Do people with mental health problems have lower adherence to precautionary measures in COVID-19 pandemic? A cross-sectional observational study in Hong Kong

Abstract

ObjectivesMental health problems are prevalent during the COVID-19 pandemic, but their effect on adherence to precautionary measures is not well understood. Given that psychological morbidities are associated with lower treatment adherence, and that precautionary measures are important in containing the spread of COVID-19, this study aims to determine if people with mental health problems have lower adherence to precautionary measures against COVID-19.DesignWe conducted a cross-sectional territory-wide online survey between 17 June and 31 July 2020 during the COVID-19 pandemic. Clinically significant mental health problems, adherence to precautionary behaviours, and confounding factors such as sociodemographic factors and self-reported physical health were assessed.SettingThe link to the questionnaire was disseminated to the general population in all 18 districts of Hong Kong using various social media platforms.Participants1036 individuals completed the survey. Of them, 1030 met the inclusion criteria of being adult Hong Kong residents.Primary outcomeAdherence to precautionary measures against COVID-19, including wearing face mask, frequent handwashing, household disinfection, social distancing, minimising unnecessary travel, and stocking up on food and daily essentials.ResultsOf the 1030 participants, 166 (16.1%) had clinically significant mental health problems. Interestingly, they were more likely to stock up on food and daily essentials during the pandemic (7 (4.2%) vs 15 (1.7%), p=0.04; unadjusted OR=2.49, 95% CI=1.00 to 6.21, p<0.05) and had a lesser tendency to stop social distancing even if the pandemic subsides (86 (51.8%) vs 513 (59.4%), p=0.07; unadjusted OR=0.74, 95% CI=0.53 to 1.03, p=0.07). The latter association remained significant after adjusting for the confounding factors (adjusted OR=0.68, 95% CI=0.48 to 0.96, p=0.03).ConclusionsContrary to our hypothesis, people who are mentally unwell might go beyond the recommended precautionary measures. Our findings highlight the need to identify mental health problems and provide care and support for those who might go too far with precautionary measures.Trial registration numberChiCTR 2000033936.

Psychosocial Factors Associated With Adherence to COVID-19 Preventive Measures in Low-Middle- Income Countries, December 2020 to February 2021

“…It is possible that in the Taiwan study conducted in February 2020, at the beginning of the epidemic general anxiety levels were higher (48.8%) leading to higher adherence behaviour [ 15 ], while in our study later in the epidemic (December 2020-February 2021) general anxiety levels were lower (21.7%) associated with lower adherence behaviour. Unlike some previous research that showed that having depressive symptoms decreased adherence to COVID-19 preventive measures [ 17 ], and having psychological distress (anxiety, depression) increased adherence to COVID-19 preventive measures [ 20 ], we did not find any significant association between depressive symptoms and any specific and summative COVID-19 preventive behaviour. In high-income countries most studies show a positive association between anxiety and adherence to COVID-19 preventive measures, while depressive symptoms had negative or positive associations with adherence to COVID-19 preventive measures.…”

“…In a large online survey among the general adult population in Germany early 2020, general anxiety symptoms were positively associated with adherence to COVID-19 safety behaviours [ 18 ]. During the severe acute respiratory syndrome (SARS) in 2003 in Hong Kong, among the general adult population higher anxiety levels were associated with higher uptake of protective measures [ 19 ], and in an online survey in June/July 2020 in Hong Kong, people with psychological distress were more likely to adhere to COVID-19 preventive measures [ 20 ]. Based on few previous studies in high-income countries, it can be hypothesized that psychological distress (anxiety, depression) influences adherence to COVID-19 preventive measures.…”

Common mental disorders during the COVID-19 pandemic in Hong Kong: Age-related differences and implications for dementia risk

“…This study was a secondary analysis of a cross-sectional survey conducted in Hong Kong during the COVID-19 pandemic ( 46 ). This planned secondary analysis specifically concerned age differences and prevalence of mental health problems of the same cohort.…”

“…As this was a secondary analysis of an earlier published study, the sample size was predetermined ( 46 ). Statistical analysis was performed using the IBM SPSS Statistics, Version-26.0 (IBM Corp).…”

Is self-reported depression, HIV status, COVID-19 health risk profile and SARS-CoV-2 exposure associated with difficulty in adhering to COVID-19 prevention measures among residents in West Africa?

“…Also, concerns about the risk of death from COVID-19, misinformation, disinformation, poor access to vaccination and health care in addition to stigma and discrimination associated with COVID-19 [30] exacerbated the risk of COVID-19 related mental problems. The prevalence of depression is as high as 30% in sub-Saharan Africa [31] Prior studies suggest that people with depression and mental challenges complied better with preventive measures [32,33]. Another study however, reported that depression was associated with lower compliance with COVID-19 precautionary measures [34].…”