Annotated bibliography

profileIbie
ThePsychologicalImpactofCOVID-19inCanada.pdf

Canadian Psychology/Psychologie canadienne The Psychological Impact of COVID-19 in Canada: Effects of Social Isolation During the Initial Response Lisa A. Best, Moira A. Law, Sean Roach, and Jonathan M. P. Wilbiks Online First Publication, September 3, 2020. http://dx.doi.org/10.1037/cap0000254

CITATION Best, L. A., Law, M. A., Roach, S., & Wilbiks, J. M. P. (2020, September 3). The Psychological Impact of COVID-19 in Canada: Effects of Social Isolation During the Initial Response. Canadian Psychology/Psychologie canadienne. Advance online publication. http://dx.doi.org/10.1037/cap0000254

The Psychological Impact of COVID-19 in Canada: Effects of Social Isolation During the Initial Response

Lisa A. Best, Moira A. Law, Sean Roach, and Jonathan M. P. Wilbiks University of New Brunswick Saint John

Canadian public health officials responded to the unprecedented global outbreak of coronavirus disease 2019 (COVID-19) by invoking public health measures ranging from extreme (e.g., quarantine) to lighter (e.g., social distancing) measures. Although necessary to mitigate disease spread, the psychological impact of social distancing and isolation is unknown (Wang et al., 2020). The impetus of this study were calls for research to compare the psychological effects of extreme and lighter measures (see Brooks et al., 2020), and our purpose was to examine the impact of COVID-19 on psychological distress to determine whether negative effects were present during the initial stages of social distancing/isolation measures. In this study, questionnaire data measuring satisfaction with life, social cohesion, psychological distress, and perceptions of risk was collected from 1381 Canadians during the early days of intense public health measures (31 March through 15 April 2020). Results suggest that even short-term social distancing practices are associated with increased psychological distress, including elevated levels of overall distress, such as panic, emotional disturbances, and depression. These results are noteworthy for several reasons: the timing of the distress, the population under investigation, and the fact that the applied mitigation was “lighter” than full quarantines previously studied. These findings suggest that after only a short period of time, less restrictive public health measures can lead to psychological distress. These results have major significance for government officials in future public health crisis as they judiciously weigh the costs and benefits of applying such measures with various public health guidelines discussed.

Public Significance Statement During a global infectious disease pandemic, public health measures are often required to slow the spread of the disease. Although these measures are necessary, they can have negative effects on mental health. Even during the first few weeks of the COVID-19 outbreak, we found that there was a psychological impact on Canadian residents. People who perceived that COVID-19 presented a large risk were more likely to feel panic, depression, and emotional disturbances. We also found that females and people who were younger were likely to experience more psychological distress. Public health officials should keep this in mind when implementing public health measures during potential subsequent waves of the pandemic.

Keywords: COVID-19, psychological distress, risk perception, short-term social distancing, social isolation

The current coronavirus disease 2019 (COVID-19) pandemic is unprecedented. As Canadian public health officials swiftly man- aged the outbreak that swept across the country, they often had to make decisions without much scientific evidence concerning the

potential effects of those decisions. Extraordinary restrictions that included school and daycare closures, prohibitions on gatherings, closures of nonessential businesses, travel restrictions into prov- inces/territories/country, and mandatory self-isolation for travelers for approximately 14 days were levied (Government of Canada, 2020). Although these measures were necessary to prevent the spread of disease, the short- and long-term effects on the psycho- logical wellness of Canadians could be significant (Brooks et al., 2020). Data collected during the first wave of the COVID-19 pandemic can help us to understand those effects, informing pol- icies that will be implemented during subsequent waves of COVID-19 or during future infectious outbreaks.

Mental Health Impacts of Public Health Measures

There is a toolbox of potential measures available to public health authorities in a pandemic scenario. The most extreme of

Editor’s Note. This article received a rapid review by one external reviewer and the Editorial team.—VMG

X Lisa A. Best, Moira A. Law, X Sean Roach, and X Jonathan M. P. Wilbiks, Department of Psychology, University of New Brunswick Saint John.

Correspondence concerning this article should be addressed to Lisa A. Best, Department of Psychology, University of New Brunswick Saint John, 100 Tucker Park Road, Saint John, NB E2K 5E2, Canada. E-mail: [email protected]

Canadian Psychology / Psychologie canadienne ISSN: 0708-5591 2020, Vol. 2, No. 999, 000 © 2020 Canadian Psychological Association http://dx.doi.org/10.1037/cap0000254

1

these is quarantine confinement of exposed individuals to a single location for a predetermined period of time, and, although highly effective at limiting the spread of infectious disease, this isolation can lead to significant psychological distress (Bai et al., 2004) and may not be practical in situations when risk of infection continues over long periods of time. Responses during the current pandemic have varied, with some countries (e.g., Italy; Government of Italy, 2020) recommending more restrictive measures than others (e.g., United States; Government of the United States, 2020). The short- and long-term mental health impact of such policies was, for the most part, unknown at the time the policies were enacted, although in subsequent months evidence began to emerge from countries that reported early cases of COVID-19 (e.g., Zhang & Ma, 2020).

Quarantine has been associated with negative psychological effects, including posttraumatic stress, depression, and fear (Blen- don, Benson, DesRoches, Raleigh, & Taylor-Clark, 2004; Liu et al., 2012; Sprang & Silman, 2013). These negative effects vary in severity and are dependent upon factors such as the duration of quarantine, fear of infection, and reliance on different sources of information (Cava, Fay, Beanlands, McCay, & Wignall, 2005; Desclaux, Badji, Ndione, & Sow, 2017; Hawryluck et al., 2004; Pellecchia et al., 2015). Given the potential for significant negative long-term mental health effects of quarantine, it has been sug- gested that governments should first exhaust less restrictive op- tions, for example, voluntary self-isolation (Barbisch, Koenig, & Shih, 2015; Rubin & Wessely, 2020). Although previous research has examined the effects of a full quarantine (Robertson, Hersh- enfield, Grace, & Stewart, 2004; Taylor, Agho, Stevens, & Ra- phael, 2008; Wang et al., 2011), relatively little is known about the mental health impacts of less restrictive practices (Brooks et al., 2020). This is particularly important to investigate given that the cumulative negative psychological impact of these various smaller restrictions, for example, separation from loved ones, reduced social gatherings, travel restrictions, may occur more quickly than presumed. These negative experiences can later impair an individ- ual’s and community’s return to prepandemic functioning.

Increased psychological distress is known to adversely impact many domains related to public policy including, but not limited to, job performance/retention (de Graaf et al., 2012), optimal family functioning (Crowe & Lyness, 2014), utilization of health care services (Simo, Bamvita, Caron, & Fleury, 2018), and edu- cational outcomes (Holmes & Silvestri, 2016), rendering this re- search foundational for informing the psychosocial components of public health guidelines during the outbreak and perhaps more importantly the post-pandemic recovery. The psychological impact of these alternative public health measures has never been assessed (Brooks et al., 2020).

Cognitive-Emotional Responses

Satisfaction with life is reported subjectively and encompasses cognitive (assessment of life circumstances) and emotional (as- sessment of negative emotions) factors (Tay, Kuykendall, & Die- ner, 2015). In previous research, satisfaction with life has been associated with better mental and physical health (Fergusson et al., 2015; Pavot & Diener, 2008), self-esteem (Kang, Shaver, Sue, Min, & Jing, 2003), positive affect (Palmer, Donaldson, & Stough, 2002), optimism (Steger, Frazier, Oishi, & Kaler, 2006), and health-promoting behaviours (Grant, Wardle, & Steptoe, 2009).

Conversely, lower levels of satisfaction with life have been asso- ciated with a number of measures of psychological distress, in- cluding depression (Schimmack, Oishi, Furr, & Funder, 2004), negative affect (Chang, Watkins, & Banks, 2004), pessimism, perceived stress, and suicidal ideation (Chang & Sanna, 2001).

In addition to overall satisfaction with life, a lack of social connectedness and increased loneliness are associated with nega- tive mental health outcomes (DiTommaso, Brannen, & Best, 2004; Taylor et al., 2007). Both social connectedness and loneliness are connected to the concept of social cohesion, which is defined by the ability of members within a society to exhibit mutual respect and work together in the interest of shared goals and the common good. Although specific definitions of social cohesion within the literature vary, one recent review emphasised a sense of belonging, tolerance, and equal rights among society members (Fonseca, Lukosch, & Brazier, 2019). Social cohesion has been positively associated with physical and mental health (Rios, Aiken, & Zautra, 2012), as well as health behaviours such as exercise and not smoking (Echeverría, Diez-Roux, Shea, Borrell, & Jackson, 2008). Given the recommendations for social/physical distancing, isola- tion, and international and interprovincial travel restrictions, the effects of social connectedness to one’s community could be protective and possibly mitigate negative effects of isolation.

Information Sources and Mental Health

Although an infectious disease pandemic and associated preven- tative regulations primarily concern physical well-being, the type of information that an individual receives during a crisis has an influence on their perception of risk and psychological responses to an outbreak. In Hong Kong, trust in reliable government- provided information about influenza was positively associated with clear understanding of the causes of H1N1 and, conversely, trust in informal information was positively associated with in- creased worry surrounding influenza (Liao, Cowling, Lam, Ng, & Fielding, 2010). During the early stages of the COVID-19 pan- demic in China, Wang et al. (2020) examined the effect of accurate information and found that levels of depression, anxiety, and stress were lower in people who had received accurate health informa- tion than those relying on inaccurate information. Thus, the degree to which an individual experiences distress attributable to the onset of a pandemic may be modulated by the information sources they consume, which ranges from data-driven information to politically charged information coming from certain sources of mass media or social media.

Purpose of the Current Study

Brooks et al. (2020) suggested that research is required to establish the effectiveness of nonquarantine public health mea- sures, as well as the short- and long-term mental health effects of these measures. Thus, the purpose of the current research was to explore the correlates of psychological distress during the earliest stages of the COVID-19 pandemic in Canada. Given that there is a paucity of literature focused on the psychological consequences during the earliest stages of a global pandemic, we focused on established correlates of psychological wellness and distress, in- cluding satisfaction with life (Diener, Emmons, Larsen, & Griffin, 1985), social connectedness (Li, Kao, & Dinh, 2015), depression

2 BEST, LAW, ROACH, AND WILBIKS

(Liu et al., 2012), and anxiety (Lau, Griffiths, Choi, & Tsui, 2009, 2010). Our primary purpose was to examine how measures of disease anxiety, risk perceptions, and social cohesion correlated with measures of psychological wellness during the implementa- tion of social distancing and isolation measures put in place during the early stages of the COVID-19 pandemic in Canada. Research such as this fills the gap in knowledge and provides policymakers with information on the psychological effects of the current public health crisis. To offer policymakers a broader knowledge base to guide decision making during future outbreaks, our second pur- pose was to determine whether different sources of information (i.e., public health, social media) and level of education were associated with psychological distress and perception of risk.

Method

Participants

In total, 297 males (Mage � 43.48, SD � 17.39), 1,072 females (Mage � 40.61, SD � 14.76), and 12 individuals not identifying as either male or female (Mage � 34.17, SD � 15.35) completed the online questionnaire package. The participants ranged in age from 16 to 100 years old, with an overall mean of 41.16 years (SD � 15.42), and a median of 41.00 years (IQR � 24). All participants reported that they lived in Canada at the time of data collection. Participants were well educated, with most currently enrolled in (n � 257) or completed (n � 416) postsecondary education programs, with an additional 464 participants who were enrolled in or had completed a graduate or professional program. The majority of participants were White (n � 1295, 93.4%), with East Asian/ Asian (n � 34, 2.5%), Black (n � 12, 0.9%), Middle Eastern (n � 9, 0.6%), Latin American (n � 7, 0.5%), Aboriginal/First Nations (n � 2, 0.1%), and Other (n � 26, 1.9%).

Materials

Satisfaction With Life Scale (SWLS; Diener et al., 1985). The SWLS is a five-item questionnaire rated on a 7-point Likert- type scale ranging from strongly agree to strongly disagree, with higher scores indicating higher satisfaction. This scale assesses general satisfaction with life and does not differentiate between different life domains. An open-ended question, “Is there anything else that you would like to tell us?” was added to assess specific pandemic experiences and reactions. The SWLS is sensitive to change in situations and, thus, is can be used to identify changes due to circumstances (Pavot & Diener, 1993). In the current study, the reliability of this measure was high, � � .89.

Social Cohesion Scale (SCS; Li et al., 2015). The SCS is a five-item questionnaire that measures cohesion in a neighbour- hood. The scale is scored on a 4-point Likert scale ranging from strongly agree to strongly disagree, with higher scores indicating less cohesion. In the current study, the reliability of this measure was good, � � .76.

COVID-19 psychological distress. There are no validated scales to specifically measure distress during global pandemics, thus five questions were adopted from Lau et al.’s (2009; 2010) investigation during the H1N1 pandemic. Participants used a 5-point Likert scale (1 � strongly disagree) to rate their panic, depression, and emotional stability as well as the degree to which

they were worried about their personal and family safety. The reliability of this scale was high, � � .82.

Perceptions of risk. Again, owing to a lack of validated instrumentation for measuring risk perceptions during a public health crisis, this questionnaire was also adopted from Lau et al.’s (2010) H1N1 research that included five items rated on a 5-point Likert scale to assess perception of risk related to the virus, for example, “I believe there is a high risk of death if someone contracted COVID.” The measure had adequate reliability, � � .72.

Information sources. Respondents were asked to rank their preference for information sources during the pandemic. Partici- pants ranked their reliance on social media, mainstream media, friends/family, employers, and public health. Mainstream media, public health announcements, and employer information were categorised as “Credible” and information from social media and social connections were considered “Not Credible.”

Procedure

This study was reviewed and approved by the University of New Brunswick, Saint John Research Ethics Board. Participants were recruited from university and social media sites (i.e., Face- book, Twitter) and were directed to an online survey platform (Qualtrics). After providing informed consent, participants com- pleted the randomized questionnaire package. Survey completion took approximately 12 min. The data were collected between March 31 and April 15, during which time strict social distancing regulations were implemented across Canada.

Results

Prior to analysis, data were screened for incomplete responses, missing values, and outliers. Given the large sample size, all of the statistical tests were adequately powered. To control for Type I error rate, statistical significance was generally assessed at p � .01. Bonferroni corrections are noted for multiple comparisons, when appropriate. Further, Cohen’s d effect size was calculated for all comparisons, with d � .02, .05, and .08 indicating a small, moderate, and large effect (Cohen, 1992).

Cognitive-Emotional Responses

The overall satisfaction with life in the current sample was 24.97, which is indicative of high satisfaction in all areas of life (Diener, 2006). In general, average scores between 20 and 24 indicate a general satisfaction with life, with some domains per- ceived as needing small improvement (see Table 1 for results). In response to the open-ended question, participants noted emotional and psychological challenges associated with COVID-19, includ- ing increased worry about personal wellness and the governmental responses to the pandemic. A series of point-biserial correlations were conducted to compare different aspects of cognitive- emotional responses with age. To confirm the nature of the asso- ciations, the linear relationship between age and each of these variables was assessed by comparing the fit of the relationship with a linear trend, as well as other trends and, in all cases, the fit with a linear trend was found to be the strongest. These correla- tions revealed that increases in age were associated with higher

3PSYCHOLOGICAL IMPACT OF COVID-19

satisfaction with life, r(1103) � .16, p � .001, and higher levels of social cohesion, r(1104) � �.09, p � .005, as well as less concern about family members contracting COVID-19, r(1140) � �.08, p � .006, panic, r(1144) � �.22, p � .001, depression, r(1144) � �.16, p � .001, emotional distress, r(1144) � �.21, p � .001, and risk perception, r(1131) � �.10, p � .001.

Participants, on average, reported that they were slightly worried about COVID-19. Table 1 shows that, for both males and females, the levels of depression, emotional distress, and panic were just slightly higher than neutral. In spite of relatively low mean levels of psychological distress, it is important to note that this sample of Canadians were distressed during the initial pandemic response; the most common response was somewhat agree for panic (27.5%), depression (28.9%), and emotional distress (31.9%), suggesting that a significant number of re- spondents had associated psychological distress. Further, cor- relational analyses indicated statistically significant negative associations between Satisfaction with Life and Depression, r(895) � �.23, p � .001, Panic, r(894) � �.12, p � .001, Emotional Distress, r(895) � �.14, p � .001, and Perception of Risk, r(886) � �.13, p � .001. In addition, overall Perception of Risk was associated with increased overall Distress, r(923) � .44, p � .001, Panic, r(922) � .35, p � .001, Depression, r(921) � .26, p � .001, and Emotional Distress, r(922) � .30, p � .001. Although participants reported greater worry about their physical health and the health of their family members, correlational analyses did not indicate a statistically significant correlation between life satisfaction and health concerns.

Lack of social cohesion was significantly correlated with variables indicating mental health concerns, including overall COVID-19 Dis- tress, r(895) � .13, p � .001, COVID-19 Panic, r(894) � .12, p � .001, COVID-19 Depression, r(893) � .12, p � .001, COVID-19 Emotional Disturbances, r(896) � .12, p � .001, and Risk Perception, r(890) � .13, p � .001. Increased cohesion was positively associated with Satisfaction with Life, r(854) � �.27, p � .001.

Given that there are well documented differences between male and females on variables associated with psychological distress, a series of independent-samples t tests were conducted to compare our measures between genders (see Table 1 for full results). Females reported more overall distress than males and had significantly higher feelings of panic, depression, and emo- tional distress. Further, they reported more concerns about contracting COVID-19 and were more concerned about the safety of their family. Despite the increased levels of psycho- logical distress, there were no statistically significant gender differences on questions assessing risk perception. Thus, al- though females worried more about COVID-19, males and females reported similar levels of risk perception.

Table 1 also shows that the overall perception of risk of personal contraction was lower than the perceived risk of family and public contraction. To further investigate these differences a 2 (gender) � 3 (perception of risk) mixed model analysis of variance was conducted. Although the main effect of gender and the interaction were not statistically significant, there was a significant main effect of risk perception, F(2, 2232) � 192.61, p � .001, �p

2 � .15. Overall, participants reported that their personal perception of risk was significantly lower than their perception of the risk of their family, p � .001, and the general public, p � .001. Further, participants perceived that the general public was at greater risk of contracting the virus than their family members (p � .001; see Figure 1).

The Effects of Education and Information Source

Participants were asked to rank their preference for various information sources. Overall, the majority of participants reported that they relied more on credible sources of information, with 31.7% (n � 439) and 42.1% (n � 30.4) of participants reporting that they received information from mainstream news sources and information from public health respectively. Few participants re-

Table 1 Mean (Standard Deviation) of Psychological Wellness and Distress for Males and Females

Measure Female Male t(p)a Cohen’s d

SWLS 25.24 (6.57) 24.16 (6.85) 2.04 (.03) 0.16 Social cohesion 1.99 (0.49) 2.03 (0.48) 1.00 (.32) 0.08 Worry total 3.50 (0.88) 3.05 (0.91) 7.06 (�.001) 0.50 Panic 3.15 (1.24) 2.41 (1.23) 8.31 (�.001) 0.60 Depression 3.14 (1.24) 2.78 (1.29) 4.03 (�.001) 0.28 Emotional distress 3.31 (1.25) 2.76 (1.36) 6.04 (�.001) 0.42 Personal safety 3.66 (1.10) 3.40 (1.19) 3.10 (.002)b 0.23 Family safety 4.26 (0.99) 3.92 (1.09) 4.66 (�.001) 0.33 Risk perception total 3.10 (0.73) 2.99 (0.83) 1.94 (.054)b 0.14 Death 2.58 (1.13) 2.26 (1.16) 3.86 (�.001) 0.28 Irreversible bodily damage 2.54 (1.08) 2.51 (1.17) 0.31 (.76) 0.03 Personal contraction 3.17 (1.11) 3.14 (1.27) 0.36 (.72) 0.03 Family contraction 3.39 (1.11) 3.25 (1.21) 1.59 (.11) 0.12 Public contraction 3.83 (0.92) 3.78 (1.08) 0.74 (.46) 0.05 Compared with other countries Canada has . . .

a lower risk of a large scale epidemic 3.20 (1.11) 3.32 (1.23) 1.86 (.06) 0.10 a greater risk of a large scale epidemic 2.04 (0.83) 2.05 (.98) 1.47 (.14) 0.01

Note. SWLS � Satisfaction With Life Scale. a Bonferroni-adjusted � of .003125 was used to account for multiple comparisons. b Equal variances not assumed.

4 BEST, LAW, ROACH, AND WILBIKS

ported relying on their employers for COVID-19 information (1.7%; n � 23). Although fewer participants reported relying on potentially unreliable sources, 24.9% of participants (n � 345) reported that their primary source of information was social media and social connections (2.6%; n � 36).

Table 2 presents the mean levels of psychological distress and risk perceptions associated with each information source. Given the small number of respondents who reported that they relied on employers and social connections, t tests were used to compare levels of psychological distress in individuals who reported a credible primary source of information (mainstream news, em- ployer information, public health announcements) and those who reported that they received their information from a less credible source (social media, social connections). Overall, individuals who relied on reliable sources of information reported less overall COVID-19 Distress, Panic, Depression, and Emotional Distur- bance. Further, these individuals reported higher Satisfaction with Life and Social Cohesion.

As would be expected, compared with individuals who did not complete a university degree, those who had a university degree were more likely to rely on credible sources of infor- mation, 361 (58%) versus 521 (78%), �2(1263) � 57.92, p � .001. Table 3 presents how level of education affected levels of psychological distress. Individuals with less education reported higher overall Distress, (1147) � �.09, p � .001, and Risk Perception, (1133) � �.11, p � .001. To further examine the effects of education, a series of t tests were conducted to examine whether individuals who had completed a university degree (undergraduate or graduate) reported higher levels of psychological distress and risk perception than those who did not have university education. Individuals who had completed a university education reported significantly less psychological distress associated with COVID-19 and were perceived a lower risk of death and irreversible bodily damage than those who did not have a university degree.

Prediction of COVID-19 Psychological Distress

To examine the overall effects of demographic and psychosocial variables that correlate with psychological distress, a hierarchical

linear regression was conducted. Demographic variables, includ- ing age, gender, level of education (Y/N university degree), and information source (Y/N credible primary information source) were entered in Block 1. Satisfaction with Life, Social Cohesion, and Overall Risk Perception scores were entered in Block 2. The overall model was statistically significant, F(7, 397) � 32.48, p � .001, and accounted for 36.4% of the variability in overall COVID-19 psychological distress. Block 1 was statistically sig- nificant, F(4, 400) � 14.09, p � .001, and accounted for 12.3% of the variability, with gender, � �.25, t � �5.28, p � .001, and age, � �.16, t � �3.14, p � .002, emerging as statistically significant predictors of overall distress. In Block 2, higher risk perception, � .463, t � 11.33, p � .001, and lower satisfaction with life, � �.10, t � �2.15, p � .032, accounted for an additional 24.1% of variability in overall psychological distress, F�(3,397) � 49.96, p � .001.

Discussion

During the initial stages of the COVID-19 pandemic in North America, Brooks and colleagues (2020) called for research on whether similar adverse responses would occur if ‘lighter’ social distancing practices were imposed, rather than full isolation quar- antines often used in previous epidemics (i.e., SARS, Cava et al., 2005; MERS, Kim et al., 2016; Ebola, Drazen et al., 2014). Based on the findings of the present study, the answer to the question with respect to the COVID-19 pandemic is, “Yes, social distancing and isolation are correlated with psychological distress,” even after relatively brief periods of policy changes.

In this study, we used well-established and validated measures of psychological well-being, including the Satisfaction with Life Scale (Diener et al., 1985) and the Social Cohesion Scale (Li et al., 2015). We also used several previously unvalidated scales to measure distress associated with COVID-19 and perceptions of individual, family, and public risk. Although some measures have not been previously validated, they were adapted from validated scales used during the H1N1 epidemic in Hong Kong (see Lau et al., 2009, 2010). The patterns of correlations between the preex- isting scales and those developed for the current study were predictable and replicate previous results, for example, the estab- lished inverse association between satisfaction with life and psy- chological distress replicates previous findings (Chang & Sanna, 2001; Chang et al., 2004; Schimmack et al., 2004). Over the course of the pandemic, we would encourage future researchers to con- tinue to use similar questionnaires, to provide additional validation of the measures used in the current study. We would suggest that the current results could serve as baseline measures of psycholog- ical distress during the first wave of COVID-19 and comparisons with data collected in subsequent waves could be made.

Psychological Impact of Social Distancing

This study confirms that even in the very early days of strict social distancing practices, Canadians indeed experienced psycho- logical distress; as levels of distress related to the virus were elevated, depression, emotional distress, and panic were slightly elevated, and these effects were greater among females. The gen- der differences in perceived distress are not specific to COVID-19 distress; Marchand, Drapeau, and Beaulieu-Prévost (2012) used

Figure 1. Perception of personal, family, and public risk of contracting COVID-19.

5PSYCHOLOGICAL IMPACT OF COVID-19

T ab

le 2

E ff

ec ts

of E

du ca

ti on

on M

ea n

(S ta

nd ar

d D

ev ia

ti on

) P

sy ch

ol og

ic al

D is

tr es

s an

d R

is k

P er

ce pt

io n

M ea

su re

D id

no t

co m

pl et

e un

iv er

si ty

ed uc

at io

n C

om pl

et ed

un iv

er si

ty ed

uc at

io n

t( p)

a

C oh

en ’s

d H

ig h

sc ho

ol or

le ss

(n �

97 )

E nr

ol le

d co

lle ge

or un

iv er

si ty

(n �

21 1)

C ol

le ge

di pl

om a

(n �

16 1)

B ac

he lo

r’ s

de gr

ee (n

� 33

8) G

ra du

at e

or pr

of es

si on

al de

gr ee

(n �

32 7)

N o

un iv

er si

ty ve

rs us

un iv

er si

ty

SW L

S 23

.6 2

(6 .8

4) 23

.3 8

(7 .0

3) 23

.5 0

(7 .2

3) 25

.4 2

(6 .1

9) 26

.6 7

(5 .9

7) 6.

25 (�

.0 01

)b 0.

39 So

ci al

co he

si on

2. 05

(0 .4

2) 2.

00 (0

.4 9)

2. 05

(0 .4

7) 2.

02 (0

.5 0)

1. 94

(0 .5

0) 1.

55 (.

12 )

0. 10

W or

ry to

ta l

3. 29

(0 .8

9) 3.

61 (0

.9 1)

3. 48

(0 .9

0) 3.

43 (0

.9 0)

3. 26

(0 .8

9) 2.

96 (.

00 3)

0. 18

Pa ni

c 3.

07 (1

.2 4)

3. 36

(1 .2

8) 3.

05 (1

.3 2)

3. 01

(1 .2

4) 2.

70 (1

.2 2)

4. 41

(� .0

01 )

0. 27

D ep

re ss

io n

3. 02

(1 .2

8) 3.

33 (1

.3 1)

3. 18

(1 .2

4) 3.

09 (1

.2 2)

2. 83

(1 .2

6) 3.

38 (�

.0 01

) 0.

20 E

m ot

io na

l di

st re

ss 3.

07 (1

.3 0)

3. 48

(1 .2

7) 3.

22 (1

.3 0)

3. 22

(1 .2

8) 3.

03 (1

.2 7)

2. 42

(. 02

) 0.

15 Pe

rs on

al sa

fe ty

3. 36

(1 .1

4) 3.

57 (1

.0 8)

3. 69

(1 .0

6) 3.

62 (1

.1 6)

3. 61

(1 .1

3) 0.

69 (.

49 )

0. 04

Fa m

ily sa

fe ty

3. 94

(1 .1

4) 4.

33 (0

.9 4)

4. 27

(0 .9

1) 4.

20 (1

.0 2)

4. 12

(1 .0

7) 1.

18 (.

24 )

0. 07

R is

k pe

rc ep

tio n

to ta

l 3.

06 (0

.8 3)

3. 23

(0 .7

3) 3.

15 (0

.7 6)

3. 05

(0 .7

4) 2.

99 (0

.7 5)

3. 28

(. 00

1) 0.

21 D

ea th

2. 73

(1 .2

0) 2.

70 (1

.1 5)

2. 72

(1 .1

4) 2.

47 (1

.1 1)

2. 27

(1 .1

1) 5.

05 (�

.0 01

) 0.

30 Ir

re ve

rs ib

le bo

di ly

da m

ag e

2. 63

(1 .1

3) 2.

61 (1

.0 7)

2. 74

(1 .1

1) 2.

50 (1

.1 0)

2. 40

(1 .1

0) 2.

95 (.

00 3)

0. 18

Pe rs

on al

co nt

ra ct

io n

3. 02

(1 .1

6) 3.

21 (1

.1 8)

3. 20

(1 .1

8) 3.

16 (1

.1 4)

3. 17

(1 .1

1) 0.

11 (.

92 )

0. 01

Fa m

ily co

nt ra

ct io

n 3.

18 (1

.1 5)

3. 57

(1 .1

5) 3.

35 (1

.1 3)

3. 36

(1 .1

1) 3.

31 (1

.1 3)

1. 27

(. 20

) 0.

08 Pu

bl ic

co nt

ra ct

io n

3. 77

(0 .9

9) 4.

06 (0

.9 0)

3. 76

(0 .9

7) 3.

76 (0

.9 5)

3. 79

(0 .9

5) 2.

17 (.

03 )

0. 12

C om

pa re

d w

ith ot

he r

co un

tr ie

s C

an ad

a ha

s ..

. a

lo w

er ri

sk of

a la

rg e

sc al

e ep

id em

ic 3.

11 (1

.1 4)

3. 11

(1 .1

5) 3.

19 (1

.1 3)

3. 21

(1 .1

7) 3.

33 (1

.1 0)

2. 09

(. 04

) 0.

12 a

gr ea

te r

ri sk

of a

la rg

e sc

al e

ep id

em ic

2. 25

(0 .9

9) 2.

26 (1

.0 0)

2. 07

(0 .8

6) 1.

95 (0

.7 8)

1. 95

(0 .8

1) 4.

53 (�

.0 01

)a 0.

29

N ot

e. SW

L S

� Sa

tis fa

ct io

n W

ith L

if e

Sc al

e. a

B on

fe rr

on i-

ad ju

st ed

� of

.0 03

12 5

w as

us ed

to ac

co un

t fo

r m

ul tip

le co

m pa

ri so

ns .

b E

qu al

va ri

an ce

s no

t as

su m

ed .

6 BEST, LAW, ROACH, AND WILBIKS

the Canadian National Population Health Survey and found that gender was a significant correlate of psychological distress. The results in the current study suggest that the psychological distress during the early pandemic response was higher than that experi- enced during the 2009 H1N1 pandemic. Lau et al. (2009) exam- ined psychological distress in Hong Kong residents during the early response to the 2009 H1N1 pandemic and found that fewer than 5% of respondents experienced panic, depression, and emo- tional distress during the early response. In the current study, participants reported that they “somewhat” or “strongly” agreed that they felt panic (�35%), depression (�37%), and emotional distress (�44%) when they thought about COVID-19. These re- sults are likely attributable to the fact that, unlike the HINI pan- demic in which quarantine measures were focused on specific locations that experienced outbreaks, the COVID-19 pandemic was worldwide and had worldwide effects.

These results are notable for several reasons: the timing of the distress, the population being studied, and the mitigation practices being examined. Most studies have only been able to scrutinize the psychological impact after a full quarantine (Hawryluck et al., 2004; Wang et al., 2011; Wu et al., 2009) that has been imposed for short durations, for example, less than 21 days (Bai et al., 2004; Cava et al., 2005; Desclaux et al., 2017; Pellecchia, Crestani, Decroo, Van den Bergh, & Al-Kourdi, 2015), and on samples consisting of health care workers (Maunder et al., 2003; Robertson et al., 2004; Wu et al., 2008). In contrast, this study establishes that members of the general Canadian population do, in fact, experi- ence elevated psychological distress (see Table 1) even during the very early stages of social distancing practices that are consider- ably lighter than full quarantine measures used during past epi- demics. These data now offer an early benchmark for initiation of adverse psychological responses owing to these lighter measures during global health crises and specifically those implemented across the country during the COVID-19 pandemic. These data can also be used as a baseline in future research, seeking to compare changes in the correlates of psychological distress over the course of an extended period of public health measures, as well as the relaxation and subsequent reimplementation of these measures during a potential second wave of the pandemic.

Prepandemic Predictors

There has been mixed evidence on whether individual charac- teristics are predictors of future psychological reactions to quar- antine (Brooks et al., 2020). Similar to past findings that quaran- tined females experience more psychological distress (Brooks et al., 2020; Moreira et al., 2020; Wang et al., 2020), current results suggest that women experiencing strict social distancing also ex- perience a more adverse psychological response despite experi- encing higher life satisfaction at the time of the survey (see Table 1). In the present study, compared with males, females reported more concerns about the safety of their family compared with men. Women typically experience more parenting stress and conflict when negotiating the workplace (Elwér, Harryson, Bolin, & Ham- marström, 2013; Hildingsson & Thomas, 2014; Taylor et al., 2008) and perhaps parenting responsibilities may exacerbate psycholog- ical distress for some women during strict social distancing. Fur- ther, an emerging body of research on academic productivity suggests that productivity of female researchers during the pan-T

ab le

3 D

if fe

re nc

es in

M ea

n (S

ta nd

ar d

D ev

ia ti

on )

P sy

ch ol

og ic

al D

is tr

es s

an d

R is

k P

er ce

pt io

n as

a F

un ct

io n

of P

ri m

ar y

In fo

rm at

io n

So ur

ce

M ea

su re

R el

ia bl

e so

ur ce

s U

nr el

ia bl

e so

ur ce

s t(

p) a

C oh

en ’s

d M

ai ns

tr ea

m m

ed ia

(n �

43 9)

E m

pl oy

er s

(n �

23 )

Pu bl

ic he

al th

(n �

42 1)

So ci

al m

ed ia

(n �

34 5)

So ci

al co

nn ec

tio ns

(n �

36 )

C re

di bl

e ve

rs us

in cr

ed ib

le

SW L

S 25

.5 4

(6 .7

8) 24

.5 6

(8 .0

4) 25

.4 8

(6 .1

2) 23

.6 8

(6 .6

2) 22

.6 9

(7 .4

0) 4.

25 (�

.0 01

) 0.

29 So

ci al

co he

si on

1. 93

(0 .4

5) 2.

14 (0

.5 4)

1. 99

(0 .5

1) 2.

09 (0

.4 7)

2. 04

(0 .5

6) 3.

74 (�

.0 01

) 0.

25 W

or ry

to ta

l 3.

25 (0

.8 7)

3. 50

(1 .0

4) 3.

45 (0

.9 0)

3. 57

(0 .9

0) 3.

04 (0

.9 9)

2. 65

(� .0

01 )

0. 18

Pa ni

c 2.

71 (1

.2 4)

3. 25

(1 .4

5) 3.

01 (1

.2 8)

3. 29

(1 .2

3) 2.

58 (1

.2 9)

4. 14

(� .0

01 )

0. 28

D ep

re ss

io n

2. 93

(1 .2

4) 3.

15 (1

.1 8)

3. 03

(1 .3

0) 3.

26 (1

.2 5)

2. 81

(1 .3

8) 2.

17 (.

00 7)

0. 18

E m

ot io

na l

di st

re ss

2. 99

(1 .2

7) 3.

35 (1

.2 3)

3. 24

(1 .3

1) 3.

39 (1

.2 9)

2. 87

(1 .2

5) 2.

45 (0

.1 4)

0. 17

Pe rs

on al

sa fe

ty 3.

52 (1

.1 4)

3. 75

(1 .3

3) 3.

71 (1

.0 8)

3. 63

(1 .0

8) 2.

97 (1

.2 0)

0. 69

(. 49

) 0.

04 Fa

m ily

sa fe

ty 4.

11 (1

.0 2)

4. 00

(1 .3

0) 4.

27 (0

.9 9)

4. 27

(0 .9

6) 4.

00 (1

.0 3)

0. 89

(. 37

) 0.

07 R

is k

pe rc

ep tio

n to

ta l

3. 05

(0 .7

4) 3.

14 (0

.8 1)

3. 03

(0 .7

4) 3.

17 (0

.7 6)

2. 90

(0 .8

3) 1.

99 (.

05 )

0. 13

D ea

th 2.

50 (1

.1 4)

2. 61

(0 .9

8) 2.

37 (1

.1 5)

2. 62

(1 .1

5) 2.

41 (0

.9 7)

2. 08

(. 04

) 0.

14 Ir

re ve

rs ib

le bo

di ly

da m

ag e

2. 51

(1 .0

7) 2.

56 (0

.9 8)

2. 46

(1 .0

9) 2.

61 (1

.1 1)

2. 67

(1 .0

4) 1.

77 (.

08 )

0. 12

Pe rs

on al

co nt

ra ct

io n

3. 09

(1 .1

4) 3.

72 (1

.2 3)

3. 20

(1 .1

5) 3.

20 (1

.1 3)

2. 85

(1 .2

6) 0.

17 (.

86 )

0. 01

Fa m

ily co

nt ra

ct io

n 3.

33 (1

.1 6)

3. 39

(1 .2

4) 3.

35 (1

.1 1)

3. 46

(1 .1

1) 3.

07 (1

.2 1)

1. 14

(. 25

) 0.

08 Pu

bl ic

co nt

ra ct

io n

3. 81

(0 .9

7) 3.

44 (1

.0 4)

3. 77

(0 .9

2) 3.

94 (0

.9 1)

3. 48

(1 .1

6) 1.

83 (.

07 )

0. 13

C om

pa re

d w

ith ot

he r

co un

tr ie

s C

an ad

a ha

s a

.. .

lo w

er ri

sk of

a la

rg e

sc al

e ep

id em

ic 3.

29 (1

.0 8)

3. 11

(1 .1

3) 3.

26 (1

.1 6)

3. 14

(1 .1

3) 3.

33 (1

.1 4)

1. 44

(. 15

) 0.

10 gr

ea te

r ri

sk of

a la

rg e

sc al

e ep

id em

ic 1.

97 (.

07 8)

2. 44

(0 .8

6) 1.

92 (0

.8 2)

2. 20

(0 .9

3) 2.

07 (0

.7 3)

4. 05

(� .0

01 )

0. 22

N ot

e. SW

L S

� Sa

tis fa

ct io

n W

ith L

if e

Sc al

e. a

B on

fe rr

on i-

ad ju

st ed

� of

.0 03

12 5

w as

us ed

to ac

co un

t fo

r m

ul tip

le co

m pa

ri so

ns .

7PSYCHOLOGICAL IMPACT OF COVID-19

demic is lower than that of their male colleagues (Andersen, Nielsen, Simone, Lewiss, & Jagsi, 2020; Nash & Churchill, 2020). This information may be especially pertinent to employers as they bring their workforce on and off site during this pandemic, espe- cially with regard to the health and productivity of female employ- ees with parenting responsibilities and warrants further study (Hildingsson & Thomas, 2014).

Similar to findings from individuals experiencing quarantine (Taylor et al., 2008), individuals with less education reported higher panic, depression, and overall distress during strict social distancing. This comes as no surprise, because education is known to be a protective factor for a multitude of social woes including poor health outcomes (Zimmerman et al., 2018), mental illness (Zhang, Chen, McCubbin, McCubbin, & Foley, 2011), suicide (Milner, Niven, & LaMontagne, 2015), conflict with the law (Zimmerman et al., 2018), and illicit drug use (Erickson et al., 2016). The present findings add adverse psychological impacts attributable to strict social distancing measures to that list. With predictions of future pandemics and a “new normal” already being projected (Rubin, 2020), education may offer one of the most accessible avenues for establishing large protective swaths for psychological wellness in the general public for future outbreaks.

Satisfaction With Life

These findings are not consistent with the moderate-to-high levels of cognitive emotional distress reported in the early stages of the current pandemic in India and China (Tian et al., 2020; Wang et al., 2020; Zhang, Wang, Rauch, & Wei, 2020). The lower psychological distress in the current study could be related to psychosocial buffers including higher life satisfaction and social cohesion of current participants and the progression of the pan- demic. China experienced the COVID-19 outbreak first and far earlier than Canada, perhaps rendering its citizens more confused and fearful as there were more unknowns in those early days of the COVID-19 pandemic (Zhang, Wang, et al., 2020). Further, in a multicountry comparison of life satisfaction, Eksi and Kaya (2017) reported that the average life satisfaction in Canada was higher than that in China, 7.61 versus 6.08 (on a 10-point scale). Thus, the different levels of psychological distress could be attributed to baseline satisfaction with life coupled with the fact that China was the first to experience the pandemic.

Although the adverse psychological impacts of strict social distancing measures imposed were relatively mild during the first few weeks of implementation, the findings remain disconcerting. Despite being highly educated and experiencing high levels of life satisfaction, the Canadians in the current study have not remained immune to the predicted psychological distress of strict social distancing measures implemented in the early stages of this global health crisis. Further analyses revealed that those experiencing lower levels of life satisfaction were indeed experiencing more distress, depression, and emotional disturbance compared with their higher counterparts. Given that life satisfaction has signifi- cant implications for mental and physical health (Fergusson et al., 2015; Pavot & Diener, 2008) and is inversely associated with depression (Schimmack et al., 2004), negative affect (Chang et al., 2004), and suicidal ideation (Chang & Sanna, 2001), these results are not surprising. This does not bode well regarding the possible short- and long-term cognitive-emotional impacts of COVID-19

on the majority of Canadians who would be less educated mem- bers of society (Wang et al., 2020). Although COVID-19 mitiga- tion measures are necessary, these results suggest that Public Health Officials should be aware of the potential negative impact on psychological wellness and take appropriate steps to ensure that services are in place for vulnerable Canadians.

Social Cohesion

Isolation is hard on human beings (Cacioppo, Hawkley, Nor- man, & Berntson, 2011) and during stressful and uncertain times, such as a global health crisis, an individual’s sense of social cohesion within their immediate community could assuage or exacerbate impending psychological distress (Zhang, Liu, Zhang, & Wu, 2020) when social distancing measures are imposed. In this study, social cohesion was found to be significantly correlated with psychological well-being; individuals embedded in socially cohe- sive neighborhoods experienced less depression, worry, emotional distress and panic. Thus, government officials should be strongly cautioned against introducing measures such as ‘snitch lines’ (Ger- ster & Russell, 2020; Hernandez-Morales, 2020; The Straits Times, 2020; Vanderklippe, 2020; Webber, 2020) that could frac- ture social cohesion in communities and ultimately diminish psy- chological well-being.

The COVID-19 global health crisis is unprecedented in scope and nature, and governments are struggling to implement evidence-based policies that quite simply do not exist. Although divisive “common sense” practices (e.g., bubble family poli- cies, snitch lines) are being promoted (Government of New Brunswick, 2020), our results caution against such policies that could erode social cohesion within communities, especially in later stages of the pandemic as potential adverse psychological impacts mount. Socially cohesive communities may endure longer periods of social distancing better; forward-thinking policymakers preparing for future outbreaks should consider initiatives to increase community social cohesion and individ- ual resiliency, rather than eroding it.

Perception of Risk

This study examined respondents’ risk perception, which we defined as their fear of infection and their perception of the seriousness of COVID-19. We included questions such as “I believe there is a high risk of death if a person contracts COVID- 19,” and found a strong relationship between high risk perceptions and elevated psychological distress, again replicating similar re- sults found in quarantined persons (Brooks et al., 2020). Remark- ably, although participants reported greater worry about the phys- ical health of themselves and their family members, there was no correlation between life satisfaction and these health concerns.

Our finding that personal perception of risk was lower than perceived family and public risk is in alignment with optimism bias (Weinstein, 1980), wherein people tend to rate their own likelihood for the occurrence of negative life events to be lower than that of others. In this instance, individuals are generally aware of the threat posed by COVID-19, but they mainly see COVID-19 as a risk to other people, replicating other studies on the initial response to COVID-19 (e.g., Wise, Zbozinek, Michelini, Hagan, & Mobbs, 2020). Further, in the current study, the perception of

8 BEST, LAW, ROACH, AND WILBIKS

personal and family risk decreased during the initial response, suggesting that although participants were aware of the continued dangers associated with COVID-19, they perceived that their per- sonal and family risks decreased over time, which could lead to a personal relaxing of public health guidelines. These findings should be used to stress the idea that public health authorities and science communicators should use what is known about these kinds of biases in social science to increase the likelihood of positive behavioural outcomes at the population level (Bavel et al., 2020).

The Impact of Information Sources

Public health officials will be relieved to learn that the current results indicated that most people relied on reliable sources of information during the initial stages of this pandemic, that is, mainstream media, public health. Unfortunately, those who turned to less reliable sources of information (i.e., social media), were also more likely to experience more psychological distress, lower satisfaction with life and lack of social cohesion with their imme- diate community. It is also noteworthy that individuals who had completed a university degree were more likely to rely on credible sources as their primary source of COVID-19 information. Inter- estingly, but not surprisingly, a reliance of noncredible sources of information coupled with less education lead to greater perceived risk of experiencing harm during this outbreak. These findings are a clear call to action for public health officials to prioritize seeking out channels of unreliable information and infusing these conduits with facts and best practices during times of crisis not only to counter misinformation but also to allay mounting psychological distress of its citizens. It would be advisable for local, provincial, and national officials to use social media channels to their advan- tage and continue to spread information through these sources. Social media platforms can be used to spread information about specific public health measures and to provide information about available psychological supports.

Prediction of COVID-19 Distress

When relevant factors were entered into a hierarchical regres- sion model, we found that we were able to account for 36.4% of the variability in psychological distress related to COVID-19. This variability was accounted for by a combination of demographic factors (12.3%) and factors related to satisfaction with life, social cohesion, and perception of risk (24.1%). These findings demon- strate that there are several factors, including gender and level of education that should be considered in assessing an individual’s susceptibility to psychological distress and risk perception related to an infectious disease pandemic. Although some of the effect sizes are small, these effects are potentially important. Given that data were collected during the initial public health regulations, the ongoing measures (or the loosening and subsequent tightening) could lead to effects that are more deleterious.

Conclusions

During a pandemic such as the current COVID-19 situation, it has been necessary to require universal social distancing policies. Although this means that we must all stay home to stay safe at a

population level, taking into consideration factors such as the ones reported in the regression model would be helpful in identifying individuals who are more at risk for psychological distress and who may need early mental health support owing to effects of the public health measures.

The current study clearly demonstrates that strict social distanc- ing measures imposed during this global health crisis have elicited similar psychological distress to those who have endured quaran- tine (Brooks et al., 2020) This research suggests that, even as early as 14 days into a global health crisis, government officials need to begin adjusting their thinking from a one-size-fits-all approach and assess the relative risk to various subpopulations on of the basis of various factors such as access to reliable information sources that may lead to variability in risk perception and psychological dis- tress. Concretely, this could mean flooding information sources that would typically be deemed unreliable (e.g., social media) with current, reliable information from public health officials. Promot- ing and/or creating information literacy courses easily accessed through social media platforms could also strengthen knowledge seeking behaviours and related outcomes in future public health crisis.

Further, policymakers need to be cognizant of the proportion of constituents living with preexisting vulnerabilities because of their demographics (e.g., lower education and life state) if they consider prolonging periods of social distancing measures during this COVID-19 pandemic. Community-based programs developed to assist these at-risk individuals during the early and later phases of lockdowns could reap high returns in mitigating psychological distress and its predictable outcomes for these subpopulations. Public health officials also need to carefully assess the relative benefits when applying controversial restrictions, for example, mandatory community face masks, on communities, as creating division could contribute to the erosion of social cohesion that appears to act as a buffer for psychological distress. More research in this area is warranted.

When not in an active state of emergency, communities assessed as lower in social cohesion should be offered programming to increase interconnectedness and build communal resilience. Like- wise, employers need to be proactive and made cognizant of offering extra supports to women employees during this pandemic as this research suggests they experienced more psychological distress during the early days of social mitigation. More research examining women’s elevated psychological distress and its rela- tionship to perception of risk for family members, employment and caregiving responsibilities during all stages of a public health crisis appears to be justified.

Echoing Brooks and colleagues’ (2020, p. 1) sentiment that “In situations where quarantine is deemed necessary, officials should quarantine individuals for no longer than required,” government officials need to be informed that even in the early days of social distancing measures individuals were already experiencing detect- able psychological distress. At the writing of this article, the majority of respondents in this study had experienced strict social distancing measures approximately 43 days longer than partici- pants in any of the studies reviewed by Brooks et al. (2020). It is a reasonable prediction that the adverse psychological impact of COVID-19 is now even greater, a fact government officials need to consider as they approach the end of the epidemic curve (Ma- cLeod, 2020; Martina & Herald, 2020). Given the current predic-

9PSYCHOLOGICAL IMPACT OF COVID-19

tions that the mitigation measures are likely to relax and tighten in response to disease spread, it is important to consider how psy- chological distress is impacted by relatively short periods of iso- lation. As we plan for potential second and third waves of disease spread, it will be important to take into account how the strength- ening and loosening of public health measures impact overall well-being.

Résumé

Les responsables de la santé publique du Canada ont répondu à l’éclosion mondiale sans précédent de la maladie du coronavirus 2019 (COVID-19) en invoquant des mesures de santé publique allant des mesures extrêmes (p. ex., la quarantaine) aux mesures plus légères (p. ex., la distanciation sociale). Bien qu’il soit néces- saire d’atténuer la propagation de la maladie, on ignore les réper- cussions psychologiques de la distanciation sociale et de l’isolement (Wang et al., 2020). L’idée de la présente étude est née à la suite de demandes de recherche visant à comparer les effets psychologiques de mesures extrêmes et de mesures plus légères (voir Brooks et al., 2020). Notre objectif était d’examiner l’impact de la COVID-19 sur la détresse psychologique afin de déterminer si des effets négatifs étaient présents au cours des premiers stades des mesures de distanciation sociale / d’isolement. Dans cette étude, les données du questionnaire mesurant la satisfaction à l’égard de la vie, de la cohésion sociale, de la détresse psy- chologique et de la perception du risque ont été recueillies auprès de 1 381 Canadiens au cours des premiers jours d’intenses mesures de santé publique (du 31 mars au 15 avril 2020). Les résultats semblent indiquer que même les pratiques de distanciation sociale à court terme sont associées à une détresse psychologique accrue, y compris des niveaux élevés de détresse globale, comme la panique, les troubles émotionnels et la dépression. Ces résultats sont dignes de mention pour plusieurs raisons : le moment de la détresse, la population à l’étude et le fait que l’atténuation appli- quée était « plus légère » que les quarantaines complètes déjà étudiées. Ces résultats semblent indiquer qu’après une courte pé- riode, des mesures de santé publique moins restrictives peuvent entraîner une détresse psychologique. Ces résultats ont une impor- tance majeure pour les responsables gouvernementaux sur les futures crises de santé publique, alors qu’ils évaluent judicieuse- ment les coûts et les avantages de l’application de telles mesures avec les diverses lignes directrices de la santé publique discutées.

Mots-clés : COVID-19, détresse psychologique, perception des risques, distanciation sociale à court terme, isolement social.

References

Andersen, J. P., Nielsen, M. W., Simone, N. L., Lewiss, R. E., & Jagsi, R. (2020). Meta-research: Is Covid-19 amplifying the authorship gender gap in the medical literature? eLife. Advance online publication. http:// dx.doi.org/10.7554/eLife.58807

Bai, Y., Lin, C.-C., Lin, C.-Y., Chen, J.-Y., Chue, C.-M., & Chou, P. (2004). Survey of stress reactions among health care workers involved with the SARS outbreak. Psychiatric Services, 55, 1055–1057. http://dx .doi.org/10.1176/appi.ps.55.9.1055

Barbisch, D., Koenig, K. L., & Shih, F. Y. (2015). Is there a case for quarantine? Perspectives from SARS to Ebola. Disaster Medicine and

Public Health Preparedness, 9, 547–553. http://dx.doi.org/10.1017/dmp .2015.38

Bavel, J. J. V., Baicker, K., Boggio, P. S., Capraro, V., Cichocka, A., Cikara, M., . . . Willer, R. (2020). Using social and behavioural science to support COVID-19 pandemic response. Nature Human Behaviour, 4, 460–471. http://dx.doi.org/10.1038/s41562-020-0884-z

Blendon, R. J., Benson, J. M., DesRoches, C. M., Raleigh, E., & Taylor- Clark, K. (2004). The public’s response to severe acute respiratory syndrome in Toronto and the United States. Clinical Infectious Diseases, 38, 925–931. http://dx.doi.org/10.1086/382355

Brooks, S. K., Webster, R. K., Smith, L. E., Woodland, L., Wessely, S., Greenberg, N., & Rubin, G. J. (2020). The psychological impact of quarantine and how to reduce it: Rapid review of the evidence. SSRN Electronic Journal, 395, 912–920. http://dx.doi.org/10.2139/ssrn .3532534

Cacioppo, J. T., Hawkley, L. C., Norman, G. J., & Berntson, G. G. (2011). Social isolation. Annals of the New York Academy of Sciences, 1231, 17–22. http://dx.doi.org/10.1111/j.1749-6632.2011.06028.x

Cava, M. A., Fay, K. E., Beanlands, H. J., McCay, E. A., & Wignall, R. (2005). The experience of quarantine for individuals affected by SARS in Toronto. Public Health Nursing, 22, 398–406. http://dx.doi.org/10 .1111/j.0737-1209.2005.220504.x

Chang, E. C., & Sanna, L. J. (2001). Optimism, pessimism, and positive and negative affectivity in middle-aged adults: A test of a cognitive- affective model of psychological adjustment. Psychology and Aging, 16, 524–531. http://dx.doi.org/10.1037/0882-7974.16.3.524

Chang, E. C., Watkins, A. F., & Banks, K. H. (2004). How adaptive and maladaptive perfectionism relate to positive and negative psychological functioning: Testing a stress-mediation model in black and white college students. Journal of Counseling Psychology, 51, 93–102. http://dx.doi .org/10.1037/0022-0167.51.1.93

Cohen, J. (1992). Statistical power analysis. Current Directions in Psycho- logical Science, 1, 98 –101. http://dx.doi.org/10.1111/1467-8721 .ep10768783

Crowe, A., & Lyness, K. P. (2014). Family functioning, coping, and distress in families with serious mental illness. The Family Journal, 22, 186–197. http://dx.doi.org/10.1177/1066480713513552

de Graaf, R., Tuithof, M., van Dorsselaer, S., & ten Have, M. (2012). Comparing the effects on work performance of mental and physical disorders. Social Psychiatry and Psychiatric Epidemiology, 47, 1873– 1883. http://dx.doi.org/10.1007/s00127-012-0496-7

Desclaux, A., Badji, D., Ndione, A. G., & Sow, K. (2017). Accepted monitoring or endured quarantine? Ebola contacts’ perceptions in Sen- egal. Social Science & Medicine, 178, 38–45. http://dx.doi.org/10.1016/ j.socscimed.2017.02.009

Diener, E. D. (2006). Understanding Satisfaction with Life scores. Re- trieved from http://labs.psychology.illinois.edu/~ediener/SWLS.html

Diener, E., Emmons, R. A., Larsen, R. J., & Griffin, S. (1985). The Satisfaction With Life Scale. Journal of Personality Assessment, 49, 71–75. http://dx.doi.org/10.1207/s15327752jpa4901_13

DiTommaso, E., Brannen, C., & Best, L. A. (2004). Measurement and validity characteristics of the short version of the social and emotional loneliness scale for adults. Educational and Psychological Measure- ment, 64, 99–119. http://dx.doi.org/10.1177/0013164403258450

Drazen, J. M., Kanapathipillai, R., Campion, E. W., Rubin, E. J., Hammer, S. M., Morrissey, S., & Baden, L. R. (2014). Ebola and quarantine. The New England Journal of Medicine, 371, 2029–2030. http://dx.doi.org/ 10.1056/NEJMe1413139

Echeverría, S., Diez-Roux, A. V., Shea, S., Borrell, L. N., & Jackson, S. (2008). Associations of neighborhood problems and neighborhood so- cial cohesion with mental health and health behaviors: The Multi-Ethnic Study of Atherosclerosis. Health & Place, 14, 853–865. http://dx.doi .org/10.1016/j.healthplace.2008.01.004

10 BEST, LAW, ROACH, AND WILBIKS

Eksi, O., & Kaya, N. (2017). Life satisfaction and keeping up with other countries. Journal of Happiness Studies, 18, 199–228. http://dx.doi.org/ 10.1007/s10902-016-9724-2

Elwér, S., Harryson, L., Bolin, M., & Hammarström, A. (2013). Patterns of gender equality at workplaces and psychological distress. PLoS ONE, 8, e53246. http://dx.doi.org/10.1371/journal.pone.0053246

Erickson, J., El-Gabalawy, R., Palitsky, D., Patten, S., Mackenzie, C. S., Stein, M. B., & Sareen, J. (2016). Educational attainment as a protective factor for psychiatric disorders: Findings from a nationally representa- tive longitudinal study. Depression and Anxiety, 33, 1013–1022. http:// dx.doi.org/10.1002/da.22515

Fergusson, D. M., McLeod, G. F., Horwood, L. J., Swain, N. R., Chapple, S., & Poulton, R. (2015). Life satisfaction and mental health problems (18 to 35 years). Psychological Medicine, 45, 2427–2436. http://dx.doi .org/10.1017/S0033291715000422

Fonseca, X., Lukosch, S., & Brazier, F. (2019). Social cohesion revisited: A new definition and how to characterize it. Innovation, 32, 231–253. http://dx.doi.org/10.1080/13511610.2018.1497480

Gerster, J., & Russell, A. (2020, April 27). Fines, snitch lines: Crackdown on coronavirus rule breakers could have consequences. Global News. Retrieved from https://globalnews.ca/news/6859320/coronavirus-police- enforcement/

Government of Canada. (2020, April 3). Community-based measures to mitigate the spread of coronavirus disease (COVID-19) in Canada. Government of Canada. Retrieved from https://www.canada.ca/en/ public-health/services/diseases/2019-novel-coronavirus-infection/ health-professionals/public-health-measures-mitigate-covid-19.html

Government of Italy. (2020, May 16). Coronavirus, the measures taken by the government. Governo Italiano Presidenza del Consiglio dei Ministri. Retrieved from http://www.governo.it/it/coronavirus-misure-del- governo

Government of New Brunswick, Office of the Chief Medical Officer of Health. (2020). Guidance document of general public health measures during COVID-19 recovery. Government of New Brunswick. Retrieved from https://www2.gnb.ca/content/gnb/en/corporate/promo/covid-19/ recovery.html

Government of the United States. (2020, May 6). Social distancing, quar- antine, and isolation. Centers for Disease Control and Prevention. Retrieved from https://www.cdc.gov/coronavirus/2019-ncov/prevent- getting-sick/social-distancing.html

Grant, N., Wardle, J., & Steptoe, A. (2009). The relationship between life satisfaction and health behavior: A cross-cultural analysis of young adults. International Journal of Behavioral Medicine, 16, 259–268. http://dx.doi.org/10.1007/s12529-009-9032-x

Hawryluck, L., Gold, W. L., Robinson, S., Pogorski, S., Galea, S., & Styra, R. (2004). SARS control and psychological effects of quarantine, To- ronto, Canada. Emerging Infectious Diseases, 10, 1206–1212. http://dx .doi.org/10.3201/eid1007.030703

Hernandez-Morales, A. (2020, April 3). Corona-snitches thrive in lock- down Europe. Politico. Retrieved from https://www.politico.eu/article/ coronavirus-lockdown-snitches-thrive-in-europe-reports-watchmen- spying-neighbors/

Hildingsson, I., & Thomas, J. (2014). Parental stress in mothers and fathers one year after birth. Journal of Reproductive and Infant Psychology, 32, 41–56. http://dx.doi.org/10.1080/02646838.2013.840882

Holmes, A., & Silvestri, R. (2016). Rates of mental illness and asso- ciated academic impacts in Ontario’s college students. Canadian Journal of School Psychology, 31, 27– 46. http://dx.doi.org/10.1177/ 0829573515601396

Kang, S. M., Shaver, P. R., Sue, S., Min, K. H., & Jing, H. (2003). Culture-specific patterns in the prediction of life satisfaction: Roles of emotion, relationship quality, and self-esteem. Personality and Social Psychology Bulletin, 29, 1596 –1608. http://dx.doi.org/10.1177/ 0146167203255986

Kim, E. Y., Liao, Q., Yu, E. S., Kim, J. H., Yoon, S. W., Lam, W. W., & Fielding, R. (2016). Middle East respiratory syndrome in South Korea during 2015: Risk-related perceptions and quarantine attitudes. Ameri- can Journal of Infection Control, 44, 1414–1416. http://dx.doi.org/10 .1016/j.ajic.2016.03.014

Lau, J. T., Griffiths, S., Choi, K. C., & Lin, C. (2010). Prevalence of preventive behaviors and associated factors during early phase of the H1N1 influenza epidemic. American Journal of Infection Control, 38, 374–380. http://dx.doi.org/10.1016/j.ajic.2010.03.002

Lau, J. T., Griffiths, S., Choi, K. C., & Tsui, H. Y. (2009). Widespread public misconception in the early phase of the H1N1 influenza epidemic. The Journal of Infection, 59, 122–127. http://dx.doi.org/10.1016/j.jinf .2009.06.004

Li, Y., Kao, D., & Dinh, T. Q. (2015). Correlates of neighborhood envi- ronment with walking among older Asian Americans. Journal of Aging and Health, 27, 17–34. http://dx.doi.org/10.1177/0898264314535636

Liao, Q., Cowling, B., Lam, W. T., Ng, M. W., & Fielding, R. (2010). Situational awareness and health protective responses to pandemic in- fluenza A (H1N1) in Hong Kong: A cross-sectional study. PLoS ONE, 5, e13350. http://dx.doi.org/10.1371/journal.pone.0013350

Liu, X., Kakade, M., Fuller, C. J., Fan, B., Fang, Y., Kong, J., . . . Wu, P. (2012). Depression after exposure to stressful events: Lessons learned from the severe acute respiratory syndrome epidemic. Comprehensive Psychiatry, 53, 15–23. http://dx.doi.org/10.1016/j.comppsych.2011.02 .003

MacLeod, M. (2020, April 17). ‘No fast way back to normal’: How some European lockdowns are easing already. CTV News. Retrieved from https://www.ctvnews.ca/health/coronavirus/no-fast-way-back-to- normal-how-some-european-lockdowns-are-easing-already-1.4900936

Marchand, A., Drapeau, A., & Beaulieu-Prévost, D. (2012). Psychological distress in Canada: The role of employment and reasons of non- employment. International Journal of Social Psychiatry, 58, 596–604. http://dx.doi.org/10.1177/0020764011418404

Martina, M., & Herald, S. (2020, April 30). Hundreds protest in Michigan as governor seeks to extend coronavirus lockdown. Global News. Re- trieved from https://globalnews.ca/news/6888357/us-coronavirus- michigan-protests/

Maunder, R., Hunter, J., Vincent, L., Bennett, J., Peladeau, N., Leszcz, M., . . . Mazzulli, T. (2003). The immediate psychological and occupational impact of the 2003 SARS crisis: An online questionnaire survey. Ca- nadian Medical Association Journal, 168, 1245–1251.

Milner, A. J., Niven, H., & LaMontagne, A. D. (2015). Occupational class differences in suicide: Evidence of changes over time and during the global financial crisis in Australia. BMC Psychiatry, 15, 223. http://dx .doi.org/10.1186/s12888-015-0608-5

Moreira, P. S., Ferreira, S., Couto, B., Machado-Sousa, M., Fernandez, M., Raposo-Lima, C., . . . Morgado, P. (2020). Protective elements of mental health status during the COVID-19 outbreak in the Portuguese popula- tion. medRxiv. http://dx.doi.org/10.1101/2020.04.28.20080671

Nash, M., & Churchill, B. (2020). Caring during COVID-19: A gendered analysis of Australian university responses to managing remote working and caring responsibilities. Gender, Work and Organization. Advance online publication. http://dx.doi.org/10.1111/gwao.12484

Palmer, B., Donaldson, C., & Stough, C. (2002). Emotional intelligence and life satisfaction. Personality and Individual Differences, 33, 1091– 1100. http://dx.doi.org/10.1016/S0191-8869(01)00215-X

Pavot, W., & Diener, E. (1993). Review of the Satisfaction With Life Scale. Psychological Assessment, 5, 164–172. http://dx.doi.org/10.1037/ 1040-3590.5.2.164

Pavot, W., & Diener, E. (2008). The Satisfaction With Life Scale and the emerging construct of life satisfaction. The Journal of Positive Psychol- ogy, 3, 137–152. http://dx.doi.org/10.1080/17439760701756946

Pellecchia, U., Crestani, R., Decroo, T., Van den Bergh, R., & Al-Kourdi, Y. (2015). Social consequences of Ebola containment measures in

11PSYCHOLOGICAL IMPACT OF COVID-19

Liberia. PLoS ONE, 10, e0143036. http://dx.doi.org/10.1371/journal .pone.0143036

Rios, R., Aiken, L. S., & Zautra, A. J. (2012). Neighborhood contexts and the mediating role of neighborhood social cohesion on health and psychological distress among Hispanic and non-Hispanic residents. An- nals of Behavioral Medicine, 43, 50–61. http://dx.doi.org/10.1007/ s12160-011-9306-9

Robertson, E., Hershenfield, K., Grace, S. L., & Stewart, D. E. (2004). The psychosocial effects of being quarantined following exposure to SARS: A qualitative study of Toronto health care workers. The Canadian Journal of Psychiatry / La Revue canadienne de psychiatrie, 49, 403– 407. http://dx.doi.org/10.1177/070674370404900612

Rubin, D. K. (2020). Covid-19 and a new normal. Engineering News- Record, 284, 10–23.

Rubin, G. J., & Wessely, S. (2020). The psychological effects of quaran- tining a city. British Medical Journal, 368, m313. http://dx.doi.org/10 .1136/bmj.m313

Schimmack, U., Oishi, S., Furr, R. M., & Funder, D. C. (2004). Personality and life satisfaction: A facet-level analysis. Personality and Social Psychology Bulletin, 30, 1062–1075. http://dx.doi.org/10.1177/ 0146167204264292

Simo, B., Bamvita, J.-M., Caron, J., & Fleury, M.-J. (2018). Patterns of health care service utilization by individuals with mental health prob- lems: A predictive cluster analysis. Psychiatric Quarterly, 89, 675–690. http://dx.doi.org/10.1007/s11126-018-9568-5

Sprang, G., & Silman, M. (2013). Posttraumatic stress disorder in parents and youth after health-related disasters. Disaster Medicine and Public Health Preparedness, 7, 105–110. http://dx.doi.org/10.1017/dmp .2013.22

Steger, M. F., Frazier, P., Oishi, S., & Kaler, M. (2006). The Meaning in Life Questionnaire: Assessing the presence of and search for meaning in life. Journal of Counseling Psychology, 53, 80–93. http://dx.doi.org/10 .1037/0022-0167.53.1.80

Tay, L., Kuykendall, L., & Diener, E. (2015). Satisfaction and happiness– the bright side of quality of life. In W. Glatzer, L. Camfield, V. Moller, & M. Rojas (Eds.), Global handbook of quality of life (pp. 839–853). Dordrecht, the Netherlands: Springer. http://dx.doi.org/10.1007/978-94- 017-9178-6_39

Taylor, M. R., Agho, K. E., Stevens, G. J., & Raphael, B. (2008). Factors influencing psychological distress during a disease epidemic: Data from Australia’s first outbreak of equine influenza. BMC Public Health, 8, 347. http://dx.doi.org/10.1186/1471-2458-8-347

Taylor, S. E., & Stanton, A. L. (2007). Coping resources, coping processes, and mental health. Annual Review of Clinical Psychology, 3, 377–401. http://dx.doi.org/10.1146/annurev.clinpsy.3.022806.091520

The Straits Times. (2020, March 30). Coronavirus: Police site crashes as New Zealanders report neighbours breaking lockdown rules. The Straits Times. Retrieved from https://www.straitstimes.com/asia/australianz/ coronavirus-police-site-crashes-as-kiwis-turn-into-shutdown-snitches

Tian, F., Li, H., Tian, S., Yang, J., Shao, J., & Tian, C. (2020). Psycho- logical symptoms of ordinary Chinese citizens based on SCL-90 during the level I emergency response to COVID-19. Psychiatry Research, 288, 112992. http://dx.doi.org/10.1016/j.psychres.2020.112992

Vanderklippe, N. (2020, March 11). China’s coronavirus response esca- lates to snitch lines, cash rewards and threats. The Globe and Mail. Retrieved from https://www.theglobeandmail.com/world/article-china- virus-response-escalates-to-snitch-lines-and-threats-of/

Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., Ho, C. S., & Ho, R. C. (2020). Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. International Journal of Envi- ronmental Research and Public Health, 17, 1729. http://dx.doi.org/10 .3390/ijerph17051729

Wang, Y., Xu, B., Zhao, G., Cao, R., He, X., & Fu, S. (2011). Is quarantine related to immediate negative psychological consequences during the 2009 H1N1 epidemic? General Hospital Psychiatry, 33, 75–77. http:// dx.doi.org/10.1016/j.genhosppsych.2010.11.001

Webber, T. (2020, April 2). Residents snitch on businesses, neighbors amid COVID-19 shutdowns. Pittsburgh Post-Gazette. Retrieved from https:// www.post-gazette.com/news/world/2020/04/02/Residents-snitch-on- businesses-neighbors-amid-shutdowns-COVID-19-coronavirus/stories/ 202004020113

Weinstein, N. D. (1980). Unrealistic optimism about future life events. Journal of Personality and Social Psychology, 39, 806–820. http://dx .doi.org/10.1037/0022-3514.39.5.806

Wise, T., Zbozinek, T. D., Michelini, G., Hagan, C. C., & Mobbs, D. (2020). Changes in risk perception and protective behavior during the first week of the COVID-19 pandemic in the United States. PsyArXiv. Retrieved from https://osf.io/dz428

Wu, P., Fang, Y., Guan, Z., Fan, B., Kong, J., Yao, Z., . . . Hoven, C. W. (2009). The psychological impact of the SARS epidemic on hospital employees in China: Exposure, risk perception, and altruistic accep- tance of risk. The Canadian Journal of Psychiatry / La Revue canadienne de psychiatrie, 54, 302–311. http://dx.doi.org/10.1177/ 070674370905400504

Wu, P., Liu, X., Fang, Y., Fan, B., Fuller, C. J., Guan, Z., . . . Litvak, I. J. (2008). Alcohol abuse/dependence symptoms among hospital employ- ees exposed to a SARS outbreak. Alcohol and Alcoholism, 43, 706–712. http://dx.doi.org/10.1093/alcalc/agn073

Zhang, S. X., Wang, Y., Rauch, A., & Wei, F. (2020). Unprecedented disruption of lives and work: Health, distress and life satisfaction of working adults in China one month into the COVID-19 outbreak. Psychiatry Research, 288, 112958. http://dx.doi.org/10.1016/j.psychres .2020.112958

Zhang, W., Chen, Q., McCubbin, H., McCubbin, L., & Foley, S. (2011). Predictors of mental and physical health: Individual and neighborhood levels of education, social well-being, and ethnicity. Health & Place, 17, 238–247. http://dx.doi.org/10.1016/j.healthplace.2010.10.008

Zhang, W., Liu, S., Zhang, K., & Wu, B. (2020). Neighborhood social cohesion, resilience, and psychological well-being among Chinese older adults in Hawai’i. The Gerontologist, 60, 229–238. http://dx.doi.org/10 .1093/geront/gnz104

Zhang, Y., & Ma, Z. F. (2020). Impact of the COVID-19 pandemic on mental health and quality of life among local residents in Liaoning Province, China: A cross-sectional study. International Journal of En- vironmental Research and Public Health, 17, 2381. http://dx.doi.org/10 .3390/ijerph17072381

Zimmerman, E. B., Woolf, S. H., Blackburn, S. M., Kimmel, A. D., Barnes, A. J., & Bono, R. S. (2018). The case for considering education and health. Urban Education, 53, 744–773. http://dx.doi.org/10.1177/ 0042085916682572

Received June 8, 2020 Revision received July 20, 2020

Accepted July 21, 2020 �

12 BEST, LAW, ROACH, AND WILBIKS

  • The Psychological Impact of COVID-19 in Canada: Effects of Social Isolation During the Initial R ...
    • Mental Health Impacts of Public Health Measures
    • Cognitive-Emotional Responses
      • Information Sources and Mental Health
      • Purpose of the Current Study
    • Method
      • Participants
      • Materials
        • Satisfaction With Life Scale (SWLS; Diener et al., 1985)
        • Social Cohesion Scale (SCS; Li et al., 2015)
        • COVID-19 psychological distress
        • Perceptions of risk
        • Information sources
      • Procedure
    • Results
      • Cognitive-Emotional Responses
      • The Effects of Education and Information Source
      • Prediction of COVID-19 Psychological Distress
    • Discussion
      • Psychological Impact of Social Distancing
      • Prepandemic Predictors
      • Satisfaction With Life
      • Social Cohesion
      • Perception of Risk
      • The Impact of Information Sources
      • Prediction of COVID-19 Distress
      • Conclusions
    • References