Exploring Factors and Associate Responses for Anxiety in the Coronavirus Disease 2019 Pandemic: A Web-Based Survey in Japan

Abstract

Background and objectives: Anxiety plays an important role in psychology. An exploration of anxiety and its associated reactions may provide insight into measures for addressing mental health problems caused by the coronavirus disease 2019 (COVID-19) pandemic. Data from this study provide potential correlational responses to anxiety.

Methods: A cross-sectional study using data collected via an online self-reported questionnaire was conducted in Japan during the COVID-19 pandemic. Using the State-Trait Anxiety Inventory (STAI-6), we assessed anxiety levels and explored the relationship between anxiety STAI-6 score, sources of COVID-19 information, the influences of COVID-19, social anxiety symptoms, discrimination, and evaluation of the government.

Results: A total of 4,127 participants were included in the analysis. The level of anxiety was not equally distributed across the general population with respect to age, gender, educational level, occupation, income, presence of underlying disease, and location (p < 0.05). The number of sources of information on COVID-19 had a positive correlation with the STAI-6 score (Spearman's rho = 0.176, p < 0.001). The influence of the pandemic was correlated with moderate-severe anxiety. A high level of anxiety added to social anxiety (Spearman's rho = 0.04, p < 0.05) and discriminatory behavior (Spearman's rho = 0.11, p < 0.01). Being female (Estimate = 0.926) and from a non-emergency area (Estimate = -0.308) was related to higher STAI scores, and higher education (Estimate = -0.305), and income (Estimate = -0.168) decreased the STAI score. The respondents who had a lower evaluative score of the preventive activities undertaken by the national and local governments had higher STAI-6 scores.

Conclusion: Our findings provide statistical evidence for the associated reaction of anxiety and that anxiety reactions may vary in predictable ways. Further studies should focus on the strategic interventions that may decrease the associated responses to anxiety, to address mental health issues due to the pandemic.

Keywords: COVID-19; STAI-6; anxiety; associate response; mental health.

FIGURE 1

Sources of information for participants in different locations to receive coronavirus disease 2019 (COVID-19)-related news. *P < 0.05; **P < 0.01.

FIGURE 2

The relationship of State-Trait Anxiety Inventory-6 (STAI-6) score and numbers of sources to get information about the COVID-19.

FIGURE 3

The situation of COVID-19 epidemic influence the participants or their family and the relation of moderate to severe anxiety symptoms. P1 means the significance of the differences in COVID-19 epidemic influences between different location; P2 means the significance of the differences in the incidence of moderate to severe anxiety symptoms amongst participants with or without COVID-19 epidemic influences (The influences included increase in family quarrels and conflicts; weakening of social connections; increased intake of alcohol; increased smoking; increase in sexual harassment or violence; sleep quality affected; becoming nervous toward people around you; people around you became nervous and anxious; gained weight).

FIGURE 4

The relationship between STAI-6 score and numbers of social anxiety symptom and discriminatory behavior related to COVID-19. S1 = STAI-6 Score; S2 = Numbers of social anxiety symptom; S3 = Numbers of discriminatory behavior related to COVID-19. *P < 0.05; **P < 0.01.

FIGURE 5

The evaluate score of governments affecting the STAI-6 score. GN Score = Evaluate score of the preventive activities by the national government; GL Score = Evaluate score of the preventive activities by the local government.