An internet-based survey was finished by 2449 Chinese residents to assess the perceived stress and health behaviors during the COVID-19 outbreak. The 44th Statistical Report on Internet Development in China demonstrated that the number of internet users was 854 million . Some studies had confirmed that,compared to the traditional paper questionnaire survey, online-based surveys were time-saving and convenient [15, 16].
High risk groups of health risk stress
Students had higher stress scores. The prevalence of perceived stress among students was high . Because of theCOVID-19, universities delayed the spring semester, and the Ministry of Education advocated the suspension of classes, and stress emerged from the unexpected events, while all of them had adverse effects on students. The outbreaks put significant psychological stress on students and caused unfavorable effects on learning , for the increased avoidance of learning activities and the reduced concentration. Those results highlighted the necessity to establish psychological support programs for students during the COVID-19 outbreak. Besides, the mental health of the isolated population deserved attention, requiring more social support and professional psychological crisis interventions.
Further, medical personnel also attracted attention. Initially, the health care workers were in the center of a stressful condition due to the uncertainty of the mode of transmission of the disease, the tremendous fear, and the rigorous implementation of infection control protocols. It was reported that 30% of the confirmed cases occurred on health care workers (HCWs)during Middle East Respiratory Syndrome-Corona Virus outbreaks, the SARS epidemic in 2003 and the influenza A/Hemagglutinin1 Neuraminidase1(H1N1) pandemic in 2009. Researchers evaluated psychological stress on HCWs with different modalities, and stress was constantly high . This study showed that 45.19% of medical professionals were in the state of health risk stress, over-loaded 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 the outbreaks. Challenges and stress could trigger common mental disorders, including anxiety and depressive disorders, and post-traumatic 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, it is necessary to further stress the awareness of self-protection, the strict implementation of infectious disease protection, the standardized practices, the peaceful mindset, and the stress relief 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, at least three groups of residents were experiencing extremely high stress. In order to improve efficiency and make good use of limited medical resources, it is important to decide the key target groups at the initial stage and set priorities accordingly. The guidelines divided the population affected by COVID-19 into four groups, the medical staff, especially those in the clinic, the suspected persons, the susceptible groups and the general public . It was essential to involve stress or psychological therapists in the overall planing of COVID-19 prevention and control. Their main responsibility was to minimize psychological harm and provide timely assistance, that is, to provide mental health support for high risk stress individuals. The work of psychological intervention was initiated by the Chinese Society of Psychiatry, a team of experts to organize intervention efforts and provide technical guidance . In the current epidemic, face-to-face psychological counseling requires high standards of on-site isolation to minimize risks. This service is only available to the clinic medical staff who are not infected, and it is not available to ordinary residents who are actually in a need of psychological intervention. In order to ensure the continuous provision of mental health services and reduce the risk of cross-infection, the government is developing and implementing remote consultation network to conduct telephone or internet-based consultations in a safe environment .
Negative Relationship between health Behavior and perceived Stress
Individual's perceived stress exerted significant effects on behaviors and experience . Data analysis of residents' health behaviors and different stress states were statistically significant (p < 0.05), which was consistent with the results of the impact of perceived stress on health behaviors investigated during the SARS epidemic . It is generally believed that stress is a process and the product of the interaction between human and environment, which mainly involves the mediating variables of stressor and the physical and mental response. Three types of responses can help the body respond to stressors, namely direct stress responses, such as fight or escape through the adaptability of secondary signals of the body and brain, the assessment of stress responses in the cortical structures and pathways . For the domestic material storage status, the study found that 71.37% of the residents had few or even no masks available when the epidemic broke out, while only 6.16% reserved sufficient disinfectant. The shortage of supplies and the sudden disruption of work and life all were the main sources of stress during the epidemic of COVID-19. Residents with monthly income more than 10,000RMB encountered lower rates of perceived stress and health risk stress, so it suggested that the economic situation was also an important factor in the face withCOVID-19.
The relation between perceived cognitive deficits and depressive symptoms partially reflected in the quality of sleep and perceptions of stress  and anxiety. 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 indicated a positive association between anxiety level and protective behaviors [25–27]. However, if anxiety got beyond some level, it would show adverse effects, and previous studies obtained the same results . Logistic regression models were also used to examine the prevalence of high levels of perceived stress and poor sleep quality and found them increased in proportion to the smart-phone use and insufficient physical activity . This work got the result that only 53.33% of residents often or always took appropriate exercises even when they were isolated at home. Study  reported that a long time staying at home would result in increased sedentary behaviors, reducing regular physical activity,and eventually leading to increased health risks or a cycle of anxiety and depression. Therefore, it is suggested to improve residents' health behaviors, keep balanced diets, maintain regular exercises and enhance immunity in a safe family environment.
Residents' cognition of disease is not optimistic under stress state
For knowledge of SARS, approximately 63% answered two or more questions correctly . Nowadays, the overall awareness rate of COVID-19 was 62.04%. This disease hasn't been fully understood, there is no drugs or vaccines specific for the virus and the official authorities are also in a high need of related information and health behaviors. This survey showed that 73.71% of the residents were very concerned with the epidemic information, which was accurate, clear, sufficient, timely, and trustworthy. Public health authorities should keep close monitor on the situation. Because the more people learn about this novel virus and its associated outbreaks, the better people can respond . The media and governments should develop more channels and methods for information disclosure, strengthening the disease education, and release epidemic information in real time. Residents should take rational views on COVID-19, abide by the special regulations, improve awareness of prevention, obtain information through official channels, relieve stress, understand the importance of home isolation, and prevent virus transmission.
Notable factors affecting health risk stress
The onset of a sudden and immediate life-threatening illness could cause high stress status . This study found that 39.89% of the residents were in the state of health risk stress. A number of important factors triggered residents' health risk stress. Perceived life threat emerged as the most significant predictor for the Impact of Event Scale—Revised(IES-R)and Hospital and Anxiety Scale(HADS)scores that reflected stress-related symptoms , Literature reported a broader range of stress status, other predictor variables such as gender, age, and perceived life threat . This study found younger residents with higher disease susceptibility perception and higher life threatening level were uncertain about 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, taking in consideration of these factors.
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, We have to acknowledge that this study had a few vital limitations. One is the potential selection bias of the participants, although enrolled from 20 provinces, not represent the status of all Chinese. Yet, due to the rather big number, it still made sense, and indicated the overall trend. Furthermore, we had to acknowledge the limitation of uncontrollable.