{"paper_id":"61806a7d-72bc-4c0a-a619-5cffe7b591ea","body_text":"Distance to Epicenter and Mental Health \nPage 1 of 18 \n \nGeographical identification of the vulnerable groups during COVID-19 crisis: the \ntyphoon eye effect and its boundary conditions \nPok Man Tang, MPhila; Stephen X. Zhang, PhDb*, Chi Hon Li, MSc a; Feng Wei, PhDc \n \na. Texas A&M University, United States   \nb. University of Adelaide, Adelaide, Australia \nc. Tongji University, Shanghai, China  \n \n \n \nE-mail Address for Each Author: \nPok Man Tang: pokmantang620@gmail.com \nStephen X Zhang: stephen.x.zhang@gmail.com \nChi Hon Li: john.lich05@gmail.com \nFeng Wei: fwei@tongji.edu.cn \n \n*Corresponding author: Chi Hon Li,  \njohn.lich05@gmail.com;  \nPhone: +1 979 676 6588;  \nAddress: 400 Bizzell St, College Station, TX 77843 \n \nDeclaration of Interest \nThe authors declare that they have no competing interests. \n  \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted May 2, 2020. ; https://doi.org/10.1101/2020.04.28.20083667doi: medRxiv preprint \nNOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.\n\n  Distance to Epicenter and Mental Health \nPage 2 of 18 \n \nGeographical identification of the vulnerable groups during COVID-19 crisis: the \ntyphoon eye effect and its boundary conditions \n \nAim:  \nAlthough some studies suggest the coronavirus disease (COVID-19) is associated with \nnegative consequences on physical health, our knowledge about the detrimental effects of \nCOVID-19 on people’s mental health is still nascent. This study uses typhoon eye theory to \noffer insights in helping clinical psychiatrists to screen people with well-being issues during \nCOVID-19 outbreak. \nMethods:  \nWe collected survey data from working adults across different geographical areas in China on \n20 and 21 February 2020 during the outbreak of COVID-19. The sample contains 308 \nworking adults, who were in various parts of China, with varying distance to the epicenter of \nWuhan.  \nResults:  \nIndividual adults’ distance to the epicenter was negatively associated with life satisfaction (β  \n= -0.235, 95% CI -0.450 to -0.020, p = 0.032) . This association between distance and life \nsatisfaction was significant only for adults who were young or had smaller family sizes. For \nexample, the negative relationship was strongest when the individuals were in the age bracket \nof 20 years old (15.7%; β  = -0.703, 95% CI -1.098 to -0.307; p = 0.001) and single (32.3%; β  \n= -0.767, 95% CI -1.125 to -0.408; p < 0.001).  \nConclusion:  \nOur results that people’s well-being deteriorates by the distance from the epicenter for \nspecific groups of people help guide mental healthcare providers towards the regions that are \nfurther away from the epicenter in the ongoing COVID-19 outbreak. Meanwhile, our results \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted May 2, 2020. ; https://doi.org/10.1101/2020.04.28.20083667doi: medRxiv preprint \n\n  Distance to Epicenter and Mental Health \nPage 3 of 18 \n \nindicate the practitioners should be cautious of using typhoon eye effect for individuals who \nwere older or had a larger family size.  \nKeywords: COVID-19; distance to the epicenter; well-being \n  \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted May 2, 2020. ; https://doi.org/10.1101/2020.04.28.20083667doi: medRxiv preprint \n\n  Distance to Epicenter and Mental Health \nPage 4 of 18 \n \nINTRODUCTION \nThe COVID-19 virus is deteriorating people’s wellbeing, as shown in an increase in the \nburnout or anxiety across communities.1 2 However, our knowledge of people’s life \nsatisfaction, one of the most prominent indicators of mental health, 3 4 during COVID-19 \ncrisis remains a lacuna. We aim to use early evidence in China to help mental health services \nproviders in screening people with wellbeing issues during COVID-19 outbreak from a novel \nperspective of typhoon eye theory.5 6 This study identifies the vulnerable regions where \nindividuals are more likely to suffer from well-being issues and helps to guide medical \nprofessionals’ attention towards the more mentally vulnerable groups that are far away from \nthe epicenter in the COVID-19 outbreak.  \nMental health services used to pay more attention to people around the center of the \nepicenter following the “ripple effect” during severe acute respiratory syndrome (SARS) and \nEbola \n7-9.  However, given the explosive information on COVID-19,10 we suspect that \nindividuals’ well-being deteriorates over distance from the epicenter, as depicted by the \npsychological typhoon eye theory.5 6 To provide evidence on the geographical distribution of \nthe wellbeing issues during COVID-19 crisis, we test whether typhoon eye theory works and \nfor whom it works in the COVID-19 outbreak.  \nTo further help clinical psychiatrists in conducting clinical screening for the \nvulnerable groups of people during the pandemic of COVID-19, we examine whether the \ntyphoon eye effect is more or less useful based on people’s age and family size. The younger \npopulation are usually more adaptive to the outbreak of virus or a natural disaster,\n11 12 \nhowever, they also tend to access information on COVID-19 more frequently via social \nmedia and other digital channels\n13 and hence are more exposed to the associated negative \ncontent.14 In addition, family size is a salient indicator of social support that one could \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted May 2, 2020. ; https://doi.org/10.1101/2020.04.28.20083667doi: medRxiv preprint \n\n  Distance to Epicenter and Mental Health \nPage 5 of 18 \n \nreceive.15 During the outbreak of a disease, family size has been found to become an \nimportant resource to buffer stress and anxiety.16 \n We surveyed working adults in locations that vary in their travel distance from the \nepicenter of Wuhan (0 to 2126 km) to examine its relationship with their life satisfaction. \nMoreover, we have also identified the vulnerable groups of people (based on age and family \nsize), for whom the typhoon eye effect of COVID-19 is more pronounced. Overall, drawing \nfrom psychological typhoon eye,\n5 6 this study provided a snapshot of adults’ well-being \nduring the ongoing COVID-19 pandemic to enable more targeted mental health support. \nMETHODS \nStudy design \nOn December 29, 2019, the first four cases of COVID-19 were identified by the local \nhospitals in Wuhan, Hubei Province, China.17 Given the severity of COVID-19, the World \nHealth Organization made the decision on presenting the outbreak as a Public Health \nEmergency of International Concern (PHEIC) on January 30, 2020.18 A week prior to this \nannouncement, the Chinese authorities decided to shut down the city of Wuhan by ceasing all \nthe transportation means, including flights, trains, subway, and ferry services.19 Nevertheless, \naround 300,000 people traveled out of Wuhan area by train before the policy was \nimplemented.20 About 70% of those people reached reach other areas within Hubei Province, \nand about 14% went to the nearby provinces, such as Henan, Hunan, Anhui, and Jiangxi.21 \nAs people left the epicenter, it is susceptible that they carry fear and anxiety to people around \nthem due to the concerns about being infected by the virus.  \nData collection and measures \nFrom February 20 to 21, 2020, we sent a survey to 410 working adults staying in various \ncities in China right after a month of the outbreak. 308 of them answered the survey, resulting \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted May 2, 2020. ; https://doi.org/10.1101/2020.04.28.20083667doi: medRxiv preprint \n\n  Distance to Epicenter and Mental Health \nPage 6 of 18 \n \nin a response rate of 75.1%. Their distance to the epicenter ranged from 0 km to 2126 km. All \nrespondents agreed to participate in the study, which was approved by the ethics committee at \nTongji University (#20200211).  \nOur survey gathered subjects’ life satisfaction, distance to the epicenter, and socio-\ndemographic characteristics, including gender, age, education, family size, the number of \noffice days last week, and job status. Life satisfaction was assessed with the Satisfaction With \nLife Scale (SWLS),22 which has five items (Cronbach’s alpha = 0.72) shown in Table 1. The \ndistance to the epicenter was calculated as each participant’s distance to Wuhan at the time of \nthe survey. Education included the categories of “elementary school”, “middle school”, “high \nschool”, “vocational school”, “bachelor”, “master”, and “doctorate”. Family size was \nmeasured as “single”, “married (without a child)”, “married (with 1 child)”, “married (with \nmore than 1 child)”, and “others: divorced/widowed”. Job status was classified as “usual \nwork routine”, “home office”, and “work suspended”. \nWe have also conducted a supplementary analysis on the relationship between the \ndistance to the epicenter and life satisfaction from data collected prior to the outbreak of \nCOVID-19 to check whether the typhoon eye effect occurred only during the COVID-19 \ncrisis. \nWe used multiple linear regression to predict life satisfaction as an outcome by \nsubjects’ gender, age, family size, education, number of working days last week, job status, \nand distance to the epicenter. We reported the descriptive and regression findings on \nunweighted data with STATA 16.0 by the statistical significance of p/i2 </i2 0.05 in Table 2. \nRESULTS \nAround half 168 (54.5%) of the subjects were male, and 140 (45.5%) were female. The \naverage distance to the epicenter of Wuhan was 0.81 (in 1000 km) with a standard deviation \nof 0.41 (in 1000 km). The average age of the subjects was 38 (s.d.= 9). For family size, most \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted May 2, 2020. ; https://doi.org/10.1101/2020.04.28.20083667doi: medRxiv preprint \n\n  Distance to Epicenter and Mental Health \nPage 7 of 18 \n \nof them fell into the categories of single: 171 (32.3%), married with one child: 177 (33.5%), \nand married with more than one child: 150 (28.4%). There were 119 (38.6%) people with \nbachelor’s degrees and 129 (42%) with elementary, middle, high, and vocational school \neducation levels. During our survey, more than half of them (175, 56.8%) did not have any \noffice day in the past week and the rest worked on average for 1.67 (s.d. 2.34) days last week. \n22 (7.1%) worked one day and 20 (6.5%) worked seven days in the past week. 132 (42.9%) \nworked from home, while 99 (32.1%) maintained the usual work routine, and 77 (25%) \nsuspended their work. \nMain Effects of the Personal Characteristics \nThe regression results in Table 2 examined the predictors of life satisfaction during the period \nof the outbreak. Male (54.5%) reported a lower level of life satisfaction than women did \n(45.5%) (β  = 0.3, 95% CI 0.13 to 0.46, p < 0.001). Younger working adults experienced less \nlife satisfaction than older adults did (β  = 0.013, 95% CI 0.002 to 0.024; p = 0.019). Single \npeople had less life satisfaction compared to those with one child (33.5%) and more than one \nchild (28.4%) (for one child: β  = 0.401, 95% CI 0.122 to 0.679; p < 0.005; for more than one \nchildren: β  = 0.418, 95% CI 0.147 to 0.689; p = 0.003). The effects of education, the number \nof office days last week, and job status on life satisfaction were not significant. \nEffect of the Distance to the Epicenter of Wuhan \nThe regression results in Table 2 indicated the negative association between the distance to \nthe epicenter and life satisfaction (β  = -0.235, 95% CI -0.450 to -0.020; p = 0.032), \nsupporting the typhoon eye effect. \nFirst, the association between the distance to the epicenter and life satisfaction was \nless negative among the older adults (β  = 0.020, 95% CI 0.004 to 0.036; p = 0.015). The \nassociation is the most negative in the youngest age bracket of 20 years old (β  = -0.703; 95% \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted May 2, 2020. ; https://doi.org/10.1101/2020.04.28.20083667doi: medRxiv preprint \n\n  Distance to Epicenter and Mental Health \nPage 8 of 18 \n \nCI -1.098 to -0.307; p = 0.001) and the second most negative in the second youngest age \nbracket of 30 years old (β  = -0.475, 95% CI -0.748 to -0.202, p = 0.001), while the group of \n40 years old were the third one (β  = -0.247, 95% CI -0.460 to -0.034; p = 0.023). The \nassociation was not significant for the age brackets of 50 years old and above. These \ninteraction effects are shown in Figure 1. \nSecond, the negative association between the distance to the epicenter and life \nsatisfaction was also buffered by large family size (β  = 0.260, 95% CI 0.098 to 0.421; p = \n0.002). Subgroup analysis revealed the typhoon eye effect was significant among the singles \n(β  = -0.767, 95% CI -1.125 to -0.408; p < 0.001),  those married without a child (2.8%; β  = -\n0.507, 95% CI -.0750 to -0.265; p < 0.001), and those married with one child (33.5%; β  = -\n0.248, 95% CI -0.451 to -0.044; p = 0.017). The association between the distance to the \nepicenter and life satisfaction was not significant for those married with more than one child \n(25.4%; β  = 0.012, 95% CI -0.264 to 0.288; p = 0.932) or indicated others in family status \n(3%; β  = 0.272, 95% CI -0.132 to 0.675; p = 0.186). These interaction effects are \ndemonstrated in Figure 2. \nSupplementary Analysis \nWe modeled the relationship between the distance to the epicenter and life satisfaction using \ncollected data from working adults before the outbreak of COVID-19. The effect of the \ndistance to the epicenter of Wuhan on life satisfaction was insignificant (β  = 0.000, 95% CI -\n0.0003 to -0.0003, p = 0.897) before the outbreak. This supplementary analysis indicates that \nthe typhoon eye effect did not occur before the COVID-19 outbreak. \nDISCUSSION \nThis study shows that people who were geographically further from the epicenter experience \nlower levels of life satisfaction in China. Following psychological typhoon eye theory, we \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted May 2, 2020. ; https://doi.org/10.1101/2020.04.28.20083667doi: medRxiv preprint \n\n  Distance to Epicenter and Mental Health \nPage 9 of 18 \n \nfurther identify the vulnerable groups that mentally suffer the most associated with their \ndistance during the outbreak: younger adults and individuals with small family size to provide \nimportant insights for mental health service providers while conducting the clinical screening. \nIn summary, our findings do not only provide psychiatric implications on the location of \nindividuals from the outbreak area but also combine this geographical result with the \ndemographic characteristics of participants to help identify the vulnerable groups who were \nin greater need of medical attention.23    \nIndeed, our results empirically confirmed the postulation of the typhoon eye theory.5 6 \nResearch from multiple disciplines of research can provide explanations of the findings. For \nexample, clinical studies found that people that did not experience the situation first-hand \noften overestimated the likelihood of infections.24 People who learned the news about the \nvirus away from the epicenter tended to exacerbate their concerns over COVID-19.25 \nSimilarly, research after the 2008 Wenchuan earthquake in China found that people far from \nthe earthquake area were more likely to suffer mentally for their higher estimation of post-\nearthquake concern.5 Understanding the life satisfaction of people with a varying \ngeographical distance to the epicenter is crucial for clinical psychiatrists during the process of \nscreening because the changes in its score are associated with the chance of suffering from \nmental disorders like depression.26 27 By revealing that people who were more distant from \nthe epicenter indeed have lower life satisfaction scores, our results guide mental health \nprofessionals to prioritize the treatment and habilitation for people based on their \ngeographical distance to the outbreak area.  \nThe findings that the typhoon eye effect was more pronounced among younger are \nconsistent with prior research. As noted earlier, younger people tend to rely on social media \nand the internet to obtain information.28 This reliance increases the likelihood of developing \nthe feelings of anxiety and burnout through inauthentic news about the epicenter. Younger \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted May 2, 2020. ; https://doi.org/10.1101/2020.04.28.20083667doi: medRxiv preprint \n\n  Distance to Epicenter and Mental Health \nPage 10 of 18 \n \nresidents can be more vulnerable to negative information on COVID-19. The other finding \nthat the psychological typhoon eye effect is more salient for people with smaller family sizes \nconsonants with the family literature.29 Support from the family attenuates the negative \npsychological impacts that one might experience facing disasters.30 Hence, we push forward \nthe claim that one’s family size is a proxy of the level of social and emotional support that \nindividuals may receive during the outbreak of COVID-19 31. \nPractically, our findings combine geographical and demographic information of \nparticipants to help identify the vulnerable groups who were in a greater need for mental \nhealth attention. Our results suggest that mental health services cannot solely use typhoon eye \neffect as the only geographical information to identify those with low life satisfaction. The \nresults that only people in the age brackets of 20-40 in regions far from the epicenter were \nmore likely to experience lower levels of life satisfaction indicate that mental healthcare \nproviders can indeed use typhoon eye effect only for people in those age brackets. This \nguidance is especially notable giving research has already differentiated adults by age groups \nregarding COVID-19 symptoms. Similarly, only adults with small family sizes in regions far \nfrom the epicenter were more likely to experience lower levels of life satisfaction, and hence \nmental healthcare providers can use typhoon eye effect to screen for mental health issues \namong people with small families.  \nLimitations \nThe context of this study has a clear epicenter of COVID-19, Wuhan, in China. However, not \nall countries have a single epicenter. For example, South Korea simultaneously had several \nepicenters 32, which opened new research avenues on the effect of geographical distance in \nthe presence of multiple epicenters. In addition, the design was unable to capture the dynamic \nmovement of the citizens across the cities in China over time to observe the fluctuations in \nthe well-being over time. Lastly, our data was collected in China, a geographically large \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted May 2, 2020. ; https://doi.org/10.1101/2020.04.28.20083667doi: medRxiv preprint \n\n  Distance to Epicenter and Mental Health \nPage 11 of 18 \n \ncountry, and it remains unclear whether the typhoon eye effects will generalize in other \ncountries, most of which are smaller. The epicenter of Wuhan is in the center of the country, \nyet an epicenter of COVID-19 in the United States of American is New York State, which is \ngeographically on the Northeastern. In that case, we suspect that the typhoon eye effects \nmight play out differently (i.e., at different pace and patterns).  \nConclusion \nOur research calls for clinical psychiatrists’ attention on people’s mental health during the \npandemic of COVID-19, especially for those who are living away from the epicenter. We \nfound that the further people are away from the epicenter, the lower are their reported life \nsatisfaction. This relationship is stronger among younger individuals and individuals with \nsmaller family sizes but not significant for older adults or those with bigger families. To \nconclude, our research helps provide insights for clinical professionals in identifying the \nvulnerable groups of people that are more exposed to the risk of mental disorder during the \npandemic of COVID-19. \nContributors: Stephen X. Zhang contributed to the planning, conduct, and reporting of the work and \nis responsible for the overall content as the guarantor. Stephen also drafted the empirical sections of \nthe paper and led the submission. Pok Man Tang drafted conceptual parts of the paper. Stephen Zhang, \nPok Man Tang, and Chi Hon Li made equal contributions to this paper. Chi Hon Li edited and \nformatted the manuscript, made the figures and tables, and prepared the submission files. Feng Wei \nled the data collection and obtained necessary funding and ethical approval. The corresponding author \nattests that all listed authors meet authorship criteria and that no others meeting the criteria have been \nomitted. \nCopyright/license for publication: The corresponding author has the right to grant on behalf of all \nauthors and does grant on behalf of all authors, a worldwide license to the Publishers and its licensees \nin perpetuity, in all forms, formats, and media (whether known now or created in the future), to i) \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted May 2, 2020. ; https://doi.org/10.1101/2020.04.28.20083667doi: medRxiv preprint \n\n  Distance to Epicenter and Mental Health \nPage 12 of 18 \n \npublish, reproduce, distribute, display and store the Contribution, ii) translate the Contribution into \nother languages, create adaptations, reprints, include within collections and create summaries, extracts \nand/or, abstracts of the Contribution, iii) create any other derivative work(s) based on the Contribution, \niv) to exploit all subsidiary rights in the Contribution, v) the inclusion of electronic links from the \nContribution to third party material where-ever it may be located; and, vi) license any third party to do \nany or all of the above. \nCompeting interests: All authors have completed the ICMJE uniform disclosure form at \nwww.icmje.org/coi_disclosure.pdf and declare: no support from any organization for the submitted \nwork; no financial relationships with any organizations that might have an interest in the submitted \nwork in the previous three years; no other relationships or activities that could appear to have \ninfluenced the submitted work. \nTransparency declaration: The corresponding author Chi Hon Li affirms that this manuscript is an \nhonest, accurate, and transparent account of the study being reported; that no important aspects of the \nstudy have been omitted; and that any discrepancies from the study as planned (and, if relevant, \nregistered) have been explained. \nFunding: The data collection was funded by the Chinese National Funding of Social Sciences (Grant \nnumber: 1509093).  \nDissemination declaration: Patients or the public were not involved in the design, or conduct, or \nreporting, or dissemination plans of our research \nData sharing: Data are available upon request. \n \n  \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted May 2, 2020. ; https://doi.org/10.1101/2020.04.28.20083667doi: medRxiv preprint \n\n  Distance to Epicenter and Mental Health \nPage 13 of 18 \n \nFigure Legends \nFigure 1. The association between distance to the epicenter and life satisfaction by \nindividuals’ age. The interaction effect was significant and strongest in the age brackets of 20, \nfollowed by the brackets of 30 and 40. The interaction effect was insignificant in the brackets \nof above 50. \n \n \nFigure 2. The association between distance to the epicenter and life satisfaction by \nindividuals’ family size. The interaction effect was significant and strongest for the \nindividuals who were single, followed by those who married without a child and with a child. \nThe interaction effect was insignificant for those who married with more than one child and \nothers. \n \n  \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted May 2, 2020. ; https://doi.org/10.1101/2020.04.28.20083667doi: medRxiv preprint \n\n  Distance to Epicenter and Mental Health \nPage 14 of 18 \n \nREFERENCES \n \n1. Lagasse J. Healthcare workers risk burnout, exposure in wake of coronavirus pandemic. \nHealthcare Finance. 2020. \n2. Langer G. Coronavirus impacts: Disrupted lives, elevated stress, and soaring worry: Poll. \nABC News. 2020. \n3. Lombardo P, Jones W, Wang L, et al. 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The satisfaction with life scale. Journal of \nPersonality Assessment. 1985; 49: 71-75. \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted May 2, 2020. ; https://doi.org/10.1101/2020.04.28.20083667doi: medRxiv preprint \n\n  Distance to Epicenter and Mental Health \nPage 15 of 18 \n \n23. Brody DJ, Pratt LA, Hughes JP. Prevalence of depression among adults aged 20 and over: \nUnited States, 2013-2016: US Department of Health and Human Services, Centers for \nDisease Control and Prevention, National Center for Health Statistics 2018. \n24. Halpern-Felsher BL, Millstein SG, Ellen JM, et al. The role of behavioral experience in \njudging risks. Health Psychology. 2001; 20: 120-29. \n25. Kasperson RE, Renn O, Slovic P, et al. The social amplification of risk: A conceptual \nframework. Risk Analysis. 1988; 8: 177-87. \n26. Koivumaa-Honkanen H, Kaprio J, Honkanen R, et al. Life satisfaction and depression in \na 15-year follow-up of healthy adults. Social psychiatry and psychiatric \nepidemiology. 2004; 39: 994-99. \n27. Rissanen T, Viinamäki H, Lehto SM, et al. The role of mental health, personality \ndisorders and childhood adversities in relation to life satisfaction in a sample of \ngeneral population. Nordic Journal of Psychiatry. 2013; 67: 109-15. \n28. Lariscy RW, Reber BH, Paek H-J. Examination of media channels and types as health \ninformation sources for adolescents: Comparisons for black/white, male/female, \nurban/rural. Journal of Broadcasting & Electronic Media. 2010; 54: 102-20. \n29. Sherbourne CD, Hays RD. Marital status, social support, and health transitions in chronic \ndisease patients. Journal of Health and Social Behavior. 1990; 31: 328-43. \n30. Lazarus PJ, Jimerson SR, Brock SE. Responding to natural disasters: Helping children \nand families. National Association of School Psychologists. 2003:  \n31. Zimmer Z, Kwong J. Family size and support of older adults in urban and rural China: \nCurrent effects and future implications. Demography. 2003; 40: 23-44. \n32. Park C-k. Coronavirus cluster emerges at another South Korean church, as others press \nahead with Sunday services. South China Morning Post. 2020. \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n \n  \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted May 2, 2020. ; https://doi.org/10.1101/2020.04.28.20083667doi: medRxiv preprint \n\n  Distance to Epicenter and Mental Health \nPage 16 of 18 \n \nTable 1. Scale of life satisfaction \n \nItems  \n1. In most ways my life is close to my ideal. \n2. The conditions of my life are excellent. \n3. I am satisfied with my life. \n4. So far I have gotten the important things I want in life. \n5. If I could live my life over, I would change almost nothing. \n \n  \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted May 2, 2020. ; https://doi.org/10.1101/2020.04.28.20083667doi: medRxiv preprint \n\n  Distance to Epicenter and Mental Health \nPage 17 of 18 \n \nTable 2. Mean estimated life satisfaction among subjects based on their gender, age, \neducation, family status, marriage status, and the distance to the epicenter \n \nVariables Count (%) Parameter estimates (95% \nCI) \nGender: \nMale 168 (54.5%) [Reference] \nFemale 140 (45.5%) 0.296 (0.133 to 0.458) \nAge 308 (100%) 0.013 (0.002 to 0.024) \nFamily size: \nSingle 171 (32.3%) [Reference] \nMarried (without children) 15 (2.8%) 0.431 (-0.057 to 0.920) \nMarried (with one child) 177 (33.5%) 0.401 (0.122 to 0.679) \nMarried (with more than \none child)  \n150 (28.4%) 0.418 (0.147 to 0.689) \nDivorced/widowed 16 (3%) -0.058 (-0.504 to 0.388) \nEducation: \nElementary school 4 (1.3%) [Reference] \nMiddle school 31 (10.1%) 0.122 (-0.600 to 0.844) \nHigh school 39 (12.7%) 0.239 (-0.481 to 0.960) \nVocational school 55 (17.9%) 0.382 (-0.339 to 1.103) \nBachelor 119 (38.6%) 0.236 (-0.486 to 0.958) \nMaster 49 (15.9%) 0.429 (-0.298 to 1.156) \nDoctorate 11 (3.6%) 0.608 (-0.213 to 1.430) \nOffice days last week: \n0 day 175 (56.8%) [Reference] \n1 day 22 (7.1%) -0.005 (-0.319 to 0.310) \n2 days 20 (6.5%) -0.071 (-0.417 to 0.275) \n3 days 21 (6.8%) 0.075 (-0.334 to 0.485) \n4 days 10 (3.2%) -0.095 (-0.633 to 0.444) \n5 days 30 (9.7%) 0.152 (-0.221 to 0.524) \n6 days 10 (3.2%) -0.054 (-0.590 to 0.482) \n7 days 20 (6.5%) 0.052 (-0383. to 0.488) \nJob status: \nUsual work routine 99 (32.1%) [Reference] \nHome office 132 (42.9%) -0.216 (-0.529 to 0.098) \nWork suspended 77 (25.0%) -0.286 (-0.631 to 0.058) \nDistance to the epicenter 308 (100%) -0.235 (-0.450 to -0.020) \nInteraction effects of age and family size \nDistance to the epicenter \n* Age 308 (100%) 0.020 (0.004 to 0.036) \nDistance to the epicenter \n* Family size 308 (100%) 0.260 (0.098 to 0.421) \n \n . CC-BY 4.0 International licenseIt is made available under a \n is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)\nThe copyright holder for this preprint this version posted May 2, 2020. ; https://doi.org/10.1101/2020.04.28.20083667doi: medRxiv preprint","source_license":"CC-BY-4.0","license_restricted":false}