Association of Depression With Precautionary Behavior Compliance, COVID-19 Fear, and Health Behaviors in South Korea: National Cross-sectional Study

Abstract

Background As of January 2022, the number of people infected with COVID-19 worldwide has exceeded 350 million. As the COVID-19 pandemic continues, people are affected in a wide range of areas of life, which in turn causes numerous psychological problems. Depression is a serious problem for people who have suffered from COVID-19. Depression can worsen COVID-19 precautionary behavior compliance or the health behavior itself. In addition, these depressive symptoms may have different characteristics depending on the individual’s gender. Objective The aim of this study was to determine whether depression is a factor that may affect COVID-19 fear, precautionary behavior compliance, and health behavior, and how these characteristic trends differ by gender. Methods This was a secondary analysis of data from the 2020 Korea Community Health Survey (KCHS), a national cross-sectional survey conducted with complex sampling analysis. In 2020, the KCHS included COVID-19–related questions. For this study, we used the KCHS data from both the COVID-19–related questions and the Patient Health Questionnaire-9 scale. After weighting the data according to the KCHS guidelines, we calculated the distribution of men and women according to depression level. The data were collected using multiple-choice questions related to precautionary behavior compliance, COVID-19–related fears, and health behavior changes. Results Of the 204,787 participants, those who were clinically depressed had a greater tendency to not comply with precautionary behaviors. Regarding COVID-19, “fear” showed a decreasing trend in both men (adjusted odds ratio [AOR] 0.72, 95% CI 0.61-0.83) and women (AOR 0.74, 95% CI 0.63-0.86) with clinically relevant depression. Moreover, for both men and women, health behaviors deteriorated as depression intensified; the AOR for sleep duration changes was 2.28 (95% CI 2.00-2.59) in men and was 2.15 (95% CI 1.96-2.36) in women. Notably, the responses of clinically depressed women revealed a doubled increase in both their drinking (AOR 2.25, 95% CI 1.88-2.70) and smoking (AOR 2.71, 95% CI 1.95-3.77) habits compared with those of nondepressed women. Conclusions Both men and women with more severe depression were more likely to violate precautionary health behaviors as their depression worsened. Health behaviors also deteriorated for both genders, but women tended to show a greater change. Therefore, additional studies and interventions for vulnerable groups such as severely depressed people are needed. More research is also necessary to develop interventions based on statistical comparisons of men and women.

Behavioral intentions of self‐isolation and informing close contacts after developing mpox‐related symptoms among young men who have sex with men in China

“…All the independent variables were entered in the multivariable regression as they are all potentially associated with behavioral intentions. [18][19][20][21][22][23]25,26 The adjusted OR (AOR) and 95% CI were reported. All analyses were carried out using the SAS 9.4 software (SAS Institute).…”

“…[19][20][21][22] Furthermore, psychosocial factors were included based on the behavioral theories (e.g., the minority stress model and the self-regulation theory 23,24 ) and previous studies, which showed that negative mental health, such as internalized stigma and depression, were barriers to practicing healthy behaviors. 25,26 This study aimed to investigate behavioral intentions of selfisolation and informing close contacts after developing mpox-related symptoms among young men who have sex with men (YMSM) aged 18−29 in China. This young age group was selected as they are more likely to report sexual risk behavior among MSM communities.…”

“…Hypothesized factors influencing self‐isolation and informing close contacts were also developed based on prior studies on other infectious diseases (e.g., COVID‐19 and HIV/AIDS), including sociodemographic variables (age and education), cognitive variables (attitude and risk perception), and behavioral variables (e.g., having multiple sexual partners and engaging in chemsex) 19–22 . Furthermore, psychosocial factors were included based on the behavioral theories (e.g., the minority stress model and the self‐regulation theory 23,24 ) and previous studies, which showed that negative mental health, such as internalized stigma and depression, were barriers to practicing healthy behaviors 25,26 …”

Association between precautionary behaviors against coronavirus disease and psychosocial factors in outpatients with a pre‐existing disease and their attendants

“…Depression symptoms, such as anhedonia and loss of energy, caused some functional impairments 26 . A previous study reported that both men and women with more severe depression were more likely to violate precautionary health behaviors as their depression worsened 27 . People with depressive symptoms would be unable to change their daily behaviors to precautionary measures during the pandemic.…”

Lifestyle Behavior Changes and Associated Risk Factors During the COVID-19 Pandemic: Results from the Canadian COVIDiet Online Cohort Study

“…The combination of poor diet quality, low physical activity, and greater alcohol intake, BMI, and smoking represents an important risk for severe COVID-19 [9], COVID-19 mortality [10], and chronic diseases during the postpandemic period [11]. Accumulating evidence shows that particular groups, such as women and younger individuals, were more susceptible to higher levels of stress and depression during the pandemic, possibly due to changes in home life among others [12][13][14][15]. These factors, combined with limited access to grocery shops [8], restaurants, and food banks, restricted budgets due to sudden unemployment, and changes in living arrangements may have affected how people modified their lifestyle during the pandemic [16,17].…”