Effects of mask wearing on anxiety of teachers affected by COVID-19: A large cross-sectional study in China

Abstract

Objective: There is a limited information on mask wearing in relation to anxiety. The aim of this study was to evaluate the association between mask wearing practice and the risk of anxiety during the COVID-19 epidemic among teachers in Henan province, China.

Methods: We enrolled 88,611 teachers in an online cross-sectional survey across three cities of Henan Province in China. A total of 94.75% of study participants completed an online questionnaire between February 4, 2020 and February 12, 2020. Mask wearing practice was defined according to its type, how it is worn, and the behavior exhibited in relation to wearing a mask. We used the Generalized Anxiety Disorder tool (GAD-7) to assess anxiety levels among study participants. Odds ratios (OR) with 95% confidence intervals (CI) were used to estimate the association between mask wearing practice and anxiety by using multivariable logistic regression models.

Results: A total of 67,357 registered teachers (25.91% men) were included in this study. After adjusting for potential confounders, participants who knew the wrong type of mask had 17% increased odds of having anxiety compared to those who knew the proper type (Aor = 1.17; 95%CI: 1.11-1.24). Odds for anxiety were higher for teachers who did not know the proper way of wearing mask compared to those who knew it properly (aOR = 1.18; 95%CI: 1.07-1.30). Not adhering to proper behavior of mask wearing was associated with 39% increased odds for anxiety (aOR = 1.39; 95%CI: 1.18-1.64). The odds for anxiety for teachers who did not adhere to all the three parameters of proper mask wearing was about 2.55 times as much compared to those who reported full compliance to the parameters (aOR = 2.55; 95%CI: 1.22-5.35). We observed similar ORs on stratified analyses across gender and age groups.

Conclusion: Our findings suggest that improper mask wearing is another important attribute that play a significant role in increasing the risk of anxiety during the COVID-19 epidemic situation. However, these results should be considered as exploratory and hence interpreted with caution.

Keywords: Anxiety; COVID-19; Mask wearing; Teachers.

Fig. 1

Association between mask wearing practices and anxiety by sex. Abbreviations: aOR, adjusted odds ratio; CI, confidence interval; I & I & I, improper type & improper way & improper behavior; I & I & P, improper type & improper way & proper behavior; I & P & I, improper type & proper way & improper behavior; I & P & P, improper type & proper way & proper behavior; P & I & I, proper type & improper way & improper behavior; P & I & P, proper type & improper way & proper behavior; P & P & I, proper type & proper way & improper behavior; P & P & P, proper type & proper way & proper behavior. Adjusted for age, sex, education status, married status, type of teachers, school location, information source, attention level, worried level, fear level.

Fig. 2

Association between mask wearing practices and anxiety by age group. Abbreviations: aOR, adjusted odds ratio; CI, confidence interval; I & I & I, improper type & improper way & improper behavior; I & I & P, improper type & improper way & proper behavior; I & P & I, improper type & proper way & improper behavior; I & P & P, improper type & proper way & proper behavior; P & I & I, proper type & improper way & improper behavior; P & I & P, proper type & improper way & proper behavior; P & P & I, proper type & proper way & improper behavior; P & P & P, proper type & proper way & proper behavior. Adjusted for age, sex, education status, married status, type of teachers, school location, information source, attention level, worried level, fear level.