Behavioral Reactions and Psychological Responses to 2019-nCoV: A Narrative Review

AUTHORS

Vahid Ranaei ORCID 1 , Zahra Pilevar 2 , Teamur Aghamolaei 3 , *

1 Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran

2 Department of Food Sciences and Technology Department, National Nutrition and Food Technology Research Institute, Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 Cardiovascular Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran

How to Cite: Ranaei V, Pilevar Z, Aghamolaei T. Behavioral Reactions and Psychological Responses to 2019-nCoV: A Narrative Review, Iran J Psychiatry Behav Sci. Online ahead of Print ; 14(3):e104727. doi: 10.5812/ijpbs.104727.

ARTICLE INFORMATION

Iranian Journal of Psychiatry and Behavioral Sciences: 14 (3); e104727
Published Online: September 6, 2020
Article Type: Review Article
Received: May 9, 2020
Revised: August 1, 2020
Accepted: August 16, 2020
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Abstract

Context: The emerging 2019-nCoV outbreak has involved almost all countries worldwide. Although the timely dissemination of clear and accurate information on threats of the disease might cause panic, it is needed for rapid adoption and implementation of prevention and control measures. From the early stages of outbreaks, the behavioral responses and public risk perception should be carefully monitored for further policies and corrective measures.

Evidence Acquisition: In the current narrative review article, the psychological and behavioral responses are reviewed after an introduction to the risk perception and role of social and personal behavioral changes in the 2019-nCoV outbreak. Additionally, the impact of public perception on mental health problems and containment of the outbreak is discussed.

Results: The consequences of the outbreak affect both infected and non-infected people in communities. People may experience loneliness, fear of catching the disease, and loss of loved ones during the outbreak. The timely understanding of the situation, implementation of urgent psychological interventions, and emotional supports are necessary to encourage people to fight this long-term outbreak and prevent subsequent mental health problems.

Conclusions: High self-control and public perception can mediate the associated psychological impacts of stressful conditions in outbreaks.

Copyright © 2020, Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

1. Context

The World Health Organization (WHO) characterized the 2019-nCoV outbreak as a Public Health Emergency of International Concern on 30, January 2020 (1). The novel coronavirus seems to be more sporadic than previous coronaviruses. However, some regions have exhibited more responsive personal and social behaviors due to the experiences of previous coronavirus outbreaks. This might be due to the realistic vision of the community to the disease and its transmission. The public perception and social and personal behavioral responses can determine the efficacy of control and prevention measures. The uncertainty about the transmission routes of 2019-nCoV disease and the unpredictability of how long the outbreak lasts can enhance public anxiety and concerns (2). Mental health problems are exacerbated by isolation and quarantine (3). Besides providing psychological counseling services such as telephone helplines, the National Health Commission guidelines have provided the emergency psychological crisis interventions for people with 2019-nCoV (4). Given that there is no definitive treatment and vaccine for the 2019-nCoV disease, the dissemination of timely information related to the outbreak has a critical role in decreasing mental health problems and containment of the outbreak. Although much research has been conducted on the treatment of 2019-nCoV disease, minimal studies have paid attention to the psychological impacts of this disease (5).

2. Evidence Acquisition

For the current article, there were no restrictions on searching electronic databases. English databases such as Google Scholar, Scopus, Science Direct, Web of Science, and PubMed were explored by using appropriate keywords such as behavioral reactions, COVID-19, psychological response, etc. In this article, we reviewed the behavioral reactions and psychological responses to the 2019-nCoV outbreak among the general population and health care workers. In addition, the psychological interventions and strategies to mitigate mental health problems due to the 2019-nCoV pandemic are reviewed.

3. Results

3.1. Psychological Responses to 2019-nCoV Disease

3.1.1. Psychological Responses in the General Population

It is unknown how many people may die or get infected by the 2019-nCoV disease and how long the outbreak lasts (6). Individuals who have 2019-nCoV may experience a range of psychological disorders even after they have been cured (7, 8). There are no therapeutic drugs and vaccines for the current novel coronavirus. This uncertainty and unpredictability can cause fear and disappointment. The fear of catching the disease and resentment regarding disclosure and loss of the loved ones due to 2019-nCoV may lead to emotional responses (9). The rapid spread of outbreaks and the fear of death cause anxiety and psychological disorders, including depression, posttraumatic stress, and substance dependence (10-12). As reported in several studies, posttraumatic stress increases in populations exposed to disasters (12). The psychological disorders due to disasters worsen by isolation, loneliness, helplessness, and loss of face-to-face connections (13, 14). Being in quarantine due to infection gives the feeling of shame and guilt (5). The uncertainty about the isolation period increases the non-compliance and can demoralize individuals (15). Prolonged isolation causes more mental health problems than short-time isolation (16, 17). Many people experience the fear of unemployment due to the economic downturn of the outbreak (18).

The implementation of precautionary measures associated with personal and social controlling behaviors such as isolation, staying home, and cleaning surfaces resulted in severe anxiety among Wuhan (32.7 %) and Shanghai (78.6 %) citizens during the early stages of the 2019-nCoV outbreak (19). Of 1,715 respondents from Hong Kong, 97% were worried, and 98% (slightly: 42%, greatly: 56%) stated that their routine lives were disrupted due to the 2019-nCoV outbreak (20). In another study on 2019-nCoV, from 1,210 Chinese respondents, 53.8%, 16.5%, 28.8%, and 8.1% were rated at the moderate to severe levels of psychological impacts, depressive symptoms, anxiety symptoms, and stress, respectively (21). Sleep, work, and other activities as routines are hindered or interrupted, which exacerbate the psychological and mental health consequences (22-24). In the 2019-nCoV outbreak, of 1,210 Chinese respondents, 84.7%, 75.2%, and 75.1% spent almost all their time at their home (20 - 24 h), were worried about their family health and were satisfied with the related disseminated information, respectively (21). The feelings like cooperation and being part of a big group can result in the selfless contribution of people (25). For efficient cooperation, the role of individuals and groups of individuals and punishments of disobedience, such as social disapproval, should be clearly specified (26-28).

3.1.2. Psychological Responses in Health Care Workers

Medical employees are in close contact with infected people who experience respiratory syndromes. Although they do their best to cure the patients, sometimes they cannot save the patients’ lives, and this results in the feeling of guilt for not being a good health worker (11). This situation of being in danger, stressful work for long hours, and heavy professional responsibilities can lead to posttraumatic stress symptoms of many hospital employees (11). These psychological disorders are enhanced in those who are single or with low household income (29). The health care workers fear of catching the disease and transmission to their families and loved ones, which can cause conflicts and dissonance (30). It has been reported that the healthcare workers in Intensive Care Units (ICU), emergency, and isolation wards are directly exposed to patients and are more likely to have adverse psychiatric disorders than other healthcare workers (31). In the SARS outbreak, 10% of the respondents (hospital employees) experienced high levels of posttraumatic stress symptoms. Those who were quarantined and their close friends and relatives were infected by SARS experienced the posttraumatic stress symptoms more than others (32). In 40% of the hospital employees who experienced high levels of posttraumatic stress symptoms, the symptoms persist three years after the outbreak (29). It has been reported that if posttraumatic stress symptoms remain six months after a disaster, they continue to remain for long periods (33).

Given that several factors influence the substance abuse or dependence, including income, gender, education level, age, etc. (34), individuals who are living in danger are prone to recurrent or prolonged disasters and are more likely to develop post-traumatic stress disorder and substance dependence (35).

3.2. Strategies to Improve Psychological Responses to 2019-nCoV Disease

The psychological interventions to tackle the mental health problems of 2019-nCoV disease should be implemented before serious issues occur (4). There are some points released by the WHO for the general population, which help in the prevention of mental health problems associated with the 2019-nCoV outbreak. Some of these measures are as follows: (1) Those who have 2019-nCoV should be supported with kindness; (2) people who are being treated for 2019-nCoV should not be called as “victims”, “diseased”, or other inappropriate titles; (3) seeking medical advice and information regarding the outbreak at specific times (once or twice a day and not more) from trusted sources; (4) supporting others besides protecting yourself; (5) amplification of hopeful and positive images of those who have recovered from 2019-nCoV; (6) honoring healthcare workers and medical employees who care people with 2019-nCoV while scarifying their lives (1). The awareness of the new lifestyle and its detrimental consequences, maintaining social networks, teleworking, and home exercise programs help in compliance with loneliness and isolation (36-38).

The related psychological treatments depend on the severity of symptoms and the conditions the patients’ experience (8). The implementation of psychological interventions such as cognitive behavior therapy (CBT) or mindfulness-based therapy (MBT), etc. might be affected by the shortage of professionals or multiple responsibilities of psychologists and psychiatrists (5). The MBT consists of relaxation techniques such as meditation practices, which prevent depression and alleviate stress, while CBT emphasizes stress management to decrease maladaptive coping (39-41). The psychologists and psychiatrists are often discouraged to enter the isolation wards or be in close contact with 2019-nCoV patients (8). The provision of relevant policies on training volunteers and mental healthcare workers and using online psychoeducation may solve this problem (4).

Some mental considerations for health care workers, according to the WHO guideline are as follows: (1) It is normal if health care workers feel being under pressure. Both mental and physical health should be maintained; (2) taking care in the best possible way; (3) keeping connection with beloved ones and others as much as possible; (4) disseminating the information to those who have cognitive, intellectual, and psychosocial disabilities in the best possible way, etc. (1).

The physical health of health care workers should be maintained through the implementation of preventive measures, such as providing personal protective equipment and facilities. Besides protecting the physical health of the front-line personnel, the psychological support for health care workers in terms of training the coping strategies and improving the emotional abilities should be provided by hospitals (11).

3.3. Behavioral Reactions to 2019-nCoV Disease

Behavioral responses have been dramatic during the rising phase of the 2019-nCoV outbreak (19). The behavioral responses depend on physiological processes. The behavioral responses and the ways people respond to 2019-nCoV play an important role in the containment of the outbreak. Making decisions and testing the theories regarding the prevention and control measures should be based on behavioral responses, which are obtained by careful monitoring of the public from the early stage of the outbreak. These data are critical to evaluate strategies of public health communication and estimate the financial costs (42). Little is known about behavioral responses to outbreaks and the ways that behavioral responses affect the epidemiology of disease and economic repercussions (43).

In a study to examine behavioral responses to the SARS outbreak, respondents were asked about recent avoidance and recommended behaviors. The results showed that people with higher anxiety and perceived risks were more likely to carry out all avoidance and recommended behaviors (19). In another study to examine behavioral responses of air travelers to pandemic influenza, people responded to risks by behavioral changes (42).

3.4. Factors Affecting Personal and Social Behavioral Reactions to 2019-nCoV

3.4.1. General Public Perceptions

In outbreaks, public perception is important to shape behavioral responses and motivate people to adopt behavioral changes (44). The knowledge about the public perception of outbreaks is helpful in identifying the best way of encouraging personal and social controlling behaviors (45). The risk perception might lead to voluntary engagement in the implementation of behaviors (20). The public perceptions about the spread have shown discrepancies across Chinese cities. For example, the population in Wuhan as the epicenter of the outbreak showed higher public awareness (46). The perception of the severity and risk of catching the disease and truthiness of information disseminated by authorities has a major role in anxiety and populations’ willingness to change their behaviors (45). The timely dissemination of transparent and accurate data on the number of infected and new cases leads to better adoption of prevention and control measures (47).

The population in unaffected areas may be well aware of the outbreak. In the Netherlands as an unaffected area, 99.6% and 91.2% of the respondents (n = 500) have heard about SARS and the associated pneumonia, respectively (48). The extent of emotional experiences varies between individuals, and everyone elicits a different degree according to the situation (49). For example, in the influenza, A H1N1v outbreak, only 10% - 30% of people were worried about catching the virus (50). The risk perception may differ by gender and level of education (51). Women and rural participants showed higher degrees of fear and anxiety during the 2019-nCoV outbreak (11).

The risk perception might be biased, if it is downplayed, the behavioral responses will be undermined and if it is overstated there will be a load of costs for economic and social aspects. Therefore, the governments or authorities should disseminate the risk of the 2019-nCoV outbreak as it really is (36). This trueness gives people trust and evokes a sense of public cooperation. The way people behave and respond in outbreaks is much related to their risk perception (52, 53). They tend to receive validated and clear information about the risk of deciding how to behave (36, 54, 55). However, there is uncertainty on how people perceive the risk. For example, afraid and angry people are more likely to have increased and decreased perception of risks, respectively (56, 57).

The behavioral responses to the newfound outbreak might be affected by public distress regarding the mortality rate and curability of the disease (47). The contradicted information released by a series of guidelines may confuse the reliability of the information. Cooperation in implementing the prevention and control measures requires the dissemination of validated information. The unclear, late, and inaccurate information about the spread of disease might lead to a lack of trust, misinformation, and hoarding. The misinformation due to a delay in the dissemination of accurate information causes fear responses (58). Besides these consequences of misinformation, the fear of 2019-nCoV infection has led to mutual discrimination between societies such as Chinses and Asian ones and has affected cross-national trades (59). The rumors about the origin of 2019-nCoV resulted in fear-mongering and racism. Chinese people who were living in other countries but had no connection with China were the first victims of this racism (58). Although no one wants the spread of disease, and there are more connections compared to previous coronavirus outbreaks, the fear and stigma might lead to some misinformation about the spread and communication (60). These rumors, perceptions, and behaviors should be responded to by official authorities or scientific centers (58).

3.4.2. Self-Control

Self-control can be defined as self-regulation and effortful executive control or conscientiousness (61). High self-control individuals can better regulate their emotions and behaviors regarding mental, physical, financial, and occupational issues to attain long-term goals (62). The psychological symptoms such as general distress, depression, and anxiety are negatively correlated with self-control (63). Self-control mediates the negative appraisal and mental health problems associated with the 2019-nCoV outbreak. Individuals with higher self-control are less vulnerable to psychological disorders and mental health problems of disasters such as outbreaks. Low self-control people are in more need of psychological aids after the 2019-nCoV outbreak (14).

3.4.3. Stages of Spread

The dissemination of clear and updated information in the stages of the spread of the SARS outbreak resulted in different psychological and behavioral responses. The perception and behavioral changes of 1,397 Hong Kong residents (18 - 60 years) during the SARS outbreak were studied during the outbreak stages. In this article, the implementation of avoidance measures such as avoiding public places and public transit was associated with the phases of the outbreak. April 1, 2003, was considered the peak day for the SARS contradiction. The perceived efficacy about avoiding crowded places was increased at the first phase (before April 1) and decreased at the second phase (after April 1) of the outbreak. However, the perceived efficacy about implementing the hygiene measures such as wearing masks and hand hygiene was high in both phases (47).

3.4.4. Government Practices

The authorities are responsible for the dissemination of accurate information about the outbreaks and associated risks. Furthermore, the government is responsible for raising public awareness and making decisions about preventive and control measures such as strict quarantine and isolation, control of transmission, surveillance, etc. Providing timely and validated information helps in making better decisions based on the information perceived. The feedback on behavioral changes and public perception has an important role in determining further decisions and measures. The government and policymakers should consider that the dissemination of relevant outbreak data to the public is not a threat to the country, and this information help in public perception and better behavioral responses (47). The authorities are responsible for the dissemination of accurate information about the outbreaks and associated risks.

4. Conclusions

There is uncertainty about the duration of the outbreak, the accuracy of the information, and statistical reports of the newfound spread, which leads to panic, confusion, and misunderstanding. There is no effective drug and vaccine for the 2019-nCoV disease. People experience the fear of catching the disease, dying, and loss of loved ones during the current outbreak. The loneliness, helplessness, and financial loss can exacerbate the conditions in isolation. Decision-makers should take prompt measures regarding the provision of preventive psychological interventions to cope with psychological disorders and mental health problems particularly in high-risk groups such as health care workers and those who have been quarantined or isolated. The emotional support of psychological professionals and the dissemination of adequate updated information appease the anxiety and emotion of society. If there is no trust providing the information backfires, the emotion of people can be easily affected by the panic of loneliness and death. Therefore, raising the public awareness of the spread statistics and transmission is a crucial factor in shaping the behavioral responses and perception. In this way, people can adopt the hard situation of the 2019-nCoV outbreak and continue to fight and implement behavioral changes.

Acknowledgements

Footnotes

References

  • 1.

    World Health Organization. Mental health and psychosocial considerations during the COVID-19 outbreak. WHO; 2020.

  • 2.

    Bao Y, Sun Y, Meng S, Shi J, Lu L. 2019-nCoV epidemic: Address mental health care to empower society. Lancet. 2020;395(10224):e37-8. doi: 10.1016/S0140-6736(20)30309-3. [PubMed: 32043982]. [PubMed Central: PMC7133594].

  • 3.

    Dar KA, Iqbal N, Mushtaq A. Intolerance of uncertainty, depression, and anxiety: Examining the indirect and moderating effects of worry. Asian J Psychiatr. 2017;29:129-33. doi: 10.1016/j.ajp.2017.04.017. [PubMed: 29061409].

  • 4.

    Duan L, Zhu G. Psychological interventions for people affected by the COVID-19 epidemic. Lancet Psychiatry. 2020;7(4):300-2. doi: 10.1016/S2215-0366(20)30073-0. [PubMed: 32085840]. [PubMed Central: PMC7128328].

  • 5.

    Ho CS, Chee CY, Ho RC. Mental health strategies to combat the psychological impact of COVID-19 beyond paranoia and panic. Ann Acad Med Singap. 2020;49(3):155-60. [PubMed: 32200399].

  • 6.

    Read JM, Bridgen JRE, Cummings DAT, Ho A, Jewell CP. Novel coronavirus 2019-nCoV: Early estimation of epidemiological parameters and epidemic predictions. MedRxiv. 2020. doi: 10.1101/2020.01.23.20018549.

  • 7.

    Fan F, Long K, Zhou Y, Zheng Y, Liu X. Longitudinal trajectories of post-traumatic stress disorder symptoms among adolescents after the Wenchuan earthquake in China. Psychol Med. 2015;45(13):2885-96. doi: 10.1017/S0033291715000884. [PubMed: 25990926].

  • 8.

    Cheng SK, Wong CW, Tsang J, Wong KC. Psychological distress and negative appraisals in survivors of severe acute respiratory syndrome (SARS). Psychol Med. 2004;34(7):1187-95. doi: 10.1017/s0033291704002272. [PubMed: 15697045].

  • 9.

    Shear MK. Grief and mourning gone awry: Pathway and course of complicated grief. Dialogues Clin Neurosci. 2012;14(2):119-28. [PubMed: 22754284]. [PubMed Central: PMC3384440].

  • 10.

    Commission S. Spring of fear, volumes 1, 2 and 3. Toronto (ON): SARS Commission (Canada); 2006.

  • 11.

    Huang L, Rong LH. Emotional responses and coping strategies of nurses and nursing college students during COVID-19 outbreak. MedRxiv. 2020. doi: 10.1101/2020/03/08/2020.03.05.20031898.

  • 12.

    Wu P, Liu X, Fang Y, Fan B, Fuller CJ, Guan Z, et al. Alcohol abuse/dependence symptoms among hospital employees exposed to a SARS outbreak. Alcohol Alcohol. 2008;43(6):706-12. doi: 10.1093/alcalc/agn073. [PubMed: 18790829]. [PubMed Central: PMC2720767].

  • 13.

    Zandifar A, Badrfam R. Iranian mental health during the COVID-19 epidemic. Asian J Psychiatr. 2020;51:101990. doi: 10.1016/j.ajp.2020.101990. [PubMed: 32163908]. [PubMed Central: PMC7128485].

  • 14.

    Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020. doi: 10.1001/jama.2020.1585. [PubMed: 32031570]. [PubMed Central: PMC7042881].

  • 15.

    Rona RJ, Fear NT, Hull L, Greenberg N, Earnshaw M, Hotopf M, et al. Mental health consequences of overstretch in the UK armed forces: First phase of a cohort study. BMJ. 2007;335(7620):603. doi: 10.1136/bmj.39274.585752.BE. [PubMed: 17664192]. [PubMed Central: PMC1988977].

  • 16.

    Marjanovic Z, Greenglass ER, Coffey S. The relevance of psychosocial variables and working conditions in predicting nurses' coping strategies during the SARS crisis: An online questionnaire survey. Int J Nurs Stud. 2007;44(6):991-8. doi: 10.1016/j.ijnurstu.2006.02.012. [PubMed: 16618485]. [PubMed Central: PMC7094220].

  • 17.

    Hawryluck L, Gold WL, Robinson S, Pogorski S, Galea S, Styra R. SARS control and psychological effects of quarantine, Toronto, Canada. Emerg Infect Dis. 2004;10(7):1206-12. doi: 10.3201/eid1007.030703. [PubMed: 15324539]. [PubMed Central: PMC3323345].

  • 18.

    Van Bortel T, Basnayake A, Wurie F, Jambai M, Koroma AS, Muana AT, et al. Psychosocial effects of an Ebola outbreak at individual, community and international levels. Bull World Health Organ. 2016;94(3):210-4. doi: 10.2471/BLT.15.158543. [PubMed: 26966332]. [PubMed Central: PMC4773931].

  • 19.

    Qian M, Wu Q, Wu P, Hou Z, Liang Y, Cowling BJ, et al. Psychological responses, behavioral changes and public perceptions during the early phase of the COVID-19 outbreak in China: A population based cross-sectional survey. MedRxiv. 2020. doi: 10.1101/2020/02/20/2020.02.18.20024448.

  • 20.

    Kwok KO, Li KK, Chan HH, Yi YY, Tang A, Wei WI, et al. Community responses during the early phase of the COVID-19 epidemic in Hong Kong: Risk perception, information exposure and preventive measures. MedRxiv. 2020. doi: 10.1101/2020.02.26.20028217.

  • 21.

    Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al. Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. Int J Environ Res Public Health. 2020;17(5). doi: 10.3390/ijerph17051729. [PubMed: 32155789]. [PubMed Central: PMC7084952].

  • 22.

    Fiese BH, Tomcho TJ, Douglas M, Josephs K, Poltrock S, Baker T. A review of 50 years of research on naturally occurring family routines and rituals: Cause for celebration? J Fam Psychol. 2002;16(4):381-90. doi: 10.1037//0893-3200.16.4.381. [PubMed: 12561283].

  • 23.

    Irish LA, Kline CE, Gunn HE, Buysse DJ, Hall MH. The role of sleep hygiene in promoting public health: A review of empirical evidence. Sleep Med Rev. 2015;22:23-36. doi: 10.1016/j.smrv.2014.10.001. [PubMed: 25454674]. [PubMed Central: PMC4400203].

  • 24.

    Chekroud SR, Gueorguieva R, Zheutlin AB, Paulus M, Krumholz HM, Krystal JH, et al. Association between physical exercise and mental health in 1.2 million individuals in the USA between 2011 and 2015: A cross-sectional study. Lancet Psychiatry. 2018;5(9):739-46. doi: 10.1016/s2215-0366(18)30227-x.

  • 25.

    Fehr E, Schurtenberger I. Normative foundations of human cooperation. Nat Hum Behav. 2018;2(7):458-68. doi: 10.1038/s41562-018-0385-5. [PubMed: 31097815].

  • 26.

    Carter H, Drury J, Rubin GJ, Williams R, Amlôt R. The effect of communication during mass decontamination. Disaster Prevent Manage. 2013;22(2):132-47. doi: 10.1108/09653561311325280.

  • 27.

    Fehr E, Gächter S. Cooperation and punishment in public goods experiments. Am Econ Rev. 2000;90(4):980-94. doi: 10.1257/aer.90.4.980.

  • 28.

    Masclet D, Noussair C, Tucker S, Villeval MC. Monetary and nonmonetary punishment in the voluntary contributions mechanism. Am Econ Rev. 2003;93(1):366-80. doi: 10.1257/000282803321455359.

  • 29.

    Chong MY, Wang WC, Hsieh WC, Lee CY, Chiu NM, Yeh WC, et al. Psychological impact of severe acute respiratory syndrome on health workers in a tertiary hospital. Br J Psychiatry. 2004;185:127-33. doi: 10.1192/bjp.185.2.127. [PubMed: 15286063].

  • 30.

    Tiong WW, Koh GC. Ethical considerations in the review of Singapore's H1N1 pandemic response framework in 2009. Ann Acad Med Singap. 2013;42(5):246-50. [PubMed: 23771113].

  • 31.

    Naushad VA, Bierens JJ, Nishan KP, Firjeeth CP, Mohammad OH, Maliyakkal AM, et al. A systematic review of the impact of disaster on the mental health of medical responders. Prehosp Disaster Med. 2019;34(6):632-43. doi: 10.1017/S1049023X19004874. [PubMed: 31625487].

  • 32.

    Wu P, Fang Y, Guan Z, Fan B, Kong J, Yao Z, et al. The psychological impact of the SARS epidemic on hospital employees in China: Exposure, risk perception, and altruistic acceptance of risk. Can J Psychiatry. 2009;54(5):302-11. doi: 10.1177/070674370905400504. [PubMed: 19497162]. [PubMed Central: PMC3780353].

  • 33.

    Sprang G. Vicarious stress: Patterns of disturbance and use of mental health services by those indirectly affected by the Oklahoma City bombing. Psychol Rep. 2001;89(2):331-8. doi: 10.2466/pr0.2001.89.2.331. [PubMed: 11783558].

  • 34.

    Jiafang Z, Jiachun W, Yunxia L, Xiaoxia Q, Ya F. Alcohol abuse in a metropolitan city in China: A study of the prevalence and risk factors. Addiction. 2004;99(9):1103-10. doi: 10.1111/j.1360-0443.2004.00799.x. [PubMed: 15317630].

  • 35.

    Kaysen D, Resick PA, Wise D. Living in danger: The impact of chronic traumatization and the traumatic context on posttraumatic stress disorder. Trauma Violence Abuse. 2003;4(3):247-64. doi: 10.1177/1524838003004003004. [PubMed: 14697125].

  • 36.

    Lunn PD, Belton CA, Lavin C, McGowan FP, Timmons S, Robertson DA. Using behavioral science to help fight the coronavirus. J Behav Public Adm. 2020;3(1). doi: 10.30636/jbpa.31.147.

  • 37.

    Cacioppo JT, Hughes ME, Waite LJ, Hawkley LC, Thisted RA. Loneliness as a specific risk factor for depressive symptoms: Cross-sectional and longitudinal analyses. Psychol Aging. 2006;21(1):140-51. doi: 10.1037/0882-7974.21.1.140. [PubMed: 16594799].

  • 38.

    Cacioppo S, Capitanio JP, Cacioppo JT. Toward a neurology of loneliness. Psychol Bull. 2014;140(6):1464-504. doi: 10.1037/a0037618. [PubMed: 25222636]. [PubMed Central: PMC5130107].

  • 39.

    Sim K, Huak Chan Y, Chong PN, Chua HC, Wen Soon S. Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease. J Psychosom Res. 2010;68(2):195-202. doi: 10.1016/j.jpsychores.2009.04.004. [PubMed: 20105703]. [PubMed Central: PMC7094450].

  • 40.

    Maunder RG, Lancee WJ, Balderson KE, Bennett JP, Borgundvaag B, Evans S, et al. Long-term psychological and occupational effects of providing hospital healthcare during SARS outbreak. Emerg Infect Dis. 2006;12(12):1924-32. doi: 10.3201/eid1212.060584. [PubMed: 17326946]. [PubMed Central: PMC3291360].

  • 41.

    Carlson LE. Mindfulness-based interventions for physical conditions: A narrative review evaluating levels of evidence. ISRN Psychiatry. 2012;2012:651583. doi: 10.5402/2012/651583. [PubMed: 23762768]. [PubMed Central: PMC3671698].

  • 42.

    Fenichel EP, Kuminoff NV, Chowell G. Skip the trip: Air travelers' behavioral responses to pandemic influenza. PLoS One. 2013;8(3). e58249. doi: 10.1371/journal.pone.0058249. [PubMed: 23526970]. [PubMed Central: PMC3604007].

  • 43.

    Smith RD. Responding to global infectious disease outbreaks: Lessons from SARS on the role of risk perception, communication and management. Soc Sci Med. 2006;63(12):3113-23. doi: 10.1016/j.socscimed.2006.08.004. [PubMed: 16978751]. [PubMed Central: PMC7130909].

  • 44.

    Fung IC, Cairncross S. Effectiveness of handwashing in preventing SARS: A review. Trop Med Int Health. 2006;11(11):1749-58. doi: 10.1111/j.1365-3156.2006.01734.x. [PubMed: 17054756]. [PubMed Central: PMC7169732].

  • 45.

    Rubin GJ, Amlot R, Page L, Wessely S. Public perceptions, anxiety, and behaviour change in relation to the swine flu outbreak: Cross sectional telephone survey. BMJ. 2009;339:b2651. doi: 10.1136/bmj.b2651. [PubMed: 19574308]. [PubMed Central: PMC2714687].

  • 46.

    Chen H, Xu W, Paris C, Reeson A, Li X. Social distance and SARS memory: Impact on the public awareness of 2019 novel coronavirus (COVID-19) outbreak. MedRxiv. 2020.

  • 47.

    Lau JT, Yang X, Tsui H, Kim JH. Monitoring community responses to the SARS epidemic in Hong Kong: From day 10 to day 62. J Epidemiol Community Health. 2003;57(11):864-70. doi: 10.1136/jech.57.11.864. [PubMed: 14600111]. [PubMed Central: PMC1732318].

  • 48.

    Brug J, Aro AR, Oenema A, de Zwart O, Richardus JH, Bishop GD. SARS risk perception, knowledge, precautions, and information sources, the Netherlands. Emerg Infect Dis. 2004;10(8):1486-9. doi: 10.3201/eid1008.040283. [PubMed: 15496256]. [PubMed Central: PMC3320399].

  • 49.

    Khalid I, Khalid TJ, Qabajah MR, Barnard AG, Qushmaq IA. Healthcare workers emotions, perceived stressors and coping strategies during a MERS-CoV outbreak. Clin Med Res. 2016;14(1):7-14. doi: 10.3121/cmr.2016.1303. [PubMed: 26847480]. [PubMed Central: PMC4851451].

  • 50.

    Rubin GJ, Potts HW, Michie S. The impact of communications about swine flu (influenza A H1N1v) on public responses to the outbreak: Results from 36 national telephone surveys in the UK. Health Technol Assess. 2010;14(34):183-266. doi: 10.3310/hta14340-03. [PubMed: 20630124].

  • 51.

    Lau CK, Diem MD, Dreyfuss G, Van Duyne GD. Structure of the Y14-Magoh core of the exon junction complex. Curr Biol. 2003;13(11):933-41. doi: 10.1016/s0960-9822(03)00328-2. [PubMed: 12781131].

  • 52.

    Brewer NT, Weinstein ND, Cuite CL, Herrington JE. Risk perceptions and their relation to risk behavior. Ann Behav Med. 2004;27(2):125-30. doi: 10.1207/s15324796abm2702_7. [PubMed: 15026296].

  • 53.

    Kahneman D, Tversky A. Choices, values, and frames. Cambridge: Cambridge University Press; 2019. doi: 10.1017/cbo9780511803475.

  • 54.

    Sheeran P, Harris PR, Epton T. Does heightening risk appraisals change people's intentions and behavior? A meta-analysis of experimental studies. Psychol Bull. 2014;140(2):511-43. doi: 10.1037/a0033065. [PubMed: 23731175].

  • 55.

    Fehr-Duda H, Epper T. Probability and risk: Foundations and economic implications of probability-dependent risk preferences. Ann Rev Econo. 2012;4(1):567-93. doi: 10.1146/annurev-economics-080511-110950.

  • 56.

    Lerner JS, Gonzalez RM, Small DA, Fischhoff B. Effects of fear and anger on perceived risks of terrorism: A national field experiment. Psychol Sci. 2003;14(2):144-50. doi: 10.1111/1467-9280.01433. [PubMed: 12661676].

  • 57.

    Pachur T, Hertwig R, Steinmann F. How do people judge risks: Availability heuristic, affect heuristic, or both? J Exp Psychol Appl. 2012;18(3):314-30. doi: 10.1037/a0028279. [PubMed: 22564084].

  • 58.

    Depoux A, Martin S, Karafillakis E, Preet R, Wilder-Smith A, Larson H. The pandemic of social media panic travels faster than the COVID-19 outbreak. J Travel Med. 2020;27(3). doi: 10.1093/jtm/taaa031. [PubMed: 32125413]. [PubMed Central: PMC7107516].

  • 59.

    Sahin AR. 2019 novel coronavirus (COVID-19) outbreak: A review of the current literature. Eurasian J Med Oncol. 2020. doi: 10.14744/ejmo.2020.12220.

  • 60.

    Kobayashi T, Jung SM, Linton NM, Kinoshita R, Hayashi K, Miyama T, et al. Communicating the risk of death from novel coronavirus disease (COVID-19). J Clin Med. 2020;9(2). doi: 10.3390/jcm9020580. [PubMed: 32098019]. [PubMed Central: PMC7073841].

  • 61.

    Moffitt TE, Arseneault L, Belsky D, Dickson N, Hancox RJ, Harrington H, et al. A gradient of childhood self-control predicts health, wealth, and public safety. Proc Natl Acad Sci U S A. 2011;108(7):2693-8. doi: 10.1073/pnas.1010076108. [PubMed: 21262822]. [PubMed Central: PMC3041102].

  • 62.

    Duckworth AL. The significance of self-control. Proc Natl Acad Sci U S A. 2011;108(7):2639-40. doi: 10.1073/pnas.1019725108. [PubMed: 21300864]. [PubMed Central: PMC3041117].

  • 63.

    Bowlin SL, Baer RA. Relationships between mindfulness, self-control, and psychological functioning. Pers Individ Dif. 2012;52(3):411-5. doi: 10.1016/j.paid.2011.10.050.

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