Anxiety as a mediator of relationships between perceptions of the threat of COVID-19 and coping behaviors during the onset of the pandemic in Poland.

At the beginning of the COVID-19 pandemic (10-14 March, 2020) we conducted a survey (n = 1028) of a nationally representative sample (age, sex, and locale) in Poland. Respondents indicated how strong they thought the threat was to themselves, to Poland, and the world. They also described their emotional reactions to the pandemic, which we used to calculate three scores: Anxiety, Hopelessness, and Panic. Respondents also indicated how often they engaged in various coping behaviors and how much they supported different types of economic sacrifice. We used these responses to calculate measures that we labelled as Spread Prevention (e.g., social distancing), Self-preservation (food stockpiling), and Economic Sacrifice (e.g., fighting COVID-19 regardless of the cost). Multiple regression analyses found that perceived threat to self was the most reliable predictor (positive) of emotional reactions and of coping behaviors, and that Anxiety was the most reliable predictor (positive) of Spread prevention and Economic sacrifice. Panic predicted (positively) Self-preservation. A series of mediation analyses found that Anxiety mediated relationships between threat and coping behaviors, and that Panic mediated the relationship between perceived threats and Self-preservation. In addition, we found that scores on all measures, except Panic, increased following the announcement of the first COVID-19 related fatality in Poland, which occurred on the third (middle) day of the study. The mediational relationships we found did not vary as a function of whether the data were collected before or after this announcement. The present results suggest that emotional reactions to perceived threats can serve an instrumental function by providing the motivation to engage in coping behaviors. Such a mechanism complements much research on stress that has focused on how coping mediates threat-emotion relationships.

Introduction

The world is facing the threat of the coronavirus, which the Secretary General of the UN said required a “War-time plan” [1]. The day the first draft of this paper was submitted (April, 7) more than 1,300,000 people around the world had been infected with COVID-19, and approximately 75,000 people had died due to complications arising from the virus. Moreover, both the number of new cases and deaths has risen over time, and it is not clear when the pandemic will end.

Governments across the world are trying to find ways to stop or at least slow down the spread of the disease, with an important goal of reducing the likelihood that health care systems will be overloaded. The term “flattening the curve” is now in common use to describe the effort to reduce the prevalence of cases, and doing this requires the action of both governments and individuals. Governments can provide treatment facilities, but unless individuals take action, such facilities will certainly be overloaded. For example, to protect themselves as well as to slow the spread of COVID-19 individuals need to do things such as wash their hands regularly, practice social distancing, and use face masks. We note that when the present study was conducted the WHO had not yet recommended the use of face masks as a preventative mechanism. Whatever the methods, the success of the fight against COVID-19 depends, in part, on how thoroughly people follow the recommendations that prevent them from contracting the virus.

The present study examined relationships between people’s perceptions of the threat of COVID-19 and their coping behaviors. We defined coping behaviors as what people were doing in response to the perceived threat of COVID, including behaviors that were recommended by the authorities (e.g., social distancing) and those that were not (e.g., hoarding). Moreover, the study examined the role that negative emotional reactions to these threats played in how people coped. NB: We use the term “emotional reactions” to refer to a broader range of constructs than is inherent in formal models of emotions [e.g., 2]. Nevertheless, we believe that this broader use is consistent with how these constructs are discussed in research on pandemics.

Our focus on relationships between threat and coping and between threat and emotional reactions was based on previous research that has consistently found that the perceived threat of an infectious disease is positively related to engaging in coping behaviors [3-5]. As noted by Bavel et al. [6], a summary of the possible applications of social science to understanding the CVOID pandemic, “people are less likely to die from over-reaction than from under-reaction, that is, not responding to signs of danger until it is too late” (p. 462). In other words, although many may think that fear paralyzes people, fear can motivate people to act.

In parallel, research has also found that anxiety is positively related to engaging in coping behaviors. For example, a review of research on reactions to the H1N1 influenza (Swine flu) found support for both of these relationships [4]. See also two studies published after this review, Van Der Weerd, Timmermans, Jma Beaujean, Oudhoff, and van Steenbergen [7] who reported positive relationships between fear/worry and adaptive behaviors in NL, and Liao, Cowling, Lam, and Fielding [8] who found that worry about H1N1 was positively related to adaptive coping in Hong Kong.

More specifically, we examined if negative emotional reactions mediate relationships between perceived threat and coping behavior. Such a possibility is suggested by thinking of emotion as a source of motivation, a conceptualization consistent with the fact that the two words share a Latin root, emovere/movere “to move.” Such a possibility was also suggested by Witte in her “Extended Parallel Process Model” ([9,10]). As noted by Witte ([9], p. 331) “Fear is a negatively-valenced emotion, accompanied by a high level of arousal, and is elicited by a threat [emphasis added] that is perceived to be significant and personally relevant.” Such a proposition is consistent with a mediational model in which fear mediates the relationship between perceived threat and coping behavior.

Such mediational relationships can also be understood in terms of Lazarus and Folkman’s model of stress and coping [11]. Within their model, the recognition of threat (primary appraisal) initiates a process that includes emotional reactions, the end result of which is coping behavior. In fact, Folkman and Lazarus [12] noted that: “Historically, coping has been viewed primarily as a response to emotion” (p. 6).

Nevertheless, to our knowledge, no previous study has examined the possibility that emotional reactions mediate relationships between stress and coping within the context of reactions to epidemics. Much of the previous research on stress and coping (within the context of epidemics or not) has emphasized (if not considered exclusively) the possibility that coping mediates relationships between threat and emotional reactions to threat [13]. Although valuable, we believe that this research needs to be complemented by research that considers the possibility that emotional reactions mediate threat-coping relationships.

Such mediational relationships are consistent with Witte’s assertion that threats elicit emotions and Folkman’s and Lazarus’s summary statement about how emotions elicit coping. People perceive a threat, they become aroused, and then they act [11]. This explanation assumes that emotions provide the energy (the motivation) to act. Moreover, we think a threat-emotion-coping sequence is more likely at the beginning of a pandemic, when the threat is being realized and people are deciding how to cope, than a threat-coping-emotion sequence, which may occur later after people have coped and re-evaluated a threat. We consider the issue of causal sequences in the discussion.

In this paper, we focus on the mediating role of negative emotional reactions in relationships between perceived threat and coping behavior in the context of coping with COVID-19. Given the relative lack of attention to such mediational relationships, we considered the possibility that different emotional reactions might mediate relationships between different types of perceived threat and different types of coping behaviors. This included the possibility that negative emotional reactions other than anxiety might mediate relationships between perceived threats and coping. Would any negative emotional reaction mediate relationships between threat and coping, or is the mediation specific to anxiety? Given the lack of research on this specific topic, we examined such relationships on an exploratory basis.

Efficacy, defined as the likelihood that a coping behavior will address the problem posed by a threat, is an important feature of most, if not all, models of reactions to threats and stress ([9,11]). In these models, behaviors that cannot be enacted or are not thought to be effective will not be exhibited. In the present study we measured coping behaviors that were practical (i.e., easily accomplished) and that were recommended by the WHO and government officials (i.e., known to be effective). We also measured coping responses that were not recommended by the WHO and government officials but were responses that were being reported in the press. We return to this issue in the discussion.

We should note that the present study was conducted within the context provided by previous research and theory on pandemics per se, with a focus on fear. Responses to pandemics can be understood from multiple perspectives, and the present study was not designed to address these different perspectives. We thought that a clear and precise focus on one model (Witte’s) would provide a comprehensible and accessible account of reactions to the COVID pandemic in terms of the components of her model. We discuss complementary contexts and perspectives at the close of this article.

Finally, as explained below, during the middle of our study, the first Polish fatality due to COVID-19 occurred. We did not anticipate that Poland would experience its first fatality during our study (although it was a near certainty that people would die at some time), but this event did provide the opportunity to examine how responses to COVID-19 changed as a result of the occurrence of this event.

Method

Context

The WHO declared the COVID-19 as a pandemic on 11 March, 2020 [14], and the data described in this study were collected between 10 and 14 March, 2020. The first case of COVID-19 in Poland was officially announced on 4 March. On 9 March the official report was that 17 people were infected with COVID-19 in Poland, and by the end of the last day of the survey 104 people were reported as having been infected with COVID-19. Although the policies now in effect in Poland had not been put into place, the government had announced that sporting events and mass meetings of any kind were canceled (10 March), and that schools, theaters, museums, cinemas, and concert halls were closed (11 March), and finally the government declared an epidemic emergency (13 March). Following this, the external borders were closed on 14 and 15 March 14, initially for 10 days. On 25 March the borders were ordered closed until at least 13 April.

It is particularly important to note that although social distancing had been recommended while our study was being conducted, there were no formal restrictions on people’s day to day activities. That is, residents could choose to isolate themselves (e.g., stay at home) or not. As intended, our data were collected before the full brunt of COVID-19 was felt in Poland but after there was some awareness of the severity of the problem and some sense of the actions the government would be taking to deal with the problem.

Conducting our study in Poland provided numerous advantages. First, there is functionally 100% literacy, so we could be certain that respondents would understand public service announcements regarding COVID-19. Second, the society is very homogeneous in terms of ethnicity, which probably reduced the influence that scapegoating minorities had on responses. Third, the country is rated to have an intermediate risk of infectious diseases, which meant respondents did not have a basis for being unusually optimistic or pessimistic about how their country would deal with COVD-19. Source for all: CIA Factbook [15].

Procedure and sample

We contracted with Ariadna Research Panel, PL [16] to collect data from a nationally representative sample in Poland. Ariadna is a private research firm that collects data from members of panels. Participants are compensated by Ariadna with credits that they can use at various retail outlets. We requested a sample that was representative in terms of age, sex, and place of residence (e.g., size of city). We collected data from 255 respondents on 10 March, 108 on 11 March, 154 on 12 March, 464 on 13 March, and 173 on 14 March. Moreover, Ariadna obtained informed consent from participants and ensured compliance with RODO protocols. The study was approved by: Komisja ds. Etyki Badań Naukowych, Uniwersytet SWPS, Filia w Poznaniu, Wydział Psychologii i Prawa. Approval number 2020-18-11. Data were collected anonymously. Participants were free to terminate participation at any time.

The initial sample was 1054. To reduce the influence of careless responding, we eliminated 26 participants whose average response time per item was less than 2sec. The final sample consisted of 549 women and 479 men, with an average age of 44.4yo (SD = 15.8yrs). Forty-four percent of the sample lived in locales/cities with 20,000 or fewer residents, 22.5% lived in cities with between 20,000 and 99,000 residents, 19.2% lived in cities between 100,000 and 500,000 residents, and 14.7% lived in cities with more than 500,000 residents. Approximately one-third (33.6%) had a university degree of some kind, another third (32.9%) had the Polish equivalent of a high school degree, and 14.2% had not completed high school. The raw data described in this article are available at OSF [17]. In order, we measured four constructs: perceived threat, emotional reactions, coping behaviors, and support for COVID prevention policies.

Measures of emotional reactions

Our measures of emotional reactions were based upon the affective circumplex [18], a model that distinguishes positive and negative emotions and activated and deactivated emotions. Given the nature of COVID-19, we measured negative emotional reactions, and we distinguished activated (e.g., anxiety and fear) and deactivated (e.g., sadness, hopeless) emotional reactions. Activated negative emotional reactions were defined in terms of being anxious, scared, worried, concerned, and fearful. Deactivated negative emotional reactions were defined in terms of being powerless, helpless, hopeless, woebegone, and sad. See [19] for a similar approach to distress related to climate change.

In addition, we measured two emotional reactions that we thought would have specific relevance to reactions to COVID-19, feeling panicked and being paralyzed by fear. Although some may think of fear and panic as points on the same continuum, panic has a stronger maladaptive component than fear [20]. By definition, panic entails an irrational component. For example, in discussing reactions to disasters, Van Bavel et al. [6] explicitly distinguish panic, which is likely to have maladaptive consequences (e.g., panic-buying), from fear, which may serve to motivate people to work cooperatively to meet the challenges posed by a disaster.

Questions about each emotional reaction were preceded by the stem: “When you think about the coronavirus, how much, if at all, do you feel.” Participants responded using five-point scales with endpoints labeled “not at all” to “extremely.” The original Polish language items and response scales and English translations of these items and scales are contained in the supplemental materials [17].

Measures of coping

How people coped with the onset of the coronavirus was an important focus of the present study. To capture the range of possible behavioral responses, we measured 11 behaviors. Some behaviors (six) were recommended by the authorities (e.g., the WHO) as ways to reduce the likelihood that a person would contract COVID-19 while also reducing the speed with which the disease would spread, i.e., “flattening the curve” of new cases. Other behaviors represented what people were doing in reaction to the pandemic.

These behaviors are listed in Table 1 (below). All questions were preceded by the stem: “How often, during the last week, did you take any of the following actions to protect yourself against the coronavirus or the consequences of the coronavirus.” All response scales ranged from 1 to 6, with endpoints labeled “not at all” and “to the maximum extent possible.” The original Polish language items and response scales and English translations of these items and scales are contained in the supplemental materials [17]. As can be seen from the labels for the response scales, participants were asked to indicate how much their behaviors had changed from normal.

Table 1

Coping behaviors: Descriptive statistics and factor loadings.

			Factor loadings
Behavior	M	SD	Spread Prevention	Self-Preservation
*Avoid contact with the sick	3.61	1.49	.86
*Wash hands	3.82	1.37	.78
*Seek information	3.92	1.42	.71
*Avoid leaving home	3.20	1.56	.70
*Avoid touching eyes and nose	2.97	1.46	.65
*Use gel (hand sanitizer)	2.74	1.53	.45	-.33
Store cleaning products	2.31	1.31		-.80
Wear masks	1.35	.99		-.69
Store foods	2.41	1.32		-.70
Consume diet supplements	2.36	1.37		-.55
Pray	2.01	1.24		-.45

* WHO recommended activities.

Note: Item loadings less than .25 deleted.

Measures of perceived threat and support of policies involving economic sacrifice

Using a 7-point scale with endpoints labeled “1 = this is not a threat at all” and “7 = maximum, the condition is critical,” participants indicated how much of a threat they thought COVID-19 was to Poland, the world, and to themselves as individuals. Using a 7-point scale with endpoints labeled “1 = definitely not” and “7 = definitely yes,” participants indicated how much they supported using societal resources to fight the spread of COVID-19. The items were: (1) To stop the spread of coronavirus we should do what is needed even if it means slowing economic growth, (2) To stop the spread of coronavirus we should do what is needed regardless of the cost, and (3) To counteract the spread of coronavirus, we must all act and give up various things, if appropriate.

Results

Calculation of scale scores

Emotional reactions

As intended, self-reports of how anxious, scared, worried, concerned, and fearful participants felt formed a reliable scale (M = 2.85, SD = 1.05, α = .95), self-reports of how powerless, helpless, hopeless, woebegone, and sad participants felt formed a reliable scale (M = 2.66, SD = 1.05, α = .92), and self-reports of feeling panicked and paralyzed by fear also formed a reliable scale (M = 2.28, SD = 1.16, α = .91). We labeled these scales “Anxiety,” “Hopelessness,” and “Panic,” respectively.

Coping behaviors

Given the lack of previous research and theorizing, we were uncertain regarding if/how to combine participants’ reports of the behaviors they exhibited in response to the onset of COVID-19. Given the similar focus of some items (e.g., storing food and storing cleaning supplies), we conducted an exploratory factor analysis following guidelines proposed by [21], i.e., a maximum likelihood extraction followed by oblimin rotation. This analysis produced two factors with eigenvalues greater than 1 (5.39, 1.44), and these two factors accounted for 62.1 percent of the total variance. The loadings for the rotated solution are presented in Table 1.

The results of these analyses were quite clear. The first factor consisted of behaviors that were recommended by the WHO (and other civil authorities) to contain the spread of COVID-19. Given the ultimate goal of these behaviors, we labeled this factor as “Spread Prevention.” The second factor consisted of behaviors that were primarily concerned with personal well-being, and we labeled this factor “Self-preservation.” Interestingly, “using masks” loaded on the second factor but not on the first factor (less than .25). This is consistent with the fact that when the study was being conducted the WHO was not recommending the routine wearing of masks by individuals who were not infected with COVID-19. The only item that had a loading of greater than .25 on both factors was using gel (hand sanitizers). The factors were negatively correlated (-.57).

We defined Spread Prevention as the mean response to the items: Avoid contact with the sick, Wash hands, Seek information, Avoid leaving home, and Avoid touching eyes and nose (scale: M = 3.51, SD = 1.18, α = .87). We defined Self-preservation as the mean response to the items: Store cleaning products, Wear masks, Store foods, Consume diet supplements, and Pray (scale: M = 2.09, SD = .96, α = .82). In the interests of conceptual clarity, using gel was not included in either score, although we should note that the results of the analyses reported below did not vary meaningfully as a function of whether using gel was included as part of either or both of these scale scores.

Note that although items loaded negatively on the second factor, the correlation between the two factors was negative. An explanation of how the signs of loadings are determined in factor analysis is well beyond the scope of this paper, but it should suffice to note that the scale scores we calculated were positively correlated (.58). Finally, participants were more likely to exhibit behaviors consistent with WHO guidelines than they were to exhibit behaviors focused on self-preservation (t(1027) = 45.4, p < .001).

Economic sacrifice

As intended, our three measures of economic sacrifice (spend even if leads to slow growth, spend regardless of cost, and give up things) constituted a reliable scale (M = 5.44, SD = 1.25, α = .89), which we labeled Economic Sacrifice.

Regression analyses: Overview

The present study was designed in part to test a mediational model in which emotional reactions were presumed to mediate relationships between perceptions of threat and coping behaviors. Before examining such possibilities, we conducted a series of regression analyses to help determine exactly what combinations of threat, emotional reactions, and behaviors should be examined. For example, if a threat was not significantly related to a behavior, there would be no reason to examine the possible mediation of this relationship by emotional reactions.

We used multiple regression rather than zero-order correlations to select variables for the mediation analyses to take into account relationships among measures of the same category (i.e., emotional reactions and threat). This also reduced the number of analyses we conducted which reduced the “studywise” error rate. We conducted a set of regression analyses for each path in the proposed mediation analyses: threat as a predictor of coping, emotional reactions as a predictor of coping, and threat as a predictor of emotional reactions. These analyses included the Economic sacrifice measure as a measure of coping behavior.

Relationships between threat and reactions to COVID: Coping behaviors and economic sacrifice

First, we regressed our two coping behavior measures and our measure of support for economic sacrifice onto our three measures of threat. For all three analyses, the overall model was significant: Spread prevention: F(3,1024) = 157.4, p < .001, R = .32; Self-preservation: F(3,1024) = 38.5, p < .001, R = .12; Economic sacrifice: F(3,1024) = 132.7, p < .001, R = .28. The estimated standardized coefficients and the results of the significance tests of these coefficients are presented in Table 2. Spread Prevention was significantly (positively) related to all three measures of threat. In contrast, only threat to self was significantly related (positively) to Self-preservation. Economic sacrifice was significantly (and positively) related to all three types of threat (threat to Poland was p = .06).

Table 2

Relationships between threat and reactions to COVID: Coping behaviors and economic sacrifice.

	Source of threat
	Self			Poland			World
Outcome		β	t		β	t		β	t
Spread Prevention		.29	6.84***		.17	3.11**		.16	3.26**
Self-Preservation		.32	6.76***		.10	1.57		-.07	1.26
Economic sacrifice		.15	3.35**		.11	1.93a		.32	6.54***

Note: Coefficients accompanied by

*** p < .001

** p < .01

a p = .06.

Relationships between emotional reactions and coping behaviors and economic sacrifice

Next, we regressed our two measures of coping behavior and our measure of support for economic sacrifice onto our three measures of emotional reactions. For all three analyses, the overall model was significant: Spread prevention: F(3,1024) = 188.4, p < .001, R = .36; Self-preservation: F(3,1024) = 137.8, p < .001, R = .29; and Economic sacrifice: F(3,1024) = 87.3, p < .001, R = .20. The estimated standardized coefficients and the results of the significance tests of these coefficients are also presented in Table 3. Spread Prevention was significantly (positively) related only to scores on the Anxiety factor. Self-preservation was significantly (positively) related only to scores on the Panic factor (Anxiety was p = .09). Economic sacrifice was significantly (and positively) related to scores on the Anxiety factor and was significantly (negatively) related only to scores on the Panic factor.

Table 3

Relationships between emotional reactions and coping behaviors and economic sacrifice.

	Anxiety		Hopelessness		Panic
Outcome	β	t	β	t	β	t
Spread Prevention	.64	10.12***	.01	< 1	-.07	1.27
Self-Preservation	.12	1.72a	-.04	< 1	.47	8.67***
Economic sacrifice	.65	9.28***	.10	1.46	-.40	6.92***

Note: Coefficients accompanied by

*** p < .001

a p = .09.

Relationships between threat and emotional reactions

Finally, we regressed our three measures of emotional reactions onto our three measures of threat. For all three analyses, the overall model was significant: Anxiety: F(3,1024) = 312.6, p < .001, R = .48; Hopelessness: F(3,1024) = 161.3, p < .001, R = .42; Panic: F(3,1024) = 151.1, p < .001, R = .33. The estimated standardized coefficients and the results of the significance tests of these coefficients are presented in Table 4. Scores on the Anxiety measure were significantly (positively) related to all three perceived threats. Scores on the Hopeless and Panic measures were significantly related (positively) to threats to the self and to Poland, but were not significantly related to perceived threat to the world.

Table 4

Relationships between threat and emotional reactions.

	Source of threat
	Self			Poland			World
Outcome		β	t		β	t		β	t
Anxiety		.47	12.73***		.14	2.96**		.14	3.25***
Hopeless		.44	11.40***		.20	3.99***		.06	1.31
Panic		.46	11.15***		.11	2.10*		.03	< 1

Note: Coefficients accompanied by

*** p < .001

** p < .01

* p < .05.

Mediation analyses

We examined mediation using a series of PROCESS (v 3.3) analyses, Model 4 [22]. For all analyses, we used bootstrapping with 10,000 samples. To provide the clearest description of mediation, we conducted separate analyses for each combination of threat, coping behavior, and emotional reaction suggested by the results of the multiple regression analyses. We report 95% confidence intervals for effects.

First, we examined how emotional reactions might mediate relationships between threat and Spread prevention. The multiple regression analyses found that Spread prevention was significantly related to all three measures of threat but was significantly related to only Anxiety. Accordingly, we ran three analyses, one in which each type of threat was a predictor and Anxiety was the mediator.

The results of these analyses were quite clear. Anxiety mediated (partially) the relationship between each type of threat and Spread prevention. For threat to self, the total effect of .43 was decomposed into an indirect effect of .24 (CI = .20 to .28) and a direct effect of .19 (p < .001, CI = .14 to .25). For threat to Poland, the total effect of .50 was decomposed into an indirect effect of .26 (CI = .22 to .31) and a direct effect of .24 (p < .001, CI = .18 to .29). For threat to the world, the total effect of .49 was decomposed into an indirect effect of .26 (CI = .22 to .30) and a direct effect of .22 (p < .001, CI = .17 to .28).

For Self-preservation, threat to self was the only significant predictor, and Panic was the only possible mediator. The analyses found that Panic mediated (partially) the relationship between threat to self and Self-preservation. The total effect of .23 was decomposed into an indirect effect of .19 (CI = .16 to .22) and a direct effect of .04 (p < .05, CI = .001 to .08).

Scores on the Economic sacrifice measure were significantly related to all three measures of threat. Threat to self was significantly related to Anxiety and Panic, and Anxiety and Panic were significantly related to Economic sacrifice. Given this, we examined the extent to which Anxiety and Panic mediated relationships between threat to self and Economic sacrifice. One set of analyses examined the mediating role of Anxiety with Panic as a covariate, and the other set of analyses examined the mediating role of Panic with Anxiety as a covariate.

The analyses found that only Anxiety mediated (partially) the relationship between threat to self and Economic sacrifice. For the analysis in which Anxiety was the mediator and Panic was the covariate, the total effect of .40 was decomposed into a direct effect of .29 (p < .001, CI = .22 to .35), and an indirect effect for Anxiety of .12 (CI = .09 to .15). In contrast, for the analysis in which Panic was the mediator and Anxiety was the covariate, the indirect effect for Panic was not significant, .003 (CI = -.011 to .017).

Similar to threat to self, threat to Poland was significantly related to the Anxiety and Panic measures, and so we examined the extent to which Anxiety and Panic mediated relationships between threat to Poland and Economic sacrifice. As before, one set of analyses examined the mediating role of Anxiety with Panic as a covariate, and the other set of analyses examined the mediating role of Panic with Anxiety as a covariate.

Similar to the results of the previous analyses, these analyses found that only Anxiety mediated (partially) the relationship between threat to Poland and Economic sacrifice. For the analysis in which Anxiety was the mediator and Panic was the covariate, the total effect of .48 was decomposed into a direct effect of .36 (p < .001, CI = .30 to .43) and an indirect effect for Anxiety of .12 (CI = .09 to .15). For the analysis in which Panic was the mediator and Anxiety was the covariate, although the indirect effect for Panic was significant, it was small, .017 (CI = .0035 to .0314).

Given that threat to the world was significantly related to only Anxiety, we examined the extent to which Anxiety mediated the relationship between threat to the world and Economic sacrifice. The analysis found that Anxiety mediated (partially) the relationship between threat to the world and Economic sacrifice. The total effect of .52 was decomposed into an indirect effect for Anxiety of .10 (CI = .05 to .15), and a direct effect of .43 (p < .001, CI = .36 to .49).

The role of the first fatality in Poland

On 12 March, at approximately 12:00 (CET), the vice president of Poznan, a city in western Poland, announced that Poland had experienced its first fatality, a 57yo woman who had lived in or around Poznan. This announcement was broadcast widely, including state-run media (e.g., www.tvp.info), and the news spread quickly through other media outlets. This tragic event occurred in the middle of our data collection and provided an opportunity to assess the impact of this news on citizens’ feelings and beliefs.

The means for each day for the variables we measured are presented in Table 5. This table also contains the results of t-tests that compared the means of responses provided before the announcement (the entire day for 10 and 11 March, and before 12:00 on 12 March) to the means of responses provided after the announcement (13 and 14 March). Given the uncertainty about exactly when participants may have heard about the first fatality on 12 March, the 86 responses made on 12 March after 12:00 are not included in the summary statistics in this table and were not included in the t-tests.

Table 5

Means for each day of study and for responses before and after notification of first fatality.

	March					First fatality
Variable	10	11	12	13	14	Before	After	t-ratio
Sample size	249	106	64	450	73	419	523
Threat to self	4.61	4.47	4.83	5.02	5.38	4.61	5.07	5.03***
Threat to Poland	4.99	4.85	5.08	5.40	5.71	4.97	5.44	6.00***
Threat to world	5.29	5.17	5.41	5.65	5.89	5.27	5.68	5.21***
Anxiety	2.71	2.67	2.79	2.89	3.16	2.71	2.93	3.22**
Hopelessness	2.53	2.51	2.71	2.69	2.92	2.55	2.72	2.51*
Panic	2.18	2.14	2.42	2.29	2.47	2.21	2.31	1.39
Spread prevention	3.16	3.13	3.33	3.74	4.03	3.18	3.78	7.90***
Self-preservation	1.93	1.97	2.22	2.12	2.23	1.99	2.14	2.44*
Economic sacrifice	5.16	5.10	4.96	5.66	6.06	5.12	5.72	7.48***

Note: 12 March includes only responses before 12:00.

*** p < .001

** p < .01

* p < .05.

The results of the analyses comparing reports of respondents before and after the fatality were quite clear. Following the first fatality, respondents perceived greater threats to the self, to Poland, and to the world then they did before the first fatality. They were also more anxious and hopeless, they engaged in more coping behaviors, and they were more supportive of economic sacrifice to fight COVID-19.

Changes in means such as these suggest that the results of the previous mediation analyses might simply reflect changes across time in the measures we collected rather than relationships among the constructs the measures represented. To address this issue, we ran a series of PROCESS analyses in which we examined if the mediational relationships we found differed as a function of when the data were collected (before or after the first fatality). In these models (model 59 in the PROCESS macro), all paths were modeled as moderated by first fatality (before vs. after), and as before, we used 10,000 bootstrapped samples with a 95% CI.

The results of these analyses did not find that the mediational effects we reported previously were moderated by time of data collection. In all analyses, the 95% confidence interval of estimate of the critical statistic, “Index of moderated mediation (difference between conditional indirect effects),” included 0.

Discussion

As expected, we found that emotional reactions to COVID-19 mediated relationships between perceptions of threat and coping behaviors. We found that anxiety was the most reliable mediator of the relationships we found between threat and coping. Anxiety mediated relationships between threats to self, Poland, and the world and engaging in WHO recommended behaviors and supporting policies to combat COVID-19 that required economic sacrifice. Feeling panic/paralyzed by fear also mediated the relationship between threat to self and self-focused behavior (e.g., hoarding). In all cases, the indirect effects were positive.

These results are consistent with Taylors’s conclusion that “A moderate level of fear or anxiety can motivate people to cope with health threats, but severe distress can be debilitating” ([23], p. 24). The means for our measures of emotional reactions to COVID-19 (both before and after the first fatality) were all below 3, the midpoint of the scale, which corresponded to a scale point of “moderately.” Such levels correspond to what Taylor was discussing as moderate. Respondents’ emotions served as a source of energy for coping while not being strong enough to dysregulate or derail their adaptive functioning.

The publication of Lazarus and Folkman’s now classic Stress, Appraisal, and Coping [24] changed how researchers and practitioners conceptualized stress and coping. Lazarus and Folkman proposed that stress and reactions to stress were involved in bidirectional relationships with coping, and much of the research that has followed this model has emphasized how coping can mediate the effects of stress. Put simply, if people believe they can cope with a stressor (i.e., self-efficacy) they will react less strongly to the stressor than if they believe they cannot cope with the stressor.

We do not disagree at all with this conclusion. Nevertheless, we believe that in the search for how the feedback loops suggested by Lazarus and Folkman work, researchers have lost sight of the importance of the initial stage of the stress reaction, i.e., the initial emotional reactions people have to stress. As suggested by Witte [9], fear can mobilize people. If people are not afraid of an event, why should they do anything about it? Certainly, after they have done something this fear may be reduced by what they have done (coping mediating relationships between threat and emotional reactions), but people need to be motivated to do something, and we believe that fear can perform this function.

Since we conducted our study, other studies have found that fear can motivate protective behaviors within the context of the COVID. For example, in a study of a representative sample in the UK, Harper et al. [25] concluded that “Consistently, the only predictor of positive behavior change (e.g., social distancing, improved hand hygiene) was fear of COVID-19.” Similarly, Winter et al. [26] concluded: “… there was a significant relationship between FCV-19S scores [a measure of fear] and adherence to the lockdown rules that were implemented in New Zealand.” Bashirian et al. [27], working within the context of Protection Motivation Theory [28], found that fear was positively related to complying with COVID preventative behaviors among medical staff in Iran.

It is important to note that the present study concerned coping behaviors that were relatively easy to enact, hand washing, social distancing, and so forth. Many models of coping and reactions to stress suggest that the extent which people cope adaptively is positively related to whether people know what to do, whether they believe they can do what is adaptive, and whether they believe that these behaviors will be effective. In other words, people are more likely to cope when self-efficacy is high. See Schwarzer [29] for a discussion of the roles of self-efficacy in health behavior. Moreover, when self-efficacy is high (as was likely the case with the present coping behaviors), the motivation provided by fear can lead to more and more adaptive coping. A meta analysis of research on Rogers’s Protection Motivation Theory also suggests the same conclusion [30].

In this regard, it is important to keep in mind that the present study was conducted at the beginning of the pandemic in Poland. There were active cases, the authorities had just begun to impose restrictions on people’s movements, and at that time they strongly recommended what individuals should do to avoid infection with COVID-19, but the full effects of the pandemic on daily life had not occurred. This is why we emphasize the importance of the threat-emotion relationship in the beginning of the stress reaction process. People knew of the threats, and there were individual differences in how severe these threats were seen to be, and there were associated individual differences in the anxiety these threats created. It is possible that the relationships we found might have been different if we had conducted the study at a different point in the progression of the pandemic in Poland, but we were interested in examining relationships at the beginning of the pandemic.

Moreover, our results suggest that it is anxiety (or more generally speaking, negative activated affect) that motivates coping behavior, not general negative affect. We did not find that sadness/hopeless (or more generally speaking, negative deactivated affect) mediated relationships between threat and coping behavior. As suggested by the title, negative deactivated affect is not associated with engaging the environment; it is associated with withdrawing from the behavioral field. Hopelessness and powerlessness are not emotional reactions that spur people to take action.

Practical implications

Although our study was conducted within the context of a pandemic of a specific virus in a specific place at a specific point in time, we think our results have implications for understanding how people react to and cope with problems that exist at a societal level. First, and most important, our results suggest that anxiety can serve a positive function. Much of the research on coping has focused on how people can reduce anxiety in the face of stress, and although reducing anxiety may be desirable in the long term, our results clearly indicate that feeling anxious was positively related to engaging in coping behaviors.

As suggested by Witte [9], it can be good to be afraid. Fear (and its affective partner, anxiety) can motivate people. The possibility that fear can be adaptive was also discussed by Harper et al. [25]. They noted that: “researchers and mental health professionals would be mindful to consider the context within which negative emotional states are experienced before considering whether such emotional states are necessarily pathological.” Nevertheless, how this motivation is channeled is distinct from the importance of it as an initiator of a process. For example, climate change is a pressing societal problem, a catastrophe in waiting; yet, collective action to mitigate climate change, which is needed, is much less common than the worldwide collective action that has occurred in response to COVID-19. Perhaps if people were more afraid of the negative consequences of climate change, they (and society writ large) would take more action.

When discussing the positive role that fear may play in increasing compliance with COVID preventative behaviors, it is important to recognize that people can be “too afraid” to take action, a state that we defined as panic. Note that the item”paralyzed by fear” was part of this measure. We found that panic was positively related to self-preservation behaviors (e.g., stockpiling) and was negatively related to support for economic sacrifice, i.e., panic was related to self-interest not group-interest. Such relationships are exactly what Van Bavel et al. [6] described when discussing how extreme fear could undermine collective action. Moreover, in terms of research on fear appeals, it has long been recognized that fear appeals can be strong. It is adaptive to be afraid; it is maladaptive to be panicked.

Our results also highlight the potential importance of external events on coping behavior. Models of coping tend to focus on intrapsychic factors such as emotions or feelings of competence. Admittedly, external events exist as influences on coping behaviors only to the extent that they become internalized in some way. Nevertheless, the occurrence of the first coronavirus-related fatality in Poland “changed the playing field.” Anxiety and coping behaviors both increased after this event.

Although this tragic event had desirable outcomes for Polish society as a whole such as greater behavioral engagement in the prevention of the spread of COVID-19, external events do not always have desirable consequences. For example, reports of individuals who claim to have been cured by some types of “natural” remedies (e.g., eating large quantities of garlic) may lead people to abandon the science-based recommendations of the authorities. Such possibilities seem to be more common given the easy access to false claims provided by the internet, and the authorities need to monitor and counteract such false claims [31,32].

Limitations and conclusions

One of the shortcomings of static mediational models is that it is difficult to compare the explanatory power of different mediational paths. For example, we examined if emotions mediated relationships between threat and coping. In contrast, some research suggests (and has examined) the possibility that coping mediates relationships between threat and emotional reactions. Although we cannot compare the strength of these two mediational paths statistically, there are reasons to believe that, at least at the beginning of the pandemic, the path we proposed and examined is stronger than a path from threat to coping to emotions.

This support comes from comparisons of what is sometimes referred to as the “ab-path” in mediation. We compared the indirect effects of threat from the present analyses (threat to emotion to coping) to the indirect effects of threat from analyses that examined threat to coping to emotion mediation. In all cases, the indirect effects of the present model (threat through emotion to coping) were stronger than the indirect effects of threat through coping to emotion. These differences ranged from 2 to 5 standard errors. Although not definitive, such comparisons support our contention that the mediating role of emotional reactions in relationships from threat to coping was stronger than the mediating role of emotional reactions in relationships from coping to threat.

Examining such possibilities requires collecting data over time, a design typically referred to as a panel design. Such data provide the opportunity to compare lagged relationships, e.g., the relationships between threat at time T1 and emotional reactions at time T2 and between emotional reactions at time T1 and threat at time T2. Such comparisons can provide insights into possible causal relationships between variables.

Karademas, Bati, Karkania, Georgiou, and Sofokleous [33] conducted a panel study about the H1N1 pandemic in 2009. They found that emotionality about H1N1 at the beginning of the pandemic (T1) was related to adaptive coping behavior four months later (T2). Unfortunately, Karademas et al., did not examine the reverse relationship, how coping at T1 was related to emotionality at T2.

Nevertheless, their results support our contention that emotional reactions to pandemics can motivate people to cope adaptively with a pandemic. More research is needed to understand the dynamics of these relationships. For example, are causal relationships between these constructs bi-directional, does the relative strength of these causal relationships change, and so forth?

By design, the present study examined responses to the COVID pandemic through the lens of a specific model, Witte’s Extended Parallel Process Model [9]. This model primarily concerns the roles that fear can play in coping with distress. Nevertheless, positive emotions can also play important roles. For example, Heffner et al. [34] found that emotionally positive messages (prosocial messages) can increase the likelihood that people self-isolate. In addition, we focused on the roles played by affect and emotion. Clearly, more cognitively focused factors need to be taken into account. For example, a recent study found that a cognitively focused prime (highlighting the importance of relying on reason when making decisions) increased intentions to wear a mask, whereas an emotionally focused prime (highlighting the importance of relying on emotions when making decisions) did not affect intentions to wear a mask [35].

In terms of cognitive considerations, there is also ample evidence that people are either intentionally misinformed about or misinterpret recommendations for how to cope with COVID [31,32]. Such realities represent a challenge to scientists and public health practitioners. There have been discussions of what can be done to counteract misinformation [36], but the task is daunting.

The COVID-19 pandemic is an international event of historic proportions. To develop and implement effective counter-measures it is critical to understand how people react to and cope with this dangerous illness. As discussed by Van Bavel et al. [6], psychological science has much to offer in the fight against COVID. We hope that despite its limitations, the present paper contributes to this effort.

2 Jul 2020

PONE-D-20-10016

Anxiety as a Mediator of Relationships between Perceptions of the Threat of COVID-19 and Coping Behaviors during the onset of the Pandemic in Poland

PLOS ONE

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'Komisja ds. Etyki Badań Naukowych

Uniwersytet SWPS, Filia w Poznaniu

Wydział Psychologii i Prawa

Approval number 2020-18-11

Data were analyzed anonymously.

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Additional Editor Comments (if provided):

I have now collected two reviews from two experts in the field. The reviewers like the paper, but suggest several improvements. Therefore, I would like to invite you to revise your work following the reviewers' comments. Needless to say that all comments should be addressed. Moreover, while reading the manuscript, I have collected a few more comments that I think can improve the manuscript. They mainly regard the literature review, which seems to be rather short (only 20 references, many of which are not journal papers) and unfocused. I think this should definitely be improved. A good starting point could be the "perspective article" about what social and behavioural science can do to support Covid-19 response, that Van Bavel et al. 2020 have published in Nature Human Behaviour. Another suggestion is to look at the papers that have investigated messages and appeals to promote pandemic response (Bilancini et al. 2020; Capraro & Barcelo, 2020a; Capraro & Barcelo, 2020b; Everett et al. 2020; Heffner et al. 2020; Jordan et al. 2020). Of course, it is not a requirement to cite exactly these papers, but they might serve as a useful starting point to improve your literature review.

I am looking forward for the revision.

References

Bilancini E, Boncinelli L, Capraro V, Celadin T, Di Paolo R (2020) The effect of norm-based messages on reading and understanding COVID-19 pandemic response governmental rules. Journal of Behavioral Economics for Policy 4, 45-55.

Capraro, V., & Barcelo, H. (2020a). The effect of messaging and gender on intentions to wear a face covering to slow down COVID-19 transmission. arXiv preprint arXiv:2005.05467.

Capraro, V., & Barcelo, H. (2020b). Priming reasoning increases intentions to wear a face covering to slow down COVID-19 transmission. arXiv preprint arXiv:2006.11273.

Everett, J. A., Colombatto, C., Chituc, V., Brady, W. J., & Crockett, M. (2020). The effectiveness of moral messages on public health behavioral intentions during the COVID-19 pandemic. https://psyarxiv.com/9yqs8/

Heffner, J., Vives, M. L., & FeldmanHall, O. (2020). Emotional responses to prosocial messages increase willingness to self-isolate during the COVID-19 pandemic. https://psyarxiv.com/qkxvb/download?format=pdf

Jordan, J., Yoeli, E., & Rand, D. (2020). Don’t get it or don’t spread it? Comparing self-interested versus prosocially framed COVID-19 prevention messaging. https://psyarxiv.com/yuq7x

Van Bavel, J. J., et al. (2020). Using social and behavioural science to support COVID-19 pandemic response. Nature Human Behaviour.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

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Comments to the Author

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Reviewer #1: Yes

Reviewer #2: Partly

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The MS presents results from a study that examined relationships between threat perceptions of, affective reactions and coping behaviors to Covid-19 at the start of the pandemic in Poland. Main results suggest that facets of emotion reactions to the pandemic (anxiety in particular) partially mediated relationships between aspects of Covid-19 threat perceptions (threat to self in particular) and coping behaviours. Moreover, although levels in all observed variables raised following the announcement of the first fatality that took place during conducting this study, this event did not seem influence the main relationships found which underlines the reliability of the tested model.

The MS and study have many things going for it. It utilizes a nationally representative study at the start of the pandemic, it distinguishes between self and collective attributions to threat perception, it distinguishes between different levels of negative emotion/affect and also measures some effective Covid-19 behaviors.

Notably, the main aimed contribution of this study is to revert relationships between threat perceptions, coping behavior and negative emotion, claiming that (negative) emotion in this case should be considered proximal to threat perception leading to respective coping behavior. The argument reads interesting and plausible. However, as a reader one would like some additional information about research (health, attitudinal or other) that went the other inverse way from that hypothesized in this study (i.e. from coping behaviors to affective reactions). In that way, the gravity of the argument will become clearer.

Authors need to substantiate analytically or otherwise their choice to include the two additional emotional states panicked, and paralyzed by fear.

Is there any evidence from data reduction to support the identification of the three negative emotion dimensions?

Discussion: I would expect that findings would help Social researchers better comprehend psychological processes involved in reaction to the pandemic; for example relationships found between threat to the self and affective reactions could inform research on self vs. social schemas (e.g., attachment or cultural orientations) regarding the pandemic. Other aspects of the study are also noteworthy supporting existing models in health behavior and extending those to pandemic-related behavior.

Overall, in discussing the main study concepts and their relationships, an effort could be made to ground those to the particular context, the start of the Covid-19 epidemic. Moreover, any information regarding likely similarities or differences with other contexts could be elaborated.

Minor points

Threat is 'perceived threat'

Emotions would be better described as 'Emotion' or 'Affective reactions to' Moreover it should be indicated as negative emotion or negative affective states

Access to the osf files can be made open to all in line with journal policy

Reviewer #2: PLOS One

MS# PONE-D-20-10016

Anxiety as a Mediator of Relationships between Perceptions of the Threat of COVID-19 and Coping Behaviors during the onset of the Pandemic in Poland

Comment to the Author(s):

The primary aim of the current study was to determine if anxiety, panic, and hopelessness mediated the relationship between perceived threat from the pandemic and various coping behaviors such as following WHO guidelines. We think these data are especially interesting because they were collected from a nationally representative sample at the beginning of the pandemic in Poland as individuals were just realizing the threat of the COVID-19 pandemic. However, we have several concerns about multiple aspects of the paper that would need to be made to the paper before we can recommend publication.

Concerns with the Introduction:

The Introduction, as written, is not as compellingly written as it could be. Primarily, we think the authors should better capitalize on the fact that these data were collected at the beginning of the pandemic. We agree that studying differences in how threat elicits emotion is important, especially during a time that could be confusing, shocking, and maybe even ambiguous for many people. Certainly, we know how the story turns out (as we write this, over 10 million cases worldwide and half a million deaths) but these data represent an window into how people pre-emptively think/feel/behave when stress is on the horizon. It is clear that the authors are aware of this strength as they write plainly in the Discussion, “this is why we emphasize the importance of the threat-emotion relationship in the beginning of the stress-reaction process”. However, this could be better introduced and expounded on in the Introduction. A smaller point, the authors should consider removing the research on efficacy from the Introduction. As written, it seems like this will be a part of the methodology. It is not (which is fine) but seems a bit of distraction.

Concerns with the Method/Measures:

Overall, this section of the paper was well-written and clear. A few issues of note:

• This paper would benefit from the addition of a procedure section.

o How were participants recruited? What kind of study did they believe they were going to take part in?

o Were the measures presented in a particular order? Counterbalanced?

o Were participants compensated in any way?

o It was unclear the order that the measures were presented in, and it was also not clear what participants were told about the study prior to signing up for the study.

• A larger concern with the methodology is the conceptualization of the economic sacrifice variable as a coping behavior. While spread prevention and self-preservation items assessed the extent to which participants took a number of specific actions, the authors used economic sacrifice items to ask about participant willingness to support certain policies or behaviors. This seems very different. First, the measurement of this variable is hypothetical in a way that self-preservation and spread prevention were not. Second, we are not sure that being willing to do something would result in stress, anxiety, or uncertainty reduction, which is what coping behaviors are hypothesized to do. We would recommend that the authors either remove this variable (we don’t think it is very compelling as measured) or make a stronger case for its conceptualization as a coping variable. (For example, can the authors show that this variable is significantly and positively related to both spread prevention and self-preservation?)

Concerns with the Results:

We had several concerns with the Results section. A word of praise first– the section was well- written and easy to follow.

• We were unable to judge the extent to which many variables were related to one another and therefore whether all analyses were actually warranted.

o Are panic and anxiety separate constructs? From a clinical perspective, they may not be (e.g., panic disorder and panic attacks are characterized as Anxiety Disorders in both the DSM-IV and the ICD-10. It could be that these two variables are highly correlated and would be better analyzed together in order to reduce the number of analyses conducted.

o We had the same question when considering the analyses related to threat (threat to self, Poland, and world) separately. The authors should give theoretical justification for keeping them separate or demonstrate statistically that they are not the same construct. If they are taping a similar construct, this too could reduce the number of necessary analyses.

• Second, the results seemed lengthier than they needed to be. Although we agree that it is important to discuss the a-to-c pathway (e.g. the relationship between threat and coping behaviors) before conducting mediational analyses, lengthy discussion of the other pathways is not necessary. We say this in part because the authors made it clear in the Introduction that a meditated relationship was always the intended prediction. Moving directly to the mediation analysis after establishing the a-c pathway is more efficient and in keeping with the theme of the paper.

• In addition, we did not feel that the analyses concerning differences in all variables before and after the first fatality were necessary and seemed a bit distracting. We say this in part because since these results did not moderate any relationships between variables and because there was no way in knowing whether or not participants knew about the first fatality in Poland. We think it was important that the authors assessed this; however, discussion of these results might be better left in a footnote or supplemental materials so as to not distract from the main purpose of the paper.

• Finally, we had some concerns about the factor analysis of the coping behaviors. It was unclear why all the items for self-preservation loaded with a negative value while the items for spread prevention loaded positively. The negative values might imply a need for reverse coding for the self-preservation items but based on the wording of the items, this doesn’t seem correct. A double check of the analyses and/or some clarification would be helpful.

Concerns with Discussion:

The Discussion section seemed quite divorced from the other parts of the paper. A few things of note:

• The authors seem to justify their results with theory that was not completely established in the Introduction. For instance, the authors discuss the Stress, Appraisal, and Coping model as a primary explanation for the results but this model was only mentioned briefly in the literature review. Further the discussion of feedback loops and bidirectional effects actually seem to weaken the results since those sorts of relationships were not (and could not be) tested.

• In other places, the Discussion seemed to lack connection to points made earlier in the paper. For example, the discussion of activated and deactivated affect (p. 20) could link back to the discussion of emotion as motivation in the Introduction to drive this point home, but it doesn’t.

• There were sections that did not seem to clearly make a point. For example, we were unclear as to the purpose of the paragraph on page 21 that discussed “desirable outcomes for Poland” and individuals’ interest in natural remedies. We also found the limitations and conclusion cursory. There was not a satisfactory discussion of the findings in context of caveats and the field more broadly. In addition, the paper just seems to end.

In sum, we think the authors have an interesting idea and some very valuable data. We hope our comments will be helpful to them and we wish them well with this work.

**********

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12 Sep 2020

Response to reviewers

PONE-D-20-10016

Anxiety as a Mediator of Relationships between Perceptions of the Threat of COVID-19 and Coping Behaviors during the onset of the Pandemic in Poland

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

2. Please provide additional details regarding participant consent. In the Methods section, please ensure that you have specified (1) whether consent was informed and (2) what type you obtained (for instance, written or verbal). If your study included minors, state whether you obtained consent from parents or guardians. If the need for consent was waived by the ethics committee, please include this information.

Reply: All RODO and consent was managed by Ariadna Research Panel, the survey company (https://panelariadna.pl/)

3. Thank you for your ethics statement:

'Komisja ds. Etyki Badań Naukowych

Uniwersytet SWPS, Filia w Poznaniu

Wydział Psychologii i Prawa

Approval number 2020-18-11

Data were analyzed anonymously.

Participants were free to terminate participation at any time.'

Please amend your current ethics statement to confirm that your named institutional review board or ethics committee specifically approved this study. Once you have amended this/these statement(s) in the Methods section of the manuscript, please add the same text to the “Ethics Statement” field of the submission form (via “Edit Submission”). For additional information about PLOS ONE ethical requirements for human subjects research, please refer to http://journals.plos.org/plosone/s/submission-guidelines#loc-human-subjects-research.

Reply: We provided the required changes.

Additional Editor Comments (if provided):

I have now collected two reviews from two experts in the field. The reviewers like the paper, but suggest several improvements. Therefore, I would like to invite you to revise your work following the reviewers' comments. Needless to say that all comments should be addressed. Moreover, while reading the manuscript, I have collected a few more comments that I think can improve the manuscript. They mainly regard the literature review, which seems to be rather short (only 20 references, many of which are not journal papers) and unfocused. I think this should definitely be improved. A good starting point could be the "perspective article" about what social and behavioural science can do to support Covid-19 response, that Van Bavel et al. 2020 have published in Nature Human Behaviour. Another suggestion is to look at the papers that have investigated messages and appeals to promote pandemic response (Bilancini et al. 2020; Capraro & Barcelo, 2020a; Capraro & Barcelo, 2020b; Everett et al. 2020; Heffner et al. 2020; Jordan et al. 2020). Of course, it is not a requirement to cite exactly these papers, but they might serve as a useful starting point to improve your literature review.

I am looking forward for the revision.

References

Bilancini E, Boncinelli L, Capraro V, Celadin T, Di Paolo R (2020) The effect of norm-based messages on reading and understanding COVID-19 pandemic response governmental rules. Journal of Behavioral Economics for Policy 4, 45-55. Posted: May 2020

Capraro, V., & Barcelo, H. (2020a). The effect of messaging and gender on intentions to wear a face covering to slow down COVID-19 transmission. arXiv preprint arXiv:2005.05467. posted: May 11, 2020

Capraro, V., & Barcelo, H. (2020b). Priming reasoning increases intentions to wear a face covering to slow down COVID-19 transmission. arXiv preprint arXiv:2006.11273. posted: June 16, 2020

Everett, J. A., Colombatto, C., Chituc, V., Brady, W. J., & Crockett, M. (2020). The effectiveness of moral messages on public health behavioral intentions during the COVID-19 pandemic. https://psyarxiv.com/9yqs8/ posted: March 20, 2020

Heffner, J., Vives, M. L., & FeldmanHall, O. (2020). Emotional responses to prosocial messages increase willingness to self-isolate during the COVID-19 pandemic. https://psyarxiv.com/qkxvb/download?format=pdf posted: April 15, 2020

Jordan, J., Yoeli, E., & Rand, D. (2020). Don’t get it or don’t spread it? Comparing self-interested versus prosocially framed COVID-19 prevention messaging. https://psyarxiv.com/yuq7x posted: April, 3, 2020

Van Bavel, J. J., et al. (2020). Using social and behavioural science to support COVID-19 pandemic response. Nature Human Behaviour. My draft manuscript copy is dated April 11. I am not certain when the original draft was first released.

Reply:

We agree that it is best for studies to be placed in an informative and appropriate context, and when doing so, it is important to be transparent about what motivated a study. Why was it done? What factors were taken into consideration? In the introduction to our paper, we discussed the fact that our study was designed using previous research on pandemics as a guide and framework. The primary model was Witte’s model of the role of fear as a motivator. The study was not designed to provide an all-purpose, broad, explanation of everything that might influence or be related to responses to a pandemic. It was meant to be a focused study on how fear might serve as a positive motivator for coping with the pandemic. We should note that no one suggested that we include research about pandemics that had been done before we conducted our study.

Nevertheless, we agree that it is appropriate and important to locate our study within the broader context of research on the COVID pandemic, and we have added a meaningful amount of material to the discussion that includes research that was done after we conducted our study and submitted our paper. Noting this, selecting citations for this expanded coverage was a bit arbitrary. For example, Research Gate recently posted that its COVID list had 96,000 papers. Assuming that only a small fraction (5%) of these concerned social scientific topics, this still leaves close to 5,000 papers that could be relevant to our concerns. Clearly, this is much too large a body of research to summarize meaningfully. We have made a good faith effort to highlight relevant findings.

In terms of why we included this material in the discussion rather than in the introduction, it is important to note that all of the suggested citations were published or posted after we designed our study, which was in late February. Moreover, our paper was submitted at the early stage of the explosion of research on the pandemic, and most the suggested papers were published or posted after we submitted our paper in early April. Introductions are meant to include work that influenced the design and execution of a study. Given this, we do not think that it is appropriate for us to describe how work that did not exist when we designed our study and did not exist when we wrote our paper influenced our study and the paper.

For example, if we discussed research on pro-sociality in the introduction, readers would (logically) want to know why we did not include something about pro-sociality in our study. If this topic was important enough to describe as a context, readers will be puzzled as to why it was not important enough to merit inclusion in the study per se. Given this, we have made only minor changes to the introduction. We included a citation to the Van Bavel paper because it reviewed some of the same literature we did but nothing more. To cite papers that did not exist before we designed and conducted our study would be disingenuous, if not unethical.

Reviewer #1:

The MS presents results from a study that examined relationships between threat perceptions of, affective reactions and coping behaviors to Covid-19 at the start of the pandemic in Poland. Main results suggest that facets of emotion reactions to the pandemic (anxiety in particular) partially mediated relationships between aspects of Covid-19 threat perceptions (threat to self in particular) and coping behaviours. Moreover, although levels in all observed variables raised following the announcement of the first fatality that took place during conducting this study, this event did not seem influence the main relationships found which underlines the reliability of the tested model.

The MS and study have many things going for it. It utilizes a nationally representative study at the start of the pandemic, it distinguishes between self and collective attributions to threat perception, it distinguishes between different levels of negative emotion/affect and also measures some effective Covid-19 behaviors.

Notably, the main aimed contribution of this study is to revert relationships between threat perceptions, coping behavior and negative emotion, claiming that (negative) emotion in this case should be considered proximal to threat perception leading to respective coping behavior. The argument reads interesting and plausible. However, as a reader one would like some additional information about research (health, attitudinal or other) that went the other inverse way from that hypothesized in this study (i.e. from coping behaviors to affective reactions). In that way, the gravity of the argument will become clearer.

Reply: We are not exactly certain what the word “revert” means in the present context. It appears that the reviewer is asking us to present/discuss research that does not support our hypotheses in the introduction. This is a bit unusual. Unfortunately, our cross-sectional design does not provide a basis to support causal relationships. Nevertheless, this is an important point, and we address this issue in the revised discussion.

Authors need to substantiate analytically or otherwise their choice to include the two additional emotional states panicked, and paralyzed by fear.

Reply: See below. We have also added further justification for distinguishing anxiety and panic, and we included this topic in the revised discussion.

Is there any evidence from data reduction to support the identification of the three negative emotion dimensions?

Reply: Although we recognize this reviewer’s concerns (and the concerns of the individuals who provided Rev 2), we think that the differences in the relationships we found as a function of distinguishing the three types of affect/emotions constitute a prima facie case for the value of making the distinctions we made. This paper was not intended to provide a basis to examine the factorial structure of emotional reactions to COVID. We would have needed to collect more data than was practical given the limits of the type of national survey we conducted. For example, we would have probably had at least 4, probably 5 items for panic as we did for the other constructs.

Discussion: I would expect that findings would help Social researchers better comprehend psychological processes involved in reaction to the pandemic; for example relationships found between threat to the self and affective reactions could inform research on self vs. social schemas (e.g., attachment or cultural orientations) regarding the pandemic. Other aspects of the study are also noteworthy supporting existing models in health behavior and extending those to pandemic-related behavior.

Overall, in discussing the main study concepts and their relationships, an effort could be made to ground those to the particular context, the start of the Covid-19 epidemic. Moreover, any information regarding likely similarities or differences with other contexts could be elaborated.

Reply: We appreciate the reviewer’s suggestions for broadening the discussion of our results, and we have added some material to the discussion to include such material.

Minor points

Threat is 'perceived threat'

Reply: We discuss perceived threat throughout the manuscript (it’s in the title of the paper), but we have added “perceived” in various instances to ensure that readers understand this.

Emotions would be better described as 'Emotion' or 'Affective reactions to' Moreover it should be indicated as negative emotion or negative affective states.

Reply: Throughout the paper, we discuss only negative emotions/affective states. Moreover, we are not sure why it is important to use the singular “emotion” instead of the plural “emotions.” We are happy to change this if it is important.

Reviewer #2:

Comment to the Author(s):

The primary aim of the current study was to determine if anxiety, panic, and hopelessness mediated the relationship between perceived threat from the pandemic and various coping behaviors such as following WHO guidelines. We think these data are especially interesting because they were collected from a nationally representative sample at the beginning of the pandemic in Poland as individuals were just realizing the threat of the COVID-19 pandemic. However, we have several concerns about multiple aspects of the paper that would need to be made to the paper before we can recommend publication.

Concerns with the Introduction:

The Introduction, as written, is not as compellingly written as it could be. Primarily, we think the authors should better capitalize on the fact that these data were collected at the beginning of the pandemic. We agree that studying differences in how threat elicits emotion is important, especially during a time that could be confusing, shocking, and maybe even ambiguous for many people. Certainly, we know how the story turns out (as we write this, over 10 million cases worldwide and half a million deaths) but these data represent an window into how people pre-emptively think/feel/behave when stress is on the horizon. It is clear that the authors are aware of this strength as they write plainly in the Discussion, “this is why we emphasize the importance of the threat-emotion relationship in the beginning of the stress-reaction process”. However, this could be better introduced and expounded on in the Introduction. A smaller point, the authors should consider removing the research on efficacy from the Introduction. As written, it seems like this will be a part of the methodology. It is not (which is fine) but seems a bit of distraction.

Reply: We are not certain about how to capitalize any further on the timing of our study. To do so transparently, we would have to have some background research and theory to guide us. There is none. In terms of efficacy, we have expanded our discussion of this in the revised discussion section.

Concerns with the Method/Measures:

Overall, this section of the paper was well-written and clear. A few issues of note:

• This paper would benefit from the addition of a procedure section.

o How were participants recruited? What kind of study did they believe they were going to take part in?

o Were the measures presented in a particular order? Counterbalanced?

o Were participants compensated in any way?

o It was unclear the order that the measures were presented in, and it was also not clear what participants were told about the study prior to signing up for the study.

Reply: We did not include details about how participants were recruited because the data were collected by a professional company using the standard procedures used by such companies. We simply assumed that readers would be familiar with how survey companies collect data and so we do not include many details about this. For panels such as this, participants are contacted by the survey company with whom they have an agreement. They are invited to participate in a survey. It is not like undergraduates who sign up for a study. More details are available on the Ariadna website. Finally, we agree that it is worth noting the order in which the measures were presented, and we have done so. In addition, we modified the heading to include Procedures.

• A larger concern with the methodology is the conceptualization of the economic sacrifice variable as a coping behavior. While spread prevention and self-preservation items assessed the extent to which participants took a number of specific actions, the authors used economic sacrifice items to ask about participant willingness to support certain policies or behaviors. This seems very different. First, the measurement of this variable is hypothetical in a way that self-preservation and spread prevention were not. Second, we are not sure that being willing to do something would result in stress, anxiety, or uncertainty reduction, which is what coping behaviors are hypothesized to do. We would recommend that the authors either remove this variable (we don’t think it is very compelling as measured) or make a stronger case for its conceptualization as a coping variable. (For example, can the authors show that this variable is significantly and positively related to both spread prevention and self-preservation?)

Reply: We understand the reviewers’ concerns here. Inadvertently, for some results, we used labels of tables that did not always maintain the distinction between economic sacrifice and coping, although the text describing the results in these tables did not make the distinction. We have changed the table labels. We should also note that measures of coping were presented separately from measures of economic sacrifice, and measures of economic sacrifice were not included in the factor analyses of coping.

Concerns with the Results:

We had several concerns with the Results section. A word of praise first– the section was well- written and easy to follow.

• We were unable to judge the extent to which many variables were related to one another and therefore whether all analyses were actually warranted.

Reply: When analyzing correlated measures there is always a tension between combining measures and analyzing them separately. We chose to analyze some measures separately for various reasons. First, given the newness of the topic, we thought that examining measures separately would be informative. COVID present unique challenges and stresses, and if measures were combined prior to analysis, important differences would/could be lost. We think it useful to keep in mind that when two variables are correlated .7 (which many might consider as reasonable basis for combining the variables into a single measure) 50% of the variance is unshared. Moreover, as we discuss below, we did find differences among measures in all of the instances for which the reviewers suggested that it might be better to combine measures. We have six tables, and following the suggestions of the reviewers we might have five, or six with fewer entries.

o Are panic and anxiety separate constructs? From a clinical perspective, they may not be (e.g., panic disorder and panic attacks are characterized as Anxiety Disorders in both the DSM-IV and the ICD-10. It could be that these two variables are highly correlated and would be better analyzed together in order to reduce the number of analyses conducted.

Reply: Although we appreciate this point, we think distinguishing panic and anxiety is worthwhile. First, the fact that panic disorders are part of anxiety disorders does not mean that panic and anxiety cannot be separated. In fact, the existence of a separate diagnoses for panic disorders suggests there is something specific about panic vs. general anxiety when discussing disorders. Moreover, using the structure of clinical diagnoses as a template for measuring non-clinical emotional experience is fraught with problems.

Most important, in regression analyses in which anxiety and panic are entered as separate predictors, meaning that the covariance between the two was part of the model (e.g., Table 3), panic was related to outcomes above and beyond relationships between anxiety and the outcomes. In fact, for economic sacrifice, the coefficient for panic was negative, whereas the coefficient for anxiety was positive. See similar differences in Table 4. Such differences constitute a prima facie case for distinguishing these two measures.

Finally, we have included new citations supporting the importance of this distinction.

o We had the same question when considering the analyses related to threat (threat to self, Poland, and world) separately. The authors should give theoretical justification for keeping them separate or demonstrate statistically that they are not the same construct. If they are taping a similar construct, this too could reduce the number of necessary analyses.

Reply: Although we appreciate the point the reviewers make, there are clear differences in the coefficients (Table 4) for the three types of identity. Moreover, because the three types of identity are entered simultaneously, the covariances between them are taken into account. We believe this qualifies as a “statistical demonstration” that it is worthwhile to distinguish the three threats. Simply because each is a measure threat is not a basis to assume that they have the same relationships with other measures (which they do not) and then combine them into a single measure.

• Second, the results seemed lengthier than they needed to be. Although we agree that it is important to discuss the a-to-c pathway (e.g. the relationship between threat and coping behaviors) before conducting mediational analyses, lengthy discussion of the other pathways is not necessary. We say this in part because the authors made it clear in the Introduction that a meditated relationship was always the intended prediction. Moving directly to the mediation analysis after establishing the a-c pathway is more efficient and in keeping with the theme of the paper.

Reply: This is simply a matter of style. We thought (and still think) that a thorough presentation of the results is appropriate given the subject matter and the hypotheses. Yes, the focus of the paper was on the mediational analyses, but we think that the other relationships merited presentation. Although presenting these analyses made the paper longer, it appears that this did not interfere with the reviewers’ comprehension, as judged by their own words: “the section was well- written and easy to follow.’

• In addition, we did not feel that the analyses concerning differences in all variables before and after the first fatality were necessary and seemed a bit distracting. We say this in part because since these results did not moderate any relationships between variables and because there was no way in knowing whether or not participants knew about the first fatality in Poland. We think it was important that the authors assessed this; however, discussion of these results might be better left in a footnote or supplemental materials so as to not distract from the main purpose of the paper.

Reply: With respect, we disagree. In terms of whether participants knew about the first fatality, we carefully classified participants in terms of when the information was made public (by the hour), and deleted participants who we could not be reasonably certain had heard the news. In Poland, this news “spread like wildfire.” We could document the numerous news outlets that carried the story, but we do not think there is a need. Admittedly, there is no control group, but we could not anticipate this would happen. Although the relationships between measures did not change after the first fatality, the means certainly did, and means matter. Our paper is about how people reacted to the COVID pandemic and news of death is part of the situation to which people are reacting.

• Finally, we had some concerns about the factor analysis of the coping behaviors. It was unclear why all the items for self-preservation loaded with a negative value while the items for spread prevention loaded positively. The negative values might imply a need for reverse coding for the self-preservation items but based on the wording of the items, this doesn’t seem correct. A double check of the analyses and/or some clarification would be helpful.

Reply: We understand the reviewers’ confusion about this issue. We neglected to mention that the correlation between the two factors was negative, which is consistent with the negative loadings on the second factor. The composite scores (scale scores) were positively correlated. This is explained in the revised manuscript.

Concerns with Discussion:

The Discussion section seemed quite divorced from the other parts of the paper. A few things of note:

• The authors seem to justify their results with theory that was not completely established in the Introduction. For instance, the authors discuss the Stress, Appraisal, and Coping model as a primary explanation for the results but this model was only mentioned briefly in the literature review. Further the discussion of feedback loops and bidirectional effects actually seem to weaken the results since those sorts of relationships were not (and could not be) tested.

Reply: We are not certain what the term “completely established” means. In the introduction, we described the relevance of the Lazarus work to our project and provided citations to this. This description is a three-sentence paragraph. It is short, but our intention was to include and describe only these elements of the of Lazarus’s model that were directly relevant to our study. The next paragraph elaborates on this point and presents support for the mediational hypothesis.

Also, we do not think that a discussion of feedback loops and bidirectionality weakens our argument As we discuss, such processes are possible, but their existence does not preclude the existence of the processes we document. We do not believe that our study can address such issues, but as we discuss in the next paragraph, no previous study has examined the mediational relationships we did, relationships that are assumed to underlie Lazarus’s model.

• In other places, the Discussion seemed to lack connection to points made earlier in the paper. For example, the discussion of activated and deactivated affect (p. 20) could link back to the discussion of emotion as motivation in the Introduction to drive this point home, but it doesn’t.

Reply: The paper is about emotion as a motivator. Following the discussion of active and deactive affect, there is a paragraph that starts with the following: “Moreover, our results suggest that it is anxiety (or more generally speaking, negative activated affect) that motivates coping behavior, not general negative affect.” This seemed to be direct to us.

• There were sections that did not seem to clearly make a point. For example, we were unclear as to the purpose of the paragraph on page 21 that discussed “desirable outcomes for Poland” and individuals’ interest in natural remedies. We also found the limitations and conclusion cursory. There was not a satisfactory discussion of the findings in context of caveats and the field more broadly. In addition, the paper just seems to end.

Reply: It is a bit difficult to reply to this comment. In terms of the paragraph on p. 21 the reviewers mention, the purpose of the paragraph is stated in the first sentence: “Although this tragic event had desirable outcomes for Polish society as a whole such as greater behavioral engagement in the prevention of the spread of COVID-19, singular events may not always have desirable consequences.” The point is that although singular events can focus attention, they can also overpower science. We included reference to the “infodemic” that considers this issue. In terms of the limitations and conclusions, just before this was a section “Practical applications,” which we think considered some of these issues. Moreover, we expanded the limitations and conclusions section.

In sum, we think the authors have an interesting idea and some very valuable data. We hope our comments will be helpful to them and we wish them well with this work.

Submitted filename: Response to reviewers.docx

Click here for additional data file.

29 Sep 2020

PONE-D-20-10016R1

Anxiety as a Mediator of Relationships between Perceptions of the Threat of COVID-19 and Coping Behaviors during the onset of the Pandemic in Poland

PLOS ONE

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PLOS ONE

Additional Editor Comments (if provided):

One of the reviewer suggests some additional minor improvements before publication. Please address these last comments at your earliest convenience. I am looking forward for the final version.

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Reviewer #1: (No Response)

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Reviewer #1: Authors have addressed points raised in the first round of reviews and the revised MS is improved as a whole. Below a few, minor, points that can improve the final MS. In the opening paragraphs of the introduction the main focus of research could be better communicated. I am referring in particular in the logical progression from the second to the third paragraph.

For the sake of parsimony, at places you could specify that the research is on negative emotion/emotional states/emotional reactions and not emotion/s at large. This can actually improve argumentation at places (i.e., p. 4 ‘More specifically, we examined if emotions mediate relationships between perceived threat and coping behavior’ and p. 5 ‘in this paper, we focus on the mediating role of emotions’ and elsewhere).

Similarly, you could provide examples of supporting research to statements such as in p. 3 “Our focus on relationships between threat and coping and between threat and emotions was based on previous research that has consistently found that the perceived threat of an infectious disease is positively related to engaging in coping behaviors.”

The terms emotion, emotions, emotional reactions, affect, affective reactions etc. are used interchangeably throughout the MS. This could be flagged in a footnote. In the first round of reviews I suggested to reserve the plural form of the term (i.e., emotions) to categorical forms of emotional states. Generally, the singular form tends to be used to signify more broad emotion-related processes such as the ones examined in this study. Such a stance could also ease the issue of considering (or not) Hopelessness and powerlessness (p. 22) an ‘emotion’ (I would not consider those as emotions).

p. 6 "Responses to …. different perspectives". Unless you provide some examples of some of the perspectives referred to in this sentence, the second part of the sentence in particular, is quite vague in meaning.

p. 12 ‘the’ WHO

p. 21 meta analysis

Reviewer #2: (No Response)

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14 Oct 2020

Reviewer #1:

Authors have addressed points raised in the first round of reviews and the revised MS is improved as a whole. Below a few, minor, points that can improve the final MS. In the opening paragraphs of the introduction the main focus of research could be better communicated. I am referring in particular in the logical progression from the second to the third paragraph.

Reply: Good point. We have revised the third paragraph to make this clearer.

For the sake of parsimony, at places you could specify that the research is on negative emotion/emotional states/emotional reactions and not emotion/s at large. This can actually improve argumentation at places (i.e., p. 4 ‘More specifically, we examined if emotions mediate relationships between perceived threat and coping behavior’ and p. 5 ‘in this paper, we focus on the mediating role of emotions’ and elsewhere).

Reply: We have added “negative” when appropriate in numerous instances, and as noted below, we have used the term “emotional reactions.”

Similarly, you could provide examples of supporting research to statements such as in p. 3 “Our focus on relationships between threat and coping and between threat and emotions was based on previous research that has consistently found that the perceived threat of an infectious disease is positively related to engaging in coping behaviors.”

Reply: Good point. We added three citations for this specific point, and we included a reference in the discussion to research on self-efficacy in health behavior.

The terms emotion, emotions, emotional reactions, affect, affective reactions etc. are used interchangeably throughout the MS. This could be flagged in a footnote. In the first round of reviews I suggested to reserve the plural form of the term (i.e., emotions) to categorical forms of emotional states. Generally, the singular form tends to be used to signify more broad emotion-related processes such as the ones examined in this study. Such a stance could also ease the issue of considering (or not) Hopelessness and powerlessness (p. 22) an ‘emotion’ (I would not consider those as emotions).

Reply: The reviewer makes a good point. We agree that it is important to be precise, and when referring to the present study, we have used the phrase “emotional reaction,” not “emotion,” throughout the paper. PLOS One does not permit footnotes, so we have inserted a brief sentence (top of p. 4, revision) describing the fact that our use of emotional reactions is broader than the construct of emotions as used in formal models of emotions.

p. 6 "Responses to …. different perspectives". Unless you provide some examples of some of the perspectives referred to in this sentence, the second part of the sentence in particular, is quite vague in meaning.

Reply: We agree that this sentence is vague. It was intentionally so because as noted in the last sentence of this paragraph, we wanted to address the issue of alternative perspectives in the discussion, something we did. We did not think we needed to review in the introduction (even in passing), the sundry models that have been used to explain reactions to pandemics because our study was not designed to compare and evaluate these other approaches.

p. 12 ‘the’ WHO

Reply: In this instance, the article “the” is not appropriate because WHO is serving as an adjective.

p. 21 meta analysis

Reply: Done

Submitted filename: Response to reviewers.docx

Click here for additional data file.

16 Oct 2020

Anxiety as a Mediator of Relationships between Perceptions of the Threat of COVID-19 and Coping Behaviors during the onset of the Pandemic in Poland

PONE-D-20-10016R2

Dear Dr. Cypryanska,

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PLOS ONE

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Reviewers' comments:

22 Oct 2020

PONE-D-20-10016R2

Anxiety as a Mediator of Relationships between Perceptions of the Threat of COVID-19 and Coping Behaviors during the onset of the Pandemic in Poland

Dear Dr. Cypryańska:

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