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. 2025 Jul 31;20(7):e0317272.
doi: 10.1371/journal.pone.0317272. eCollection 2025.

Psychological distress and compliance with sanitary measures during the Covid-19 pandemic

Irwin Hecker  1 , Solène Wallez  1 , Honor Scarlett  1 , José Luis Ayuso-Mateos  2   3   4 , Richard Bryant  5 , Giulia Caggiu  6   7   8 , Claudia Conflitti  6   7 , Katalin Gémes  9 , Josep Maria Haro  10   11 , Vincent Lorant  12 , Roberto Mediavilla  2   3   4 , Ellenor Mittendorfer-Rutz  9 , Anna Monistrol-Mula  4   11   13 , Matteo Monzio Compagnoni  6   7 , Papoula Petri-Romão  14 , Irene Pinucci  15 , Marit Sijbrandij  16 , Jutta Stoffers-Winterling  14   17 , Henrik Walter  18 , Murielle Mary-Krause  1 , Maria Melchior  1
Affiliations

Psychological distress and compliance with sanitary measures during the Covid-19 pandemic

Irwin Hecker et al. PLoS One. .

Abstract

Background: This study aims to understand the relationship between the experience of psychological distress and compliance with COVID-19 sanitary measures. We testeed whether this relationship was modified by individuals' gender and socioeconomic status (i.e., educational level and employment).

Methods: Data from four European cohort studies (n = 13,635), were analysed using an Individual Participant Data (IPD) meta-analytic approach. Mixed effect models were employed to examine associations between mental health difficulties and compliance with sanitary measures, as well as effect modification by socioeconomic status. Statistical models were stratified by gender.

Results: We found a statistically significant association between mental health difficulties and increased compliance with sanitary measures in women, while amongst men the statistically significant association observed was opposite. Moreover, there was a statistically significant interaction between participants' educational level and mental health difficulties amongst men only, indicating especially low compliance levels with COVID-19 sanitary measures amongst individuals with only primary schooling and who reported psychological distress.

Conclusion: The association between psychological distress and compliance with sanitary measures is complex-positive in women, negative in men. Men experiencing mental health difficulties, especially those with lower educational attainment, exhibit low levels of compliance with sanitary measures. These results suggest that psychological distress and its possible consequences should be considered when designing measures addressing infectious disease spread.

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Conflict of interest statement

none.

Figures

Fig 1
Fig 1. Association between psychological distress and compliance with sanitary measures in COMET, COVID and I, Mind COVID, TEMPO studies, and all populations, March 2020–August 2022, n = 13,635 (multivariate mixed models, adjusted odds-ratios (aOR), 95% confidence interval (CI)).
All models adjusted for gender (except when stratified), age, education, employment status, number of children, and stringency. Both x and y axes show z scores.
Fig 2
Fig 2. Interaction between participants’ educational level and psychological distress in relation to compliance with COVID-19 sanitary measures (COMET, COVID and I, Mind COVID, TEMPO studies), March 2020–August 2022, n = 13,635 (multivariate mixed models).
All models adjusted for age, education, employment status, number of children, and stringency. Both x and y axes show z scores.
Fig 3
Fig 3. Interaction between participants’ employment status and psychological distress in relation to compliance with COVID-19 sanitary measures (COMET, COVID and I, Mind COVID, TEMPO studies), March 2020–August 2022, n = 13,635 (multivariate mixed models).
All models adjusted for age, education, employment status, number of children, and stringency. Both x and y axes show z scores.
See this image and copyright information in PMC

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