3201/eid2902.220959 · Cited by 11
Hellem, T., Benavides‐Vaello, S., & Taylor‐Piliae, R. E. (2021) · Journal of Evidence-Based Integrative Medicine · doi:10.1177/2515690x211006332 · Cited by 13
Aldhuwayhi, S. D., Shaikh, S. A., Mallineni, S. K., Kumari, V. V., Thakare, A. A., Khan, A. R., Mustafa, M. Z., & Manva, M. Z. (2021) · Disaster Medicine and Public Health Preparedness · doi:10.1017/dmp.2021.215 · Cited by 11
Heidler, F., Baldt, J., Frahm, N., Langhorst, S. E., Mashhadiakbar, P., Streckenbach, B., Burian, K., Zettl, U. K., & Richter, J. (2022) · Scientific Reports · doi:10.1038/s41598-022-18912-3 · Cited by 13
Meaklim, H., Le, F., Drummond, S. P. A., Bains, S. K., Varma, P., Junge, M. F., & Jackson, M. L. (2024) · Sleep · doi:10.1093/sleep/zsae028 · Cited by 10
“…not universally stressful for everyone [7, 8] (e.g. older adults, males, and more financially secure individuals reported lower rates of stress [5, 9]), stress levels increased globally during the first wave of the pandemic [10, 11], which may have precipitated or perpetuated ongoing insomnia…”
BackgroundPan, Q., Fu, W., & Zhang, Y. (2024) · Applied Psychology Health and Well-Being · doi:10.1111/aphw.12543 · Cited by 12
Jain, T., Shukla, R., & Panwar, N. (2024) · Psychological Reports · doi:10.1177/00332941241268625 · Cited by 10
“This was important to examine since avoidance coping, which was found to be frequently used among young adults (Park et al., 2020; Shuster et al., 2023), is detrimental to their academic, social, and personal success (Balazs et al., 2018).”
Evidence of Stability in Patient-Reported Global Health During the COVID-19 Pandemic
Lapin, B. R., Tang, W. H. W., Honomichl, R. D., Hogue, O., & Katzan, I. L. (2021) · Value in Health · doi:10.1016/j.jval.2021.06.009 · Cited by 10
“Overall wellbeing was threatened by aspects of the pandemic, including social isolation, decreased social support, economic uncertainty, greater inactivity, and less access to basic services.(13,14) Although several studies have demonstrated increased rates of anxiety, depression, and posttraumatic stress disorder sym…”
Cernasev, A., Desai, M., Jonkman, L. J., Connor, S. E., Ware, N., Sekar, M. C., & Schommer, J. C. (2021) · Pharmacy · doi:10.3390/pharmacy9040159 · Cited by 10
“Indeed, growing concern about stress experienced by student pharmacists may have detrimental effects on overall wellbeing [19,20].”
BackgroundRisk and resilience in couple’s adjustment to the COVID-19 pandemic
Xiang, E., Zhang, X., Raza, S. A., Oluyomi, A., Amos, C. I., & Badr, H. (2022) · Journal of Social and Personal Relationships · doi:10.1177/02654075221094556 · Cited by 11
Abuhammad, S., Khabour, O. F., Alzoubi, K. H., El-zubi, F. K., & Hamaieh, S. H. (2022) · International Journal of Clinical Practice · doi:10.1155/2022/4495806 · Cited by 10
“In a USA study, adherence to the Center for Disease Control and Prevention guideline was generally high with suboptimal adherence to social distancing and hygiene practices in younger adults [27].”
Panno, A., Theodorou, A., Massullo, C., Bratman, G. N., Imperatori, C., Carbone, G. A., & Gross, J. J. (2022) · Health Care For Women International · doi:10.1080/07399332.2022.2083622 · Cited by 11
“Moreover, women reported being more vulnerable and sensitive to COVID-19 related stressors such as fear of being infected, changes in everyday routine, and job loss than men (Frederiksen et al., 2020; Park et al., 2020).”
BackgroundChanges in Academic Performance after Transitioning to Remote Proctoring: A Before-After Evaluation
Hall, E. A., Roberts, M. B., Taylor, K. A., & Havrda, D. E. (2022) · Pharmacy · doi:10.3390/pharmacy10040092 · Cited by 13
Rubeis, V. D., González, A., de Groh, M., Jiang, Y., Oz, U. E., Tarride, J., Basta, N. E., Kirkland, S., Wolfson, C. M., Griffith, L. E., et al. (2023) · International Journal of Obesity · doi:10.1038/s41366-023-01258-9 · Cited by 10
Tillman, G., March, E., Lavender, A. P., Braund, T. A., & Mesagno, C. (2023) · Behavioral Sciences · doi:10.3390/bs13090698 · Cited by 17
“To deal with missing data we generated multivariate imputations by chained equations using the “Mice” package in R [32].”
MethodFinancial Stress and COVID-19: A Comprehensive Analysis of the Factors Associated with the Pandemic
Moon, K., Heo, W., Lee, J. M., & Grable, J. E. (2023) · Risks · doi:10.3390/risks11120218 · Cited by 10
“For instance, during the Ebola outbreak in Africa, women faced disproportionately heightened responsibilities in caregiving, partly due to their increased roles as primary caregivers (Androsik 2020; Park et al. 2020).”
InfluentialBradley, J. R. (2020) · Bayesian Analysis · doi:10.1214/20-ba1246 · Cited by 10
“However, social distancing comes as a cost, and can be detrimental to economies and cause psychological distress (Long, 2020; Park et al., 2020).”
BackgroundMoradi, Y., Mollazadeh, F., Karimi, P., Hosseingholipour, K., & Baghaei, R. (2021) · Perspectives In Psychiatric Care · doi:10.1111/ppc.12741 · Cited by 12
“Research suggests distraction, positive thinking, and normalization significantly contribute to stress moderation in patients.(4,23) In the study by Hao et al.”
BackgroundCOVID-19 Pandemic and Lockdown: Associations With Personality and Stress Components
Smrdu, M., Kuder, A., Turk, E., Čelik, T., Šet, J., & Kralj‐Fišer, S. (2021) · Psychological Reports · doi:10.1177/00332941211043451 · Cited by 9
“(2020) and Aschwanden et al. (2020). Both reported conscientious individuals not wearing face masks in public, since it was not specifically recommended by the CDC (Centers for disease control and prevention).”
BackgroundWarren, A. M., Bennett, M., Danesh, V. C., Waddimba, A. C., Tovar, M., Gottlieb, R., & Powers, M. B. (2021) · Psychiatry Research Communications · doi:10.1016/j.psycom.2021.100005 · Cited by 10
Messner, W. (2021) · PLoS ONE · doi:10.1371/journal.pone.0261858 · Cited by 10
“I thereby aim to analyze an important observation in extant empirical COVID19 research, which documented individuals reporting high safety compliance without endorsing pandemic anxiety [41].”
BackgroundPsychological withdrawal and mental health during the COVID-19 pandemic: a longitudinal study
Landa, S. U., Puente-Martínez, A., & Castro, J. L. G. (2021) · Psychology and Health · doi:10.1080/08870446.2021.2019254 · Cited by 10
A qualitative report of the perceptions of the COVID-19 pandemic from collegiate student-athletes
Rowe, D. C., Winkelmann, Z. K., Arent, S. M., Arent, M. A., Chandler, A. J., Uriegas, N. A., & Torres-McGehee, T. M. (2022) · AIMS Public Health · doi:10.3934/publichealth.2022025 · Cited by 10
Rubeis, V. D., Anderson, L. N., Khattar, J., de Groh, M., Jiang, Y., Oz, U. E., Basta, N. E., Kirkland, S., Wolfson, C. M., Griffith, L. E., et al. (2022) · CMAJ Open · doi:10.9778/cmajo.20210313 · Cited by 10
“15,16 Experiences of stress and coping vary among older adults, whereby adults in the oldest age groups have reported less mental health effects early in the pandemic, despite their increased risk for worse health outcomes with COVID-19.”
Perimenopause meets life: observations from the Women Living Better Survey
Woods, N. F., Coslov, N., & Richardson, M. K. (2022) · Menopause The Journal of The North American Menopause Society · doi:10.1097/gme.0000000000002072 · Cited by 10
Iosifyan, M., Arina, G. A., & Nikolaeva, V. V. (2023) · Journal of Health Psychology · doi:10.1177/13591053221142348 · Cited by 10
“…from different countries reported that the COVID-19 pandemic has contributed to a major mental health burden, including increased levels of stress, general anxiety, depressive symptoms, and fear of infection (Huang and Zhao, 2020; Mertens et al., 2020; Park et al., 2020; Pieh et al., 2021).”
BackgroundSchlesier, J., & Westphal, A. (2024) · Stress and Health · doi:10.1002/smi.3422 · Cited by 12
Kumar, R., Singh, A., Mishra, R., Saraswati, U., Bhalla, J., & Pagali, S. R. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.920581 · Cited by 9
MyTimeUse: An Online Implementation of the Day-Reconstruction Method
Rinderknecht, R. G., Doan, L., & Sayer, L. C. (2022) · Journal of Time Use Research · doi:10.32797/jtur-2022-3 · Cited by 9
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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