3.1. Survey respondents
Psychological symptoms during of COVID-19 were measured using the DASS-21 (11) and the IES-R (6). The sample mean score for the DASS-21 scale was M = 24.87 (SD = 26.97). Sample mean scores for the DASS-21 subscales were 8.88 (SD = 10.26) for depression, 5.42 (SD = 8.38) for anxiety and 10.58 (SD = 10.85) for stress.
According to the cut-off scores proposed by Wang et al. (2020), 2,652 (64.3%) participants showed a low score on the depression subscale (score: 0–9), 383 (9.3%) were considered to suffer from mild depression (score: 10–12), 547 (13.3%) from moderate depression (score: 13–20), and 544 (13.2%) from severe or extremely severe depression (score: 21–42). N = 3,069 (74.4%) participants showed a low score on the anxiety subscale (score: 0–6), 216 (5.2%) were considered to suffer from mild anxiety (score: 7–9), 369 (8.9%) from moderate anxiety (score: 10–14), and 472 (11.4%) from severe or extremely severe anxiety (score: 15–42). N = 2,546 (61.7%) participants showed a low score on the stress subscale (score: 0–10), 703 (17%) were considered to suffer from mild stress (score: 11–18), 435 (10.5%) from moderate stress (score: 19–26), and 442 (10.7%) from severe or extremely severe stress (score: 27–42).
Cut-off scores from the German version of the DASS-21 (11) revealed 544 (13.2%) clinically relevant cases of depression, 574 (13.9%) clinically relevant cases of anxiety and 769 (18.6%) clinically relevant cases of stress.
The sample mean score of the IES-R was 32.36 (SD = 24.02). According to the cut-of scores proposed by Creamer et al. (2003), 1,771 (42.9%) participants rated the psychological impact as minimal (score<23), 570 (13.8%) as mild (score: 24–32), 231 (5.6%) as moderate, and 1554 (37.7%) as severe (score: >33).
In direct comparison with the results of Wang et al. (2020), significantly less Austrian individuals rated the psychological impact of the COIVD-19 outbreak as moderate or severe (Wang et al., 2020: 53.8% vs 43.3%; X² (2, N = 5,336) = 142.67, p < .001. In contrast, significantly more participants of the Austrian sample reported severe depression (Wang et al., 2020: 4.3% vs 13.2%; X² (3, N = 5,336) = 89.61, p < .001), severe anxiety (Wang et al., 2020: 8.4% vs 11.4%; X² (3, N = 5,336) = 138.02, p < .001) and severe stress (Wang et al., 2020: 2.6% vs 10.7%; X² (3, N = 5,336) = 126.79, p < .001).
3.2. Associations with sociodemographic variables
Men reported significantly lower stress (B = -4.68, 95% CI = -5.42, -3.94, p < .001), anxiety (B = -2.59, 95% CI = -3.17, -2.01, p < .001), depression (B = -2.74, 95% CI = -3.45, -2.03, p < .001), and less psychological impact of the current event (B = -11.41, 95% CI = -13.04, -9.78, p < .001) than women. Higher age was significantly associated with less stress (B = -0.11, 95% CI = -0.13, -0.09, p < .001), anxiety (B = -0.05, 95% CI = -0.08, -0.03, p < .001), and depression (B = -0.11, 95% CI = -0.13, -0.09, p < .001). Participants living together with children showed significantly higher stress (B = 0.82, 95% CI = -1.83, -0.51, p < .001), but lower scores in depression (B = -1.17, 95% CI = -1.83, -0.51, p < .001). Lower levels of education were significantly associated with higher scores of stress, anxiety, depression and psychological impact of COVID-19. For example, lower secondary education was significantly associated with more anxiety (B = 2.20, 95% CI = 0.63, 3.77, p = .006), depression (B = 4.33, 95% CI = 2.41, 6.25, p < .001) and more psychological impact (B = 7.59, 95% CI = 3.08, 12.10, p < .001) compared to doctorate/PhD (for further details, see Table 1). Unemployed status was significantly associated with higher stress (B = 3.19, 95% CI = 1.61, 4.71, p < .001), anxiety (B = 2.73, 95% CI = 1.55, 3.91, p < .001), depression (B = 4.60, 95% CI = 3.17, 6.03, p < .001) and greater impact of the event (B = 4.71, 95% CI = 1.32, 8.1, p = .006) as compared to respondents who were employed. Student, respectively pupil status was significantly associated with higher stress (Student: B = 1.83, 95% CI = 0.86, 2.80, p < .001) and depression (Student: B = 3.52, 95% CI = 2.61, p < .001, 4.43; Pupil: B = 5.17, 95% CI = 3.26, 7.08, p < .001) as compared to employed participants. Individuals working from home showed significantly lower anxiety (B = -1.31, 95% CI = -1.88, -0.74, p < .001), depression (B = -2.28, 95% CI = -2.98, -1.58, p < .001), and IES-R scores (B = -2.34, 95% CI = -3.99, -0.69, p = .005) as compared to those working under normal conditions. Participants on sick leave scored significantly higher in stress (B = 3.96, 95% CI = 1.51, 6.41, p = .002), anxiety (B = 4.80, 95% CI = 2.91, 6.69, p < .001), depression (B = 4.17, 95% CI = 1.86, 6.48, p < .001), and IES-R (B = 8.93, 95% CI = 3.5, 14.36, p = .001) as compared to those working under normal conditions. Further analyses revealed that an increase of hours per day spent at home was significantly associated with higher stress (B = 0.19, 95% CI = 0.11, 0.27, p < .001), anxiety (B = 0.10, 95% CI = 0.04, 0.16, p = .002) and depression (B = 0.18, 95% CI = 0.11, 0.25, p < .001), while a higher number of social contacts with friends and/or family members was significantly associated with lower scores in anxiety and depression. For example, contacting family or friends every few days was significantly associated with lower anxiety (B = ‑3.51, 95% CI = -5.66, -1.36, p = .001) and depression (B = -3.69, 95% CI = - .33, -1.05, p = .006) as compared to no contact. For further details, see Table 1.
3.3. Associations with health status
Higher scores in self-rated health were significantly associated with lower scores in stress (B = -4.83, 95% CI = -4.39, -5.27, p < .001), anxiety (B = -3.76, 95% CI = -3.42, -4.10, p < .001), depression (B = -4.83, 95% CI = -4.39, -5.27, p < .001), and IES-R (B = -7.68, 95% CI = -6.67, -8.69, p < .001). Several participants reported a range of physical symptoms, most frequently headache (46.7%), coryza (31.7%), sore throat (23.5%), myalgia (22.7%), cough (21.5%), dizziness (15.3%), respiratory problems (5.4%), chills (3.6%), and fever (1.8%). Linear regression analyses showed that physical health concerns were significantly associated with higher scores in stress, anxiety, depression and the IES-R scores. For example, having a pre-existing health condition was significantly associated with more stress (B = 1.83, 95% CI = 0.99, 2.67, p < .001), anxiety (B = 2.10, 95% CI = 1.45, 2.75, p < .001), depression (B = 1.67, 95% CI = 0.88, 2.46, p < .001) and higher scores in the IES-R (B = 4.26, 95% CI = 2.40, 6.12, p < .001). For further details, see Table 2.
In the last two weeks, 8.3% of the participants reported to have received medical treatment, 2.6% reported direct and 7.3% indirect contact with individuals with confirmed COVID-19 infection. Moreover, 13.2% reported contact with individuals with suspected COVID-19 infection, 35.7% contact with infected materials, and 0.4% had been admitted to the hospital. Only 1.5% had been tested for COVID-19 and 4.3% reported being under quarantine by a health authority. Medical treatment within the last 14 days was significantly associated with higher stress (B = 3.68, 95% CI = 2.49, 4.87, p < .001), anxiety (B = 2.98, 95% CI = 2.06, 3.90, p < .001), depression (B = 3.21, 95% CI = 2.08, 4.34, p < .001) and higher scores in the IES-R (B = 5.59, 95% CI = 2.94, 8.24, p < .001). Indirect contact with individuals with a confirmed COVID-19 infection and contact with an individual with suspected infection was significantly associated with higher stress (indirect contact: B = 2.25, 95% CI = 0.98, 3.52, p < .001; suspected contact: B = 2.02, 95% CI = 1.05, 2.99, p < .001), anxiety (indirect contact: B = 1.74, 95% CI = 0.76, 2.72, p < .001; suspected contact: B = 1.60, 95% CI = 0.85, 3.35, p < .001), depression (indirect contact: B = 2.05, 95% CI = 0.85, 3.25, p < .001; suspected contact: B = 1.31, 95% CI = 0.38, 2.23; p = .005) and higher scores in the IES-R (indirect contact: B = 3.71, 95% CI = 0.90, 6.52, p = .010; suspected contact: B = 4.11, 95% CI = 1.95, 6.27, p < .001). In contrast, direct contact with an individual with confirmed infection was significantly associated with anxiety (B = 2.36, 95% CI = 0.75, 3.97, p = .004), but not with stress, depression or the IES-R. Contact with potentially infectious material was significantly positively associated with stress (B = 0.79, 95% CI = 0.10, 1.48, p = .025), anxiety (B = 0.88, 95% CI = 0.35, 1.41, p < .001) and depression (B = 0.85, 95% CI = 0.20, 1.50, p = .011). Having been tested for COVID-19 was significantly associated with stress (B = 4.49, 95% CI = 1.78, 7.20, p = .001), anxiety (B = 2.20, 95% CI = 0.10, 4.30, p = .041) and depression (B = 3.86, 95% CI = 1.29, 6.43, p = .003). Being under quarantine within the last 14 days was significantly associated with more stress (B = 2.80, 95% CI = 1.57, 4.43, p < .001), anxiety (B = 3.04, 95% CI = 1.78, 4.10, p < .001), depression (B = 2.82, 95% CI = 1.28, 4.36, p < .001) and higher scores in the IES-R (B = 6.69, 95% CI = 3.07, 10.3, p < .001).
3.4. Associations with virus-specific knowledge and concerns
The majority of the participants were aware of the increase of the number of infected individuals (99.7%), the number of deaths (99.1%) and the number of recovered individuals (87.7%). The knowledge about the increase in the number of recovered individuals and infections was significantly associated with lower stress (recovered: B = -1.71, 95% CI = -2.72, -0.70, p < .001; infected: B = -6.30, 95% CI = -11.98, -0.62, p < .001), anxiety (recovered: B = -1.73, 95% CI = ‑2.51, ‑0.95, p < .001; infected: B = -7.89, 95% CI = -12.28, -3.50, p < .001), depression (recovered: B = ‑2.04, 95% CI = -2.99, -1.09, p < .001; infected: B = -7.58 , 95% CI = -12.96, -2.20, p < .001) and lower scores in the IES-R (recovered: B = -4.36, 95% CI = -6.59, -2.13, p < .001; infected: B = -12.76, 95% CI = -25.36, -0.16, p < .001). Further, the belief that COVID-19 cannot be transmitted via air, was significantly associated with lower stress (B = -2.17, 95% CI = -2.94, -1.4, p < .001), anxiety (B = -1.45, 95% CI = ‑2.05, -0.85, p < .001), depression (B = ‑1.80, 95% CI = -2.53; -1.07, p < .001) and lower scores in the IES-R (B = ‑3.74, 95% CI = ‑5.46, ‑2.02, p < .001).
The most prominent source of health information about COVID-19 was the internet (56.3%), followed by TV (30.3%) and radio (7.3). Internet as preferred source of information was significantly associated with higher stress (B = 1.37, 95% CI = ‑0.89, 3.63) and depression (B 1.04, 95% CI = -0.82, 2.90) as compared to the reference category “TV”. Most of the respondents (84.9%) were highly satisfied or somewhat satisfied with the available health information. Satisfaction with the health information was significantly associated with lower anxiety (B = -2.44, 95% CI = -4.21, -0.67, p = .007), while dissatisfaction with the provided information was associated with higher stress (B = 4.26, 95% CI = 0.93, 7.59, p = .012).
Most of the participants stated that they are very confident (20.8%) or confident (58.6%) regarding the diagnostic capabilities of the health system, while 18.5%, respectively, 2.1% were rather not confident or not confident at all. Less confidence in the doctor’s ability to diagnose COVID-19 was significantly related to higher stress (B = -2.72, 95% CI = -3.19, -2.25, p < .001), anxiety (B = ‑1.99, 95% CI = -2.36, -1.62, p < .001), depression (B = -2.70, 95% CI = ‑3.15, -2.25, p < .001) and a higher IES-R score (B = -4.77, 95% CI = -5.82, -3.72, p < .001). 71.5% were very worried or somewhat worried about other family members getting COVID-19, while 41.6% of the respondents were very worried or somewhat worried about their children getting infected. High levels of concern about other family members or children were significantly associated with higher stress (family members: B = 5.39, 95% CI = 3.43, 7.35, p < .001; children: B = 5.21, 95% CI = 3.85, 6.57, p < .001), anxiety (family members: B = 4.16, 95% CI = 2.64, 5.68, p < .001; children: B = 4.48, 95% CI = 3.43, 5.53, p < .001), depression (family members: B = 2.97, 95% CI = 1.09, 4.85, p = .002; children: B = 4.48, 95% CI = 3.43, 5.53, p < .001), and more psychological impact of the outbreak (family members: B = 10.47, 95% CI = 6.12, 14.82, p < .001; children: B = 12.10, 95% CI = 9.09, 15.11, p < .001).
Almost half of the participants (49.8%) thought that an own infection was likely or very likely, but the majority (92.2%) believed that it was very likely or somewhat likely to survive a COVID-19 infection. Higher perceived likelihood of being infected with COVID-19 was significantly associated with higher stress (B = 2.94, 95% CI = 1.49, 4.39, p < .001) and depression (B = 2.40, 95% CI = 1.02, 3.78, p < .001), while a higher perceived likelihood of surviving COVID-19 infection was significantly associated with less stress (B = ‑4.71, 95% CI = -6.26, -3.16, p < .001), anxiety (B = ‑5.04, 95% CI = -6.59, -4.21, p < .001), depression (B = -4.18, 95% CI = -5.65, 2.71, p < .001) and impact of event (B = -14.35, 95% CI = -17.76, -10.94, p < .001). For details, see Table 3.
3.5 Associations with precautionary measures
97.3% of the participants stated, that they were mostly or always washing their hands thoroughly, 81.6% were mostly or always washing their hands immediately after touching a potentially infectious object, 78.68% were mostly or always covering their mouth when sneezing or coughing, 66.4% were mostly or always washing their hands immediately after sneezing or coughing, 64.6% mostly or always avoided sharing utensils, 20.6% reported that they are mostly or always wearing gloves while shopping and 3.7% reported to frequently wear face masks. Covering the mouth while coughing and sneezing was significantly associated with higher stress (B = 0.35, 95% CI = 0.08, 0.62, p = .011), anxiety (B = 0.32, 95% CI = 0.11, 0.53, p < .002), and higher scores in the IES-R (B = 1.77, 95% CI = 1.17, 2.37, p < .001). Washing hands thoroughly was significantly associated with lower depression (B = -0.62, 95% CI = ‑1.20, -0.04, p = .036) and higher scores in the IES-R (B = 2.89, 95% CI = 1.53, 4.25, p < .001). Washing hands immediately after coughing or sneezing and washing hands after touching contaminated objects was significantly associated with higher anxiety (coughing/sneezing: B = 0.43, 95% CI = 0.21, 0.65, p < .001; touching objects: B = 0.53, 95% CI = 0.29, 0.77, p < .001) and higher scores in the IES-R (coughing/sneezing: B = 1.96, 95% CI = 1.34, 2.58, p < .001; touching objects: B = 2.25, 95% CI = 1.57, 2.93, p < .001). Wearing masks and gloves was significantly associated with higher stress (masks: B = 0.74, 95% CI = 0.32, 1.16, p < .001; gloves: B = 0.61, 95% CI = 0.39, 0.83, p < .001), anxiety (masks: B = 0.83, 95% CI = 0.51, 1.15, p < .001; gloves: B = 0.63, 95% CI = 0.46, 0.80, p < .001), depression (only wearing gloves: B = 0.46, 95% CI = 0.25, 0.67, p < .001), and higher scores in the IES-R (masks: B = 2.28, 95% CI = 1.36, 3.20, p < .001; gloves: B = 2.11, 95% CI = 1.63, 2.59, p < .001).
The majority (83.1%) of the participants continued their physical activity during the last 14 days. Physical activity was significantly associated with lower stress (B = ‑0.90, 95% CI = -1.13, -0.67, p < .001), anxiety (B = -0.65, 95% CI = -0.83, -0.47, p < .001), depression (B = ‑0.89, 95% CI = -1.11, -0.67, p < .001) and lower scores in the IES-R (B = -1.50, 95% CI = -2.02, -0.98, p < .001). 15.4% of the individuals always or often felt that too much unnecessary worry had been made about COVID-19. Interestingly, this belief was associated with higher stress (B = 0.81, 95% CI = 0.50, 1.12, p < .001), anxiety (B = 0.51, 95% CI = 0.27, 0.75, p < .001), depression (B = 0.90, 95% CI = 0.61, 1.19, p < .001) and higher scores in the IES-R (B = 1.16, 95% CI = 0.48, 1.84, p < .001). For details see Table 4.
3.6. Need for additional health information
Almost all participants asked for additional information about COVID-19. Most frequently mentioned were advices on how to treat an infection (62.4%), more information about coping strategies for psychological stress (51.1%), ways to strengthen the immune system (50.9%) and information about the regional development of the infection (46%). 24.8% requested detailed information about how to prevent an infection and 23% of the individuals needed further information for victims of domestic violence. For details, see Figure 2. The need for the respective information was significantly associated with higher stress, anxiety, depression and psychological impact of the event (data not shown).