Cited by 728COVID-19 and Mental HealthCOVID-19 Prevention and ImpactCommunication and COVID-19 Impact

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Americans’ COVID-19 Stress, Coping, and Adherence to CDC Guidelines

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Park, Crystal L., Russell, Beth S., Fendrich, Michael, Finkelstein-Fox, Lucy, Hutchison, Morica, Becker, Jessica·2020·Journal of General Internal Medicine

DOI 10.1007/s11606-020-05898-9PMC PMC7259430

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Abstract

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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Long, L. J., Viana, A. G., Zvolensky, M. J., Lü, Q., & Gallagher, M. W. (2024) · Journal of Clinical Psychology · doi:10.1002/jclp.23746 · Cited by 8
Impact of the COVID-19 Shutdown on Mental Health in Appalachia by Working Status
Haynes, E. N., Hilbert, T. J., Westneat, S., Leger, K. A., Keynton, K., & Bush, H. (2021) · PubMed Central · doi:10.13023/jah.0301.03 · Cited by 6
Experiences of children (ages 6–12) during COVID‐19 pandemic from mothers' perspectives
Işık, R. A., Güneş, N. B., & Kaya, Y. (2021) · Journal of Child and Adolescent Psychiatric Nursing · doi:10.1111/jcap.12355 · Cited by 6
Compliance with local travel restrictions and face masks during first phase of COVID-19 pandemic in Ireland: a national survey
Kearney, P. M., Spillane, M., Humphries, R., Gannon, A., Stamenic, D., Bhuachalla, C. N., Hoevel, P., Arensman, E., O‘Riordain, M., Troya, M. I., et al. (2022) · Journal of Public Health · doi:10.1093/pubmed/fdac017 · Cited by 8
Subjective psychological impacts during COVID‐19 lockdown on older people, risk profiles and coping strategies: Results of an online survey in Spain
Doménech, S., Alias, S. B., Luque, X. R. I., Salvà, A., Figuls, M. R. I., & Coll‐Planas, L. (2022) · Journal of Community Psychology · doi:10.1002/jcop.22833 · Cited by 6
“Daily personal routines, healthy habits and being active, filling up time or distraction, and seeking emotional support were frequently informed strategies to manage psychological stress as reported by other studies (Holmes et al., 2020; Park et al., 2020).”
Result
Religious Views of Suffering Profile Groups during COVID-19
Wang, K. T., Cowan, K. J., Eriksson, C. B., Januzik, M., & Conant, M. R. (2022) · Religions · doi:10.3390/rel13050453 · Cited by 7
Examining the Impact of COVID-19 Experiences on Reported Psychological Burden Increase in Older Persons: The Effects of Illness Severity and Social Proximity
Heidinger, T., & Richter, L. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.884729 · Cited by 6
Psychosocial impact of COVID-19 among adults in the southeastern United States
Richmond, J., Sanderson, M., Shrubsole, M. J., Holowatyj, A. N., Schlundt, D. G., & Aldrich, M. C. (2022) · Preventive Medicine · doi:10.1016/j.ypmed.2022.107191 · Cited by 6
“Evidence in the U.S. is accumulating to suggest high rates of stress, depression, and anxiety symptoms since the start of the pandemic (Holingue et al., 2020; McGinty et al., 2020; Park et al., 2020; Saha et al., 2020; Xiong et al., 2020).”
Understanding Changes in Social Cannabis Use among Young Adults During the COVID-19 Pandemic: A Social Network Analysis
DiGuiseppi, G., Fedorova, E. V., Conn, B. M., Lankenau, S. E., Davis, J. P., Ataiants, J., & Wong, C. (2023) · Cannabis · doi:10.26828/cannabis/2023.01.003 · Cited by 6
“Email: diguisep@usc.edu Cannabis, A Publication of the Research Society on Marijuana 21 recommendations (Park et al., 2020; Suffoletto et al., 2020).”
Background
Perceived Stress and Coping among University Students Amidst COVID-19 Pandemic
Shuster, C. L., Tate, M. C., Schulz, C. T., Reyes, C. T., Drohan, M. M., Astorini, A. G., Stamates, A. L., Yang, M., & Robbins, M. L. (2023) · COVID · doi:10.3390/covid3100105 · Cited by 6
The relationship between the risk perception, stress level, and coping for the outdoor recreation participants during pandemic
Yoon, J. I., Jin-Wook, H., & Yi, J. (2021) · Korean Journal of Leisure, Recreation & Park · doi:10.26446/kjlrp.2021.3.45.1.89 · Cited by 6
Society of Behavioral Medicine (SBM) Position Statement: increase access to mental health services due to COVID-19-related parent and family stress
Bean, M. K., Adams, E. L., Buscemi, J., Ford, S., Wischenka, D. M., Behrman, P., Wilson, D. K., Gladstone, T. R. G., & Fitzgibbon, M. (2021) · Translational Behavioral Medicine · doi:10.1093/tbm/ibab063 · Cited by 6
Learning from and Leveraging Multi-Level Changes in Responses to the COVID 19 Pandemic to Facilitate Breast Cancer Prevention Efforts
Bowen, D. J., Rentscher, K. E., Wu, A. Y., Darien, G., Haile, H. G., Mandelblatt, J. S., & Kavanaugh-Lynch, M. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18136999 · Cited by 5
“At the level of the geopolitical environment, the pandemic has highlighted longstanding structural inequities and racial stereotyping and discrimination [26,37].”
Background
Effect of coping strategies on acute stress during the COVID–19 pandemic in Greece
Strongylaki, N. P., Pilafas, G., Dermati, A., Menti, D., & Lyrakos, G. N. (2021) · Health & Research Journal · doi:10.12681/healthresj.27473 · Cited by 7
Anxiety, depression and coping strategies among chronic medical patients with coronavirus disease-2019: a multicenter follow-up cohort study
Shousha, H. I., Madbouly, N. M., Afify, S., Asem, N., Fouad, E. A., Maher, R., Moussa, S. S., Abdelazeem, A., Youssif, E. M., Harhira, K. Y., et al. (2021) · Journal of Mental Health · doi:10.1080/09638237.2021.1979491 · Cited by 6
Changes in Mental Health and Views on Communication and Activities of Public Institutions among Swedes during the COVID-19 Pandemic—A Cross-Sectional Repeated Measures Design
Kerstis, B., Giannotta, F., Wågert, P. V. H., Hellström, C., Lindberg, D., Stier, J., & Elvén, M. (2021) · Healthcare · doi:10.3390/healthcare9111498 · Cited by 6
“A relationship between information about COVID-19 and anxiety and stress symptoms [14] has been found.”
Background
The effects of COVID-19-related stress among parents and children in Ohio child care programs: a mixed-methods study
Burkhart, K., Minnes, S., Yamoah, O., Doernberg, E., Balser, S., Ciesielski, T. H., Dimitropoulos, A., Nock, N., & Freedman, D. A. (2021) · Children's health care · doi:10.1080/02739615.2021.1997602 · Cited by 5
Public perceptions during the first wave of the COVID-19 pandemic in Canada: a demographic analysis of self-reported beliefs, behaviors, and information acquisition
Leigh, J. P., Brundin‐Mather, R., Soo, A., FitzGerald, E. A., Mizen, S. J., Dodds, A., Ahmed, S. B., Burns, K. E. A., Plotnikoff, K. M., Rochwerg, B. N., et al. (2022) · BMC Public Health · doi:10.1186/s12889-022-13058-3 · Cited by 9
“Similarly, research early in the COVID-19 pandemic demonstrated that women and those of older age were more likely to report adhering to the Center for Disease Control and Prevention (CDC) guidelines [30].”
Method
The impact of the COVID-19 pandemic on families in GermanyPreprint
Brandstetter, S., Poulain, T., Vogel, M., Meigen, C., Melter, M., Seelbach-Göbel, B., Apfelbacher, C., Kieß, W., Kabesch, M., Körner, A., et al. (2020) · medRxiv · doi:10.1101/2020.10.05.20206805 · Cited by 6
The Indirect Effects of Disordered Social Media Use on Stress and Depression via Fear of COVID-19Preprint
Tillman, G. (2020) · doi:10.31234/osf.io/dbg62 · Cited by 6
Coping, symptoms, and insomnia among people with heart failure during the COVID-19 pandemic.
O’Connell, M., Jeon, S., Conley, S., Linsky, S., & Redeker, N. S. (2023) · European Journal of Cardiovascular Nursing · doi:10.1093/eurjcn/zvac072 · Cited by 5
Avoidant Parent-Child Communication About COVID-19: A Longitudinal Investigation of Associations with Youth Adjustment Across the First 6 Months of the Pandemic
Malloy, L. C., Dykstra, V. W., Steen, L. A. R., Filoso, D., Salem, H., Comer, J. S., Peris, T. S., Pincus, D. B., Ehrenreich, J. T., & Evans, A. D. (2023) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-023-01133-1 · Cited by 5
How we survived: older adults’ adjustment to the lockdowns due to the COVID-19 pandemic
Jarego, M., Tasker, F., Costa, P. A., Ribeiro, J. L. P., & Ferreira-Valente, A. (2024) · Current Psychology · doi:10.1007/s12144-024-05860-6 · Cited by 5
“…coping strategies, the entire sample mentioned adopting protective behaviors to prevent contagion, as found in other studies (Greenwood-Hickman et al., 2021; Park et al., 2020; Rotenberg et al., 2021), probably because older adults are more vulnerable to a COVID-19 infection (Shahid et al., 2020).”
Moderating Effect of Perceived Remaining Time in the Relationship between Job Demands and Job Stress
Rizki, L. P., & Purba, D. E. (2022) · Asian Academy of Management Journal · doi:10.21315/aamj2022.27.1.3 · Cited by 5
Lingering Effects of COVID-19 Stressors on Mental Health and Alcohol Use in Middle Aged to Older Adults
Lin, T. W., Richman, J. A., Johnson, T. P., & Rospenda, K. M. (2023) · Aging and Health Research · doi:10.1016/j.ahr.2023.100178 · Cited by 5
Drinking to Cope With the COVID-19 Pandemic Mediates Pathways From COVID-19 Anxiety to Alcohol Use and Alcohol Myopia Consequences
Lac, A. (2024) · Journal of Dual Diagnosis · doi:10.1080/15504263.2024.2343372 · Cited by 5
“…to illness and death, safety precautions such as washing hands and disinfecting, quarantining to minimize the transmission of the virus, complying with governmental mandates, and other disruptions to normalcy (Omer et al., 2020; Park et al., 2020; Pfefferbaum & North, 2020; Taylor et al., 2020).”
Slovak parents’ mental health and socioeconomic changes during the COVID-19 pandemic
Vargová, L., Mikulášková, G., Fedáková, D., Lačný, M., Babjáková, J., Šlosáriková, M., Babinčák, P., Ropovik, I., & Adamkovic, M. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.934293 · Cited by 4
“Don’t Touch Your Face!” The Contribution of Habit Reversal in the COVID-19 Pandemic
Varrasi, S., Castellano, S., Platania, G. A., Guerrera, C. S., Caponnetto, P., & Pirrone, C. (2022) · Health Psychology Research · doi:10.52965/001c.39650 · Cited by 5
The Relationship between Personality Traits and Compliance with the COVID-19 Preventive Measures in Kosovo
Telaku, N., Musliu, A., Cana, L., Han, H., & Zharku, L. (2022) · Psych · doi:10.3390/psych4040063 · Cited by 5
“Overall, studies have found that people have experienced high levels of concern and stress over the pandemic situation, whereas the severity and contagiousness of the virus, followed by the length of quarantine and financial complications were the most common stressors [79].”
Background
COVID-19 stressors for Hispanic/Latino patients living with type 2 diabetes: a qualitative study
Williams, M. S., Cigaran, E., Martinez, S., Marino, J., Barbero, P., Myers, A. K., DiClemente, R. J., Goris, N., Gomez, V. C., Granville, D., et al. (2023) · Frontiers in Clinical Diabetes and Healthcare · doi:10.3389/fcdhc.2023.1070547 · Cited by 5
“The recommended mitigation and prevention strategies may have had unintended consequences such as affecting access to vital resources and social support networks, which have been proven to be instrumental in coping with stress, particularly for members of the H/L community (43, 44).”
Background
Seeing COVID‐19 is believing: Direct and indirect experiences with COVID‐19 predict health behaviors through conspiracy beliefs and risk perception
Evans, N. D., & Fetterman, A. K. (2023) · Journal of Applied Social Psychology · doi:10.1111/jasp.13002 · Cited by 5
“There have been mixed results (Park et al., 2020).”
A Dynamic Reaction-restore-type Transmission-rate Model for COVID-19
Córdova‐Lepe, F., & Gutiérrez-Jara, J. P. (2024) · WSEAS TRANSACTIONS ON BIOLOGY AND BIOMEDICINE · doi:10.37394/23208.2024.21.12 · Cited by 5
“Although the most widespread would be psychological (pandemic fatigue, [63],[64]), economic (economic insecurity, [65], [66]) and informational (low-risk perception, [67], [68], [69], [70]) types.”
Impact of COVID-19 pandemic on influenza vaccination rate among health care workers
Alshagrawi, S. S. (2024) · Human Vaccines & Immunotherapeutics · doi:10.1080/21645515.2024.2426284 · Cited by 5
Emerging Adults’ Adherence to Preventative Health Guidelines in Response to COVID-19
Feldman, E. C. H., Balistreri, K. A., Lampert-Okin, S. L., Durkin, L. K., Bugno, L. T., Davies, W. H., & Greenley, R. N. (2021) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsab047 · Cited by 5
Self-rated mental health among sexual health service clients during the first months of the COVID-19 pandemic, British Columbia, Canada
Salway, T. J., Ablona, A., Chang, H.-J., Watt, S., Worthington, C., Grace, D., Wong, J., Ogilvie, G. S., Grennan, T., & Gilbert, M. (2021) · Preventive Medicine · doi:10.1016/j.ypmed.2021.106789 · Cited by 5
Adaptive Play
Cahill, T. J. (2021) · Annual Symposium on Computer-Human Interaction in Play · doi:10.1145/3450337.3483522 · Cited by 5
“Unsurprisingly in light of the significant disruptions and restrictions resulting from the COVID-19 pandemic, an attendant increase in excess stress among large segments of the global population has been observed in the past year and a half [3, 16, 20].”
Background
Community Health Needs Assessment Data and Community Recovery From COVID-19
Molella, R. G., Murad, A. L., Sherden, M., Fritz, D. J., Sadecki, E. N., Briggs, G., Wang, Z., & Murad, M. H. (2022) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2022.02.010 · Cited by 5
LGBTQIA+ people’s service access during the COVID-19 pandemic: Obstacles to care and provider adaptations
Osborn, M. T. (2022) · Sexual and Gender Diversity in Social Services · doi:10.1080/10538720.2022.2053025 · Cited by 6
“The onset of the global COVID-19 pandemic has exacerbated existing barriers to care and services for populations who already experience systemic exclusion and access inequality (Azar et al., 2020; Czeisler et al., 2020; Park et al., 2020; van Dorn et al., 2020).”
Background
Impact of Perceived Stress During the SARS-CoV-2 Pandemic on Rheumatoid Arthritis Patients' Disease Activity
Pham, A., Brook, J. K., Elashoff, D. A., & Ranganath, V. K. (2022) · JCR Journal of Clinical Rheumatology · doi:10.1097/rhu.0000000000001861 · Cited by 5
A prospective study revealing a compounded burden of COVID-19, sex, and clinical diagnosis of alcohol use disorder and HIV infection on quality of life, anxiety, and alcohol use
Lannoy, S., Fama, R., Sassoon, S. A., Berre, A. L., Asok, P., Zahr, N. M., Adolf Pfefferbaum, A., & Sullivan, E. V. (2022) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2022.06.017 · Cited by 5
An experimental COVID‐19 messaging study in a representative sample of the Scottish population: Increasing physical distancing intentions through self‐efficacy
den Daas, C., Johnston, M., Hubbard, G., & Dixon, D. L. (2022) · British Journal of Health Psychology · doi:10.1111/bjhp.12632 · Cited by 6
“Nevertheless, several studies show that adherence to physical distancing, especially just after easing of the lockdown towards the end of the first wave of the pandemic, was high in North America and Europe including the UK (Coroiu et al., 2020; Dixon et al., 2021; Park et al., 2020).”
BackgroundResult
Stress, trauma, and perception of eating behavior changes during the first weeks of the COVID‐19 outbreak
Karvay, Y., Helion, C., Vafiadis, A., Smith, D. V., & Jarcho, J. M. (2022) · International Journal of Eating Disorders · doi:10.1002/eat.23863 · Cited by 4
Neuroeconomics of decision-making during COVID-19 pandemic
Bashir, S., Mir, A., Altwaijri, N. A., Uzair, M., Khalil, A., Albesher, R., Khallaf, R. A., Alshahrani, S. S., & Abualait, T. (2023) · Heliyon · doi:10.1016/j.heliyon.2023.e13252 · Cited by 6
STIGMA AND LOW SENSE OF COHERENCE AS LONG-TERM PREDICTORS OF DEPRESSIVE AND ANXIETY SYMPTOMS IN THE POPULATION AMID THE COVID-19 PANDEMIC
Mihevc, M., & Šter, M. P. (2023) · Psychiatria Danubina · doi:10.24869/psyd.2023.250 · Cited by 6
“The rationale for this clas - sification is based on previous research (Wu et al. 2009, Park et al. 2020).”
BackgroundMethodInfluential
Young people's recommended coping strategies to manage social isolation: Lessons from the COVID-19 pandemic lockdown in the UK
Jong, A., Riddleston, L., Mathur, M., Duncan, K. B., Lalioti, K., Fuhrmann, D., & Lau, J. Y. F. (2023) · Current Research in Behavioral Sciences · doi:10.1016/j.crbeha.2023.100133 · Cited by 5
Estimated public health impact of concurrent mask mandate and vaccinate-or-test requirement in Illinois, October to December 2021
Castonguay, F. M., Barnes, A., Jeon, S., Fornoff, J., Adhikari, B. B., Fischer, L. S., Greening, B., Hassan, A. O., Kahn, E. B., Kang, G. J., et al. (2024) · BMC Public Health · doi:10.1186/s12889-024-18203-8 · Cited by 5
Is RAS the Link Between COVID-19 and Increased Stress in Head and Neck Cancer Patients?
Iftikhar, A., Islam, M. R., Shepherd, S. D., Jones, S., & Ellis, I. (2021) · Frontiers in Cell and Developmental Biology · doi:10.3389/fcell.2021.714999 · Cited by 5
PSYCHOLOGICAL DEFENSE IN THE ORGANIZATION OF THE TIME PERSPECTIVE OF STUDENTS UNDER COVID-RESTRICTIONS
Плохіх, В. В., & Suponeva, L. (2021) · Science and Education · doi:10.24195/2414-4665-2021-3-2 · Cited by 5
Emotional Support and Mental Health during the COVID-19 Pandemic: A Focus on Gender and Sexual Identities
Gustafson, K. E., Manning, W. D., & Dush, C. M. K. (2024) · Socius Sociological Research for a Dynamic World · doi:10.1177/23780231241247999 · Cited by 4
“During the corona-virus disease 2019 (COVID-19) pandemic, stress levels (Park et al. 2020; Prowse et al. 2021; Taylor et al. 2020a, 2020b) and the prevalence of mental health issues (Ettman et al. 2020; Hawes et al. 2021) for general population samples substantially increased.”

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.
ORCID: Park, Crystal L.
Russell, Beth S.
Fendrich, Michael
Hutchison, Morica
Becker, Jessica
Venue: Journal of General Internal Medicine
Publisher: Springer Science and Business Media LLC
Published: 2020-05-29
Volume: 35
Issue: 8
Pages: 2296-2303
ISSN: 0884-8734 (ISSN-L)
1525-1497
DOI: 10.1007/s11606-020-05898-9
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
Licence: www.springer.com/tdm (tdm)
www.springer.com/tdm (vor)
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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