Adherence to the Recommendations from the Portuguese General Directorate of Health (GDH) during the COVID-19 pandemic: fear or prosocial behaviour?

Introduction: During a public health crisis, preventive measures are essential. However, to make them effective, all citizens must be engaged. Objective(s): To analyse the differential role of individual and contextual variables in the adherence to public health recommendations. Method(s): 1376 adults (70.5% female;mean age=35.55+/-14.27) completed a survey between September/2020 and May/2021 with: Adherence Scale to the Recommendations during COVID-19 (ASR-COVID19;evaluates three dimensions of adherence), Fear of Covid-19 Scale (FC19S) and Toronto and Coimbra Prosocial Behaviour Questionnaire (ProBeQ;assesses empathy and altruism). Result(s): Adherence did not differ between individuals with or without personal or family history of COVID-19 infection. ASRCOVID19 and all dimensions were positively correlated to ProBeQ's altruism and empathy (from r=.32 to r=.54);FCV19S correlated positively to total adherence score and house sanitation (from r=.18 to r=.26;all p<.01). Linear regressions revealed that altruism and empathy (first model), as well as fear of Covid-19 (second model), were significant predictors of adherence;however, while the first model explained ffi28% of its variance, the second (FCV19S as independent variable) only explained ffi3%. Regression models performed in a subsample of participants with personal or family history of COVID-19 revealed that only empathy, but not altruism, was a significant predictor of adherence;in this subsample, fear was no longer a significant predictor of adherence, except for lockdown and use of teleservices. Conclusion(s): Based on our results, we suggest health care providers and public health campaigns should take into consideration social solidarity and altruism, as well as previous experiences, when appealing to public's engagement in health behaviour.

From Perceived Vulnerability to Disease to Psychological Distress in times of COVID19 pandemic

Introduction: Perceived vulnerability to disease/PVD may influence psychological reactions to COVID-19 pandemic. Objective(s): To analyse the role of PVD in psychological distress/PD during the COVID-19 pandemic, testing whether it is mediated by perceived risk of COVID-19, fear of COVID-19 and repetitive negative thinking/RNT. Method(s): Participants (N=413 adults;69.2% women) were recruited from September until December 2020, via social networks. They completed the following self-report validated questionnaires: Perceived Vulnerability to Disease Questionnaire/ PVDQ;Perceived Risk of COVID-19 Scale, Fear of COVID-19 Scale;Perseverative Thinking Questionnaire and Depression Anxiety and Stress Scale. As women had significantly higher levels of PVD, COVID-19 perceived risk and fear, RNT, and psychological distress/PD, gender was controlled in mediation analysis (using PROCESS macro for SPSS;Hayes 2018). Result(s):All the variables significantly (p<.01), moderately (r>.20) and positively correlated. The serial mediation model 6 with the three sequential mediators resulted in significant total effect (c=.326, se=.0791, p<.001, CI:.1702-.4814), non-significant direct effect (c'=.111, se=.065, p=.087, CI:-.0162 to .2380), significant total indirect effect (.2149, se=.065, CI:.1079-.3278);most indirect effects were significant, including the indirect 7 (.0144, se=.0077, CI=.0017-.0320), that goes through all mediators (PVD->COVID19 perceived risk->COVID19 fear->RNT->PD), meaning full mediation. Conclusion(s): The effect of PVD on psychological distress operates by increasing the perception of risk and the fear of COVID-19, which intensify related worries and ruminations in times of pandemic. People with high perceived threat, aversion and discomfort in situations associated with increased risk of infection should be helped to decrease dysfunctional cognitive contents and processes in times of pandemic.

Relationship between personality, adherence to (mental) health behaviours and psychological distress during the COVID-19 pandemic

Introduction: Public health authorities around the world have been disseminating messages to support mental health and psychosocial well-being during the COVID-19 pandemic. Based on the Portuguese guidelines, we have developed the Adherence Scale to the RecommendationsforMental Health during the COVID-19 Pandemic (ASR-MH-COVID19) to better understand this health behaviour. Objective(s): To analyse the relationship between sociodemographics, personality traits, Adherence (to the Recommendations for Mental Health during the COVID-19 Pandemic) and psychological distress. Method(s): 413 individuals (69.2% female;mean age=31.02+/-14,272) completed an on-line survey, in September-December 2020, including sociodemographic questions, ASR-MH-COVID19, NEO-FFI-20 and Depression Anxiety Stress Scale (DASS-21) and Health Perception Scale. Result(s):Adherence scores did not significantly differ by gender, age and years of education. Women presented higher DASS and Neuroticism scores (p<.01). Adherence were negatively correlated with Neuroticism (r=-.247) and with Depression/Anxiety/Stress (all r.- 200), positively with Openness to Experience (r=.174), Conscientiousness (r=.194) and Perceived Health (Physical, r=.173 and Psychological, r=.215) (all p<.01). Mediation analysis (Hays' Macro Process - Model 4) revealed that Adherence is a partial mediator between Openness and DASS and Conscientiousness and DASS;when considering Neuroticism, only the direct effect was significant. The effect of Perceived Health (both Physical and Psychological) on DASS was also mediated by Adherence. Conclusion(s): The Health Behaviour Model proposes a pathway linking personality and health that applies to these results about adherence and psychological distress during the COVID-19 pandemic. Personality and perceived health (also a trait) influence both adherence to mental health behaviours and psychological distress. Understanding personality is vital for health care providers.

Adherence Scale to the Recommendations for Mental Health during the COVID-19 pandemic from the Portuguese General Directorate of Health (ASR-MHCOVID19) - Development and validation

Introduction: The COVID-19 crisis has generated an increasing stress throughout the population. Objective(s): To develop and validate the Adherence Scale to the Recommendations for Mental Health during the COVID-19 pandemic from the Portuguese General Directorate of Health (GDH) (ASR-MH-COVID19). Method(s): The items content was based on the GDH guides for the prevention of mental health and psychosocial well-being of the general population during the COVID-19 outbreak. After content and facial validity analysis, the preliminary version of the ASR-MHCOVID19 (8 items to be answered on a Likert scale) was completed by 413 individuals (69.2% female;mean age=31.02+/-14,272), in September-December 2020 (Sample1) and then by 967 (70.9% female;mean age=34.02+/-14,272), in February-May 2021 (Sample2). Sample1 was randomly divided in two sub-samples. Sample1A was used for exploratory factor analysis/EFA and Sample1B for confirmatory factor analysis/CFA;CFA was then replicated with Sample2. The online surveys also included the Adherence Scale to the Recommendations of Portuguese GDH to minimize the impact of COVID-19 (ASR-COVID-19;Pereira et al. 2020). Result(s): CFAs were informed by EFA and showed that the unidimensional model presented acceptable-good fit indexes (Sample1B: chi2 /df=2.747;RMSEA=.0980, p<.001;CFI=.973;TLI=.918, GFI=.972;Sample2: chi2 /df=3.327;RMSEA=.0490, p<.001;CFI=.993;TLI=.983, GFI=.990). Cronbach's alfas were alpha<.850. Pearson correlations between ASR-MH-COVID19 and ASR-COVID19 were significant (p<.01) and moderate-high for the total (r=.753) and dimensional scores (Distance and respiratory hygiene, r=.739;House and personal hygiene, r=.584;Use of remote services and isolation r=.425). Conclusion(s): The new ASR-MH-COVID19 has shown validity and reliability, allowing the investigation of this (mental) health behaviour.

Worries during the COVID-19 pandemic - which were the most prevalent and disturbing?

Introduction: The COVID-19 pandemic has brought additional worries and challenges to people's lives, with potential implications for psychological well-being. Objective(s): To understand which worries and life changes have affected most the Portuguese general population during the COVID-19 pandemic and to analyse which contents are associated with higher levels of repetitive negative thinking/RNT and psychological distress/PD. Method(s): In September-December 2020, 413 Portuguese adults (69.2% female;Mean age= 31.02+/-14.272) were asked one open questions, with reference to the COVID-19 pandemic period: "what was your biggest worry?" the answers were independently categorized by two researchers. Participants also filled the validated Depression Anxiety and Stress Scale and the Perseverative Thinking Questionnaire. Result(s): The most prevalent worries were about: 1) fear of contamination (oneself and others-48.7%;2) physical and mental health and well-being (self and others)-27.2%;3) studies and profession-13.3%;4) uncertainty about the future-7.7%;5) economic-financial issues-6.5%;6) miscellaneous-3.3%;7) no worries-0.7%. Participants who had worries of the theme 4 had the highest RNT and PD mean scores, followed by themes 3 and 5, and then themes 2 and 1. These thematic groups significantly (p<.01) differ between each other (except 3-5) and from the other groups. RNT was a significant predictor of PD (R2 =37.0%, beta=.609, p<.001). Conclusion(s): People who worry about the future uncertainties, occupational activities and finances should be systematically assessed with regard to their levels of anxiety, depression and stress and they can learn to deal with the RNT as a way to reduce their psychological suffering in times of pandemic.