{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T10:41:58Z","timestamp":1781174518166,"version":"3.54.1"},"reference-count":29,"publisher":"MDPI AG","issue":"22","license":[{"start":{"date-parts":[[2020,11,13]],"date-time":"2020-11-13T00:00:00Z","timestamp":1605225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["XX"],"award-info":[{"award-number":["XX"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>The novel coronavirus disease 2019 (COVID-19) pandemic brought about several features that increased the sense of fear and confusion, such as quarantine and financial losses among other stressors, which may have led to adverse psychosocial outcomes. The influence of such stressors took place within a broader sociocultural context that needs to be considered. The objective was to examine how the psychological response to the pandemic varied across countries and identify which risk\/protective factors contributed to this response. An online survey was conducted from 29 May 2020\u201312 June 2020, among a multinational sample of 8806 adults from eight countries\/regions (Canada, United States, England, Switzerland, Belgium, Hong Kong, Philippines, New Zealand). Probable generalized anxiety disorder (GAD) and major depression episode (MDE) were assessed. The independent role of a wide range of potential factors was examined using multilevel logistic regression. Probable GAD and MDE were indicated by 21.0% and 25.5% of the respondents, respectively, with an important variation according to countries\/regions (GAD: 12.2\u201331.0%; MDE: 16.7\u201332.9%). When considered together, 30.2% of the participants indicated probable GAD or MDE. Several factors were positively associated with a probable GAD or MDE, including (in descending order of importance) weak sense of coherence (SOC), lower age, false beliefs, isolation, threat perceived for oneself\/family, mistrust in authorities, stigma, threat perceived for country\/world, financial losses, being a female, and having a high level of information about COVID-19. Having a weak SOC yielded the highest adjusted odds ratio for probable GAD or MDE (3.21; 95% confidence interval (CI): 2.73\u20133.77). This pandemic is having an impact on psychological health. In some places and under certain circumstances, however, people seem to be better protected psychologically. This is a unique opportunity to evaluate the psychosocial impacts across various sociocultural backgrounds, providing important lessons that could inform all phases of disaster risk management.<\/jats:p>","DOI":"10.3390\/ijerph17228390","type":"journal-article","created":{"date-parts":[[2020,11,13]],"date-time":"2020-11-13T08:44:02Z","timestamp":1605257042000},"page":"8390","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":64,"title":["One Virus, Four Continents, Eight Countries: An Interdisciplinary and International Study on the Psychosocial Impacts of the COVID-19 Pandemic among Adults"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6269-8801","authenticated-orcid":false,"given":"M\u00e9lissa","family":"G\u00e9n\u00e9reux","sequence":"first","affiliation":[{"name":"Department of Community Health Sciences, Faculty of Medicine &amp; Health Sciences, Universit\u00e9 de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip J.","family":"Schluter","sequence":"additional","affiliation":[{"name":"School of Health Sciences, University of Canterbury-Te Whare Wananga o Waitaha, Christchurch 8140, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8706-7758","authenticated-orcid":false,"given":"Kevin KC","family":"Hung","sequence":"additional","affiliation":[{"name":"Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response, JC School of Public Health and Primary Care, Chinese University of Hong Kong, Ngan Shing Street 30-32, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chi Shing","family":"Wong","sequence":"additional","affiliation":[{"name":"Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response, JC School of Public Health and Primary Care, Chinese University of Hong Kong, Ngan Shing Street 30-32, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine","family":"Pui Yin Mok","sequence":"additional","affiliation":[{"name":"Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response, JC School of Public Health and Primary Care, Chinese University of Hong Kong, Ngan Shing Street 30-32, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6799-6779","authenticated-orcid":false,"given":"Tracey","family":"O\u2019Sullivan","sequence":"additional","affiliation":[{"name":"Interdisciplinary School of Health Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON K1N 7K4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1215-6777","authenticated-orcid":false,"given":"Marc D.","family":"David","sequence":"additional","affiliation":[{"name":"D\u00e9partement de communication, Facult\u00e9 des Lettres et Sciences Humaines, Universit\u00e9 de Sherbrooke, Sherbrooke, QC J1K 2R1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1094-6751","authenticated-orcid":false,"given":"Marie-Eve","family":"Carignan","sequence":"additional","affiliation":[{"name":"D\u00e9partement de communication, Facult\u00e9 des Lettres et Sciences Humaines, Universit\u00e9 de Sherbrooke, Sherbrooke, QC J1K 2R1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriel","family":"Blouin-Genest","sequence":"additional","affiliation":[{"name":"School of Applied Politics, Facult\u00e9 des Lettres et Sciences Humaines, Universit\u00e9 de Sherbrooke, Sherbrooke, QC J1K 2R1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5457-9391","authenticated-orcid":false,"given":"Olivier","family":"Champagne-Poirier","sequence":"additional","affiliation":[{"name":"D\u00e9partement de communication, Facult\u00e9 des Lettres et Sciences Humaines, Universit\u00e9 de Sherbrooke, Sherbrooke, QC J1K 2R1, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00c9ric","family":"Champagne","sequence":"additional","affiliation":[{"name":"School of Political Studies, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario K1N 6N5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathalie","family":"Burlone","sequence":"additional","affiliation":[{"name":"School of Political Studies, Faculty of Social Sciences, University of Ottawa, Ottawa, Ontario K1N 6N5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zeeshan","family":"Qadar","sequence":"additional","affiliation":[{"name":"National Collaborating Centre for Infectious Diseases, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 0T5, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teodoro","family":"Herbosa","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, College of Medicine, University of Philippines, Manille Grand Manille 1000, Philippines"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gleisse","family":"Ribeiro-Alves","sequence":"additional","affiliation":[{"name":"Centro Universit\u00e1rio de Bras\u00edlia, Bras\u00edlia 70850-090, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald","family":"Law","sequence":"additional","affiliation":[{"name":"Department of Health, Manila, Manille 2932, Philippines"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginia","family":"Murray","sequence":"additional","affiliation":[{"name":"Public Health England, London SE1 8UG, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8854-5093","authenticated-orcid":false,"given":"Emily Ying Yang","family":"Chan","sequence":"additional","affiliation":[{"name":"Collaborating Centre for Oxford University and CUHK for Disaster and Medical Humanitarian Response, JC School of Public Health and Primary Care, Chinese University of Hong Kong, Ngan Shing Street 30-32, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathalie","family":"Pignard-Cheynel","sequence":"additional","affiliation":[{"name":"Acad\u00e9mie du journalisme et des m\u00e9dias, Universit\u00e9 de Neuch\u00e2tel, 2000 Neuch\u00e2tel, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00e9bastien","family":"Salerno","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Gen\u00e8ve, Boulevard du Pont-d\u2019Arve 40, 1205 Gen\u00e8ve, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9307-8880","authenticated-orcid":false,"given":"Gr\u00e9goire","family":"Lits","sequence":"additional","affiliation":[{"name":"Institut Langage et Communication, Universit\u00e9 catholique de Louvain, 1348 Louvain-la-Neuve, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leen","family":"d\u2019Haenens","sequence":"additional","affiliation":[{"name":"Institute for Media Studies, KU Leuven, 3000 Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3831-266X","authenticated-orcid":false,"given":"David De","family":"Coninck","sequence":"additional","affiliation":[{"name":"Centre for Sociological Research, KU Leuven, 3000 Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koenraad","family":"Matthys","sequence":"additional","affiliation":[{"name":"Centre for Sociological Research, KU Leuven, 3000 Leuven, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6405-6765","authenticated-orcid":false,"given":"Mathieu","family":"Roy","sequence":"additional","affiliation":[{"name":"Department of Family Medicine &amp; Emergency Medicine, Faculty of Medicine &amp; Health Sciences, Universit\u00e9 de Sherbrooke, Sherbrooke, QC J1H 5N4, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,11,13]]},"reference":[{"key":"ref_1","unstructured":"Worldometers 2020 (2020, September 12). COVID-19 Coronavirus Pandemic Reported Cases and Deaths by Country, Territory, or Conveyance. Available online: https:\/\/www.worldometers.info\/coronavirus\/?utm_campaign=homeAdvegas1?#countries."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1016\/S2215-0366(20)30168-1","article-title":"Multidisciplinary research priorities for the COVID-19 pandemic: A call for action for mental health science","volume":"7","author":"Holmes","year":"2020","journal-title":"Lancet Psychiatry"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"317","DOI":"10.1177\/0020764020915212","article-title":"The outbreak of COVID-19 coronavirus and its impact on global mental health","volume":"66","author":"Torales","year":"2020","journal-title":"Int. J. Soc. Psychiatry"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"102066","DOI":"10.1016\/j.ajp.2020.102066","article-title":"COVID-19 and mental health: A review of the existing literature","volume":"52","author":"Rajkumar","year":"2020","journal-title":"Asian J. Psychiatry"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e01745","DOI":"10.1002\/brb3.1745","article-title":"Risk, resilience, psychological distress, and anxiety at the beginning of the COVID-19 pandemic in Germany","volume":"10","author":"Petzold","year":"2020","journal-title":"Brain Behav."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Mazza, C., Ricci, E., Biondi, S., Colasanti, M., Ferracuti, S., Napoli, C., and Roma, P. (2020). A Nationwide Survey of Psychological Distress among Italian People during the COVID-19 Pandemic: Immediate Psychological Responses and Associated Factors. Int. J. Environ. Res. Public Health, 17.","DOI":"10.3390\/ijerph17093165"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/j.bbi.2020.05.040","article-title":"Mental health consequences during the initial stage of the 2020 Coronavirus pandemic (COVID-19) in Spain","volume":"87","author":"Saiz","year":"2020","journal-title":"Brain Behav. Immun."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e04399","DOI":"10.1016\/j.heliyon.2020.e04399","article-title":"Exploring COVID-19 stress and its factors in Bangladesh: A perception-based study","volume":"6","author":"Islam","year":"2020","journal-title":"Heliyon"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"113172","DOI":"10.1016\/j.psychres.2020.113172","article-title":"\u201cChris\u201d Factors associated with depression, anxiety, and PTSD symptomatology during the COVID-19 pandemic: Clinical implications for U.S. young adult mental health","volume":"290","author":"Liu","year":"2020","journal-title":"Psychiatry Res."},{"key":"ref_10","unstructured":"Antonovsky, A. (1987). Unraveling the Mystery of Health: How People Manage Stress and Stay Well, Jossey-Bass."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1027\/1015-5759\/a000337","article-title":"Are three items sufficient to measure sense of coherence? Evidence from nonclinical and clinical samples","volume":"34","author":"Chiesi","year":"2018","journal-title":"Eur. J. Psychol. Assess."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Dymecka, J., Gerymski, R., and Machnik-Czerwik, A. (2020). How does stress affect our life satisfaction during COVID-19 pandemic? Moderated mediation analysis of sense of coherence and fear of coronavirus 2020. PsyArXiv Prepr.","DOI":"10.31234\/osf.io\/3zjrx"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1016\/j.genhosppsych.2009.03.001","article-title":"Long-term psychiatric morbidities among SARS survivors","volume":"31","author":"Mak","year":"2009","journal-title":"Gen. Hosp. Psychiatry"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1016\/S2215-0366(20)30046-8","article-title":"Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed","volume":"7","author":"Xiang","year":"2020","journal-title":"Lancet Psychiatry"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1159\/000510752","article-title":"Impact of COVID-19 on public mental health and the buffering effect of a sense of coherence","volume":"89","author":"Sopp","year":"2020","journal-title":"Psychother. Psychosom."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/0091-7435(86)90025-3","article-title":"Health promotion and the knowledge-attitude-behavior continuum","volume":"15","author":"Bettinghaus","year":"1986","journal-title":"Prev. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1136\/ebm.11.6.184","article-title":"The GAD-7 scale was accurate for diagnosing generalised anxiety disorder","volume":"11","author":"Swinson","year":"2006","journal-title":"Evid. Based Med."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Levis, B., Benedetti, A., and Thombs, B.D. (2019). Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: Individual participant data meta-analysis. BMJ, 365.","DOI":"10.1136\/bmj.l1476"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1017\/S1481803500013336","article-title":"Understanding receiver operating characteristic (ROC) curves","volume":"8","author":"Fan","year":"2006","journal-title":"Can. J. Emerg. Med."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Hosmer, D.W., and Lemeshow, S. (2000). Applied Logistic Regression, Wiley.","DOI":"10.1002\/0471722146"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"G\u00e9n\u00e9reux, M., Roy, M., David, M.D., Carignan, M.E., Blouin-Genest, G., and Champagne-Poirier, O. Psychological response to the COVID-19 pandemic in Canada: Main stressors and assets, Global Health Promot., submitted in July 2020.","DOI":"10.1177\/17579759211023671"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"54","DOI":"10.24095\/hpcdp.37.2.04","article-title":"The burden of generalized anxiety disorder in Canada","volume":"37","author":"Louise","year":"2017","journal-title":"Health Promot. Chronic Dis. Prev. Can."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.jad.2019.05.040","article-title":"Seasonal variation in symptoms of depression: A Canadian population based study","volume":"255","author":"Lukmanji","year":"2019","journal-title":"J. Affect. Disord."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"345","DOI":"10.3389\/fpsyt.2018.00345","article-title":"Prevalence Rates and Predictors of Generalized Anxiety Disorder Symptoms in Residents of Fort McMurray Six Months After a Wildfire","volume":"9","author":"Agyapong","year":"2018","journal-title":"Front. Psychiatry"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1007\/s11469-018-0004-8","article-title":"Prevalence Rates and Correlates of Probable Major Depressive Disorder in Residents of Fort McMurray 6 Months After a Wildfire","volume":"17","author":"Agyapong","year":"2018","journal-title":"Int. J. Ment. Health Addict."},{"key":"ref_26","first-page":"869","article-title":"Strengthening sense of coherence: Opportunities for theory building in health promotion","volume":"31","author":"Super","year":"2016","journal-title":"Health Promot. Int."},{"key":"ref_27","first-page":"1","article-title":"Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: A systematic review and meta-analysis","volume":"16","author":"Salari","year":"2020","journal-title":"Glob. Health"},{"key":"ref_28","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_29","doi-asserted-by":"crossref","unstructured":"Klaiber, P., Wen, J.H., DeLongis, A., and Sin, N.L. (2020). The Ups and Downs of Daily Life During COVID-19: Age Differences in Affect, Stress, and Positive Events. J. Gerontol. Ser. B.","DOI":"10.1093\/geronb\/gbaa096"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/22\/8390\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:32:46Z","timestamp":1760178766000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/22\/8390"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,13]]},"references-count":29,"journal-issue":{"issue":"22","published-online":{"date-parts":[[2020,11]]}},"alternative-id":["ijerph17228390"],"URL":"https:\/\/doi.org\/10.3390\/ijerph17228390","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11,13]]}}}