Evolving policies, enduring impacts: Cross-sectional surveys of mental health, risk-related perceptions, and coping behaviors throughout China's U-turn in its stringent zero-COVID policy

Objective

China's early encounter with COVID-19 and protracted prevention policies, presents an ideal case to study psychological changes during a prolonged and evolving crisis. This study aims to examine the shifts in mental health symptoms, risk-related perceptions, and associated coping behaviors within two large-scale samples of Chinese respondents, spanning from the pandemic's onset to the relaxation of the zero-COVID policy. Moreover, the study strives to identify protective factors that could potentially mitigate the pandemic's impact.

Methods

Two online surveys were conducted during China's initial pandemic phase (February 25–28, 2020) and the relaxation of the zero-COVID policy (March 30–April 18, 2023). Participants' mental health indicators, risk-related perceptions, and coping behaviors were assessed using the Depression, Anxiety, and Stress Scale-21 Items, the 9-item Bergen Burnout Inventory, and other adopted scales. Multivariable linear models were employed to examine the enduring psychological impact of the pandemic and identify potential protective factors.

Results

Analysis of two datasets comprising 1946 and 1878 participants from the onset and the remission of China's COVID-19 pandemic revealed an upward trend in various mental health indicators of Chinese respondents between 2020 and 2023. Similarly, risk-related perceptions, encompassing perceived severity, susceptibility, and self-efficacy, and risk-related information sharing witnessed an increase. Being female, single, residing in rural areas, having higher education, and lacking acquaintances with COVID-19 are protective factors against mental health risks. Additionally, being female, married, over 30, living in big cities, having higher education, and lacking personal or acquaintances' infection history are associated with engaging in protective behaviors and reduced information avoidance.

Conclusion

The study investigated the changes in mental health symptoms, risk-related perceptions, and coping behaviors of Chinese respondents between 2020 and 2023 and identified protective factors against the pandemic's impact, including demographic (gender, age), social (education, marital status, residence), and exposure (infection history) elements. Understanding these fluctuations and protective elements is crucial for policymakers, as it can inform the development of targeted strategies to alleviate negative psychological impacts while effectively managing future pandemics.