Risk and Protective Factors for Anxiety Disorder During COVID-19 Pandemic

Abstract Background: COVID-19 is a global pandemic and an anxiety-provoking event. Therefore, a study was conducted to identify potential risk and protective factors related to anxiety during COVID-19 pandemic.Methods: We collected information on demographic data and lifestyles by conducting a web-based survey of 19,802 participants from 34 provinces in China during COVID-19 pandemic. Level of anxiety was evaluated using the Self-Rating Anxiety Scale. We used ordinal multivariable logistic regression to estimate the associations of anxiety level with potential risk and protective factors, and further developed a new score to simplify the assessment of anxiety disorder during COVID-19 crisis.Results: Among 19,802 participants (mean [SD] age, 25.3 [8.1], years; 10,121 [51.1%] men), we found that those who were front-line medical personnel, suffered from chronic diseases, with present symptom of SARS-CoV-2 infection or contact history had 112%, 93%, 40% and 15% increase risk of higher anxiety level; while those with knowledge about personal protective measures or wore masks had 75% and 29% lower risk of higher anxiety level respectively. We developed a risk score by calculating the sum of single score of 17 factors. Each one increase of the risk score was associated with a 297% increase in anxiety index score. In categorical analysis, low risk (the risk score between 1 to 2), the moderate risk group (the risk score of 3) and high risk group (the risk score ≥4) had a -0.40 (95% CI: -1.55, 0.76), 1.44 (95% CI: 0.27, 2.61) and 9.18 (95% CI: 8.04, 10.33) increase in anxiety index score, and a 26% (95% CI: -7%, 72%), 172% (95% CI: 100%, 270%), and 733% (95% CI: 516%, 1026%) higher risk of anxiety disorder respectively, when compared with the very low risk group (the risk score of 0). The AUC was 0.73 (95% CI: 0.72, 0.74) for the model fitted the developed risk score, with the cut-off point of 3.5.Conclusions: These findings revealed protective and risk factors associated with anxiety disorder, and propose a practical and simple method of identifying people who are at an increased risk of anxiety disorder during COVID-19 pandemic.