Our findings revealed the risk perception and negative emotions of HCWs varied in different gender, profession and the location, as well as in different periods of COVID-19. Our findings also revealed differences in the association between risk perception and negative emotions across the two periods. The levels of tension, fear, worry and risk perception were higher during Period 1 than they were during Periods 2 of COVID-19. Over the different periods, worry was found to be closely related to and a significant predictor of high-level risk perception in the period 1; whereas the predictive type of negative emotion changed to tension in the period 2.
The current study examined differences in risk perception and negative emotions and the varied associations between those variables among HCWs across two period of COVID-19. The first hypothesis that risk perception and negative emotions decreased during two successive periods of COVID-19 were supported by our findings, which were convergent to the development of the pandemic. In fact, our study was consisted with few longitudinal or cohort studies conducted after the outbreak of SARS which showed during the initial phases of the SARS outbreak a steady increase showed in risk perception and then leveled off in later phases[17, 26]. As a infectious disease, the increase of risk perception could be neutralized by the effective vaccines or behavioral containment measures, so that it is likely the notion of risk will be less concerned. As regards the negative emotion components, significant decreases were found in tension, fear, and worry across the two studied periods. In period 1, which was the peak of the pandemic, an initial knowledge about the origin or the life course of a newly emerging virus was lack and visible effects are delayed, therefore, unknown risks and threats to public health were produced. HCWs, as the first-line warriors for the public health, were dispatched to the hardest-hit areas or mandated to work under the threat of infection. Hence, tension, fear and worry were dominated in the dimension of HCWs negative emotions. Whereas in period 2, when the pandemic was contained with protective measures, tension, fear and worry were gradually relieved and the perception of the pandemic was reduced, however, the risk was not nullified as none specific treatment and vaccine were developed at this moment. From the practical views of the results, in the acute stage of COVID-19, tension, fear and worry are likely to be imminent and therefore hamper the rational perception about gains and losses related to protective behaviors of HCWs not only for themselves but also their patients. In such cases, the proper emotion copying ways could be avail for fending off the invisible losses and long-term consequences. In the later stage, risks were downplayed due to the emotional copying strategy, which would have double effects on the protective behaviors. To ensure the safety, it would be better to monitor the risk perception and negative emotions of HCWs for the sake of preventing the return of the pandemics.
Notably, some demographical differences were detected in the analysis. In China’s COVID-19 responses, female nurses and community health workers were the first line of defense against the outbreak, which could explain why the two samples were dominated by female HCWs, most of who were nurses. Therefore, the study might be less convinced for the interpretation of gender difference, but we specially found doctors were more negative feelings, like impatience, sadness, upset and tension in the period 1. It may be reflected the hardship of doctors since there were the overwhelm stress from saving the life-threaten patience and numerous patience waiting for them. Consequently, the risk perception was also higher in the doctors with more negative emotions. While in period 2, nurses showed higher risk perception than doctors, which could be explained by that in the stage nurses had to take more care supports for the patience and intense contacts. More importantly, in the late stage of COVID-19, not dispatched HCWs rated higher in the subscale of impatience, sadness, tension and worry compared to HCWs dispatched to Wuhan, while their risk perception was not significantly different. It could be the potential reasons that on the one hand dispatched HCWs received more psychological and substantial helps and on the other, they could have improvement in coping emotions after confronting with the worse stress. Alternatively, it could be a caveat for the sampling bias. Thereby, more studies focused on the difference between dispatched HCWs and not dispatched to clear the pandemic’s impacts on HCWs mental health.
After controlled the effect of gender, profession and location, the further exploration for association between negative emotions and risk perception not only provided the supports for our third hypothesis, but also the emotion-based risk perception. Damasio has thus suggested that automated incentive or alarm signals linked to pleasant or unpleasant “gut feelings” often precede cognitive reasoning. In a similar vein, processing theories have emphasized the importance of an emotion–cognition pathway[28, 29]. In an acute threat situation like COVID-19, emotional aspects might gain more immediate importance, especially in the early stages of an outbreak when experts are unable to make more than tentative statements and provide partly contradictory prognoses and recommendations. Under these circumstances cognitive risk assessments might be severely hampered by lack of evidence-based information. Consequently, individuals might have little choice but to rely on experiential judgement. Our results showed the consistent positive relation between negative emotions and risk perception in the entire course of the pandemic, similar to the results of Goodwin and Sun using public samples and a lot researches about the emotion and risk perception for vaccine. This study was novel not only the background and subjects but also the repeated cross-sectional method which could give light on the emotional effect on risk perception. As the analytical data showed, worry could be prominent contributor to the higher level of risk perception immediately after the outbreak of pandemic, while gradually the prominent components of negative emotions varied with the course of pandemic, and thus in the our second studied period of COVID-19, tension, reflecting the local situation and the severity of pandemic, played a key role in the risk perception. However, what role exactly an emotion-based judgement plays in interaction with risk-related cognition is still an issue in need of clarification. Besides, only a minority of the subgroup of studies which investigated the possible predictive role of risk perception for protective behaviors could actually be considered model-based. The resulting lack of opportunity for studying the complexity of the decision-making process is bound to also affect the extent to which findings for the relationship between risk perception and protective behaviors can be interpreted. Thus, a more systematic application of multifactor models, including the emotion-based models, would allow for far more complex insights into the workings of risk perceptions in shaping behavior.
The current study has some limitations that should be addressed. First, the data were collected in the midst of COVID-19. Therefore, some degree of potential sample bias should be taken into account. For
example, the two samples each included a higher percentage of females than males, nurses than doctors (This issue was particularly acute for the Period 2 sample). Therefore, future studies should recruit larger samples of male and female HCWs. Moreover, the current study employed a cross-sectional repeated design to examine differences in the levels of negative emotions and risk perception. Further studies should adopt a longitudinal design, to follow the same sample of HCWs across different periods. That type of study would be the best way to examine changes in the levels of different variables and the associations between those variables among the same individuals over time, which could also provide more valuable findings to the emotion-cognition-behavior model of risk perception. Moreover, the follow-up researches could achieve more convinced results about the effect of being dispatched for HCWs defensing against the pandemics and contribute to the targeted help services for HCWs.