Perceived Beliefs, Uncertainty, and Behavioral Responses During the COVID-19 Outbreak in China: Findings From a Convenience Sample.

PURPOSE: To investigate perceived beliefs, uncertainty, and behavioral responses among Chinese residents toward the COVID-19 outbreak, and explore their relationships amid an incipient pandemic. DESIGN: A cross-sectional correlational survey with a combination of a convenience and snowball sampling design. SETTING: This study was conducted online from February 7 to 14, 2020, the third week after the lockdown of Wuhan city on January 23. PARTICIPANTS: A total of 2,654 residents was contacted, 2,534 agreed to participate, and 2,215 completed valid questionnaires. The sample covered 30 provinces, municipalities, autonomous regions of China, and a broader region. MEASURES: The Uncertainty About COVID-19 Scale was applied to assess perceived public uncertainty. Five dimensions of health beliefs about COVID-19 and 12 health-related response behaviors were measured. ANALYSIS: Univariate analysis and multiple linear regression models were used to identify associations. Mediation was assessed by a bootstrapping technique. RESULTS: Five constructs of health beliefs were found to be significant predictors of multiple response behaviors. Uncertainty about COVID-19 has a direct relationship with general response behaviors (ß=-0.119**) and sanitization practices (ß=-0.068**). Emergency coping behaviors aside, uncertainty also partially mediated associations between perceived susceptibility, perceived effectiveness, and perceived barriers influencing general response behaviors and sanitization practices, respectively. CONCLUSION: Findings provide evidence-based information to government and policymakers for designing effective health communication messages and intervention strategies by targeting the key constructs of the health belief model and reducing perceived uncertainty about COVID-19. They support public health-related response behaviors to prevent COVID-19 spread among the population.

Social distancing predicts suicide rates: Analysis of the 1918 flu pandemic in 43 large cities, research note.

Social distancing (e.g., school and business closings) has been emphasized in current sociopolitical efforts in controlling COVID-19. Such policies are assumed to increase suicide risk through lowering social integration. While two studies have linked the presence of a pandemic to suicide rates, no study has assessed the degree of social distancing on suicide rates during a pandemic. The present study fills this gap with data on the extent of social distancing during the Spanish flu epidemic in 43 large cities. The results find that increasing social distancing increases suicide rates independent of the influenza mortality rate.

Fatal self-injury in the United States, 1999-2018: Unmasking a national mental health crisis.

BACKGROUND: Suicides by any method, plus 'nonsuicide' fatalities from drug self-intoxication (estimated from selected forensically undetermined and 'accidental' deaths), together represent self-injury mortality (SIM)-fatalities due to mental disorders or distress. SIM is especially important to examine given frequent undercounting of suicides amongst drug overdose deaths. We report suicide and SIM trends in the United States of America (US) during 1999-2018, portray interstate rate trends, and examine spatiotemporal (spacetime) diffusion or spread of the drug self-intoxication component of SIM, with attention to potential for differential suicide misclassification. METHODS: For this state-based, cross-sectional, panel time series, we used de-identified manner and underlying cause-of-death data for the 50 states and District of Columbia (DC) from CDC's Wide-ranging Online Data for Epidemiologic Research. Procedures comprised joinpoint regression to describe national trends; Spearman's rank-order correlation coefficient to assess interstate SIM and suicide rate congruence; and spacetime hierarchical modelling of the 'nonsuicide' SIM component. FINDINGS: The national annual average percentage change over the observation period in the SIM rate was 4.3% (95% CI: 3.3%, 5.4%; p<0.001) versus 1.8% (95% CI: 1.6%, 2.0%; p<0.001) for the suicide rate. By 2017/2018, all states except Nebraska (19.9) posted a SIM rate of at least 21.0 deaths per 100,000 population-the floor of the rate range for the top 5 ranking states in 1999/2000. The rank-order correlation coefficient for SIM and suicide rates was 0.82 (p<0.001) in 1999/2000 versus 0.34 (p = 0.02) by 2017/2018. Seven states in the West posted a ≥ 5.0% reduction in their standardised mortality ratios of 'nonsuicide' drug fatalities, relative to the national ratio, and 6 states from the other 3 major regions a >6.0% increase (p<0.05). INTERPRETATION: Depiction of rising SIM trends across states and major regions unmasks a burgeoning national mental health crisis. Geographic variation is plausibly a partial product of local heterogeneity in toxic drug availability and the quality of medicolegal death investigations. Like COVID-19, the nation will only be able to prevent SIM by responding with collective, comprehensive, systemic approaches. Injury surveillance and prevention, mental health, and societal well-being are poorly served by the continuing segregation of substance use disorders from other mental disorders in clinical medicine and public health practice. FUNDING: This study was partially funded by the National Centre for Injury Prevention and Control, US Centers for Disease Control and Prevention (R49CE002093) and the US National Institute on Drug Abuse (1UM1DA049412-01; 1R21DA046521-01A1).