Research as consistently shown that major life changes can lead to severe and sometimes chronic psychological stress[17]. With more than 2.1 cases confirmed worldwide, and over 140,000 reported deaths[19], the COVID-19 epidemic constitutes a pervasive source of potential stress on a global scale. Indeed, with many countries swiftly instituting strict control measures, normal routines were drastically disrupted with the closing of businesses, industries, and schools – and the recommendation (or requirement) that individuals remain at home. Such behavioral changes, whether mandatory or not, can be expected to negatively challenge individuals’ mental health and/or emotional well-being.
Our study, conducted across provincial China (Taiwan excepted) at the height of the COVID-19 epidemic, suggests that being female, somewhat younger (≤ 45 years old), more highly educated, unemployed, and in poorer overall health were all risk factors for experiencing psychological stress. Uncertainty of one’s local disease status (epidemic) and some prior personal COVID-19-related contact were also factors contributing to one’s perceived stress. In contrast, “protective” factors included frequent contacting with colleagues, calmness of mood, and psychological resilience. Higher desire for knowledge about the COVID-19, diseases/psychological/economic problems and cannot go to work/study difficulties during the epidemic were the risk factors of stress.
Disease susceptibility, and the economic problems that can result from an inability to work, can be prime contributors to psychological stress. Similarly, uncertainty and lack of control resulting from lockdowns, restrictions, quarantines, etc. arguably impacted every Chinese residents’ life and, potentially, detrimentally affected their physical, social-psychological, and economic conditions[2, 3]. The sustained, long-term implementation of these safeguards undoubtedly prolonged an already stressful and challenging situation – and the loss of both income and personal identity associated with the lack of employment likely resulted in increased anxiety. Indeed, for respondents without sustainable incomes, the effects were especially dire.
The full range of possible impacts should be considered when implementing disease control and prevention measures, and disseminating easily-assessible, understandable knowledge of COVID-19 and providing alternative venues for personal contact with friends or colleagues can be effective buffers against psychological stress. Conforming to the common perceptions, people alerted to risks and threats instinctively seek outside help, confirmed in a recent Chinese study demonstrating that individuals, on average, spent ≥ 3 hours per day during the epidemic associated with mental health[ 20]. Social support, typically associated with lower depression and anxiety, could further buffer the cognitive effects of stress[21]. Our findings suggest that appropriate social supports, such as frequent contacting with colleagues, to relieve stress during an epidemic might include providing more professional knowledge of protective measures, real-time updates and report, access to urgent medical service, basic living security measures, and alternative means to interpersonal communication.
Age was another factor related to self-reported stress – with study findings suggesting that younger (≤ 45) respondents experienced greater stress. These results were consistent with the previously-cited Chinese COVID-19 study and others involving the psychological impacts of disasters[20, 22]. Exactly why this is the case remains somewhat unclear: Perhaps older persons pay more attention on positive emotion simulation and neglect negative simulation (“positive effects”)[23], or maybe those younger face feel greater social, emotional, and/or economic responsibilities toward their families' health and protection.
Our study also highlighted the importance of resilience as a “protective” factor to psychological stress, often vis-à-vis a greater sense of adaptability and control over one’s external environment. In fact, studies have found that psychological resilience both directly and indirectly protects some individuals against stress-related mental health problems (e.g., PTSD, anxiety, depression)[24, 25]. In our study, males’ higher resilience may partially explain their comparatively (vs. females) lower stress levels.
This finding of female’s stress was being greater than that of males in response to such situations was also consistent with existing evidence[14, 16]. Observed sex differences of stress are often attributed to differential impacts on individuals’ social environmental, psychodynamic, and cognitive processes[26, 27]. Behavioral responses to distress and the experience/expression of emotion are also thought to be moderated by sex[13] and, more recently, sex differences in susceptibility to stress have been expanded to include physiological factors [28, 29] such as ovarian hormone fluctuations[26, 30] and endogenous estradiol changes across the menstrual cycle [31]. Similarly, stress-related fMRI studies have found brain functions associated with emotion and stress regulation, self-referential processing, and cognitive control to be more pronounced in males[32].
Sex differences in self-reported stress are further reflected in the perceived need of psychological support services, which were seen as more evident in females than in males. Again, the underlying mechanisms are unclear, but it may be that males are more likely to self-manage coping responses to stress, while female are more likely to seek external or professional help.
This study had several limitations. First, although study respondents reflect a national sample, most of the non-random, convenience sample were located outside the heaviest epidemic area – which may have had some impact on findings. Moreover, the cross-sectional design makes establishing the causal nature of relationships problematic. Second, in response to the rising trend of COVID-19 epidemic and the infectious characteristics, we were forced to use WeChat online survey. Finally, for ethical reasons, we purposely did not ask about confirmed or suspected infection among respondents themselves, and the proportion reporting close contact and having completed medical observations were few.