The coronavirus disease 2019 (COVID-19) pandemic has caused enormous global disruption. Hong Kong with population 7.5 million had reported 11,461 cases of COVID-19 including 203 fatal cases as of 30 March 2021 (Hong Kong Center for Health Protection, 19 March 2021). Although the number of COVID-19 cases to date has been relatively small, Hong Kong had experienced a number of surges in transmission in 2020 (Hong Kong Center for Health Protection, 19 March 2021). Prior to the availability of an effective vaccine, public engagement with public health and social measures (PHSMs) was critical for pandemic control (Cowling et al., 2020). Public perception of their vulnerability to and the severity of the disease, personal confidence in self-protection and trust in the government in pandemic control are important determinants of compliance with PHSMs during a pandemic (Bish & Michie, 2010; Leung et al., 2003; Liao, Cowling, Lam, Ng, & Fielding, 2010; Liao, Cowling, Lam, & Fielding, 2011; Storopoli, Braga da Silva Neto, & Mesch, 2020). According to the Transactional Theory of Stress and Coping (TTSC) (Lzarus & Folkman, 1984), the primary stressor (e.g. COVID-19) stimulates stress appraisal which comprises evaluation of potential threat, harm caused by the stressor and individual resources or capacity to manage the stress. The stress appraisal subsequently motivates various behavioural coping strategies. TTSC also proposes that appraisal of the primary stressor (i.e., the pandemic) and the secondary stressors (e.g., the control measures) could cause enormous psychological impact (Lzarus & Folkman, 1984). This is evidenced in the current pandemic. For instance, studies had reported a prevalence of 35% of psychological distress in Chinese adults (Qiu et al., 2020), a prevalence of around 15%, 8% and 5% of moderate, moderately severe and severe depression symptoms, respectively, in US adults (Ettman et al., 2020), and a prevalence of 27% of mental distress of clinical significance in UK adults (Pierce et al., 2020). Stress results from the interaction between personal resource (internal and external) and the situation (McLeod, 2012). The prolonged PHSMs may disproportionally affect and cause more psychological distress in the population who have fewer resources or perceive lower personal capacity to cope with the changing situation such as females, younger adults and people of lower income, with lower job security and being unemployed (González-Sanguino et al., 2020; Qiu et al., 2020; Xiong et al., 2020). Most studies on public psychobehavioural responses to COVID-19 were conducted during the initial stage of the pandemic or when the countries were lockdown (Ettman et al., 2020; González-Sanguino et al., 2020; Luo, Guo, Yu, Jiang, & Wang, 2020; Pierce et al., 2020; Qiu et al., 2020; Salari et al., 2020; Storopoli et al., 2020). There remained limited understanding about the psychological impact in the general public throughout different stages of the pandemic. In addition, according to Model of Self-regulation (MSR) (Carver, Scheier, & Fulford, 2008), the process of coping with stress can also be viewed as a self-regulatory process through which individuals take actions to cope with the changing situation to achieve certain personal goals (e.g. self-protection or pandemic control). This subsequently generates a feedback process through which individuals evaluate whether their personal goals are achieved through the effort input. If they constantly receive negative feedbacks (e.g., the pandemic repeatedly surges and negative impacts of the coping strategies), it will cause feeling of self-regulation failure and fatigue (e.g., pandemic fatigue) (Michie, West, & Harvey, 2020; World Health Organization, 2020) which will in turn demotivates existing coping effort (e.g., compliance with precautionary behaviours). How individuals appraised their precautionary behaviours (particularly physical distancing behaviours) would affect precautionary behaviours against the COVID-19 pandemic was seldom studied.
This was a repeated cross-sectional study to monitor the changes of public stress appraisal including COVID-19 risk perception, personal efficacy and confidence in government’s pandemic control, behavioural coping (i.e., precautionary behaviours) and psychological distress over one year of the pandemic in 2020 in Hong Kong. We also aimed to examine the interrelationships among appraisal of stress and precautionary behaviours, adoption of precautionary behaviours and psychological distress, and to identify socioeconomic strata associated with increased vulnerability to psychological distress throughout different stages of the pandemic.