Rapid assessment of psychological and epidemiological correlates of COVID-19 concern, financial strain, and health-related behavior change in a large online sample
Open accessAbstract
COVID-19 emerged in November 2019 leading to a global pandemic that has not only resulted in widespread medical complications and loss of life, but has also impacted global economies and transformed daily life. The current rapid response study in a convenience online sample quickly recruited 2,065 participants across the United States, Canada, and Europe in late March and early April 2020. Cross-sectional findings indicated elevated anxiety and depressive symptoms compared to historical norms, which were positively associated with COVID-19 concern more strongly than epidemiological data signifying risk (e.g., world and country confirmed cases). Employment loss was positively associated with greater depressive symptoms and COVID-19 concern, and depressive symptoms and COVID-19 concern were significantly associated with more stringent self-quarantine behavior. The rapid collection of data during the early phase of this pandemic is limited by under-representation of non-White and middle age and older adults. Nevertheless, these findings have implications for interventions to slow the spread of COVID-19 infection.
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Nelson et al surveyed 2000 individuals from the United States, Canada, and Europe, and found elevated symptoms of anxiety and depression compared to historical norms and observed factors similar to the concerns we detected regarding symptomatic expressions and those related to seeking support.
“Nelson et al [101] surveyed 2000 individuals from the United States, Canada, and Europe, and found elevated symptoms of anxiety and depression compared to historical norms and observed factors similar to the concerns we detected regarding symptomatic expressions and those related to seeking support.”
From Psychosocial Effects of the COVID-19 Pandemic: Large-scale Quasi-Experimental Study on Social Media (2020) · cites this paper as [101]
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BackgroundGeprägs, A., Bürgin, D., Fegert, J. M., Brähler, E., & Clemens, V. (2023) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/s13034-023-00571-5 · Cited by 30 · see citing works
Cheng, P., Casement, M. D., Cuellar, R., Johnson, D. A., Kalmbach, D. A., Castelan, A. C., & Drake, C. L. (2021) · SLEEP · doi:10.1093/sleep/zsab242 · Cited by 29 · see citing works
Clay, L., & Rogus, S. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18041451 · Cited by 29 · see citing works
“The impacts of COVID-19 on mental health are likely due to the psychological suffering associated with the risk of contracting the disease and the secondary effects of the pandemic, including economic instability, loneliness, and social isolation [19,22].”
BackgroundHaucke, M. N., Heinz, A., Liu, S., & Heinzel, S. (2022) · Journal of Medical Internet Research · doi:10.2196/32598 · Cited by 27 · see citing works
“Reasons for this are an increase of distress or loneliness during the COVID-19 lockdown [4-7], yet most studies are overlooking the directionality between behavior and cognition over time.”
BackgroundHaucke, M. N., Liu, S., & Heinzel, S. (2021) · JMIR Mental Health · doi:10.2196/29419 · Cited by 25 · see citing works
The Impact of COVID-19 on the Mental Well-Being of College Students
Sauer, N. J., Sałek, A., Szlasa, W., Ciecieląg, T., Obara, J., Gaweł, S., Marciniak, D. M., & Karłowicz-Bodalska, K. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19095089 · Cited by 25 · see citing works
Geprägs, A., Bürgin, D., Fegert, J., Brähler, E., & Clemens, V. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19148734 · Cited by 21 · see citing works
Weiskittle, R., Tsang, W., Schwabenbauer, A. K., Andrew, N., & Mlinac, M. E. (2021) · Clinical Gerontologist · doi:10.1080/07317115.2021.1906812 · Cited by 22 · see citing works
Haucke, M. N., Golde, S., Saft, S., Hellweg, R., Liu, S., & Heinzel, S. (2022) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2022.105894 · Cited by 23 · see citing works
Lalot, F., Abrams, D., Heering, M. S., Babaian, J., Özkeçeci, H., Peitz, L., Hayon, K. D., & Broadwood, J. (2022) · Political Psychology · doi:10.1111/pops.12871 · Cited by 22 · see citing works
“During the COVID-19 pandemic, Nelson et al. (2020) found that COVID-19 case rates were positively associated with COVID-19 concern.”
BackgroundCOVID-19 health behaviors in a sexual minority sample: The impact of internalized stigma.
Solomon, D. T., Morey, K. E., Williams, C. J., Grist, C. L., & Malesky, L. A. (2021) · Psychology of Sexual Orientation and Gender Diversity · doi:10.1037/sgd0000466 · Cited by 21 · see citing works
Stassart, C., Wagener, A., & Étienne, A.-M. (2021) · Psychologica Belgica · doi:10.5334/pb.1059 · Cited by 21 · see citing works
COVID-19: Impact of Diagnosis Threat and Suggestibility on Subjective Cognitive Complaints
Winter, D., & Braw, Y. (2021) · International Journal of Clinical and Health Psychology · doi:10.1016/j.ijchp.2021.100253 · Cited by 22 · see citing works
“The study was conducted using the Qualtrics survey software (for a related study using the platform, see Nelson et al., 2020).”
Refaeli, T., & Achdut, N. (2021) · Sustainability · doi:10.3390/su13126942 · Cited by 20 · see citing works
“, [56,67]) and to assess financial strain in the wake of the pandemic [17]; (2) PIA during the COVID-19 pandemic was assessed by the question: “Has there been an adverse change in your ability to cover your household monthly expenses since the COVID-19 outbreak?” (1 = yes).”
BackgroundResultGoins, R. T., Anderson, E. L., Minick, H., & Daniels, H. (2021) · Frontiers in Public Health · doi:10.3389/fpubh.2021.660536 · Cited by 20 · see citing works
Chassang, I., Rohmer, O., & Chauvin, B. (2024) · Risk Analysis · doi:10.1111/risa.17636 · Cited by 19 · see citing works
“…serious threat to political stability (e.g., loss of trust in governments—Cori et al., 2020; science skepticism—Rutjens et al., 2021), global economy (Nelson et al., 2020), and public health (World Health Organization, 2020); that is, the pandemic went clearly against what…”
Anxiety sensitivity prospectively predicts pandemic-related distress
Schmidt, N. B., Morabito, D. M., Mathes, B. M., & Martin, A. D. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.05.124 · Cited by 19 · see citing works
White, R., Livingston, L. A., Taylor, E., Close, S. A. D., Shah, P., & Callan, M. J. (2022) · Journal of Autism and Developmental Disorders · doi:10.1007/s10803-022-05469-3 · Cited by 18 · see citing works
“We asked participants ‘How concerned do you feel about COVID-19?’ which was answered on a 5-point scale from Not at all concerned to Extremely concerned (Nelson et al., 2020).”
BackgroundWong, D. F. K., Lau, Y. Y., Chan, H. S., & Zhuang, X. (2022) · Child & Family Social Work · doi:10.1111/cfs.12934 · Cited by 18 · see citing works
“First, the outbreak has led to economic decline in many countries resulting from disrupted business activities and lockdown of non-essential businesses (Nelson et al., 2020), which in turn has contributed to economic strain for the general population.”
BackgroundHamshari, Y. M., Alqam, M. A., & Ali, H. Y. (2022) · Cogent Economics & Finance · doi:10.1080/23322039.2022.2157541 · Cited by 21 · see citing works
“Giuliani et al. (2020) and Nelson et al. (2020) discussed its relationship to pollution.”
BackgroundKeller, F. M., Dahmen, A., Derksen, C., Kötting, L., & Lippke, S. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18178936 · Cited by 19 · see citing works
“Hence, we cannot be certain whether the COVID-19 pandemic was associated with an aggravated symptom increase with respect to symptoms of depression, anxiety, stress, and loneliness, as shown by previous literature [49,54].”
ResultAdler, A. B., Gutierrez, I. A., Gomez, S. A. Q., Beymer, M. R., Santo, T. J., Thomas, J. L., Cates, D., Bell, A. M., & Quartana, P. J. (2022) · BMC Public Health · doi:10.1186/s12889-022-13345-z · Cited by 17 · see citing works
“Gender Given the potential effect of gender on mental health and health-related behaviors [25, 27], we accounted for gender in our analyses.”
MethodThe mental health toll among healthcare workers during the COVID-19 Pandemic in Malawi
Maliwichi, L., Kondowe, F. J. M., Mmanga, C., Mchenga, M., Kainja, J., Nyamali, S., & Ndasauka, Y. (2024) · Scientific Reports · doi:10.1038/s41598-024-61216-x · Cited by 17 · see citing works
Park, S., Marcotte, R. T., STAUDENMAYER, J. W., Strath, S. J., Freedson, P. S., & Chasan‐Taber, L. (2022) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-022-05236-3 · Cited by 16 · see citing works
“These lockdowns have been shown to adversely impact mental health, diet, sleep, financial stability, and social relationships, resulting in unexpected and sudden shifts in human behavior [2, 3].”
BackgroundZika virus infection of the placenta alters extracellular matrix proteome
Borges-Vélez, G., Rosado-Philippi, J., Cantres-Rosario, Y. M., Carrasquillo-Carrión, K., Roche-Lima, A., Pérez-Vargas, J., González-Martínez, A., Correa-Rivas, M. S., & Meléndez, L. M. (2021) · Journal of Molecular Histology · doi:10.1007/s10735-021-09994-w · Cited by 16 · see citing works
Arena, A., Orsini, B., Esposti, E. D., Raimondo, D., Lenzi, J., Verrelli, L., Iodice, R., Casadio, P., & Seracchioli, R. (2021) · Annals of Medicine · doi:10.1080/07853890.2021.1991589 · Cited by 16 · see citing works
“Even more, information on experiences of SARS-CoV-2 in the general population shows more anxiety and depression compared to historical norms [14].”
BackgroundEvaluating an online well-being program for college students during the COVID-19 pandemic
Villarino, R. T., Villarino, M. L., Temblor, M. C., Chabit, N. T., Arcay, C. A. L., Gimena, G. B., Bernard, P. M., & Plaisent, M. (2022) · Journal of Health Sciences · doi:10.17532/jhsci.2022.1631 · Cited by 15 · see citing works
“Thus, as various recent studies have stressed, there is a priority to evaluate the impact of the rising epidemic on the mental health and well-being of college students (11).”
BackgroundCOVID-19 Impact Battery: Development and Validation
Schmidt, N. B., Allan, N. P., Koscinski, B., Mathes, B. M., Eackles, K., Accorso, C., Saulnier, K. G., Allan, D. M., Potter, K., Garey, L., et al. (2021) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-021-09919-7 · Cited by 14 · see citing works
Fertility treatment delays during COVID-19: Profiles, feelings and concerns of impacted patients
Gürtin, Z. B., Yasmin, E., Silva, P. D., Dennehy, C., Harper, J. C., & Kanjani, S. (2022) · Reproductive Biomedicine & Society Online · doi:10.1016/j.rbms.2021.12.004 · Cited by 14 · see citing works
Chan, J. K., Marzuki, A. A., Vafa, S., Thanaraju, A., Yap, J., Chan, X. W., Harris, H. A., Todi, K., & Schaefer, A. (2024) · BMC Psychology · doi:10.1186/s40359-024-01715-8 · Cited by 17 · see citing works
Kaveh-Yazdy, F., & Zarifzadeh, S. (2020) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2020.104309 · Cited by 13 · see citing works
“Nelson et al. [30] studied psychological and epidemiological concerns of society through the lens of surveys in social media.”
Andrade, R. M. R., Marcela Larraguibel, Q., Davanzo, M. P., Montt, M. E., Halpern, M., & Aldunate, C. (2021) · Terapia psicológica · doi:10.4067/s0718-48082021000200273 · Cited by 14 · see citing works
“Estos factores interactúan con la maduración cerebral y los efectos moderadores del aislamiento social, lo que puede contribuir en la aparición de trastornos psiquiátricos en la adolescencia (Nelson et al., 2020).”
Lim, S. R., Ng, Q. X., Xin, X., Lim, Y. L., Boon, E. S. K., & Liew, T. M. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192113834 · Cited by 13 · see citing works
“, elevated levels of anxiety and depressive symptoms [4].”
BackgroundInfluentialPeng, S., Lai, X., Du, Y., Li, Y., Tian, K., & Gan, Y. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.616723 · Cited by 12 · see citing works
Shelter-in-place orders, loneliness, and collaborative behavior
Babin, J. J., Foray, M., & Hussey, A. J. (2021) · Economics & Human Biology · doi:10.1016/j.ehb.2021.101056 · Cited by 11 · see citing works
“Some unfortunate byproducts of SPOs are that they affect normal social interaction levels, employment, and consumption (Nelson et al., 2020), leading to adverse effects on crime rates health.”
BackgroundBaetens, I., Vanderfaeillie, J., Soyez, V., Vantilborgh, T., Meersschaut, J. V. D., Schotte, C., & Theuns, P. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.889503 · Cited by 11 · see citing works
“COVID-19 and the measures taken to contain the pandemic had a detrimental impact on subjective wellbeing (Nelson et al., 2020).”
BackgroundWright, G. G., Herbert, L., Hilaire, B., & Campbell, L. O. (2021) · The Career Development Quarterly · doi:10.1002/cdq.12275 · Cited by 11 · see citing works
“These conditions create an added barrier for individuals who are looking for new employment (Brooks et al., 2020; Nelson et al., 2020).”
BackgroundKeller, F. M., Dahmen, A., Derksen, C., Kötting, L., & Lippke, S. (2021) · JMIR Mental Health · doi:10.2196/30610 · Cited by 10 · see citing works
Graph-based joint pandemic concern and relation extraction on Twitter
Shi, J., Li, W., Yongchareon, S., Yang, Y., & Bai, Q. (2022) · Expert Systems with Applications · doi:10.1016/j.eswa.2022.116538 · Cited by 10 · see citing works
Domosławska-Żylińska, K., Krysińska-Pisarek, M., Czabanowska, K., & Sesa, G. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph192013473 · Cited by 10 · see citing works
“(2020) [10] established a link between risk perceptions and self-quarantining.”
BackgroundPark, J., & Kim, S. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20054425 · Cited by 11 · see citing works
Predicting Suicide in Counties: Creating a Quantitative Measure of Suicide Risk
Mobley, K., & Taasoobshirazi, G. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19138173 · Cited by 11 · see citing works
“A combination of increased social isolation and social strain lead to significant increases in mental health concerns during the pandemic [70].”
BackgroundWichaidit, W., Prommanee, C., Choocham, S., Chotipanvithayakul, R., & Assanangkornchai, S. (2022) · PeerJ · doi:10.7717/peerj.13307 · Cited by 9 · see citing works
“With regard to the outcomes, we presented prevalence of anxiety disorder and depressive symptoms as binary outcome using the same cut-off for GAD-7 and PHQ-2 as in previous studies ( Nelson et al., 2020 ; Hertz-Palmor et al., 2021 ) in order to allow for higher statistical power.”
Zengi̇n, M., Başoğul, C., & Yayan, E. H. (2021) · International Journal of Clinical Practice · doi:10.1111/ijcp.14839 · Cited by 9 · see citing works
Actual versus perceived infection rates of COVID-19: Impact on distress, behavior and disability
Schmidt, N. B., Martin, A. D., Allan, N. P., Mathes, B. M., Saulnier, K. G., & March, D. S. (2021) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2021.03.061 · Cited by 9 · see citing works
Investigating Mental Health Among Malaysian University Students During Covid-19 Pandemic
Hassan, N. A., Majeed, H. A., Tajuddin, J. M., Abdullah, N. H., & Ahmad, R. B. (2022) · Malaysian Journal of Social Sciences and Humanities (MJSSH) · doi:10.47405/mjssh.v7i1.1224 · Cited by 12 · see citing works
MacDonald, H. Z. (2023) · Journal of American College Health · doi:10.1080/07448481.2022.2155053 · Cited by 8 · see citing works
Lin, C.-H., Lin, S., Hu, B.-H., & Lo, C. O. (2023) · Journal of American College Health · doi:10.1080/07448481.2022.2162824 · Cited by 8 · see citing works
“10,12,16 16–20 For example, researchers found that students in severely impacted regions in the US experienced high rates of anxiety/depression and financial instability associated with the epidemic.”
Concerns in the Norwegian Population during the Initial Lockdown Due to the COVID-19 Pandemic
Schou‐Bredal, I., Skogstad, L., Grimholt, T. K., Bonsaksen, T., Ekeberg, Ø., & Heir, T. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18116119 · Cited by 8 · see citing works
“A study from the United States reported that the top concern of the public was getting sick because of COVID-19 and not being able to obtain medical help [11].”
BackgroundFinancial Disruption and Psychological Underpinning During COVID-19: A Review and Research Agenda
Singh, S., & Bedi, D. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.878706 · Cited by 7 · see citing works
Financial well-being and life satisfaction of individuals during the Covid-19 outbreak
Çopur, Z., & Doğan, N. (2023) · Pressacademia · doi:10.17261/pressacademia.2023.1739 · Cited by 7 · see citing works
Ko, E., Lee, S., Jang, K., & Kim, S. (2024) · Cities · doi:10.1016/j.cities.2023.104758 · Cited by 7 · see citing works
Ochnik, D., Rojczyk, E., Choina, Z., Nowak, H., Skalska, M., Sroka, M. I., Stach, A., Sudoł-Ginalska, N., Wąsik, M., & Blažková, I. (2024) · Scientific Reports · doi:10.1038/s41598-024-80095-w · Cited by 7 · see citing works
Mental health during the first wave of COVID-19 in Canada, the USA, Brazil and Italy
Turna, J., Patterson, B. A., Bergmann, C. G., Lamberti, N., Rahat, M., Dwyer, H., Francisco, A. P., Vismara, M. E. M., Dell’Osso, B. M., Sideris, B., et al. (2021) · International Journal of Psychiatry in Clinical Practice · doi:10.1080/13651501.2021.1956544 · Cited by 7 · see citing works
“These challenges have been highlighted in previous epidemics including Severe Acute Respiratory Syndrome [SARS], SARS-CoV-2, H1N1, Middle East Respiratory Syndrome [MERS] and Ebola.”
BackgroundAn agent-based model to assess citizens’ acceptance of COVID-19 restrictions
Falcone, R., & Sapienza, A. (2021) · Journal of Simulation · doi:10.1080/17477778.2021.1965501 · Cited by 7 · see citing works
“People were required to undertake costly behavioural changes, not only in economic terms but even restricting their personal freedom (Nelson et al., 2020).”
BackgroundTeixeira, K. D. O. M., de Lisboa, J. L., Dias, B. M. F., Ferreira, R. C., Zarzar, P. M., & Sampaio, A. A. (2022) · Research Society and Development · doi:10.33448/rsd-v11i4.26426 · Cited by 7 · see citing works
Being a Parent during COVID-19: Risk for Psychological Distress in the United States and Italy
Lai, J., Pham, P. T., Bate, J., Prout, T. A., Carollo, A., Setoh, P., Esposito, G., & Borelli, J. L. (2022) · Social Sciences · doi:10.3390/socsci11040173 · Cited by 7 · see citing works
“…regarding the negative mental health ramifications of contexts that arise during the pandemic, including work and financial strain (Di Giuseppe et al. 2020; Hertz-Palmor et al. 2021; Holman et al. 2020; Le et al. 2020; Mamun et al. 2021; Nelson et al. 2020; Son et al. 2020; Wang et al. 2020).”
BackgroundWilliamson, V. G., Berger, E. L., Barendse, M. E. A., Pfeifer, J. H., Dahl, R. E., & Magis‐Weinberg, L. (2022) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-022-00928-y · Cited by 7 · see citing works
“The PHQ-2 has been used in studies around the world including in studies of health and well-being during the COVID-19 pandemic (Gelaye et al., 2016; Kroenke et al., 2003; Löwe et al., 2005; Nelson et al., 2020).”
MethodParent Mental Health Before and During the COVID-19 Pandemic
Suarez, G. L., Boone, M. H., Burt, S. A., Shewark, E. A., Mitchell, C. M., Guzmán, P., Lopez‐Duran, N. L., Klump, K. L., Monk, C. S., & Hyde, L. W. (2023) · Child Psychiatry & Human Development · doi:10.1007/s10578-023-01642-6 · Cited by 6 · see citing works
“Cross-sectional data indicated that rates of depression and anxiety in adults were elevated during the pandemic compared to historical norms [3], a finding consistent across a narrative review of recent cross-sectional studies, research commentaries, and editorials [4].”
COVID-19 Concern and Stress in Bangladesh: Perceived Social Support as a Predictor or Protector
Uddin, M. K., Islam, M. N., & Ahmed, O. (2022) · Trends in Psychology · doi:10.1007/s43076-022-00158-7 · Cited by 6 · see citing works
“Some studies found that social support is a protector against self-isolation, social distancing, worry about coronavirus, etc. (Banerjee et al., 2020; Nelson et al., 2020).”
Han, P., Wang, L., Song, Y., & Zheng, X. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.1084562 · Cited by 7 · see citing works
- Authors
- Nelson, B. W., Pettitt, A., Flannery, J. E., & Allen, N. B.
- Affiliations
- University of North Carolina at Chapel Hill (US)
- University of Oregon (US)
- Corresponding author
- Nelson, Benjamin W.
- Pettitt, Adam
- Flannery, Jessica E.
- Allen, Nicholas B.
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2020-11-11
- Volume
- 15
- Issue
- 11
- Pages
- e0241990
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC7657530
- OpenAlex
- W3106477851
- Cited by
- 175
- References
- 31
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 14 · 2023: 28 · 2022: 55 · 2021: 52 · 2020: 16
- FWCI
- 15.11
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by)
- Funders
- Ann Swindells Endowment to the University of Oregon
- 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, COVID-19 worry, anxiety, depressive symptoms, financial stress, job loss, health behavior change, psychological impact of pandemic, online surveys
- MeSH terms
- Betacoronavirus, COVID-19, SARS-CoV-2, Adolescent, Adult, Aged, Anxiety, Cross-Sectional Studies, Depression, Female, Humans, Life Style, Male, Mental Health, Middle Aged, Pneumonia, Viral, Quarantine, Surveys and Questionnaires, Social Isolation, Health Behavior, Coronavirus Infections, Young Adult, Economic Recession, Pandemics
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