Probable anxiety and components of psychological resilience amid COVID-19: A population-based study

Wai Kai Hou, Horace Tong, Li Liang, Tsz Wai Li, Huinan Liu, Menachem Ben-Ezra, Robin Goodwin, Tatia Mei chun Lee

Research output: Contribution to journalArticlepeer-review

40 Scopus citations


Background: This study examined the associations between components of psychological resilience and mental health at different levels of exposure to COVID-19 stressors. Methods: A population-representative sample of 4,021 respondents were recruited and assessed between February 25th and March 19th, 2020. Respondents reported current anxiety symptoms (7-item Generalized Anxiety Disorder scale [GAD-7]), cognitive components (perceived ability to adapt to change, tendency to bounce back after adversities) and behavioral components (regularity of primary and secondary daily routines) of resilience, worry about COVID-19 infection, and sociodemographics. Results: Logistic regression revealed that cognitive and behavioral components of resilience were not correlated with probable anxiety (GAD-7≥10) among those reporting no worry. Among respondents who were worried, all resilient components were inversely associated with probable anxiety. Specifically, propensity to bounce back and regular primary routines were more strongly related to lower odds of probable anxiety among those reporting lower levels of worry. Limitations: The cross-sectional design limits causal inference. Second, other resilient components and some key daily routines that could be related to better mental health were not assessed. Third, generalizability of the findings to other similar major cities is uncertain because cases and deaths due to COVID-19 in Hong Kong have been comparatively lower. Conclusions: To foster mental health, cultivation of confidence in one's ability to adapt to change and a propensity to bounce back from hardship should be coupled with sustainment of regular daily routines. Such assessment and intervention protocols could be more relevant to those who suffer heightened levels of exposure to COVID-19 stressors.

Original languageEnglish
Pages (from-to)594-601
Number of pages8
JournalJournal of Affective Disorders
StatePublished - 1 Mar 2021


  • Anxiety
  • COVID-19
  • Psychological resilience
  • Stressor exposure


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