COVID protection behaviours, mental health, risk perceptions and control beliefs: A dynamic temporal network analysis of daily diary data

Background: Behavioural non-pharmaceutical interventions (NPIs) such as social distancing and hygiene (masking, hand hygiene) were implemented widely during the COVID-19 pandemic to control infections. NPI adherence is crucial for effectiveness, but has also been implied in an increase in mental health problems. However, existing studies often have designs unsuited to understanding mechanistic relationships between NPI adherence, mental health symptoms, and health-related cognitions (risk perceptions, control beliefs). Understanding these mechanisms is crucial for the refinement of existing and the designs of effective future NPIs. Purpose: To separate between- and temporal within-person associations between mental health, risk cognitions and NPI adherence. Methods: Six-month ecological momentary assessment study with six 4-day assessment bouts in 397 German adults. Daily measurement of adherence, mental health symptoms and cognitions during bouts. We used dynamic temporal network analysis to estimate between- person, as well as contemporaneous and temporal within-person effects for distancing and hygiene NPIs. Results: Distinct networks of mental health, health cognitions and adherence emerged. Participants with higher control and higher susceptibility were also more adherent. Similar within-person contemporaneous patterns; additionally, distancing and loneliness were associated. Temporally, better adherence to NPIs was associated with better mental health on subsequent days, whereas higher loneliness was associated with better subsequent hygiene adherence. Conclusion: Findings suggest no negative impact of NPI adherence on mental health or vice versa, but instead suggest that adherence might improve mental health symptoms. Control beliefs and risk perceptions are important covariates of adherence - both on between-person and within-person level.