We conducted an internet survey on 2449 Chinese residents of perceived stress and health behaviors during the COVID-19 outbreak. The 45th Statistical Report on Internet Development in China showed that China's internet population was 904 million, with the internet popularizing rate reaching 64.5% . Previously, some studies had also used internet survey and confirmed that it was time-saving and convenient Compared with the traditional paper questionnaire survey [15, 16].
High risk groups of health risk stress
Students had higher stress scores, previously, the prevalence of perceived stress among students was high . At the current stage, universities delayed the start of the semester, the ministry of education advocated the suspension of classes, and stress from unexpected events, that was COVID-19, all of them had adverse effects on students. Outbreaks can put significant psychological stress that may lead to unfavorable effects on learning and the overall psychological health of students , While distressing their overall psychological health, this situation could adversely affect learning, by the increased avoidance of learning activities and reducing their concentrations. all of these results highlight the need to establish psychological support programs for students during an COVID-19 outbreak. Besides, there is no doubt that the mental health of the isolated population deserved attention, these individuals needed more social support and professional Psychological crisis interventions.
Further, Medical personnel were also the focus of attention. Initially, the health care workers were placed in a stressful condition due to the uncertainty about the mode of transmission of the disease, tremendous fear, and implementation of rigorous infection control protocols, It had been found that 30% of confirmed cases were health care workers (HCWs)during Middle East Respiratory Syndrome-Corona Virus outbreaks, During the SARS epidemic in 2003 and the influenza A/Hemagglutinin1 Neuraminidase1(H1N1) pandemic in 2009, researchers evaluated psychological stress on HCWs using different modalities, and stress was found constantly high . This study showed that 45.19% of medical workers were in a state of health risk stress, a large burden in the clinical treatment and public prevention efforts in hospitals and community settings. such psychological distress may affect HCWs, who would be in a high demand and shortage during outbreaks. Challenges and stress they experienced could trigger common mental disorders, including anxiety and depressive disorders, and posttraumatic stress disorder, which in turn could result in hazards that exceed the consequences of the epidemic itself [19, 20]. For on-the-job medical personnel, they should further strengthen their awareness of self-protection, emphasize strict implementation of infectious disease protection measures, standardize operations, maintain a peaceful mindset, and relieve stress in a timely manner. The hospital should provide timely management and technical support, allocate and guarantee supplies, and provide online and offline psychological counseling services.
Totally, there were at least three types of residents with extremely high stress. In order to improve efficiency and make good use of limited medical resources, it is important to establish key target groups at the initial stage and set priorities accordingly. Nowadays, The guidelines divided the population affected by COVID-19 into four levels, the first level included medical staff, especially in the front line, the second level included suspected people, and the forth level contained susceptible groups and general public . It was essential to incorporate stress buster or psychological therapists into the overall deployment of COVID-19 epidemic prevention and control, the main premise of stress buster or psychological therapists is to minimize psychological harm and provide timely assistance for epidemic prevention and control, that is to say, to provide mental health support for high risk stress individuals. The work of Psychological intervention was initiated by the Chinese Society of Psychiatry, with a team of experts established to organize intervention efforts and provide technical guidance . In the current epidemic status, face-to-face psychological counseling requires high standards of on-site isolation to minimize risks. This service is only available to front-line medical staff who have not been infected, so it is not suitable for ordinary residents who need psychological intervention. In order to ensure the continuous provision of mental health services and reduce the risk of cross-infection, the Chinese government is developing and implementing a remote consultation network to conduct telephone or internet consultations in a safe environment .
Negative Relationship between health Behavior and perceived Stress
Individual's perceived stress often exert significant effects on behavior habit and experience , Data analysis of residents' health behaviors and different stress states were statistically significant (p < 0.05). Which is consistent with the results of the impact of perceived stress on health behaviors investigated by the work during the SARS epidemic . At present, it is generally believed that stress is a process and the product of the interaction between human and environment, which mainly includes the mediating variable of stress source and the physical and mental response. It has been suggested that there are three types of response that can help the body respond to stressors, namely direct stress responses. This kind of response can make the body respond quickly to fight or escape when it responds to stressors. Adaptability of secondary signals of the body and brain; and an assessment of stress responses based on cortical structures and pathways involved in cognitive processes through which the subject responds to the stressor . For the domestic material reserve status, this survey found that 71.37% of the residents had little or no masks when the epidemic broke out, while only 6.16% had more or sufficient disinfectant. The shortage of supplies and the sudden disruption of work and life may all become main sources of stress for residents during the epidemic of COVID-19. We also found residents with monthly income more than 10,000 RMB have lower rates of perceived stress and health risk stress, so we had to admit that the economic situation was also an important factor that should not be ignored.
The link between perceived cognitive deficits and depressive symptoms is partially explained by quality of sleep and perceptions of stress , anxiety, as well. Anxiety levels closely mirrored the daily number of new cases and were strongly associated with the intensity of the outbreak . Psychobehavioral responses during the SARS or H1N1 influenza outbreaks showed a positive association between anxiety level and personal protective behaviors [25–27], however, if the anxiety level continues to rise, it will have adverse effects, the previous study also showed the same results . Logistic regression models were also used to examine the prevalence of high levels of perceived stress and poor sleep quality, increased in proportion to the heavy smartphone use and insufficient physical activity . This work showed that only 53.33% of residents often or always take appropriate exercise even when they are isolated in home. Relevant study  have shown that staying at home for a long period of time may lead to increased sedentary behaviors, thereby reducing regular physical activity, eventually leading to increased health risks or causing a cycle of anxiety, depression, and vice. Therefore, it is suggested to strengthen residents' health behaviors, pay attention to a balanced diet, maintain regular exercise and improve immunity in a safe family environment.
Residents' cognition of disease is not optimistic under stress state
As for knowledge, approximately 63% answered two or more questions correctly regarding knowledge of SARS . Nowadays, the overall disease awareness rate was 62.04% of COVID-19. This disease hasn't been fully understood, there is currently no specific drug or vaccine, the need for disease information and health behaviors by official authorities is also high. This survey showed that 73.71% of the residents were very concerned about the epidemic information, which is accurate, clear, sufficient, timely, and trustworthy. Public health authorities should keep monitoring the situation, as the more we learn about this novel virus and its associated outbreaks, the better we can respond . The media and governments at all levels should enrich the channels and methods of information disclosure, strengthen the education of disease-related knowledge, and release epidemic information in real time to meet the needs of different groups. Residents should take a rational view of COVID-19, abide by the special regulations during the epidemic, increase awareness of prevention, obtain information through official channels, relieve stress, understand the importance of home isolation, and avoid virus transmission.
Notable factors affecting health risk stress
The onset of a sudden and immediately life-threatening illness could lead to high stress status . This study found that 39.89% of the residents were in a state of health risk stress. A number of important factors triggered residents' health risk stress. Perceived life threaten emerged as the most significant predictor for the Impact of Event Scale—Revised (IES-R)and Hospital and Anxiety Scale (HADS) scores that reflect stress-based symptoms , In literature for a broader range of stress status, other predictor variables such as gender, age, and perceived life threat were found , further, this study showed that residents who were younger, with higher disease susceptibility perception, higher life threaten level, uncertain home isolation importance or extremely unclear about the difference between Common cold and COVID-19, significantly associated with health risk stress. It is necessary to take effective measures to deal with health risk stress based on these factors can be intervened.
This study had several highlights. Firstly, to minimize personal contact during the outbreak, participants were surveyed by internet instead of face-to-face, internet survey is different from traditional investigation methods, it is rapid and convenient. Secondly, this work revealed some specific individuals need to be deeply concerned. Lastly, effective psychological interventions for residents keep mental health against COVID-19 are needed, we put forward some suggestions for psychological interventions. However, this study had a few vital limitations. One is the potential selection bias of the study participants, although it covered the residents of 20 provinces, did not represent the status of all Chinese. Yet, due to a rather big number of the responses, it still makes sense, and showed the overall trend. Furthermore, we had to acknowledge the limitation of uncontrollable.