COVID-19 stressors and health behaviors: A multilevel longitudinal study across 86 countries

Shian-Ling Keng^{1

2}, Michael V Stanton³, LeeAnn B Haskins⁴, Carlos A Almenara⁵, Jeannette Ickovics^{6

2}, Antwan Jones⁷, Diana Grigsby-Toussaint⁸, Maximilian Agostini⁹, Jocelyn J Bélanger¹⁰, Ben Gützkow⁹, Jannis Kreienkamp⁹, Edward P Lemay Jr¹¹, Michelle R vanDellen⁴, Georgios Abakoumkin¹², Jamilah Hanum Abdul Khaiyom¹³, Vjollca Ahmedi¹⁴, Handan Akkas¹⁵, Mohsin Atta¹⁶, Sabahat Cigdem Bagci¹⁷, Sima Basel¹⁰, Edona Berisha Kida¹⁴, Allan B I Bernardo¹⁸, Nicholas R Buttrick¹⁹, Phatthanakit Chobthamkit²⁰, Hoon-Seok Choi²¹, Mioara Cristea²², Sára Csaba²³, Kaja Damnjanovic²⁴, Ivan Danyliuk²⁵, Arobindu Dash²⁶, Daniela Di Santo²⁷, Karen M Douglas²⁸, Violeta Enea²⁹, Daiane G Faller³⁰, Gavan Fitzsimons³¹, Alexandra Gheorghiu²⁹, Ángel Gómez³², Ali Hamaidia³³, Qing Han³⁴, Mai Helmy^{35

36}, Joevarian Hudiyana³⁷, Bertus F Jeronimus⁹, Ding-Yu Jiang³⁸, Veljko Jovanović³⁹, Željka Kamenov⁴⁰, Anna Kende²³, Tra Thi Thanh Kieu⁴¹, Yasin Koc⁹, Kamila Kovyazina⁴², Inna Kozytska²⁵, Joshua Krause⁹, Arie W Kruglanski¹¹, Anton Kurapov²⁵, Maja Kutlaca⁴³, Nóra Anna Lantos²³, Cokorda Bagus Jaya Lesmana⁴⁴, Winnifred R Louis⁴⁵, Adrian Lueders⁴⁶, Marta Maj⁴⁷, Najma Iqbal Malik¹⁶, Anton Martinez⁴⁸, Kira O McCabe⁴⁹, Jasmina Mehulić⁴⁰, Mirra Noor Milla³⁷, Idris Mohammed⁵⁰, Erica Molinario⁵¹, Manuel Moyano⁵², Hayat Muhammad⁵³, Silvana Mula²⁷, Hamdi Muluk³⁷, Solomiia Myroniuk⁹, Reza Najafi⁵⁴, Claudia F Nisa¹⁰, Boglárka Nyúl²³, Paul A O'Keefe², Jose Javier Olivas Osuna⁵⁵, Evgeny N Osin⁵⁶, Joonha Park⁵⁷, Gennaro Pica⁵⁸, Antonio Pierro²⁷, Jonas Rees⁵⁹, Anne Margit Reitsema⁹, Elena Resta²⁷, Marika Rullo⁶⁰, Michelle K Ryan^{9

61}, Adil Samekin⁶², Pekka Santtila⁶³, Edyta M Sasin¹⁰, Birga M Schumpe⁶⁴, Heyla A Selim⁶⁵, Wolfgang Stroebe⁹, Samiah Sultana⁹, Robbie M Sutton²⁸, Eleftheria Tseliou¹², Akira Utsugi⁶⁶, Jolien Anne van Breen⁶⁷, Caspar J Van Lissa⁶⁸, Kees Van Veen⁹, Alexandra Vázquez³², Robin Wollast⁶⁹, Victoria Wai-Lan Yeung⁷⁰, Somayeh Zand⁷¹, Iris Lav Žeželj²⁴, Bang Zheng⁷², Andreas Zick⁵⁹, Claudia Zúñiga⁷³, N Pontus Leander^{9

74}

Affiliations

¹ Monash University Malaysia, Malaysia.
² Yale-NUS College, Singapore, Singapore.
³ California State University, East Bay, USA.
⁴ University of Georgia, USA.
⁵ Universidad Peruana de Ciencias Aplicadas, Peru.
⁶ Yale University, USA.
⁷ The George Washington University, USA.
⁸ Brown University, USA.
⁹ University of Groningen, The Netherlands.
¹⁰ New York University Abu Dhabi, United Arab Emirates.
¹¹ University of Maryland, College Park, USA.
¹² University of Thessaly, Volos, Greece.
¹³ International Islamic University Malaysia, Gombak, Malaysia.
¹⁴ University of Pristina, Pristina, Kosovo.
¹⁵ Ankara Science University, Ankara, Turkey.
¹⁶ University of Sargodha, Sargodha, Pakistan.
¹⁷ Sabanci University, Istanbul, Turkey.
¹⁸ De La Salle University, Manila, Philippines.
¹⁹ University of Virginia, Charlottesville, USA.
²⁰ Thammasat University, Bangkok, Thailand.
²¹ Sungkyunkwan University, Seoul, South Korea.
²² Heriot Watt University, United Kingdom.
²³ Eötvös Loránd University (ELTE), Budapest, Hungary.
²⁴ University of Belgrade, Belgrade, Serbia.
²⁵ Taras Shevchenko National University of Kyiv, Kiev, Ukraine.
²⁶ Leuphana University Luneburg, Lüneburg, Germany.
²⁷ Sapienza University of Rome, Rome, Italy.
²⁸ University of Kent, Canterbury, UK.
²⁹ Alexandru Ioan Cuza University of Iasi, Iasi, Romania.
³⁰ National University of Singapore, Singapore, Singapore.
³¹ Duke University, Durham, USA.
³² Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain.
³³ University Setif 2, Sétif, Algeria.
³⁴ University of Bristol, Bristol, UK.
³⁵ Menoufia University, Al Minufiyah, Egypt.
³⁶ Sultan Qaboos University, Egypt.
³⁷ Universitas Indonesia, Depok, Indonesia.
³⁸ National Chung-Cheng University, Chiayi, Taiwan.
³⁹ University of Novi Sad, Novi Sad, Serbia.
⁴⁰ University of Zagreb, Zagreb, Croatia.
⁴¹ HCMC University of Education, Ho Chi Minh City, Viet Nam.
⁴² Independent Researcher, Nur-Sultan, Kazakhstan.
⁴³ Durham University, Durham, UK.
⁴⁴ Udayana University, Denpasar, Indonesia.
⁴⁵ University of Queensland, Brisbane, Australia.
⁴⁶ University of Limerick, Ireland.
⁴⁷ Jagiellonian University, Kraków, Poland.
⁴⁸ University of Sheffield, Sheffield, UK.
⁴⁹ Carleton University, Canada.
⁵⁰ Usmanu Danfodiyo University Sokoto, Sokoto, Nigeria.
⁵¹ Florida Gulf Coast University, USA.
⁵² University of Cordoba, Córdoba, Spain.
⁵³ University of Peshawar, Peshawar, Pakistan.
⁵⁴ University of Padova, Italy.
⁵⁵ National Distance Education University, Spain.
⁵⁶ National Research University Higher School of Economics, Moscow, Russia.
⁵⁷ NUCB Business School, Nagoya, Japan.
⁵⁸ University of Camerino, Camerino, Italy.
⁵⁹ University of Bielefeld, Bielefeld, Germany.
⁶⁰ University of Siena, Siena, Italy.
⁶¹ University of Exeter, Exeter, UK.
⁶² School of Liberal Arts, M. Narikbayev KAZGUU University, Nur-Sultan, Kazakhstan.
⁶³ New York University Shanghai, Shanghai, China.
⁶⁴ University of Amsterdam, The Netherlands.
⁶⁵ King Saud University, Riyadh, Saudi Arabia.
⁶⁶ Nagoya University, Nagoya, Japan.
⁶⁷ Leiden University, Leiden, The Netherlands.
⁶⁸ Utrecht University, Utrecht, The Netherlands.
⁶⁹ Université Clermont-Auvergne, France.
⁷⁰ Lingnan University, Tuen Mun, Hong Kong.
⁷¹ University of Milano-Bicocca, Italy.
⁷² Imperial College London, London, UK.
⁷³ Universidad de Chile, Santiago, Chile.
⁷⁴ Wayne State University, USA.

PMID: 35313454
PMCID: PMC8928741
DOI: 10.1016/j.pmedr.2022.101764

COVID-19 stressors and health behaviors: A multilevel longitudinal study across 86 countries

Shian-Ling Keng et al. Prev Med Rep. 2022.

. 2022 Mar 17:27:101764.

doi: 10.1016/j.pmedr.2022.101764. eCollection 2022 Jun.

Authors

Affiliations

¹ Monash University Malaysia, Malaysia.
² Yale-NUS College, Singapore, Singapore.
³ California State University, East Bay, USA.
⁴ University of Georgia, USA.
⁵ Universidad Peruana de Ciencias Aplicadas, Peru.
⁶ Yale University, USA.
⁷ The George Washington University, USA.
⁸ Brown University, USA.
⁹ University of Groningen, The Netherlands.
¹⁰ New York University Abu Dhabi, United Arab Emirates.
¹¹ University of Maryland, College Park, USA.
¹² University of Thessaly, Volos, Greece.
¹³ International Islamic University Malaysia, Gombak, Malaysia.
¹⁴ University of Pristina, Pristina, Kosovo.
¹⁵ Ankara Science University, Ankara, Turkey.
¹⁶ University of Sargodha, Sargodha, Pakistan.
¹⁷ Sabanci University, Istanbul, Turkey.
¹⁸ De La Salle University, Manila, Philippines.
¹⁹ University of Virginia, Charlottesville, USA.
²⁰ Thammasat University, Bangkok, Thailand.
²¹ Sungkyunkwan University, Seoul, South Korea.
²² Heriot Watt University, United Kingdom.
²³ Eötvös Loránd University (ELTE), Budapest, Hungary.
²⁴ University of Belgrade, Belgrade, Serbia.
²⁵ Taras Shevchenko National University of Kyiv, Kiev, Ukraine.
²⁶ Leuphana University Luneburg, Lüneburg, Germany.
²⁷ Sapienza University of Rome, Rome, Italy.
²⁸ University of Kent, Canterbury, UK.
²⁹ Alexandru Ioan Cuza University of Iasi, Iasi, Romania.
³⁰ National University of Singapore, Singapore, Singapore.
³¹ Duke University, Durham, USA.
³² Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain.
³³ University Setif 2, Sétif, Algeria.
³⁴ University of Bristol, Bristol, UK.
³⁵ Menoufia University, Al Minufiyah, Egypt.
³⁶ Sultan Qaboos University, Egypt.
³⁷ Universitas Indonesia, Depok, Indonesia.
³⁸ National Chung-Cheng University, Chiayi, Taiwan.
³⁹ University of Novi Sad, Novi Sad, Serbia.
⁴⁰ University of Zagreb, Zagreb, Croatia.
⁴¹ HCMC University of Education, Ho Chi Minh City, Viet Nam.
⁴² Independent Researcher, Nur-Sultan, Kazakhstan.
⁴³ Durham University, Durham, UK.
⁴⁴ Udayana University, Denpasar, Indonesia.
⁴⁵ University of Queensland, Brisbane, Australia.
⁴⁶ University of Limerick, Ireland.
⁴⁷ Jagiellonian University, Kraków, Poland.
⁴⁸ University of Sheffield, Sheffield, UK.
⁴⁹ Carleton University, Canada.
⁵⁰ Usmanu Danfodiyo University Sokoto, Sokoto, Nigeria.
⁵¹ Florida Gulf Coast University, USA.
⁵² University of Cordoba, Córdoba, Spain.
⁵³ University of Peshawar, Peshawar, Pakistan.
⁵⁴ University of Padova, Italy.
⁵⁵ National Distance Education University, Spain.
⁵⁶ National Research University Higher School of Economics, Moscow, Russia.
⁵⁷ NUCB Business School, Nagoya, Japan.
⁵⁸ University of Camerino, Camerino, Italy.
⁵⁹ University of Bielefeld, Bielefeld, Germany.
⁶⁰ University of Siena, Siena, Italy.
⁶¹ University of Exeter, Exeter, UK.
⁶² School of Liberal Arts, M. Narikbayev KAZGUU University, Nur-Sultan, Kazakhstan.
⁶³ New York University Shanghai, Shanghai, China.
⁶⁴ University of Amsterdam, The Netherlands.
⁶⁵ King Saud University, Riyadh, Saudi Arabia.
⁶⁶ Nagoya University, Nagoya, Japan.
⁶⁷ Leiden University, Leiden, The Netherlands.
⁶⁸ Utrecht University, Utrecht, The Netherlands.
⁶⁹ Université Clermont-Auvergne, France.
⁷⁰ Lingnan University, Tuen Mun, Hong Kong.
⁷¹ University of Milano-Bicocca, Italy.
⁷² Imperial College London, London, UK.
⁷³ Universidad de Chile, Santiago, Chile.
⁷⁴ Wayne State University, USA.

PMID: 35313454
PMCID: PMC8928741
DOI: 10.1016/j.pmedr.2022.101764

Abstract

Anxiety associated with the COVID-19 pandemic and home confinement has been associated with adverse health behaviors, such as unhealthy eating, smoking, and drinking. However, most studies have been limited by regional sampling, which precludes the examination of behavioral consequences associated with the pandemic at a global level. Further, few studies operationalized pandemic-related stressors to enable the investigation of the impact of different types of stressors on health outcomes. This study examined the association between perceived risk of COVID-19 infection and economic burden of COVID-19 with health-promoting and health-damaging behaviors using data from the PsyCorona Study: an international, longitudinal online study of psychological and behavioral correlates of COVID-19. Analyses utilized data from 7,402 participants from 86 countries across three waves of assessment between May 16 and June 13, 2020. Participants completed self-report measures of COVID-19 infection risk, COVID-19-related economic burden, physical exercise, diet quality, cigarette smoking, sleep quality, and binge drinking. Multilevel structural equation modeling analyses showed that across three time points, perceived economic burden was associated with reduced diet quality and sleep quality, as well as increased smoking. Diet quality and sleep quality were lowest among respondents who perceived high COVID-19 infection risk combined with high economic burden. Neither binge drinking nor exercise were associated with perceived COVID-19 infection risk, economic burden, or their interaction. Findings point to the value of developing interventions to address COVID-related stressors, which have an impact on health behaviors that, in turn, may influence vulnerability to COVID-19 and other health outcomes.

Keywords: COVID-19; Economic burden; Health behaviors; Infection risk.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

**Fig. 1**
Interaction between Infection Risk and Economic Burden in Predicting Diet Quality. *Note*: Low economic burden is represented as the 10th percentile, equal to 1.67 on the economic burden scale of 1 to 8; High economic burden is represented as the 90th percentile, equal to 6.33 on the economic burden scale of 1 to 8. Thin dotted lines represent 95% confidence intervals.

**Fig. 2**
Interaction between Infection Risk and Economic Burden in Predicting Sleep Quality. *Note*: Low economic burden is represented as the 10th percentile, equal to 1.67 on the economic burden scale of 1 to 8; High economic burden is represented as the 90th percentile, equal to 6.33 on the economic burden scale of 1 to 8. Thin dotted lines represent 95% confidence intervals.

See this image and copyright information in PMC

References

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COVID-19 stressors and health behaviors: A multilevel longitudinal study across 86 countries

Affiliations

COVID-19 stressors and health behaviors: A multilevel longitudinal study across 86 countries

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources