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Relationship between COVID-19 stressors and health behaviours: results from The Psycorona Study

The pandemic is teaching us key lessons about the relationship between different types of stressors and health outcomes.

Covid-19 Fatigue – Part One: A report by Asia Fitness Today

In a recent study published in Preventive Medicine Reports*, Dr Shian-Ling Keng, Associate Professor from the Department of Psychology at Monash University Malaysia, along with a team of 107 researchers from over 40 countries globally, are charting COVID-19’s deadly sweep across the world by delving into the virus’ often overlooked impact on people’s health behaviours. This study is conducted with Dr Michael Stanton, Assistant Professor in the Department of Public Health at California State University, East Bay as a co-leading investigator. Other key collaborators of the study include Dr LeeAnn Haskins (University of Georgia, USA), Dr Jeannette Ickovics (Yale University, USA), Dr Antwan Jones (the George Washington University, USA), Dr Diana Grigsby-Toussaint (Brown University, USA), and Dr Carlos Almenara (Universidad Peruana de Ciencias Aplicadas, Peru).

Anxiety associated with the COVID-19 pandemic and home confinement measures have been found to be associated with adverse health behaviours, such as unhealthy eating, smoking, drinking, and decreased physical activity. These unhealthy behaviours are risk factors for non-communicable diseases, including obesity, diabetes, and cardiovascular diseases, which in turn increase the risk of contracting COVID-19 and greater disease severity and may eventually lead to increased mortality. However, to date, most studies have been limited by regional sampling, which precludes the examination of behavioural consequences associated with the pandemic at a global level.

Descriptive Statistics for COVID-19 Stressors and Health Behaviors. | Download Scientific Diagram ( – image via license: Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International

Using data from the global PsyCorona project, an international, longitudinal online study of psychological and behavioural correlates of COVID-19, Dr Keng and over 100 behavioural scientists surveyed 7,402 adult participants from 86 countries across three waves of assessment and measured  their perceived infection risk, economic burden, and engagement in health behaviours ranging from physical exercise, unhealthy eating, smoking, to alcohol consumption. By employing a multilevel regression approach in its data analysis, the team tested whether COVID-19 infection risk and economic burden correlate with a decline in healthy behavioural habits. The study found that perceived economic burden was linked with reduced diet quality and sleep quality, as well as increased smoking. There was also an interaction between perceived COVID-19 infection risk and economic burden, such that diet quality and sleep quality were lowest among those reported high levels of COVID-19 infection risk and economic burden. Neither binge drinking nor physical exercise were associated with perceived COVID-19 infection risk, economic burden, or their interaction.  

“The pandemic is teaching us key lessons about the relationship between different types of stressors and health outcomes across different socioeconomic groups. In particular, it highlights the importance of attending to cumulative, negative effects of high infection risk and economic burden on health outcomes”, said Dr Keng. This project began when Dr Keng was a faculty member with the Division of Psychology at Yale-NUS College, Singapore.

Since March 2020, the PsyCorona scientists have conducted ongoing 20-minute interviews with more than 60,000 people in 115 countries. The survey topics range from handwashing and mask-wearing to dissatisfaction with government messaging. The project is jointly funded by the New York University Abu Dhabi, the University of Groningen in the Netherlands, and the Instituto de Salud Carlos III in Madrid, with Dr Pontus Leander (Wayne State University, USA) and Dr Jocelyn Bélanger (NYU Abu Dhabi, United Arab Emirates) as principal investigators. 

“We are asking: If you perceive that you will get infected, and if you think that in the next few months your personal situation will be worse due to the economic consequences of COVID, will you sleep less, and will you eat more and eat unhealthy food?” Dr Stanton explained.

Preliminary findings from the study point to the value of developing interventions to address COVID-related stressors, which have an impact on health behaviours that, in turn, may influence vulnerability to COVID-19 and other health outcomes. Dr Keng noted that the relationships between COVID-19 stressors and health behaviours appear to be consistent across geographical regions — from impoverished nations to more developed European countries and the United States, and the relationships remained after controlling for variations in gender, age and levels of education. As a next step, the team aims to examine psychological mechanisms that may account for the relationships, including negative emotions and use of coping strategies such as problem solving and avoidance.

Dr Jones, Associate Professor from the Department of Sociology at The George Washington University, expressed that pandemics are notorious for inciting short- and long-term economic challenges. “However, there has been less attention on…how socially and economically vulnerable populations will be affected by the changing spatial landscape brought on by the consequences of the pandemic,” he stated.

Another co-author, Dr Grigsby-Toussaint, Associate Professor of Behavioural and Social Sciences and Epidemiology at the Brown University School of Public Health, indicated that supporting and engaging in international collaborative efforts are critical for mitigating the impact of COVID-19. “Although effective interventions targeting COVID-19 have to be tailored to the local context, it is important to have a broader view of stressors and health behaviours that are continuing to drive the pandemic.”

*Articles published on Preventive Medicine Reports are peer-reviewed and made freely available for everyone to read, download, and reuse in line with the user license displayed on the article.

AFT Ed.’s notes:

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