Exploring Anxiety and Chain Reaction of Anxiety in COVID-19 Pandemic: A large population Web-based survey in Japan

Background: Anxiety plays an important role in psychology, explore the anxiety and its chain reactions can provide a good insight of the measures to address mental health problem caused by the COVID-19 (Coronavirus Disease 2019) epidemic. Methods: : A cross-sectional study using data collected via an online self-reported questionnaire was conduct on Japan during the COVID-19 pandemic. Using State-Trait Anxiety Inventory (STAI-6) to assess the level of anxiety, and explore the relationship of anxiety STAI-6 Score, sources of COVID-19 information, the influences of COVID-19, social anxiety symptoms, discrimination, and evaluation toward the government. Results: : 4,127 participants were included to the analysis. The level of anxiety is not equally distributed across the general population with different age, gender, educational level, occupation, income, presence of underlying disease and location ( P <0.05). The numbers of sources to get information about COVID-19 have a positive correlation with STAI-6 Score (Spearman’rho=0.176, P <0.001). The influences caused by the pandemic are related to moderate-severe anxiety. Then the high level of anxiety would add to social anxiety (Spearman’rho=0.04, P <0.05) and discrimination behaviors (Spearman’rho=0.11, P <0.01). Generalized additive model shows that high anxiety would lower the responders’ evaluations of the preventive measures took by either national government or local government. Conclusions: : Our findings provide a statistical evidence for the chain reaction of anxiety, that anxiety reactions may vary in predictable ways. Further researches can focus on what types of strategic interventions can cut the chain response of anxiety, in order to address the mental health problems in a pandemic.