The relationship between COVID-19 Stressors and health behaviours

9 June 2022

The pandemic is teaching us key lessons about the relationship between different types of stressors and health outcomes. In a recent study published in Preventive Medicine Reports, Dr Shian-Ling Keng, Associate Professor of Clinical Psychology 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 has 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.

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 7,902 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. Diet and sleep quality were the lowest among those reported high levels of COVID-19 infection risk and economic burden. Neither binge drinking nor physical exercise was associated with perceived COVID-19 infection risk, economic burden, or 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 an associate professor in 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.

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. 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 the use of coping strategies such as problem-solving and avoidance.