COVID-19 stressors and health behaviors: A multilevel longitudinal study across 86 countries

PsyCorona Collaboration, Shian Ling Keng*, Michael V. Stanton, Lee Ann B. Haskins, Carlos A. Almenara, Jeannette Ickovics, Antwan Jones, Diana Grigsby-Toussaint, Maximilian Agostini, Jocelyn J. Bélanger, Ben Gützkow, Jannis Kreienkamp, Edward P. Lemay, Michelle R. vanDellen, Georgios Abakoumkin, Jamilah Hanum Abdul Khaiyom, Vjollca Ahmedi, Handan Akkas, Mohsin Atta, Sabahat Cigdem BagciSima Basel, Edona Berisha Kida, Allan B.I. Bernardo, Nicholas R. Buttrick, Phatthanakit Chobthamkit, Hoon Seok Choi, Mioara Cristea, Sára Csaba, Kaja Damnjanovic, Ivan Danyliuk, Arobindu Dash, Daniela Di Santo, Karen M. Douglas, Violeta Enea, Daiane G. Faller, Bertus F. Jeronimus, Yasin Koc, Joshua Krause, Maja Kutlaca, Anton Martinez, Kira O. McCabe, Solomiia Myroniuk, Boglárka Nyúl, Anne Margit Reitsema, Michelle K. Ryan, Edyta M. Sasin, Wolfgang Stroebe, Samiah Sultana, Jolien Anne van Breen, Kees Van Veen, N. Pontus Leander

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

6 Citations (Scopus)
25 Downloads (Pure)


Anxiety associated with the COVID-19 pandemic and home confinement has been associated with adverse health behaviors, such as unhealthy eating, smoking, and drinking. However, most studies have been limited by regional sampling, which precludes the examination of behavioral consequences associated with the pandemic at a global level. Further, few studies operationalized pandemic-related stressors to enable the investigation of the impact of different types of stressors on health outcomes. This study examined the association between perceived risk of COVID-19 infection and economic burden of COVID-19 with health-promoting and health-damaging behaviors using data from the PsyCorona Study: an international, longitudinal online study of psychological and behavioral correlates of COVID-19. Analyses utilized data from 7,402 participants from 86 countries across three waves of assessment between May 16 and June 13, 2020. Participants completed self-report measures of COVID-19 infection risk, COVID-19-related economic burden, physical exercise, diet quality, cigarette smoking, sleep quality, and binge drinking. Multilevel structural equation modeling analyses showed that across three time points, perceived economic burden was associated with reduced diet quality and sleep quality, as well as increased smoking. Diet quality and sleep quality were lowest among respondents who perceived high COVID-19 infection risk combined with high economic burden. Neither binge drinking nor exercise were associated with perceived COVID-19 infection risk, economic burden, or their interaction. Findings point to the value of developing interventions to address COVID-related stressors, which have an impact on health behaviors that, in turn, may influence vulnerability to COVID-19 and other health outcomes.

Original languageEnglish
Article number101764
Number of pages8
JournalPreventive Medicine Reports
Publication statusPublished - Jun-2022


  • COVID-19
  • Economic burden
  • Health behaviors
  • Infection risk

Cite this