Exposure to the COVID-19 News on Social Media: Psychological and Self-reported Behavioural Responses Among Iranian Adults

Background: Exposure to news on coronavirus disease 2019 (COVID-19) pandemic is inevitable. This study aimed to explore associations between exposure to COVID-19 news on social media and psychological and behavioral consequences among Iranians. Methods: This was a telephone-based survey carried out in April 2020 in Iran. Iranian adults aged 18 and over were randomly selected from the postal codes and using their mobile phones. A self-designed questionnaire was administered to collect data on participants’ characteristics and questions to address their psychological and behavioral responses regarding the COVID-19 pandemic. A multivariate logistic regression model was performed to assess the relationship between anxiety, fear, and behavioral responses and independent variables including exposure to news. Results: In all 1563 adults participated in the study. The mean age of respondents was 39.17±13.5 years. Moderate to high-level anxiety was reported by 55.4% of participants, while fear of being affected by coronavirus was reported by 54.1%. Overall 88% reported that they changed their behaviors to some extent. Exposure to the COVID-19 news on social media was by far the most inuencing variable on anxiety (OR= 2.21, 95% CI: 1.62-3.04; P < 0.0001), fear (OR = 1.95, 95% CI: 1.49-2.56; P < 0.0001), and change in health behaviors (OR = 2.02, 95% CI: 1.28-3.19; P = 0.003) in the regression model. While independent variables did not show signicant associations with anxiety and behavior change, the fear of being infected by the COVID19 was associated with the female gender and some socio-economic characteristics of the participants. Conclusion: Although exposure to the COVID-19 news on social media seemed to be associated with excessive anxiety and fear among people, it also, to some extent, positively has changed people’s health behaviors towards preventive measures.


Introduction
The outbreak of COVID-19 had a detrimental effect on global healthcare systems with a rapid and profound impact on every aspect of human life [1], from the way people socialize, to work, live, shop, and plan for the future [2]. In addition to the global spread of the virus itself, another sort of pandemic developed misleading rumors and disinformation were shared through online media, including all the larger social media, video, and messenger platforms such as Twitter, Facebook, Instagram, WhatsApp, and YouTube [3]. Scienti cally unfounded speculations on potential causes and cures made the rounds, causing confusion and risky behavior among people who followed misleading and false recommendations [4].
It is well-documented that pandemics can lead to heightened levels of stress and consequently anxiety that is a common response to any stressful situation. Recent evidence suggests that individuals who are kept in quarantine, experience signi cant distress which can be appeared in the form of anxiety, anger, confusion, and post-traumatic stress symptoms [5]. The media has the most in uential power either negative or positive on people's knowledge during pandemics. This technology has been reporting continuously across borders to keep all informed about the pandemic situation and now this has led to a massive and different public reaction. As a result, the number of information people obtain about the COVID-19 from the media daily is raising a lot of concern for people leading to heightened, for example, levels of anxiety or concern [6].
The psychological and behavioral responses of the public are expected to largely in uence the personal protective measures and eventually the clinical outcome [7]. Mental health professionals need to provide the necessary support to those exposed and to those who deliver care. To help the outbreak management of COVID-19 in Iran, there is an urgent need to understand the public's awareness and attitudes towards COVID-19. This study aimed to assess the psychological and behavioral response to the news of the COVID-19 pandemic among the Iranian adult population.

Design and participants
The present study was a telephone-based cross-sectional survey conducted during the COVID-19 pandemic in April 2020. A sample of Iranian adults aged 18 years and above were randomly selected from the list of post codes and using their mobile phones. All provinces in Iran were de ned as the strata and proportional to the population of each province the required sample size was drawn. The primary sampling unit consisted of individuals living in the province. All participants were made aware of the study protocol, and verbal informed consent was obtained.

Sample size
The sample size was based on the following formula: n = Z 2 P (1-P)/d 2 Considering Z = 1.96, P = 0.5 (assuming 50% would use social media), and d = 3% (precision), a sample size of 1067 participants was estimated. Considering the design effect (Deff = 1.5) recruiting a sample of 1600 was thought. However, in practice 1563 adults were included in the study.

Measurement
A self-designed questionnaire with two sections was administered. The socio-demographic information included the recording of age, gender, marital status, education, economic status, and occupation. In addition, six items were included to address people's exposure to news on the COVID-19 pandemic (3 items), and three items were asked to measure psychological and behavioral responses (hand washing, wearing face mask and practicing social distancing). Each item was rated on a 5-point Likert scale.

Data collection
At the begging of the phone interview, people were asked for consent. After they accepted to take part in the survey, the interviewers asked the questions one by one and lled in the demographic details and the six study questions. All interviewers were trained for this speci c study to assure that ethical principles and consistency in data collection were considered.

Statistical analyses
Descriptive statistics were used to report the data including mean, standard deviation, and frequency, and percentage. To assess the association between dependent variables (anxiety, fear, and self-reported behavior change) and exposure to news on COVID-19 both univariate and multivariable logistic regression analysis was performed. The results were presented as odds ratio and 95% con dence intervals. All statistical analyses were performed using R software (ver. 11, College Station, Texas, USA).

Participants
In all 1563 adults participated in the study. The mean age was 39.17 ± 13.5 in this study. It can be seen that approximately, half of the sample population was in the middle economic status, while the vast majority of individuals were high school-educated adults (60.1%) and university or college-leveled institutes (35.3%). The description of sociodemographic variables is summarized in Table 1. behaviors. The detailed results are shown in Table 2.

Feeling of anxiety
In the multivariate logistic regression model, experience of anxiety signi cantly was associated with exposure to news on social media (OR = 2.21, 95% CI: 1.62-3.04); P < 0.0001). The results are shown in Table 3.  Table 4.

Self-reported behavioral response
The only factor that in uenced behavior change was exposure to COVID-19 news on social media (OR = 2.02, 95% CI: 1.28-3.19; P = 0.003). In fact, people reported that they took more preventive measures (hand washing, wearing face mask, social distancing) after exposure to COVID-19 news on social media. The results are reported in Table 5. The current study did not assess the possible relationship between anxiety and the exposure time. A study from Bangladesh showed that more than 4 hours of using social media was related to its higher levels of anxiety [10]. Also, it is important to note isolation, quarantine, social distancing, and loneliness all could led to spending more hours in social media [11].
Although the current study did not show a signi cant relationship between most independent variables and anxiety, a study from Iran, ten percent of the study population showed anxiety symptoms that had an association with female gender, younger age, and experience of COVID-19 among family members or friends [12]. Similarly a study reported that anxiety and depression of the Iranian population were associated with female sex, cardiovascular diseases, smoking, and history of COVID-19 symptoms including fever, cough, and shortness of breath [13].
Fear Different factors had a signi cant relationship with fear including female sex, middle economic status, being employed, following COVID-19 statistics released by the state, and exposure to news in social media. In the study of Mertens et al. in the Netherlands, using social media and anxiety were among the main factors affecting fear of COVID-19 [14]. Also, Lin et al reported similar ndings in Hong-Kong where they reported that social media provoked fear in society [15].
Using the Fear of COVID-19 Scale [16] a study showed that the fear was signi cantly accompanied by psychological distress including anxiety, depression, and stress, and also with lower life satisfaction [17]. disinfecting. Also, it may be an effective way to prevent the spreading of fake news [23]. An online survey on American adolescents aged 13 to 18 years old showed that news monitoring was associated with greater social responsibility, more disinfecting, and attitudes about the greater severity of COVID-19 [24].
Therefore, it could be concluded that the adequate emphasis on the importance of COVID-19 without raising an ocean of disinformation, may improve people's responsibility and change their attitudes toward positive health behaviours including disinfecting frequently. prejudice against Asians while those who followed left-wing social media and news, had lower prejudice. Interestingly those who had trust in social media and digital news together had lower prejudice [26].
Olagoke et al have reported that exposure to COVID-19 news had both positive and negative effects. The exposure was associated with behaviour change of self-protection against the virus, however it also was related to depressive symptoms [27]. This study demonstrated somehow a similar nding, as it proposes that exposure to COVID-19 news in social media was associated with both positive and negative effects.
Although one hypothesis is that exposure leads to behaviour change through provoking anxiety and fear feelings, further studies need to investigate such relationship. But it seems besides the process of change in behaviour after exposure to COVID-19 mews, social media may be an opportunity to improve health behaviours.

Limitations
One limitation was that the fact that we did not ask participants how much they were spending on social media. This was a cross-sectional study in nature and thus could not indicate causality and the ndings should be interpreted with caution.

Conclusion
The study ndings showed that association exist between exposure to the COVID-19 news on social media and anxiety, fear, and behaviour change. Indeed, exposure to COVID news on social media should be balanced against harms and bene ts.