{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T22:58:38Z","timestamp":1793055518289,"version":"4.5.0"},"reference-count":40,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2020,7,8]],"date-time":"2020-07-08T00:00:00Z","timestamp":1594166400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Effective management of the global pandemic caused by Severe Acute Respiratory Syndrome Coronavirus 2 (also known as COVID-19), resulted in the implementation of severe restrictions in movement and enforcement of social distancing measures. This study aimed to understand and characterize the psychosocial effects of the COVID-19 pandemic in the general population and to identify risks and protective factors that predict changes in mental health status. In addition, the study investigated compliance with precautionary measures (PM) to halt the spread of the virus. The online anonymous survey collected information on sociodemographic data, compliance with PM, quality of life (QOL), and mental health via the Generalized Anxiety Disorder-7 (GAD-7) and Patient Health Questionnaire-9 (PHQ-9). A total of 1642 adult participants (71.6% women, 28.4% men) completed the survey in the European island country, Cyprus. A large percentage (48%) reported significant financial concerns and 66.7% significant changes in their QOL. About 41% reported symptoms associated with mild anxiety; 23.1% reported moderate-severe anxiety symptoms. Concerning depression, 48% reported mild and 9.2% moderate-severe depression symptoms. Women, younger age (18\u201329), student status, unemployment status, prior psychiatric history, and those reporting greater negative impact on their QOL, were at higher risk for increased anxiety and depression symptoms (p &lt; 0.05). The youngest age group and males also reported lower levels of compliance with PM. Higher compliance with PM predicted lower depression scores (p &lt; 0.001) but higher anxiety for measures related to personal hygiene. The results of this study provide important data on the effects of the COVID-19 outbreak on mental health and QOL and identify a variety of personal and social determinants that serve as risks and protective factors. Furthermore, it has implications for policy makers demonstrating the need for effective mental health programs and guidance for the implementation of PM as a public health strategy.<\/jats:p>","DOI":"10.3390\/ijerph17144924","type":"journal-article","created":{"date-parts":[[2020,7,8]],"date-time":"2020-07-08T11:47:46Z","timestamp":1594208866000},"page":"4924","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":453,"title":["Prevalence and Predictors of Anxiety and Depression Symptoms during the COVID-19 Pandemic and Compliance with Precautionary Measures: Age and Sex Matter"],"prefix":"10.3390","volume":"17","author":[{"given":"Ioulia","family":"Solomou","sequence":"first","affiliation":[{"name":"Center for Applied Neuroscience, University of Cyprus, Nicosia 1678, Cyprus"},{"name":"Department of Psychology, University of Cyprus, Nicosia 2109, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7928-8363","authenticated-orcid":false,"given":"Fofi","family":"Constantinidou","sequence":"additional","affiliation":[{"name":"Center for Applied Neuroscience, University of Cyprus, Nicosia 1678, Cyprus"},{"name":"Department of Psychology, University of Cyprus, Nicosia 2109, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,7,8]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2020, June 04). Advice for Public: Protecting Yourself and Others from Spread of COVID-19. Available online: https:\/\/www.who.int\/emergencies\/diseases\/novel-coronavirus-2019\/advice-for-public."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"taaa021","DOI":"10.1093\/jtm\/taaa021","article-title":"The reproductive number of COVID-19 is higher compared to SARS coronavirus","volume":"27","author":"Liu","year":"2020","journal-title":"J. Travel Med."},{"key":"ref_3","unstructured":"(2020, June 05). European Centre for Disease Prevention and Control COVID-19 Situation Update Worldwide, as of 4 June 2020. Available online: https:\/\/www.ecdc.europa.eu\/en\/geographical-distribution-2019-ncov-cases."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1093\/pcmedi\/pbaa006","article-title":"Recommended psychological crisis intervention response to the 2019 novel coronavirus pneumonia outbreak in China: A model of West China Hospital","volume":"3","author":"Zhang","year":"2020","journal-title":"Precis. Clin. Med."},{"key":"ref_5","unstructured":"Worldometer (2020, June 05). Cyprus Population (2020). Available online: https:\/\/www.worldometers.info\/world-population\/cyprus-population\/."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"479","DOI":"10.1080\/14616690701744364","article-title":"A comparative perspective on intergenerational support: Responsiveness to parental needs in individualistic and familialistic countries","volume":"10","author":"Kalmijn","year":"2008","journal-title":"Eur. Soc."},{"key":"ref_7","unstructured":"Hadjicostis, M. (2020, June 04). Cyprus: In fighting virus, politicians listened to experts. AP NEWS 2020, 23 April 2020. Available online: https:\/\/apnews.com\/122494a5194d860a4dac4af79796f04f."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1016\/S0140-6736(20)30460-8","article-title":"The psychological impact of quarantine and how to reduce it: Rapid review of the evidence","volume":"395","author":"Brooks","year":"2020","journal-title":"Lancet"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1177\/070674370404900607","article-title":"Stress and Psychological Impact on SARS Patients during the Outbreak","volume":"49","author":"Chua","year":"2004","journal-title":"Can. J. Psychiatry"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.1017\/S0033291704002247","article-title":"Severe acute respiratory syndrome (SARS) in Hong Kong in 2003: Stress and psychological impact among frontline healthcare workers","volume":"34","author":"Tam","year":"2004","journal-title":"Psychol. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"7","DOI":"10.3201\/eid1007.030703","article-title":"SARS Control and Psychological Effects of Quarantine, Toronto, Canada","volume":"10","author":"Hawryluck","year":"2004","journal-title":"Emerg. Infect. Dis."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1177\/070674370905400504","article-title":"The Psychological Impact of the SARS Epidemic on Hospital Employees in China: Exposure, Risk Perception, and Altruistic Acceptance of Risk","volume":"54","author":"Wu","year":"2009","journal-title":"Can. J. Psychiatry"},{"key":"ref_13","first-page":"1245","article-title":"The immediate psychological and occupational impact of the 2003 SARS outbreak in a teaching hospital","volume":"168","author":"Maunder","year":"2003","journal-title":"CMAJ"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Tan, B.Y.Q., Chew, N.W.S., Lee, G.K.H., Jing, M., Goh, Y., Yeo, L.L.L., Zhang, K., and Chin, H.-K. (2020). Psychological Impact of the COVID-19 Pandemic on Health Care Workers in Singapore. Ann. Intern. Med.","DOI":"10.7326\/M20-1083"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/j.jpsychores.2009.04.004","article-title":"Psychosocial and coping responses within the community health care setting towards a national outbreak of an infectious disease","volume":"68","author":"Sim","year":"2010","journal-title":"J. Psychosom. Res."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., Ho, C.S., and Ho, R.C. (2020). Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17051729"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"112934","DOI":"10.1016\/j.psychres.2020.112934","article-title":"The psychological impact of the COVID-19 epidemic on college students in China","volume":"287","author":"Cao","year":"2020","journal-title":"Psychiatry Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"142","DOI":"10.5195\/jmla.2018.319","article-title":"Research Electronic Data Capture (REDCap)","volume":"106","author":"Patridge","year":"2018","journal-title":"JMLA"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1016\/S0165-0327(03)00198-8","article-title":"Measuring depression outcome with a brief self-report instrument: Sensitivity to change of the Patient Health Questionnaire (PHQ-9)","volume":"81","author":"Kroenke","year":"2004","journal-title":"J. Affect. Disord."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7","volume":"166","author":"Spitzer","year":"2006","journal-title":"Arch. Intern. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1097\/MLR.0b013e318160d093","article-title":"Validation and Standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the General Population","volume":"46","author":"Decker","year":"2008","journal-title":"Med. Care"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"551","DOI":"10.1016\/j.genhosppsych.2013.04.006","article-title":"Standardization of the depression screener Patient Health Questionnaire (PHQ-9) in the general population","volume":"35","author":"Kocalevent","year":"2013","journal-title":"Gen. Hosp. Psychiatry"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1111\/j.1600-0047.2004.00325.x","article-title":"Prevalence of mental disorders in Europe: Results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project","volume":"109","author":"Alonso","year":"2004","journal-title":"Acta Psychiatr. Scand. Suppl."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2861","DOI":"10.1038\/s41598-018-21243-x","article-title":"Prevalence of Depression in the Community from 30 Countries between 1994 and 2014","volume":"8","author":"Lim","year":"2018","journal-title":"Sci. Rep."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1606","DOI":"10.4088\/JCP.v69n1011","article-title":"Gender differences in Generalized Anxiety Disorder: Results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)","volume":"69","year":"2008","journal-title":"J. Clin. Psychiatry"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1017\/S0033291798008150","article-title":"Age differences in depression and anxiety symptoms: A structural equation modelling analysis of data from a general population sample","volume":"29","author":"Christensen","year":"1999","journal-title":"Psychol. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1037\/0882-7974.20.2.330","article-title":"Age Differences in Exposure and Reactions to Interpersonal Tensions: A Daily Diary Study","volume":"20","author":"Birditt","year":"2005","journal-title":"Psychol. Aging"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1017\/S1074070800000602","article-title":"Online versus Face-to-Face: Students\u2019 Preferences for College Course Attributes","volume":"46","author":"Mann","year":"2014","journal-title":"J. Agric. Appl. Econ."},{"key":"ref_29","first-page":"29","article-title":"Comparative Analysis of Learner Satisfaction and Learning Outcomes in Online and Face-to-Face Learning Environments. 21","volume":"11","author":"Johnson","year":"2000","journal-title":"J. Interact. Learn. Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1159\/000440835","article-title":"Cognitive-Linguistic Performance and Quality of Life in Healthy Aging","volume":"67","author":"Constantinidou","year":"2015","journal-title":"Folia Phoniatr. Logop."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1007\/s11136-009-9481-3","article-title":"Gender and age differences in domain-specific life satisfaction and the impact of depressive and anxiety symptoms: A general population survey from Germany","volume":"18","author":"Daig","year":"2009","journal-title":"Qual. Life Res."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"326","DOI":"10.1192\/bjp.bp.106.025106","article-title":"Impact of psychiatric disorders on health-related quality of life: General population survey","volume":"190","author":"Saarni","year":"2007","journal-title":"Br. J. Psychiatry"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"325","DOI":"10.1037\/a0026243","article-title":"Higher-order structure in the trajectories of depression and anxiety following sudden involuntary unemployment","volume":"121","author":"Howe","year":"2012","journal-title":"J. Abnorm. Psychol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"502","DOI":"10.2105\/AJPH.75.5.502","article-title":"Effects of unemployment on mental and physical health","volume":"75","author":"Linn","year":"1985","journal-title":"Am. J. Public Health"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1007\/s10663-015-9306-2","article-title":"Fairness and reflexivity in the Cyprus bail-in","volume":"43","author":"Zenios","year":"2016","journal-title":"Empirica"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Zenios, S.A. (2013). The Cyprus Debt: Perfect Crisis and a Way Forward. SSRN J.","DOI":"10.2139\/ssrn.2233239"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Jacob, L., Haro, J.M., and Koyanagi, A. (2019). Relationship between living alone and common mental disorders in the 1993, 2000 and 2007 National Psychiatric Morbidity Surveys. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0215182"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1093\/pubmed\/21.3.283","article-title":"Social determinants of GHQ score by postal survey","volume":"21","author":"Harrison","year":"1999","journal-title":"J. Public Health"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1016\/j.euroneuro.2011.08.008","article-title":"Cost of disorders of the brain in Europe 2010","volume":"21","author":"Gustavsson","year":"2011","journal-title":"Eur. Neuropsychopharmacol."},{"key":"ref_40","unstructured":"Bloom, D.E., Cafiero, E., Jan\u00e9-Llopis, E., Abrahams-Gessel, S., Bloom, L.R., Fathima, S., Feigl, A.B., Gaziano, T., Hamandi, A., and Mowafi, M. (2012). The Global Economic Burden of Noncommunicable Diseases, World Economic Forum. PGDA Working Papers; Program on the Global Demography of Aging."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/14\/4924\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:48:59Z","timestamp":1760176139000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/14\/4924"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7,8]]},"references-count":40,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2020,7]]}},"alternative-id":["ijerph17144924"],"URL":"https:\/\/doi.org\/10.3390\/ijerph17144924","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,7,8]]}}}