Public behavior change, perceptions, depression, and anxiety in relation to the COVID-19 outbreak

Background The COVID-19 has spread rapidly and world-widely, which elicits public panic and psychological problems. Public protective behaviors and perception play crucial roles in controlling the spread of illness and psychological status. Methods We conducted a cross-sectional online survey in the hardest-hit Hubei province and other areas in China affected by COVID-19 outbreak. Questions about their basic information, the perception of the COVID-19 outbreak, recent preventive or avoidance behaviors, and self-reported mental health scales including the Patient Health Questionnaire (PHQ-9) and Self-Rating Anxiety Scale (SAS) were included. Binary logistic regressions were used to investigate the association between personal variables/perceptions and psychological distress. Results 6,261 people were included for analysis, with 3,613 (57.7%) in Hubei province (1,743 in Wuhan). A majority of people have adopted preventive and avoidance behaviors. People from Hubei, with contact history, and people who or whose family members were infected had much higher depression or anxiety prevalence. Providing truthful and sufficient information, informing the public about the severity of the disease, and perceptions that the outbreak will be control by protective behaviors were associated with lower depression and anxiety prevalence. Conclusions Assessing the public response, perception, and psychological burden during the outbreak may help improve public health recommendations and deliver timely psychological intervention. Further researches can focus on the psychological status of a specialized group to identify ways for better support based on public response and psychological demand.