Association of COVID-19 Pandemic-Related Factors With Mental Health Symptoms in Hong Kong: A Population-Based Study

Abstract

Purpose: Coronavirus disease 2019 (COVID-19) pandemic is expanding, resulting in substantial changes in daily-, study-, and work-life of the affected populations [1]. Adverse mental health impacts are emerging [2]. However, specific pandemic-related risk factors remained unclear. We examined the impact of the COVID-19 pandemic, including shortages of preventive materials, negative perceptions, and reduction in income, in association with mental health symptoms in Chinese general adults in Hong Kong. Methods: The population-based Hong Kong COVID-19 Health Information Survey was conducted from 9-23 April 2020 (after the peak of the second wave of local outbreak) on 1501 adults randomly sampled by random-digit-dialing of landline telephone (n=500) and online survey on a population-representative mobile phone panel (n=1001) with response rates of 61.3% and 61.7%, respectively [3]. Target population was general Hong Kong residents aged 18 or above. Shortage of preventive materials (facemasks, alcohol-based hand sanitizers, and cleaning products), extent of agreement to negative perceptions (5 items, each ranged 1-5, e.g., “I feel the outbreak greatly affected my daily life”), and reduction in income since the outbreak (no change, small reduction, reduction by half, larger reduction, or unemployed) were assessed. Mental health symptoms measured included stress (Perceived Stress Scale-4, range 0-16) [4], anxiety (General Anxiety Disorders-2, range 0-6, cutoff >2) and depressive symptoms (Patient Health Questionnaire-2, range 0-6, cutoff >2) [5]. Results were weighted according to population figures from Census and Statistics Department on the sex, age, and education attainment distributions of Hong Kong general population. Associations were analyzed by multivariable linear and logistic regression adjusting for sociodemographic and health-related covariates, including confirmed cases or close contacts of confirmed cases, chronic disease, self-rated health, and smoking and alcohol drinking behavior. Results: Of the 1501 participants (52.5% female, 55.0% aged 30 to 59 years), the average stress score was 7.20 (SD 2.12). 218 (15.8%) and 206 (14.8%) participants had anxiety and depressive symptoms, respectively. Shortage in facemasks (20.8%), alcohol-based hand sanitizers (13.9%), and cleaning products (7.3%) were reported. Participants generally disagreed with the perception of at risk of getting infected in the coming 6 months (mean 2.2, SD 1.1), but tended to worry that the people around pose a threat to themselves (mean 3.6, SD 0.9) and perceive the outbreak have greatly affected their daily life (mean 3.7, SD 0.9). 59.3% employed participants had income reduction and 6.2% had become unemployed since the outbreak. Stress, anxiety, and depressive symptoms were more prevalent in those with shortages of preventive materials and negative perceptions of the outbreak (all P<0.05). Reduction in income and unemployment was associated with more mental health symptoms (all P<0.05). Conclusion: We provided the first evidence that shortage of preventive materials, negative perceptions of the outbreak, financial loss, and unemployment were prevalent during the outbreak and were associated with higher stress and more anxiety and depressive symptoms. The results showed that strong support for the vulnerable populations is urgently needed during the pandemic. Further research are warranted to understand the causes and mechanisms of mental health problems and to guide the design for effective interventions.