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Title: Factors related to preventive COVID-19 infection behaviors among people with mental illness
Authors: Chang, KC
Strong, C
Pakpour, AH
Griffiths, MD
Lin, CY 
Issue Date: 2020
Source: Journal of the Formosan Medical Association, 2020, v. 119, no. 12, p. 1772-1780
Abstract: Background/Purpose: Because of the spread of novel coronavirus disease 2019 (COVID-2019), preventive COVID-19 infection behaviors become important for individuals, especially those who are vulnerable. The present study proposes a model to explain the preventive COVID-19 infection behaviors among people with mental illness in Taiwan.
Methods: A cross-sectional design was carried out and 414 patients with mental illness (230 males [55.6%]; mean age = 46.32 [SD = 10.86]) agreed to participate in the study. All the participants completed the Preventive COVID-19 Infection Behaviors Scale, Self-Stigma Scale-Short, Believing COVID-19 Information Scale, Fear of COVID-19 Scale, and Depression Anxiety Stress Scale-21. Regression models and structural equation modeling (SEM) were applied to examine the factors associated with preventive COVID-19 infection behaviors.
Results: Both regression models and SEM showed that trust in COVID-19 information sources (standardized coefficient [β] = 0.211 in regression; β = 0.194 in SEM) and fear of COVID-19 (β = −0.128 in regression; β = −0.223 in SEM) significantly explained preventive behaviors among individuals with mental illness. The SEM further showed that fear of COVID-19 was significantly explained by trust in COVID-19 information sources (β = 0.220) and self-stigma (β = 0.454).
Conclusions: Based on the results, healthcare providers should help individuals with mental illness reduce self-stigma and fear of COVID-19 which would consequently improve their preventive COVID-19 infection behaviors. Moreover, improving trust in COVID-19 information sources for individuals with mental illness may be another method to improve their preventive behaviors.
Keywords: COVID-19
Preventive behavior
Psychological distress
Publisher: Elsevier
Journal: Journal of the Formosan Medical Association 
ISSN: 0929-6646
EISSN: 1876-0821
DOI: 10.1016/j.jfma.2020.07.032
Rights: © 2020, Formosan Medical Association. Published by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license (
The following publication Chang, K. C., Strong, C., Pakpour, A. H., Griffiths, M. D., & Lin, C. Y. (2020). Factors related to preventive COVID-19 infection behaviors among people with mental illness. Journal of the Formosan Medical Association, 119(12), 1772-1780, is available at
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