Perceived risk of COVID-19 hurts mental health: the mediating role of fear of COVID-19 and the moderating role of resilience

Abstract

Background Depression and anxiety have been found prevalent during all phases of the COVID-19 pandemic. In late December 2022, all COVID-19 control measures were lifted in China, leading to a surge in COVID-19 infections. The public’s perceived risk and fear of COVID-19 would increase. According to Common Sense Model (CSM), emotional illness representation of a disease, i.e., how people feel about the disease (fear of COVID-19), would result in mental distress. This study aimed to examine the prevalence of depression and anxiety in the Chinese general population and explore the mediating role of fear of COVID-19 between COVID-19 perceived risk and depression/anxiety and the moderating role of resilience between fear of COVID-19 and depression/anxiety. Method A cross-sectional online survey was conducted in Wenzhou, China, immediately following all COVID-19 control measures lifted. The 9-item Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder 7 (GAD-7), the COVID-19 Risk Perception Scale, the Fear of COVID-19 Scale, and the Connor-Davidson Resilience Scale (CD-RISC) were used to evaluate depression, anxiety, COVID-19 perceived risk, fear of COVID-19, and resilience, respectively. Structural Equation Modeling (SEM) with Maximum Likelihood (ML) estimator, with adjustment of the significant background factors was performed to test the moderated mediation. Data obtained from 935 participants were finally analyzed. Results The prevalence of moderate to severe depression and anxiety was 23.7% and 9.5%, respectively. The present study revealed positive associations among COVID-19 perceived risk, fear of COVID-19 and depression/anxiety, and negative associations between resilience and fear of COVID-19/depression/anxiety. Fear of COVID-19 partially mediated between COVID-19 perceived risk and depression/anxiety. Furthermore, resilience significantly moderated between fear of COVID-19 and depression/anxiety. Two moderated mediation models were constructed. Conclusion Depression and anxiety were prevalent among Chinese adults during the final phase of the pandemic in China. The significant mediation role of fear of COVID-19 implies that reducing fear of COVID-19 may effectively alleviate depression and anxiety symptoms. Moreover, enhancing public resilience during an epidemic crisis is crucial for promoting mental health.