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APP| Published By AEIRC| https://doi.org/10.29052/2412-3188.v7.i1.2020.9-18 
 

Ann. psychophysiol. 
ISSN 2412-3188 (Online) | 2410-1354 (Print) 

 
 
Original Article                                                                                  

Psychological Response & Perceived Risk 
Associated with Coronavirus Disease  
Saima Khan1, Yusra Saleem2 & Syed A Aziz2,3 

1Laboratory of Skeletal Development and Regeneration, The Institute of Life Science, 
Chongqing Medical University, Chongqing-China 
2Advance Educational Institute & Research Centre (AEIRC), Karachi-Pakistan 
3University of Ottawa & Health Canada, Canada  
 

Abstract 
Background: The Coronavirus Disease 2019 (COVID-19) was declared a pandemic 

by WHO as it is found to be excessively transmissible & to spread throughout the 

world. The disease has caused a worldwide impact because of the need to establish 

worldwide activity by extensive social distancing and quarantine due to the daily 

rising death toll. Through this study, we examined intend to examine the 

psychological effects, perceptual vulnerability, and perceived stress developed 

among the general population. 

Methodology: The study was conducted from 2nd March to 26th May 2020. A total 

of 2188 of subjects replied to our informal online survey internationally. The 

respondent's demographic details and data regarding precautionary measures, 

perceptual vulnerability, perceived stress, and level of susceptibility of COVID-19 

was collected. The perceived stress scale (PSS-10) was used for assessment of 

perceived anxiety, stigmatization, and fear of developing COVID-19.   

Results: As per the study findings, moderate perceived stress was observed among 

66.6% of the respondents. Among the protective measures, washing hands was 

most frequent 56.2%, but the use of face mask wasn't widespread, i.e. 48.9% rarely 

or never used face masks. 37.1% felt anxious around sick people, 58.5% were 

usually bothered by the people sneezing without covering their mouths. 32.3% 

occasionally felt agitated because of no control over the current situation & 18.6% 

frequently felt stressed and/or nervous. The contact history revealed that 11.2% 

had close contact, 20.9% had a non-close contact, and 12.9% were those who had 

suspected connection with a confirmed case.   

Conclusion: Evidently, COVID-19 has numerous psychological impacts, and the 
responses vary due to perceived vulnerability & stress. The social distancing, 
disease fear, and quarantine may have some negative effects which may have some 
lasting consequences on general population.   

  

Keywords 
COVID-19, Perceived Vulnerability, Psychological Impacts, Perceived Stress, 

Disease Susceptibility. 

Citation: Khan S, Saleem Y, Aziz SA. 
Psychological Response & Perceived 
Risk Associated with Coronavirus 
Disease. APP. 2020; 7(1):9-18 
 
Corresponding Author Email:  
saima@aeirc-edu.com 
 
DOI: 10.29052/2412-3188.v7.i1.2020.9-18 
 
Received 02/06/2020 
 
Accepted 10/09/2020 
 
Published 01/10/2020 
 
Copyright © The Author(s). 2020 This  
 is an open access article distributed 
under the terms of the Creative 
Commons Attribution 4.0 International 
License, which permits unrestricted use, 
distribution, and reproduction in any 
medium, provided the original author 
and source are credited.  
 

 

Funding: The author(s) received no 
specific funding for this work. 

Conflicts of Interests: The authors 
have declared that no competing 
interests exist. 
 

http://creativecommons.org/licenses/by/4.0/)
http://creativecommons.org/licenses/by/4.0/)
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Introduction  
The novel outbreak of COVID-19 emerged 
from China by the end of 2019, followed by a 
continuous spread globally1. Although it is 
not new for the medical community, the 
current pandemic is the 5th type of 
coronavirus infection, i.e. severe acute 
respiratory syndrome, SARS-CoV21 spread 
in 2002-2003 8,098 cases and a 10% death rate. 
However, the associated contingency of 
COVID-19 is reported to be more lethal with 
a higher rate of symptomatic and 
asymptomatic fatalities that directed 
immediate emergency to be led by the 
scientific and medical community2. The virus 
has been known to cause a range of illnesses 
from a minor cold to severe complications 
like acute respiratory distress syndrome 
(ARDS), that were also observed in 2012 
through Middle East Respiratory Syndrome 
(MERS-CoV) and the SARS-CoV in 2003. Still, 
this strain of COVID-19 is somewhat 
different from the ones previously identified 
among humans1,3.  
 
COVID-19 was declared a Pandemic by 
WHO due to its transmission mode and 
reported means of infection spread4. An 
emergency has been announced to control 
global health, and severe preventive 
measures are being taken to prevent the 
disease from spreading globally2. According 
to the World Health Organization (WHO), 
there were almost 1,133,681 confirmed cases 
of COVID-19 globally by April 5, 2020, and 
62,784 confirmed deaths from 209 affected 
countries, areas, or territories with confirmed 
cases4. Moreover, specific guidelines for both 
biomedical and psychological management 
of this pandemic have been issued by WHO5. 
They are recommending that preventive 
measures are as necessary as medical aid 
during this physiological health crisis5. The 
global scenario that is considered a threat to 
any healthy individual's well-being has 
created much psychological stress globally 
and already generated fear among 
individuals. This might be due to the daily 
news depiction indicating rising figures of 

suspected and confirmed COVID-19 cases 
and pertinacious quarantine2.  
 
Apart from physical suffering, it is not 
uncommon for confirmed or suspected 
patients of COVID-19 to deal with 
psychological pressure and other health-
related problems5. The mental health of the 
affectees has not been adequately assessed.  
Many of the academic institutes are now 
providing counselling services for such 
psychologically affected individuals6. The 
negative psychological impact of the 
epidemic and social distancing includes Post-
Traumatic Stress (PTS) symptoms, 
depression, anxiety, and anger confirmed 
amongst individuals6. 
 
Moreover, numerous studies have presented 
that front-line healthcare workers and patients 
are more susceptible to the emotional 
influences of COVID-197. Additionally, 
rejection, loneliness, depression, insomnia, 
anxiety, and hopelessness were also 

experienced. Increased risk of aggression and 
suicide were also reported but rarely8. It is 
noteworthy that this disease is not only 
disrupting the physical state of humans but 
also demolishing our psychological well-
being. 
 
Furthermore, mass quarantine is expected to 
elevate anxiety significantly for several 
reasons. This raised anxiety might also have 
follow-on consequences for further health 
dealings9, as the general population is 
encountering disappointment, boredom, and 
irritability under the isolation measures7. 
Moreover, strict social distancing and 
compulsory contact tracing policies by health 
specialists could cause discrimination, 
societal rejection, financial loss, inability to 
perform routine work, and stigmatization6. A 
recent study, including 4,607 individuals of 
Chinese descent, disclosed that these 
individuals' cognitive evaluations, 
particularly their perceived severity of 
COVID-19, are associated with increased 
negative emotions and behavioural 
reactions10.  



 

   

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Furthermore, the health experts are of no 
exception during the crucial time as they are 
on the forefront, in direct and close contact 
with the infected patients, suspected cases, 
families and are also answerable to the public 
inquiries7. 
 
Competent efforts are required concerning all 
disciplines to combat COVID-19, both 
medically and psychologically. There is little 
to no known evidence on mental health and 
psychological influences due to the COVID-
19 pandemic within the general population11. 
Most of the COVID-19 related research 
emphasizes epidemiology and the clinical 
features of the diseased persons12, the 
genomic description13 and the challenges 
faced by the global health authorities9. There 
is no ongoing research investigating the 
psychological influence of COVID- 19 on the 
general population to the best of our 
knowledge. Hence, the current study aimed 
to stimulate research on the psychological 
impacts of the COVID-19 pandemic. It is 
intended to explore the incidences of 
psychological distress and identify the 
perceived risks and protectiveness among 
general the population. This might support 
the healthcare authorities in preserving the 
mental health of the community during this 
pandemic. 

 

Methodology 
The survey was created and distributed using 
online survey administration app (Google 
Forms). Data was collected from March 2 to 
May 26, 2020. A total of 2188 subjects replied 
to our informal online survey globally. 
Participants were notified that they would 
not be compensated for their participation in 
the study and could stop taking the study at 
any time. They were also informed that the 
purpose of the study was to investigate their 
attitudes about COVID-19. The institutional 
ethics committee approved survey 
procedures. Subjects completed the online 
survey by using their phone or computer. 
The survey was advertised through social 
media (e.g., Facebook, Twitter). The 
respondent's demographic details were 

inquired, and the data regarding 
precautionary measures, perceptual 
vulnerability, perceived stress, and level of 
susceptibility of COVID-19 were collected. 
The Perceived Stress Scale (PSS-10) was used 
to assess perceived anxiety, stigmatization, 
and fear of developing COVID-19.  
 
The collected data were analyzed using SPSS 
version 22.0, and all qualitative variables like 
gender, regional distribution, protective 
measures, personal habits, perceptual 
vulnerability, and perceived stress subscale 
scoring, etc. were given as frequency and 
percentages. All quantitative variables like 
age and perceived stress scores were 
presented using mean and standard 
deviation (SD).   
 

Result 
Respondents’ characteristics 
Overall, 2188 responders from 21 different 
countries globally took part in the electronic 
survey. Of the total, 68.1% were females, and 
31.9% were males with a mean age of 
28.22±9.42 years. Most of the respondents 
included post-graduate students (40.3%), 
followed by under-graduates (24.3%) and 
graduates (21.5%). The majority of responses 
were obtained from the Eastern 
Mediterranean Region (27.90%), i.e. Pakistan, 
Saudi Arabia, Tunisia, and The United Arab 
Emirates, followed by countries from The 
European Region (27.51%), namely Belgium, 
Finland, France, Germany, Greece, Poland, 
Portugal and The United Kingdom (Table 1). 
The demographic characteristics of the study 
participants are displayed in table 1. 
 
Predictors for implementation of 
precautionary measures 
Regarding the protective measures taken by 
the responders and personal habits 
developed after the declaration of the 
COVID-19 pandemic, the most reported 
action and the most frequently established 
practice was washing hands with soap, i.e. 
56.2% of respondents washed their hands 
very often.  Moreover, 54% cover their mouth 
habitually while coughing or sneezing, and 



 

   

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28.2% would immediately wash their hands 
after while 32.7% of respondents would 
sometimes wash their hands after sneezing, 
coughing, or rubbing their nose. The essential 
protective measure of wearing face masks 

wasn't ubiquitous, as only 22.9% of 
respondents were using face masks 
frequently, while 26.9% of the respondents 
never used face masks.

 
Table 1: Demographic characteristics & Regional distribution of the study participants along 

with Protective measures, personal habits and various aspects of  
perceptual vulnerability. 

Variables  n=2188 

Gender Female 1491(68.1) 

Male 697(31.9) 

Age (Years) Mean ± Standard deviation   28.22±9.42 

Education  Graduate  470(21.5) 

Post-Graduate 882(40.3) 

Under-Graduate 532(24.3) 

Others 304(13.8) 

Countries Western Pacific Region Australia 86(3.9) 

East African Region Tanzania 69(3.2) 

East Asian Region Taiwan 86(3.9) 

South Asian Region Bangladesh 82(3.7) 

South-East Asia Region India 151(6.9) 

Eastern Mediterranean 
Region 

Pakistan 342(15.6) 

Saudi Arabia 71(3.2) 

Tunisia 108(4.9) 

United Arab 
Emirates 

90(4.1) 

European Region Belgium 63(2.9) 

Finland 66(3) 

France 60(2.7) 

Germany 106(4.8) 

Greece 62(2.8) 

Poland 103(4.7) 

Portugal 56(2.6) 

United 
Kingdom 

86(3.9) 

Region of the Americas Canada 108(4.9) 

United States 
of America  

167(7.6) 

Western Pacific Region Malaysia 95(4.3) 

New Zealand 73(3.3) 

Philippines 58(2.7) 

Habits Fairly 
Often 

Never Rarely Sometime Very 
Often 

Wearing face masks 291(13.3) 588(26.9) 480(22) 617(28.2) 212(9.7) 

Washing hands with soaps 606(27.7) - 81(3.7) 271(12.4) 1230(56.2) 

Covering mouth while coughing or 
sneezing 

445(20.3) 59(2.7) 96(4.4) 406(18.6) 1182(54) 



 

   

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Washing hands after touching possible 
contaminated objects 

558(25.5) 51(2.3) 221(10.1) 361(16.5) 997(45.4) 

Washing hands immediately after 
sneezing, coughing or rubbing the nose 

495(22.6) 85(3.9) 276(12.6) 715(32.7) 617(28.2) 

Perceptions 

Based on my past experiences, I am not 
likely to get sick  

252(11.5) 632(28.9) 498(22.8) 600(27.4) 206(9.4) 

I have a history of susceptibility to 
infectious diseases 

239(10.9) 873(39.9) 606(27.7) 344(15.7) 126(5.8) 

I am more likely to catch an infectious 
disease than the people around me 

190(8.7) 523(23.9) 689(31.5) 617(28.2) 169(7.7) 

It does not make me anxious to be 
around sick people 

284(12.9) 424(19.3) 441(20.2) 812(37.2) 227(10.4) 

My immune system protects me from 
most illnesses that other people get 

538(24.6) 151(6.9) 359(16.4) 818(37.4) 322(14.7) 

*Values are given as n(%)  
 
The perceptual vulnerability of respondents 
The respondents' perceived vulnerability was assessed. It was found that 14.7% of the respondents 
reported that their immune system protects them from most illnesses that often affect others. 
Moreover, 10.3% of the respondents were not very anxious around the sick people, while 37.1% 
sometimes felt anxious. Around 7.7% of the respondents thought they were more likely to catch 
infectious diseases, 5.8% were sure of disease susceptibly, and 9.4% believed that they were less 
likely to get sick (Table 1).        
 
Perceived Stress among the respondents 
The respondents' level of perceived stress due to the COVID-19 outbreak was assessed through the 
Perceived Stress Scale (PSS-10). Both negative and positive subscales were used except for items 4 
& 5. As per the analysis, the mean PSS score was 19.98±6.08, indicating that most of the respondents 
had moderate perceived stress (66.6%). Moreover, 17.9% were those displaying high perceived 
stress and 15.4% with low perceived pressure. The descriptive summary shows that 58.5% of the 
respondents reported that people who sneeze without covering their mouths make them anxious. 
While 32.3% sometimes felt agitated because the things happened were outside their control, and 
29.4% reported that they sometimes felt difficulties piling up so high that they could not recover. 
18.6% frequently felt stressed and nervous and fearful, and 17.6% believed they were unable to 
control the essential things in their life. Moreover, 25% very often felt upset because of the 
unexpected happenings of COVID-19, followed by 23.4% reporting it fairly often and 27% 
sometimes (Table 2).    
 

Table 2: Shows the Perceived Stress among the respondents 

PSS-10 score (Mean ± SD) 19.98±6.08 

Subscale Scoring  n(%) 

Low Perceived Stress (≤ 13) 338(15.4) 

Moderate Perceived Stress (14-26) 1458(66.6) 

High Perceived Stress (≥ 27) 392(17.9) 

Descriptive Results  Fairly 
Often 

Never Rarely Sometimes Very 
Often 

In the last month, how often 
have you been upset because of 

512(23.4) 204(9.3) 334(15.3) 590(27) 548(25) 



 

   

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something that happened 
unexpectedly? 

In the last month, how often 
have you felt that you could not 
control the essential things in 
your life? 

456(20.8) 188(8.6) 474(21.7) 680(31.1) 384(17.6) 

In the last month, how often 
have you felt nervous and 
stressed? 

454(20.7) 160(7.3) 452(20.7) 712(32.5) 406(18.6) 

In the last month, how often 
have you found that you could 
not cope with all the things you 
had to do? 

456(20.8) 270(12.3) 498(22.8) 624(28.5) 320(14.6) 

In the last month, how often 
have you been able to control 
irritations in your life? 

554(25.3) 136(6.2) 334(15.3) 896(41) 246(11.2) 

In the last month, how often 
have you felt that you were on 
top of things? 

424(19.4) 286(13.1) 562(25.7) 750(34.3) 150(6.9) 

In the last month, how often 
have you been angered because 
of things that happened that 
were outside of your control? 

400(18.3) 208(9.5) 488(22.3) 706(32.3) 386(17.6) 

In the last month, how often 
have you felt difficulties were 
piling up so high that you could 
not overcome them? 

446(20.4) 322(14.7) 536(24.5) 644(29.4) 238(10.9) 

It bothers me when people 
sneeze without covering their 
mouths 

392(17.9) 62(2.8) 136(6.2) 318(14.5) 1280(58.5) 

*For item 1-3, 6, 9 (0 – never; 1 - almost never; 2 – sometimes; 3 - fairly often; 4 - very often) 
*For item 7 & 8 (4 – never; 3 - almost never; 2 – sometimes; 1 - fairly often; 0 - very often) 

 
Level of direct and indirect contact history with diagnosed COVID19 cases 

 
Figure 1: Shows the level of susceptibility of the respondents following their contact history

11.2%
20.9%

9.6% 12.9%

78.2% 59.8%
69.4%

53.9%

10.5%
19.3% 21%

33.2%

Close contact with a
confirmed case

Non-close contact with a
confirmed case

Indirect contact with a
confirmed case

Suspected contact with a
case / infected materials

Yes No May Be



 

   

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Respondents reported their level of 
susceptibility as per their experience and 
understanding. Around 11.2% of the 
respondents reported that they had close 
contact with a confirmed case, and 10.5% 
were not very sure of any such incident, 
while 78.2% faced no such circumstances. 
20.9% had a non-close contact, 9.6% had an 
indirect connection with a confirmed case, 
while 12.9% had contact with a hypothetical 
case. 
 

Discussion 
The outcome of this study has expanded our 

limited understanding about the influence of 

the coronavirus pandemic and the associated 

psychological impacts14, raising a key 

concern against the negative impact held by 

the news, social distancing and quarantine in 

modern times. As it has been identified that 

COVID-19 spreads mainly through close 

contact from the droplets generated during 

spitting and sneezing from infected 

individuals15. Although quarantine and 

social distancing are recommended to lessen 

the disease transmission, the long-lasting 

implications associated with the diseases 

affecting people psychologically must also be 

considered before implementing these 

protective measures. We have the evidence 

indicating a positive history of psychological 

distress among the SARS survivors back in 

200416. After the SARS outbreak in 2003, the 

survivors suffered from stress and anxiety 

even after one year of the outbreak16. Despite 

knowing the adverse and long-term impacts 

of these preventive measures, we continue to 

follow the trend. Social distancing & 

quarantine has been accepted and 

implemented globally to minimize the 

disease spread.    

 

Unstable mental health is prominent among 

the general public and the sufferers of 

COVID-1917. It was revealed that more than 

32.3% felt agitated because the things that 

happened were outside their control, and 

18.6% frequently felt stressed, nervous and 

fearful because of the unprecedented 

happening of COVID-19. The study reveals 

an association between participants' risk 

perceptions built on individual experiences 

and existing circumstances. A wide range of 

literature depending on health actions and 

risk of communication provides a context for 

understanding this link. The risk of 

transmission should be considered as a 

critical element in encouraging people to 

adopt healthy behaviors18. That has been 

proven by both the health belief model and 

protective motivation theory, indicating that 

positive behavioural change is associated 

with risk prevention. Belief in one's ability to 

make the necessary change and belief that 

making the change may result in the health 

benefits for oneself has long been known and 

practiced19. 

 

Some of the respondents also ignored 

protective measures; for instance, 26.9% were 

not wearing masks, whereas others created 

new stricter rules for themselves. For 

example, 45% revealed washing hands after 

touching possibly contaminated objects, 56% 

showed washing hand with soap, while 54% 

cover their mouth while sneezing or 

coughing (Figure 1). Similar studies indicated 

that societal, psychological, and cultural 

influences modulate risk perceptions20,21. 

Literature suggests that the perceived level of 

risk associated with any event can be 

overstated compared to the originality, 

which might be due to the unmanageability 

of the associated risks22,23. 

 

The psychological health influence of 

COVID-19 among the patients, caretakers, 

and hospital employees is overwhelming 

compared to those disasters where contact to 

a threat was brief. Moreover, the perceptual 

vulnerability, stress, and psychological 

responses to COVID-19 significantly differ 

amongst people as per the present study's 

findings. Previously, research conducted on 



 

   

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perception-related responses to the SARS 

epidemic indicated that increased fear, sense 

of social isolation, and occupational stress 

were significantly associated with PTS 

symptom levels24. We also assessed the level 

of suppressibility of COVID-19 among the 

general population as per their 

understanding. It appears that 11.2% of the 

respondents had close contact with a 

confirmed case in the last two months while 

78.2% had no close contact, 20.9% had a non-

close contact, and 9.6% had an indirect 

connection with a confirmed case (Figure 1). 

The study presenting the epidemiological 

analysis of COVID-19 among different age 

groups indicated that the infection rate and 

associated mortality is high among older age 

groups25. 

 

Moreover, the stress induced by the COVID-

19 outbreak is evident and accepted. WHO 

states that this pandemic has widely 

increased the general population's stress 

levels, mainly due to unfamiliarity and high 

mortality within a short duration of time5. 

The mean PSS score was 19.98 ± 6.08, which 

lies under the moderate category, i.e. most of 

the respondents (66.6%) had mild perceived 

stress due to this pandemic for helping the 

psychological sufferers. WHO highly 

recommends minimizing the exposure to 

COVID-19 associated news is the primary 

reason behind anxiety and depression5. 

Moreover, the exposure must only be limited 

and acquired only at certain times in a day or 

two and only from a reliable source giving 

practical and authentic information5. During 

this health crisis, it is imperative to bring up 

facts to combat fear among the population. 

The information regarding the disease, either 

related to spreading, prevention, or 

protective measures, must be scrutinized 

before implementation and dissemination. 

One must be very careful while sharing the 

news, as the intensity of the disinformation 

and myths depends on how many people 

believe it and share it.   

This article outlines the perceived and 

psychological concerns associated with 

COVID-19 that must be known and considered 

by healthcare providers, front-line personnel, 

and the general population while taking 

preventive measures. Social distancing and 

quarantine are more likely to induce 

psychological distress because of increased 

fear of disease, limited knowledge, and altered 

risk perceptions due to varying emotional 

states7. The incomplete and evolving 

understanding of this catastrophic condition 

has promoted psychological suffering among 

the general population. 

 

Conclusion 
In conclusion, COVID-19 has shown to be a 

strong reason for psychological distress within 

the global population as perceived by many 

with moderate intensity. Moreover, the state of 

fear, perceived vulnerability, social distancing, 

and global panic seem to major contributing 

factors in causing this stress that can further 

impact the general population's health and 

well-being. One of the primary reasons behind 

the fact is an unknown and unusual situation 

as the current generations face a pandemic for 

the first time. The reactions are more precisely 

associated with one's psychological response 

towards a new threat. The study can help get 

some insight and propose any interventional 

measures to combat the psychological impacts 

of COVID-19 that will curtail the sufferings 

during this period of uncertainty. 

 

Acknowledgement  
We would like to acknowledge all the 

responders for their time and cooperation. The 

study was designed & supported by the 

Advance Educational Institute & Research 

Centre (AEIRC). 

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