Anxiety levels, precautionary behaviours and public perceptions during the early phase of the COVID-19 outbreak in China: a population-based cross-sectional survey

Abstract

Objective: To investigate psychological and behavioural responses to COVID-19 among the Chinese general population.

Design, setting and participants: We conducted a population-based mobile phone survey between 1 February and 10 February 2020 via random digit dialling. A total of 1011 adult residents in Wuhan (n=510), the epicentre and quarantined city, and Shanghai (n=501) were interviewed. Proportional quota sampling and poststratification weighting were used. Multivariable logistic regression models were used to investigate perception factors associated with the public responses.

Primary outcome measures: We measured anxiety levels using the 7-item Generalised Anxiety Disorder Scale (GAD-7) and asked respondents to report their precautionary behaviours before and during the outbreak.

Results: The prevalence of moderate or severe anxiety was significantly higher (p<0.001) in Wuhan (32.8%) than Shanghai (20.5%). Around 79.6%-88.2% residents reported always wearing a face mask when they went out and washing hands immediately when they returned home, with no discernible difference across cities. Only 35.5%-37.0% of residents reported a handwashing duration above 40 s as recommended by the WHO. The strongest predictor of moderate or severe anxiety was perceived harm of the disease (OR 1.8, 95% CI 1.5 to 2.1), followed by confusion about information reliability (OR 1.7, 95% CI 1.5 to 1.9). None of the examined perception factors were associated with odds of handwashing duration above 40 s.

Conclusions: Prevalence of moderate or severe anxiety and strict personal precautionary behaviours was generally high, regardless of the quarantine status. Our results support efforts for handwashing education programmes with a focus on hygiene procedures in China and timely dissemination of reliable information.

Keywords: health policy; mental health; public health.

Figure 1

The timeline of the COVID-19 outbreak compared with the survey dates is presented for Wuhan and other parts of China (Panel A) and Shanghai (Panel B). Note that different scales are used in the two panels. The vertical axis for Panel A is the number of reported cases and that for Panel B is the number of confirmed cases. Diagnostic criteria were changed in Hubei Province (Wuhan is the capital city of Hubei Province) on 12 February 2020. Since then confirmed cases are based on clinical diagnosis instead of laboratory testing in Hubei province. NHC, National Health Commission of China; PHEIC, Public Health Emergency of International Concern.