This study showed a network of factors affecting anxiety, fear, and behaviour change during the COVID-19 pandemic. Exposure to COVID-19 news had a significant relationship with both anxiety and fear, and also with health behaviour change.
Anxiety
Exposure to COVID-19 news was the only factor that had a significant relationship with anxiety. The impact of news on anxiety has been reported in previous studies too. In the cross-sectional study of Gao et al in China, there were high rates of anxiety and depression among the Chinese general adult population, and more exposure to social media was significantly associated with worsening anxiety/depressive disorders. Gao et al have suggested that the government should consider the adverse result of infodemic during the COVID-19 pandemic on people's mental health [8]. Ni et al in another cross-sectional study in China have reported similar findings [9].
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 significant 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 significant 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 findings 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 significantly accompanied by psychological distress including anxiety, depression, and stress, and also with lower life satisfaction [17]. Similar findings have been reported in many other countries [18–21]. Aslam et al investigated the news headlines regarding the COVID-19 pandemic and their induced emotions. More than half of the headlines were accompanied by negative emotions while 30 percent of news evoked positive emotions [22].
Behaviour change
Social media was the only factor influencing health behaviour. Yousuf et al. have reported that using social media for a campaign of behaviour change, led to the improvement of hand washing and 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.
The study by Zhao et al. in the USA concluded a relationship between media trust and preventive health behaviours. Those Americans who trusted CNN more than Fox News, had a better engagement with behaviours such as washing hands, avoiding public places, or wearing masks [25]. This study shows that to what extent social media has importance in shaping knowledge, attitude, and behaviours during the COVID-19 pandemic and not only taking account of the media in psychological research is necessary, but also there should be an emphasis on the contents of it. Also, Tsai et al in the USA have reported that traditional news exposure combined with conservative ideology and trust in such social media raise a 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 finding, 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 findings should be interpreted with caution.