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Prevalence and Predictors of Anxiety and Depression Symptoms during the COVID-19 Pandemic and Compliance with Precautionary Measures: Age and Sex Matter
Open accessAbstract
Effective management of the global pandemic caused by Severe Acute Respiratory Syndrome Coronavirus 2 (also known as COVID-19), resulted in the implementation of severe restrictions in movement and enforcement of social distancing measures. This study aimed to understand and characterize the psychosocial effects of the COVID-19 pandemic in the general population and to identify risks and protective factors that predict changes in mental health status. In addition, the study investigated compliance with precautionary measures (PM) to halt the spread of the virus. The online anonymous survey collected information on sociodemographic data, compliance with PM, quality of life (QOL), and mental health via the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9). A total of 1642 adult participants (71.6% women, 28.4% men) completed the survey in the European island country, Cyprus. A large percentage (48%) reported significant financial concerns and 66.7% significant changes in their QOL. About 41% reported symptoms associated with mild anxiety; 23.1% reported moderate-severe anxiety symptoms. Concerning depression, 48% reported mild and 9.2% moderate-severe depression symptoms. Women, younger age (18–29), student status, unemployment status, prior psychiatric history, and those reporting greater negative impact on their QOL, were at higher risk for increased anxiety and depression symptoms (p < 0.05). The youngest age group and males also reported lower levels of compliance with PM. Higher compliance with PM predicted lower depression scores (p < 0.001) but higher anxiety for measures related to personal hygiene. The results of this study provide important data on the effects of the COVID-19 outbreak on mental health and QOL and identify a variety of personal and social determinants that serve as risks and protective factors. Furthermore, it has implications for policy makers demonstrating the need for effective mental health programs and guidance for the implementation of PM as a public health strategy.
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“The levels of clinically significant anxiety and depression observed in this sample of healthcare professionals are higher than those reported in the general Cypriot population (23.1% and 9.2%, respectively) during the COVID‐19 pandemic (Solomou & Constantinidou, 2020).”
From Beyond the physical risk: Psychosocial impact and coping in healthcare professionals during the COVID‐19 pandemic. (2025) · cites this paper as Solomou & Constantinidou, 2020
In the citing paper
“and data about the COVID-19 pandemic have echoed these findings.16, 17, 18, 19, 20, 21”
From Trajectories of anxiety and depressive symptoms during enforced isolation due to COVID-19 in England: a longitudinal observational study (2021) · cites this paper as [17]
In the citing paper
“Previous studies during the COVID-19 pandemic have already highlighted that women and younger adults had higher levels of anxiety and depression than men and older adults,4, 17, 18 but our data show that these groups have also had faster improvements in their symptoms.”
From Trajectories of anxiety and depressive symptoms during enforced isolation due to COVID-19 in England: a longitudinal observational study (2021) · cites this paper as [17]
In the citing paper
“Similarly, there has been some indication that pre-existing psychiatric conditions are a risk factor for poorer mental health outcomes,22 which has also been echoed by data from the COVID-19 pandemic.16, 17”
From Trajectories of anxiety and depressive symptoms during enforced isolation due to COVID-19 in England: a longitudinal observational study (2021) · cites this paper as [17]
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Citations
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“19 Therefore, more studies are needed to understand compliance and its mental health implications from a cultural coping perspective so that culturally-in-formed and contextually-specific policy and practical implications can be implemented to enable Chinese people better respond to future public…”
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“However, some evidence suggests that the COVID-19 pandemic has a negative impact on the overall quality of life (Solomou and Constantinidou, 2020).”
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Espinosa, A. E., Riascos, Á. J., Álvarez, A., Gallegos, A., Suaza, A. G., Molano, A., Zambrano, A., Lessing, B., Fragozo, C. Q., Diartt, C., et al. (2022) · Editorial Universidad del Rosario eBooks · doi:10.12804/urosario9789587848496 · Cited by 4
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Psychopathic traits predict lower adherence to COVID-19 containment measures
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Covıd-19 Pandemisinin Bireysel ve Sosyal Etkileri
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“Similarly, other studies indicated that students were at a higher risk of anxiety and depression (Esterwood & Saeed, 2020; Solomou & Constantinidou, 2020).”
ResultMolina-Oliva, M., Martín-Sánchez, R., Pastor-Benito, E., Cámara, R. S., García, R. M. C., Thuissard, I. J., Fernández-Domínguez, J. J., Matellán‐Hernández, M. P., Pascual, S. N., & Sánchez, A. M. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20043574 · Cited by 5
“In addition, sudden changes in lifestyles and disruption to regular social activities increased the negative impact of the pandemic on the mental health of younger HCWs to a greater extent [78].”
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“For this variable, the values found in our sample are also higher than other studies in the same context, namely the investigations carried out in Austria [34], in France [38], in China [11] and in Cyprus [39].”
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Budrie, L., & Narinesingh, A. (2021) · Ethics Medicine and Public Health · doi:10.1016/j.jemep.2021.100749 · Cited by 3
de Família, M., Santana, M. M., Gonçalves, A. M., de Família, M., Henriques, D., de Família, M., Velho, D. A. C., de Família, M., Cardoso, J., de Família, M., et al. (2021) · Revista Portuguesa de Clínica Geral · doi:10.32385/rpmgf.v37i6.13049 · Cited by 3
Rodríguez, M., & Rodríguez, A. (2022) · African journal of rhetoric · doi:10.21134/haaj.v22i1.649 · Cited by 3
Majumdar, S., Acholia, P., Saraf, S., & Khurana, S. (2022) · SAGE Open · doi:10.1177/21582440221079878 · Cited by 3
“This has been reported previously by Solomou and Constantinidou (2020) who found a similar pattern of increased anxiety associated with following personal hygiene measures and health precautions concerning the pandemic.”
Backgroundde Souza, L. M., Freitas, K. S., Filho, A. M. D. S., Teixeira, J. R. B., Souza, G. S. S., Fontoura, E. G., Coifman, A. H. M., & Portela, P. P. (2022) · Revista Brasileira de Terapia Intensiva · doi:10.5935/0103-507x.20220080-pt · Cited by 5
Siamisang, K., Mokgethi, N., Nthibo, L. A., Boitshwarelo, M., & Lesetedi, O. (2024) · Pan African Medical Journal · doi:10.11604/pamj.2024.47.152.40908 · Cited by 2
“Total scores of 0-4 are considered normal, 5-9 as mild, 10-14 as moderate, 15-19 as moderately severe and 20-27 as severe depressive disorder [24].”
BackgroundPersonality traits and adherence on COVID-19 preventive measures in a two-year follow-up study
Reggiani, L. C., Londero, I., & da Rocha, N. S. (2025) · Scientific Reports · doi:10.1038/s41598-025-12176-3 · Cited by 2
“The correlations between adherence to these measures and depressive symptoms were identified as negative 38 or even as statistically non-significant 36 .”
Mordeno, I. G., Lucero, L., & Bigcas, J. D. (2026) · Frontiers in Education · doi:10.3389/feduc.2026.1850327 · Cited by 2
Aditya, Y., Martoyo, I., & Amir, Y. (2022) · Jurnal Studi Pemuda · doi:10.22146/studipemudaugm.74817 · Cited by 3
Valtueña-García, M., Martín-Gil, E., González-Blanco, L., de la Fuente-Tomás, L., Santo, F. D., Alvarez-Vázquez, C., Moya-Lacasa, C., Martínez-Cao, C., García-Álvarez, L., Sáiz, P. A., et al. (2023) · Actas Españolas de Psiquiatría · Cited by 2
Effects of Locomotion Regulatory Mode on COVID-19 Anxiety: The Mediating Role of Resilience
Destro, C. L., & da Costa, A. L. C. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20156533 · Cited by 2
COVID-19 Pandemic and Food Insecurity Fuel the Mental Health Crisis in Africa
Beck, J., Koebach, A., Abreu, L., Regassa, M. D., Hoeffler, A., Stojetz, W., & Brück, T. (2024) · International Journal of Public Health · doi:10.3389/ijph.2023.1606369 · Cited by 2
“Whilefuelinganxietymaycarrytheadvantageofstronger compliancetocontagioncontainmentmeasures,e.g.,[48,51],it mayalsocausehigherGADrates(amongstotherconsequences): Forinstance,ameta-analysiswith72,585participants[52]revealed thatparticipantswithGADpresentedwithahigherincidenceof lifetime perpetration…”
BackgroundInfluentialFountoulakis, K. Ν., Vrubļevska, J., Abraham, S., Adorjan, K., Ahmed, H. U., Alarcón, R. D., Arai, K., Salihu, A., Berk, M., Bjedov, S., et al. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.02.050 · Cited by 4
Rizanaj, N., & Gavazaj, F. Q. (2024) · COVID · doi:10.3390/covid4070072 · Cited by 2
“Both individuals infected with the virus and those who are not may experience psychiatric effects due to various factors, including widespread anxiety, social isolation, stress among health-care and essential workers, and economic hardship, such as unemployment or financial struggles [38].”
BackgroundMraović, I. C., Vukičević, J. P., & Vinogradac, V. P. (2021) · Društvene i humanističke studije · doi:10.51558/2490-3647.2021.6.3.183 · Cited by 2
Compliance Toward Protective Precautions During and After the Lockdown Among Citizens of Riyadh
Alassaf, W., AlQahtani, S., Binladen, T., Almagushi, S., Alsaeed, H., Alhussein, G., Albakr, L., & Alshahrani, W. S. (2021) · Cureus · doi:10.7759/cureus.20320 · Cited by 2
Sáenz, E. D. J. Q., Carrillo, J. F. S., Rivera‐Lozada, O., & Bonilla-Asalde, C. A. (2022) · F1000Research · doi:10.12688/f1000research.70655.2 · Cited by 2
Douglas, E., McCabe, L., Treanor, C., & Nearchou, F. (2022) · International Journal of Health Promotion and Education · doi:10.1080/14635240.2022.2075429 · Cited by 2
“This is surprising given that some studies showed that being a woman increases susceptibility to experiencing COVID-19 posttraumatic distress depression and anxiety (Solomou and Constantinidou 2020; Pieh, Budimir, and Probst 2020).”
ResultChela-Àlvarez, X., Sánchez-Rodríguez, C., Bulilete, O., Vidal-Thomàs, M., & Llobera, J. (2022) · The Qualitative Report · doi:10.46743/2160-3715/2022.5153 · Cited by 2
The Role of Nursing Practice to Prevent Ventilator-associated Pneumonia in the Intensive Care Units
Shudaifat, Y., ALBashtawy, M., Qaddumi, J. A. S., Baqir, M., Zamzam, S., Ibnian, A. M., & Alkhawaldeh, A. (2021) · Medico-Legal Update · doi:10.37506/mlu.v21i3.2996 · Cited by 2
The Effect of Teleworking on Anxiety During COVID-19
Baykal, E. (2021) · Advances in electronic government, digital divide, and regional development book series · doi:10.4018/978-1-7998-8925-0.ch010 · Cited by 2
Polat, F., & DELİBAŞ, L. (2022) · Anatolian Journal of Health Research · doi:10.29228/anatoljhr.57300 · Cited by 2
Sáenz, E. D. J. Q., Carrillo, J. F. S., Rivera‐Lozada, O., & Bonilla-Asalde, C. A. (2022) · F1000Research · doi:10.12688/f1000research.70655.3 · Cited by 2
“These findings are important to highlight because depressive disorders are more frequent in young adults,(5) a situation that continues in the context of the COVID-19 pandemic.(30) Age is an important sociodemographic variable in mental health, with the group of young adults showing higher levels of anxiety and depres…”
BackgroundInfluentialLeblanc-Sirois, Y., Gagnon, M.-È., & Blanchette, I. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.883995 · Cited by 2
“, 2020; Solomou and Constantinidou, 2020) and female gender (Clark et al., 2020; Galasso et al., 2020; Haischer et al., 2020; Solomou and Constantinidou, 2020; Nivette et al., 2021).”
BackgroundResultInfluentialReview Literatur: Faktor Resiko Depresi dan Kecemasan Pada Tenaga Kesehatan Selama Wabah COVID-19
Widiani, E., & Palupi, L. M. (2022) · Jurnal Kesehatan Andalas · doi:10.25077/jka.v11i1.1923 · Cited by 3
Book, J., Broichhaus, L., Grüne, B., Nießen, J., Wiesmüller, G. A., Joisten, C., & Kossow, A. (2022) · BMJ Open · doi:10.1136/bmjopen-2022-063358 · Cited by 2
Álvaro Cavieres, F., & Marcelo Arancibia, M. (2022) · Medwave · doi:10.5867/medwave.2022.11.2637 · Cited by 1
Bhattacharya, D. (2023) · International Journal of Community Medicine and Public Health · doi:10.18203/2394-6040.ijcmph20230251 · Cited by 2
Predictores de la salud mental durante la cuarentena por la COVID-19
Abreu, Y. D., & Angelucci, L. T. (2023) · Revista de Psicopatología y Psicología Clínica · doi:10.5944/rppc.33264 · Cited by 2
Barbuzza, A. R., Benedetti, P., Goyeneche, C., Reppucci, V., Moscato, F., Butavand, D. R., Katche, C., Medina, J. H., Moncada, D., Viola, H., et al. (2023) · Journal of Neuroeducation · doi:10.1344/joned.v4i1.42396 · Cited by 2
Curtis, A. F., Jagannathan, S., Musich, M. L., Miller, M. B., & McCrae, C. S. (2024) · Brain Sciences · doi:10.3390/brainsci14040346 · Cited by 1
“Furthermore, studies have shown that younger adults are less likely to take COVID-19 precautionary measures compared to their older counterparts [34].”
BackgroundPossible repercussions of the COVID-19 pandemic on women with fibromyalgia: longitudinal study
de Melo, G. A., Madruga, M. L. L. H., de Oliveira, M. B. R., & Alves, N. T. (2022) · Brazilian Journal Of Pain · doi:10.5935/2595-0118.20220043-en · Cited by 2
Vizioli, N. A. (2024) · Psychological Thought · doi:10.37708/psyct.v17i1.792 · Cited by 2
“This result could be explained by considering the expectations set by the people who invested more in their training and their financial stress (Le et al., 2020; McCloud & Bann, 2019; Solomou & Constantinidou, 2020; Somers et al., 2006).”
BackgroundAssessment of self-satisfaction, happiness, and quality of life (QoL) among adults: An online survey
Dehury, R., Gadiraju, P., Singh, P., Vanlalhruaii, C., Dehury, P., Devaraju, K., & Behera, S. (2024) · Journal of Education and Health Promotion · doi:10.4103/jehp.jehp_1528_23 · Cited by 2
“Seven dimensions such as loss of confidence, [59] Unhappy and depression, [60] Negative feelings and low mood, [61] Poor sex life Satisfaction, [62] Loss of sleep over worry, [63] and constantly under strain [64] and Self‑worthlessness [65] are performing at poor and abysmal levels shown to”
BackgroundRajkumar, R. P. (2021) · Cureus · doi:10.7759/cureus.20013 · Cited by 2
“An association between certain types of anxiety and adherence to protective measures such as hand hygiene and masking has been reported by some authors, suggesting that mild anxiety during a pandemic may be adaptive [27,51].”
BackgroundPsychological Perspectives on COVID-19
Hosseini-Nezhad, S., Safdar, S. F., Hosseini-Nezhad, P., & Luu, L. A. N. (2022) · Contributions to economics · doi:10.1007/978-3-030-89996-7_14 · Cited by 2
Adaptive function and correlates of anxiety during a pandemicPreprint
Salalι, G. D., Uysal, M. S., & Bevan, A. (2021) · Research Square · doi:10.21203/rs.3.rs-271498/v1 · Cited by 3
Leblanc-Sirois, Y., Gagnon, M.-È., & Blanchette, I. (2020) · doi:10.31234/osf.io/2p39h · Cited by 2
Tracking the impact of COVID-19 and lockdown policy on public mental health using social mediaPreprint
Li, M., Hua, Y., Liao, Y., Zhou, L., Li, X., Wang, L., & Yang, J. (2022) · Research Square · doi:10.21203/rs.3.rs-1498436/v1 · Cited by 2
No Time to Die—Literally: Risk, Fandom, and Theatergoing during the COVID‐19 Pandemic
Johnson, T., & Funnell, L. (2022) · Popular Culture Review · doi:10.18278/pcr.33.2.3 · Cited by 1
Theurel, A., & Witt, A. (2023) · Psychology · doi:10.4236/psych.2023.141005 · Cited by 1
“…health of young adults has been particularly affected by the Covid-19 pandemic and the associated restrictive measures (e.g., state-enforced lockdowns and quarantine, closure of schools and businesses, limits on social gatherings) (e.g., O’Connor et al. (2021); Solomou & Constantinidou (2020)).”
Background
Metadata
- Authors
- Solomou, I., & Constantinidou, F.
- Affiliations
- University of Cyprus (CY)
- Corresponding author
- Constantinidou, Fofi
- Venue
- International Journal of Environmental Research and Public Health
- Publisher
- MDPI AG
- Published
- 2020-07-08
- Volume
- 17
- Issue
- 14
- Pages
- 4924
- ISSN
- 1660-4601 (ISSN-L)
- PMC
- PMC7400373
- OpenAlex
- W3041468347
- Cited by
- 591
- References
- 39
- Citations by year
- 2026: 8 · 2025: 22 · 2024: 52 · 2023: 92 · 2022: 197 · 2021: 185 · 2020: 35
- FWCI
- 50.84
- Type
- journal article
- Language
- en
- Open access
- gold
- dx.doi.org
- Licence
- Locations
- International Journal of Environmental Research and Public Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Keywords
- COVID-19 pandemic, anxiety symptoms, depressive symptoms, quality of life, mental health, risk and protective factors, age and sex differences, financial concerns, unemployment, social distancing, personal hygiene, Cyprus
- MeSH terms
- Betacoronavirus, COVID-19, SARS-CoV-2, Adolescent, Adult, Anxiety, Cyprus, Depression, Female, Humans, Male, Mental Health, Middle Aged, Patient Compliance, Pneumonia, Viral, Quality of Life, Surveys and Questionnaires, Prevalence, Universal Precautions, Coronavirus Infections, Young Adult, Pandemics
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