Volume 73, No.1: 2021 Siriraj Medical Journal
https://he02.tci-thaijo.org/index.php/sirirajmedj/index
1
Original Article
SMJ
Pakpoom Maneepongpermpoon, M.D., Jarurin Pitanupong, M.D.
Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla 90110, ailand.
Knowledge, Risk Perception, Precautionary
Behavior and Level of Worry towards the 2019
Coronavirus Disease (COVID-19) among
Psychiatric Outpatients
ABSTRACT
Objective: To identify level of worry towards COVID-19, and related factors among psychiatric outpatients.
Methods: A cross-sectional study surveyed psychiatric outpatients at Songklanagarind Hospital; from May to
June, 2020.e questionnaires composed of; 1) Demographic inquiry 2) COVID-19 knowledge 3) COVID-19 risk
perception 4) COVID-19 precautionary behaviors 5) Level of worry towards COVID-19. All data were analyzed
using descriptive statistics, and associated factors as to the level of worry towards COVID-19 were analyzed by
chi-square and logistic regression.
Results: ere were 400 participants; neurosis (60.0%), and non-neurosis (40.0%). e majority of participants were
female (62.0%), with a mean age of; 44.5±14.6 years. Almost all participants reported a good score of COVID-19
knowledge (91.8%), and having good precautionary behavior towards COVID-19 (97.5%). Majority of participants
had a low risk perception (54.2%) and a low level of worry towards COVID-19 (67.0%). Generalized anxiety disorder
and major depressive disorder participants were the 1
st
and 2
nd
group who had a high to moderate level of worry
towards COVID-19. Aside from, from the multivariate analysis, this study indicated income, psychiatric disorders
and risk perception towards COVID-19 were statistically signicant associated factors related to levels of worry.
Conclusion: Most psychiatric outpatients had good knowledge, good precautionary behaviors and a low level
of worry towards COVID-19; with associated factors to level of worry being income, risk perception and being
diagnosed with generalized anxiety disorder. However, major depressive disorder patients should also be concerned.
Keywords: COVID-19; knowledge; perception; psychiatric patient; worry (Siriraj Med J 2021; 73: 1-9)
Corresponding author: Jarurin Pitanupong
E-mail: pjarurin@medicine.psu.ac.th
Received 18 August 2020 Revised 24 September 2020 Accepted 25 September 2020
ORCID ID: http://orcid.org/0000-0001-9312-9775
http://dx.doi.org/10.33192/Smj.2021.01
INTRODUCTION
e 2019 coronavirus disease (COVID-19) epidemic
in China became a global health horror, and the rapid
spread of the disease raised grave concerns about the future
trajectory of the outbreak.
1
In January 2020, the World
Health Organization (WHO) declared the COVID-19
epidemic as a public health emergency of international
concern.
2
In ailand, on the 13
nd
of January 2020, the
rst COVID-19 case from Wuhan, Hubei Province,
China was imported.
3
During the initial phase of the COVID-19 epidemic
in China, feelings of extreme vulnerability, uncertainty
and threat to life were perceived.
4
In addition, it caused a
profoundly wide range of psychosocial impacts on people
Volume 73, No.1: 2021 Siriraj Medical Journal
https://he02.tci-thaijo.org/index.php/sirirajmedj/index
2
Maneepongpermpoon et al.
individually, within the community and on international
levels. According to the individual impact level, the study
reported that the Chinese people suered from a moderate
to severe psychological impact;
5,6
such as, fear of falling
sick or dying, feelings of helplessness, worrying or anxiety
about their family members contracting COVID-19
and stigma. Female gender, student status, specific
physical symptoms and poor self-rated health status
were signicantly associated with a greater psychological
impact of the outbreak; causing higher levels of stress,
anxiety, depression,
6
fear and stigma, which might be
certainly a consequence of mass quarantine.
6,7
Some
quarantined people expressed psychological concerns
including fears about infecting others, being infected
themselves or having avoidance behaviors of people
and places aer quarantine.
8
Additionally, during the
“repair” phase: when the infection was being brought
under control, depression and avoidance were evident.
4
However, during the outbreak of this severely infectious
disease, the changing of individual mental health and
psychosocial responses to crisis were the major topics
that needed essential and adequate handling.
9
e next
emerging outbreak of disease, like COVID-19, may cause
the same psychological impact; informed, ignorance,
panic,
10-12
fear
13,14
and misperceived as possible sources
for infection,
9,14
or it may cause dierent responses. In
addition to this, the stigmatization of patients who are
perceived as possible sources for infection,
9
is remarkable.
Psychiatric patients are people with vulnerable mental
health, when having signicant stress, some patients
have maladaptive coping, or use an immature defense
mechanism.
15
In the past, the study about psychiatric
inpatient’s reaction to the SARS epidemic reported the
patients attempted to reduce the eect of stress by living
in an “autistic bubble” or by denying it was happening.
On the other hand, some patients also psychotically
interpreted these stressors.
16
ereby, psychiatric patients
should be protected by adequate caution and sucient
supplies of protective gear.
11
However, COVID-19 is
a new, emerging, and rapidly evolving situation. is
outbreak may impact not only healthy people
11-13
, but also
those with vulnerable mental health.
17
Studies concerning
knowledge, risk perception or concern, precautionary
behavior, levels of worry towards COVID-19 and related
factors among patients with mental health problems will
provide basic, useful information for employment of realistic
risk perception, eective precautions, communication
through various information sources and psychosocial
support frameworks before, during and aer a challenging
incident.
18-20
MATERIALS AND METHODS
Study design
is cross-sectional study explored all psychiatric
outpatients, who were diagnosed with generalized anxiety
disorder (GAD), panic disorder, major depressive disorder
(MDD), schizophrenia and bipolar disorder (BD), at
Songklanagarind Hospital, Faculty of Medicine, Prince
of Songkla University. e inclusion criterions were
psychiatric outpatients, who able to complete all of the
questionnaires. Exclusion criterion were patients who had
more than one psychiatric diagnosis or comorbidity and
were unable or lacked the mental capacity to complete all
of the questionnaire, or when it was inconvenience for
them to participate or those that wanted to stop doing
the questionnaire.
Patients interested in participating in the study,
were provided with the rationale and overview of the
research, and the researcher called them for an interview,
by telephone, later. If, at that time was not convenient for
the participants the researcher would request an interview
later or stop the interview. Adhering to the policy of
strict condentiality, the signatures of the participants
were not required, and all of the participants retained
the right to withdraw from the research at any time.
Aer the interview, the participants received the result
promptly, and advice, or further management would be
provided; if the participants had a high level of worry.
is study was endorsed by e Ethics Committee
of the Faculty of Medicine, Prince of Songkla University.
(REC:63-166-3-4)
Participants
Using n. for. Survey from R program, the sample size
was given as at least 384 subjects. en the participants
were included from all psychiatric outpatients, who
had an appointment and were followed up at the
psychiatric outpatient clinic; from May to June, 2020.
e co-researcher grouped the patients by counting 80
participants per diagnosis. e neurosis group contained
patients diagnosed with panic disorder, GAD and MDD.
Whereas the non-neurosis group contained patients
diagnosed with schizophrenia and BD. Each diagnosis
was retrieved from the medical register, which was based
on ICD-10 criteria.
Measurement tools
Questionnaire modication was performed by 5
psychiatrists, then content validity was conducted. e
questionnaires composed of 5 parts:
1) Personal and demographic inquiry consisting
Volume 73, No.1: 2021 Siriraj Medical Journal
https://he02.tci-thaijo.org/index.php/sirirajmedj/index
3
Original Article
SMJ
of gender, age, education level, religion, hometown,
marriage status, income and underlying disease.
2) Knowledge towards COVID-19 contained 5 items;
etiology; route of infection; nature of disease. Each item
was rated into 2-points ranging from “1” (disagree) to
“2” (agree).
5,21
A total score of more than 3 was having
good knowledge, and a score of less than 3 was poor
knowledge.
3) Risk perception towards COVID-19 contained
6 items; personal and comparative risk of contracting
COVID-19 at the same gender, age and living area;
personal and comparative beliefs in the ability to prevent
COVID-19 and general infectious diseases. Each item
was rated into 3-points ranging from “1” (low risk) to
“3” (high risk). e total scores ranged from 6 to18; a
score of 6 (low risk perception), 7-12 (moderate risk
perception), 13-18 (high risk perception).
22
4) e precautionary behaviors towards COVID-19
were measured by 10 items. e items were: avoiding
travel in aected areas, or travel on public transport, eating
at food courts or restaurants, going to work or school,
shaking hands; wearing mask protection; washing your
hands by having taken extra care of cleanliness; health
promotion by eating a balance diet, regular exercise
and sleeping enough. e total scores ranged from 10
to 30; a score of 10 (poor precaution), 11-20 (moderate
precaution), 21-30 (good precaution).
22
5) e level of worry towards COVID-19 contained
5 items; worry about one’s own risk of COVID-19;
prevention and avoidance behavior; disturbance of daily
activity. Each item was rated into 3-points ranging from
“1” (no worry) to “3” (high worry).
22,23
e total scores
ranged from 5 to 15; a score of 5-6 (low level of worry),
7-11 (moderate level of worry), 12-15 (high level of
worry).
23
Statistical analysis
All data were analyzed, in order to describe the
knowledge, risk perception, precautionary behavior and
level of worry towards COVID-19, using the descriptive
statistic method. e results were presented as average,
percentage, frequency, and standard deviation. Associated
factors to level of worry towards COVID-19 were analyzed
by chi-square and logistic regression.
RESULTS
Demographic characteristics
ere were 400 psychiatric outpatients who completed
the questionnaires by telephone, 248 were female (62.0%)
and 204 were unmarried (51.0%). Overall, the mean
age was 44.5±14.6 years. Of the participants, 245 were
employed (61.3%) and the median income (IQR) was
20,000 (20,000-30,000) Baht, per month. In addition,
more than a half of the participants (64.5%) had no
medical illness. (Table 1)
Knowledge towards COVID-19
Almost all participants had a good score of knowledge
towards COVID-19 (91.8%). e mean score of knowledge
towards COVID-19, among all participants, was 4.7±0.9;
whereas, the mean score of knowledge towards COVID-19
among both neurosis and non-neurosis groups was 4.8±0.9,
4.6±0.9, respectively. However, when a comparison of the
mean scores of knowledge towards COVID-19 between the
two groups was made it revealed a statistically signicant
dierence. Schizophrenic disorder participants were the
group which had the lowest number of a good score of
knowledge towards COVID-19 (77.5%). (Table 2)
In addition, the majority of participants gained their
COVID-19 information and knowledge from television,
family members and social media (98.8%, 67.0%, 59.5%,
respectively). Besides this, the participants felt satised
with the amount of health information available in
media (95.2%).
e risk perception towards COVID-19
According to this survey, more than a half of the
participants had low risk perception towards COVID-19
(54.2%). e mean score of risk perception towards
COVID-19, among all participants, was 7.8±2.2; whereas,
the mean score of risk perception towards COVID-19
among the neurosis and non-neurosis group were 8.2±2.4,
7.2±1.8, respectively. In addition, there was statistically
signicant dierence of the mean score of risk perception
towards COVID-19 between the two groups. (Table 2)
e precautionary behavior towards COVID-19
Almost all participants had good precautionary
behavior towards COVID-19 (97.5%). e mean score
of precautionary behavior towards COVID-19 among
all participants was 24.8±2.3; whereas, the mean score
of precautionary behavior towards COVID-19 among
both the neurosis and non-neurosis group were 25.5±2.2,
23.9±2.1, respectively. Among the precautionary behavior
towards COVID-19, there was no statistically signicant
dierence between the two groups. (Table 2)
e level of worry towards COVID-19
More than a half of the participants had a low level
of worry towards COVID-19 (67.0%). e mean level
of worry towards COVID-19, among all participants,
was 6.4±1.9; whereas, the mean level of worry towards
Volume 73, No.1: 2021 Siriraj Medical Journal
https://he02.tci-thaijo.org/index.php/sirirajmedj/index
4
TABLE 1. Demographic characteristics (n=400).
Demographic Number (%) Chi2
characteristics P-value
Neurosis Non-neurosis
All group GAD Panic MDD Total BD Schizophrenia Total
(n=400) (N=80) (N=80) (N=80) (N=240) (N=80) (N=80) (N=160)
Gender <0.001
Male 152 (38.0) 17 (21.2) 16 (20.0) 28 (35.0) 61 (25.4) 47 (58.8) 44 (55.0) 91 (56.9)
Female 248 (62.0) 63 (78.8) 64 (80.0) 52 (65.0) 179 (74.6) 33 (41.2) 36 (45.0) 69 (43.1)
Marital status <0.001
Single/ Divorce 211 (52.8) 23 (28.7) 36 (45.0) 48 (60.0) 107 (44.6) 38 (47.5) 66 (82.5) 104 (65.0)
Married 189 (47.2) 57 (71.2) 44 (55.0) 32 (40.0) 133 (55.4) 42 (52.5) 14 (17.5) 56 (35.0)
Religion 0.84
Buddhism 337 (84.2) 70 (87.5) 66 (82.5) 65 (81.2) 201 (83.8) 70 (87.5) 66 (82.5) 136 (85.0)
Islam, other 63 (15.8) 10 (12.5) 14 (17.5) 15 (18.8) 39 (16.2) 10 (12.5) 14 (17.5) 24 (15.0)
Highest level of education 0.01
Primary school and below 119 (29.8) 37 (46.2) 28 (35) 13 (16.2) 78 (32.5) 17 (21.2) 24 (30) 41 (25.6)
Secondary school 124 (31.0) 13 (16.2) 14 (17.5) 34 (42.5) 61 (25.4) 32 (40.0) 31 (38.8) 63 (39.4)
Bachelor degrees and above 157 (39.2) 30 (37.5) 38 (47.5) 33 (41.2) 101 (42.1) 31 (38.8) 25 (31.2) 56 (35.0)
Home province 0.68
Songkhla 261 (65.2) 48 (60) 57 (71.2) 54 (67.5) 159 (66.2) 51 (63.7) 51 (63.7) 102 (63.7)
Other 139 (34.8) 32 (40) 23 (28.7) 26 (32.5) 81 (33.8) 29 (36.2) 29 (36.2) 58 (36.2)
Income (Baht/month) 0.19
No salary 135 (33.8) 35 (43.8) 18 (22.5) 37 (46.2) 90 (37.5) 16 (20.0) 29 (36.2) 45 (28.1)
≤15,000 58(14.5) 11(13.8) 14(17.5) 10(12.5) 35(14.6) 10(12.5) 13(16.2) 23(14.4)
15,001-25,000 134 (33.5) 24 (30.0) 34 (42.5) 19 (23.8) 77 (32.1) 34 (42.5) 23 (28.7) 57 (35.6)
>25,000 73 (18.2) 10 (12.5) 14 (17.5) 14 (17.5) 38 (15.8) 20 (25.0) 15 (18.8) 35 (21.9)
Medical illness 1
No 258 (64.5) 38 (47.5) 60 (75.0) 57 (71.2) 155 (64.6) 45 (56.2) 58 (72.5) 103 (64.4)
Yes 142 (35.5) 42 (52.5) 20 (25.0) 23 (28.7) 85 (35.4) 35 (43.8) 22 (27.5) 57 (35.6)
Chi2 p-value is comparison between neurosis and psychosis
Maneepongpermpoon et al.
Original Article
SMJ
Volume 73, No.1: 2021 Siriraj Medical Journal
https://he02.tci-thaijo.org/index.php/sirirajmedj/index
5
TABLE 2. Knowledge, risk perception, precautionary behavior and level of worry towards COVID-19 (n=400).
Number (%) Chi2
P-value
Neurosis Non-neurosis
All group GAD Panic MDD Total BD Schizophrenia Total
(n=400) (N=80) (N=80) (N=80) (N=240) (N=80) (N=80) (N=160)
Knowledge < 0.001
Poor 21 (5.2) 5 (6.2) 2 (2.5) 4 (5.0) 11 (4.6) 2 (2.5) 8 (10.0) 10 (6.2)
Fair 12 (3.0) 1 (1.2) 0 (0.0) 0 (0.0) 1 (0.4) 1 (1.2) 10 (12.5) 11 (6.9)
Good 367 (91.8) 74 (92.5) 78 (97.5) 76 (95.0) 228 (95.0) 77 (96.2) 62 (77.5) 139 (86.9)
Risk perception <0.001
Low risk 217 (54.2) 35 (43.8) 42 (52.5) 34 (42.5) 111 (46.2) 54 (67.5) 52 (65.0) 106 (66.2)
Moderate 169 (42.2) 39 (48.8) 35 (43.8) 42 (52.5) 116 (48.3) 25 (31.2) 28 (35.0) 53 (33.1)
High 14 (3.5) 6 (7.5) 3 (3.8) 4 (5.0) 13 (5.4) 1 (1.2) 0 (0.0) 1 (0.6)
Precautionary behavior 0.53
a
Poor 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0)
Moderate 10 (2.5) 2 (2.5) 2 (2.5) 1 (1.2) 5 (2.1) 1 (1.2) 4 (5.0) 5 (3.1)
Good 390 (97.5) 78 (97.5) 78 (97.5) 79 (98.8) 235 (97.9) 79 (98.8) 76 (95.0) 155 (96.9)
Level of worry <0.001
Low 268 (67.0) 39 (48.8) 59 (73.8) 44 (55.0) 142 (59.2) 61 (76.2) 65 (81.2) 126 (78.8)
Moderate 120 (30.0) 36 (45.0) 19 (23.8) 32 (40.0) 87 (36.2) 18 (22.5) 15 (18.8) 33 (20.6)
High 12 (3.0) 5 (6.2) 2 (2.5) 4 (5.0) 11 (4.6) 1 (1.2) 0 (0.0) 1 (0.6)
a
Fisher's exact test
Chi2 p-value is comparison between neurosis and psychosis
Volume 73, No.1: 2021 Siriraj Medical Journal
https://he02.tci-thaijo.org/index.php/sirirajmedj/index
6
Maneepongpermpoon et al.
COVID-19 among the neurosis and non-neurosis groups
were 6.8±2.1, 5.9±1.6, respectively. Amongst the level
of worry towards COVID-19, there were statistically
significant differences between the two groups. In
addition, GAD and MDD participants were the 1
st
and
2
nd
groups who had high to moderate levels of worry
towards COVID-19. (Table 2)
e association between demographic characteristics,
knowledge, risk perception, precautionary behavior
towards COVID-19, and level of worry
Variables, whose p-values from the univariate
analysis were lower than 0.2, were included in multivariate
analysis. From the multivariate analysis it was indicated
that income, psychiatric disorder, and risk perception
towards COVID-19 were statistically signicant associated
factors related to level of worry.
Finally, the participants who had lower income
reported more level of worry than the higher income and
unemployed groups. Comparing with GAD participants,
other neurosis and non-neurosis participants had lower
level of worry towards COVID-19. (Table 3)
DISCUSSION
is survey indicated that the majority of psychiatric
outpatients had good knowledge towards COVID-19 as
well as which, they perceived that they had a low risk
perception towards COVID-19 infection. However, almost
all psychiatric outpatients still had good precautionary
behavior towards COVID-19. e reason for this outcome
might be that all participants were psychiatric outpatients,
who might have a few psychological symptoms and more
ability to get news or health information than psychiatric
inpatients. Besides, all participants were university
hospital outpatients who might get more medical data
towards COVID-19 than general psychiatric hospital
patient. In addition, the majority of schizophrenia and
bipolar outpatients at Songklanagarind Hospital had
TABLE 3. Factors associated with moderate to high level of worry towards COVID-19.
Factors Crude OR Adjusted OR P-value
(95%CI) (95%CI) LR-test
Income 0.016
≥25,000 Reference Reference
15,001-25,000 1.34 (0.74,2.42) 1.81 (0.84,3.90)
≤15,000 1.92(0.95,3.89) 2.83(1.06,7.51)*
No income 0.39 (0.20,0.76) 0.70 (0.28,1.72)
Psychiatric disease <0.001
GAD Reference Reference
Panic 0.34(0.17,0.66) 0.18(0.07,0.46)*
MDD 0.78 (0.42,1.45) 0.55 (0.22,1.36)
BD 0.30(0.15,0.58) 0.30(0.12,0.80)*
Schizophrenia 0.22(0.11,0.45) 0.16(0.06,0.44)*
Risk perception <0.001
Moderatetohighrisk Reference Reference
Lowrisk 0.02(0.01,0.05) 0.03(0.01,0.06)*
*Statistical signicance
Volume 73, No.1: 2021 Siriraj Medical Journal
https://he02.tci-thaijo.org/index.php/sirirajmedj/index
7
Original Article
SMJ
fair to good quality of life, low level of stigma as well as
having self-esteem and self-actualization.
24,25
Moreover,
most of the psychiatric patients’ caregivers were either;
their mother or father or close relatives; who had a low
feeling of burden in caring. Hence, they could take care
of and help the psychiatric patients to cope or protect
themselves towards COVID-19 via adequate caution very
well.
26
erefore, the participants in this study had good
precautionary behavior and low level of worry towards
COVID-19, which was dierent from the previous study
conducted as to the SARS epidemic, in which it reported
that psychiatric inpatients attempted to reduce the eect
of stress by denying the signicance of these stressors.
16
However, the study found the prevalence of moderate
to high level of worry towards COVID-19, among the
psychiatric outpatients, was 33.0%. Moreover, the GAD
participants reported the highest level of worry towards
COVID-19, which might be the nature of the disorder.
As the previous study, during the COVID-19 epidemic
in China, 23.6% neurosis patients with, major depressive
disorder, anxiety disorders, mixed anxiety and depressive
disorder reported a score of 10 or higher in the DASS-
21 anxiety score, indicating the presence of moderate
to severe anxiety symptoms.
27
Moreover, the related
factors to level of worry towards COVID-19 were risk
perception towards COVID-19. e higher risk perception
of infection was associated with a higher level of worry
and protective behavior.
28,29
ose results were the same
as the ndings from this study.
In addition, our study identied that unemployed
status was significantly associated with low level of
worry towards COVID-19. e reason might be due to
spending more time at home, so as the risk perception
was lower. On the other hand, employed status and
stay-at-home orders were associated with greater health
anxiety, nancial worry and loneliness.
30
erefore, the
employed group should be considered as part of the
mental health crisis. Furthermore, a high education
level was signicantly associated with a high level of
worry towards COVID-19. More educated patients may
have more knowledge, can get more information, so
their over-concern might lead to a higher level of worry
towards COVID-19. As the previous study showed that
the more level of epidemic knowledge, the more level
of epidemic worry.
22
In contrast; however, some studies
have shown that improving knowledge of the epidemic
could reduce the fear and anxiety.
31
Finally, this study showed 91.8% of participants had a
good score of COVID-19 knowledge. Moreover, 97.5% of
the participants had good precautionary behavior towards
COVID-19. In our opinion, ailand is a country that has
an excellent, primary health care system, which provides
for a good capacity to distribute health knowledge, health
promotion and prevention towards COVID-19, for all
of those living in the ai population. Hence, all over
ai people can perceive the current health information
correctly and in a real time process.
Strengths and limitations
is study had strengths and limitations. To our
knowledge, it is the rst study that explored coping
strategies, knowledge, and levels of psychological problems
in people with mental disorders. e study also involved a
considerable sample size of the participants with various
diagnoses. However, there were some limitations to this
study. Regarding the cross-sectional survey, this study
employed self-reporting questionnaire’s, for individual
evaluation via telephone. Because of social distancing
policy, we could not perform a face to face interview,
so the information might have been led into a bias. In
addition, restriction of inpatient admission, therefore, we
could not evaluate the inpatient who assumed having more
active symptoms. Moreover, this study was quantitative,
and the sample size was restricted to only psychiatric
outpatients from the university hospital in the lower
part of Southern ailand and psychiatric outpatients
from other general psychiatric hospital or clinic were not
included. Furthermore, this study surveyed only GAD,
panic disorder, MDD, BD and schizophrenia patients
whereas, healthy control group was not compared. us,
it is too soon to generalize nation-wide, or cannot be
used for summing up all ai psychiatric outpatients or
inpatients. Besides these factor, the study surveyed in
the nearly ‘repair’ phase of the COVID-19 epidemic in
ailand, thus saying it may not cover all related matters
to patient stress, during all phases of this epidemic.
Future recommendations and implications
Henceforward, studies have been recommended to
include additional psychiatric outpatients and inpatients
at other hospitals, within ailand. In other words, a
multi-center study should be introduced. Furthermore,
comparing with normal people, and including other
psychiatric patients such as obsessive–compulsive disorder,
schizoaective disorder should be performed. Moreover,
other studies should retain more qualitative or in depth
methods for specic psychiatric disorders, and survey
them during all epidemic phases.
CONCLUSION
Most psychiatric outpatients had good knowledge,
good precautionary behavior and a low level of worry
Volume 73, No.1: 2021 Siriraj Medical Journal
https://he02.tci-thaijo.org/index.php/sirirajmedj/index
8
Maneepongpermpoon et al.
towards COVID-19. Associated factors, as to the level of
worry; being income, risk perception and being diagnosed
with GAD. However, MDD were the patient whom
should be as of as concern.
ACKNOWLEDGEMENTS
is study was fully supported by the Faculty of
Medicine, Prince of Songkla University, ailand.e data
analysis were provided by Mrs. Nisan Werachattawan and
Ms. Kruewan Jongborwanwiwat. In addition, we would
like to show our gratitude to all psychiatric outpatients
who collaborated in this survey.
Conict of interest: e authors declare no conict of
interest.
REFERENCES
1. Wang C, Horby P, Hayden F, Gao G. A novel coronavirus
outbreak of global health concern. Lancet 2020;395:470-3.
2. Mahase E. China coronavirus: WHO declares international
emergency as death toll exceeds 200. BMJ 2020;368: m408.
3. World Health Organization. Coronavirus disease (COVID-19)
outbreak [Internet]. 2020 [cited 2020 Jan 12] Available from:
https://www.who.int/csr/don/14-january-2020-novel-coronavirus-
ailand.
4. Chong M, Wang W, Hsieh W, Lee C, Chiu N, Yeh W, et al.
Psychological impact of severe acute respiratory syndrome on
health workers in a tertiary hospital. Br J Psychiatry 2004;185:
127-33.
5. Wang C, Pan R, Wan X, Tan Y, Xu L, Ho C, et al. Immediate
psychological responses and associated factors during the
initial stage of the 2019 Coronavirus Disease (COVID-19)
epidemic among the general population in China. Int J Environ
Res Public Health 2020;17:1729.
6. Rubin G, Wessely S. e psychological eects of quarantining
a city. BMJ 2020;368: m313.
7. Lima C, Carvalho P, Lima I, Nunes J, Saraiva J, Souza R, et al.
e emotional impact of coronavirus 2019-Ncov. Psychiatry
Res 2020;287:112915.
8. Reynolds D, Garay J, Deamond S, Moran M, Gold W, Styra R.
Understanding, compliance and psychological impact of the
SARS quarantine experience. Epidemiol Infect 2008;136:997-
1007.
9. Brug J, Aro A, Oenema A, de Zwart O, Richardus J, Bishop
G. SARS risk perception, knowledge, precautions, and information
sources, the Netherlands. Emerg Infect Dis 2004;10: 1486-9.
10. Siegrist M, Zingg A. e role of public trust during pandemics.
European Psychologist 2014;19:23-32.
11. Bish A, Michie S. Demographic and attitudinal determinants
of protective behaviors during a pandemic: A review. Br J
Health Psychol 2010;15:797-824.
12. Lau J, Griths S, Choi K, Tsui H. Avoidance behaviors and
negative psychological responses in the general population in
the initial stage of the H1N1 pandemic in Hong Kong. BMC
Infect Dis 2010;10:139.
13. Smith B, Kay V, Hoyt T, Bernard M. Predicting the anticipated
emotional and behavioral responses to an avian u outbreak.
Am J Infect Control 2009;37:371-80.
14. Maunder R, Hunter J, Vincent L, Bennet J, Peladeau N, Leszcz
M, et al. e immediate psychological and occupational impact
of the 2003 SARS outbreak in teaching hospital. CMAJ
2003;168:1245-51.
15. Switaj P, Anczeweska M, Chrostek A, Sabariego C, Cieza A,
Bickenbach J, et al. Disability and schizophrenia: a systematic
review of experienced psychosocial diculties. BMC Psychiatry
2012;9:193.
16. Lancu I, Strous R, Poreh A, Kotler M, Chelben Y. Psychiatric
inpatients’ reactions to the SARS epidemic: an Israeli survey.
Isr J Psychiatry Relat Sci 2005;42:258-62.
17. Xiang Y, Zhao Y, Liu Z, Li X, Zhao N, Cheung T, et al. e
COVID-19 outbreak and psychiatric hospitals in China:
managing challenges through mental health service reform.
Int J Bio Sci 2020;16:1741-4.
18. Kang L, Ma S, Chen M, Yang J, Wang Y, Li R, et al. Impact on
mental health and perceptions of psychological care among
medical and nursing sta in Wuhan during the 2019 novel
coronavirus disease outbreak. Brain Behav Immun 2020;87:
11-7.
19. Greenberg N, Docherty M, Gnanpragasam S, Wessely S.
Managing mental health challenges faced by healthcare workers
during covid-19 pandemic. BMJ 2020;368: m1211.
20. Chen Q, Liang M, Li Y, Guo J, Fei D, Wang L, et al. Mental
health care for medical sta in China during the COVID-19
outbreak. Lancet Psychiatry 2020;7: e15-6.
21. Takkonen L, Vehkalahti K. Measurement errors in multivariate
measurance scales. J Multivar Anal 2005;96:172-89.
22. Vartti A, Oenema A, Schreck M, Uutela A, de Zwart O, Brug
J, et al. SARS knowedge, perception, and behaviors: A comparison
between Finns and the Dutch during the SARS outbreak in
2003. Int J Behav Med 2009;16:41-8.
23. Department of Mental Health. Mental Health Crisis Assessment
and Treatment Team: MCATT COVID-19 [Internet].
[cited 2020 Jan 12] Available from: http://galya. go.th/2020/
PDF/6manulADMCATTCOVID19.pdf
24. Wiwattanaworaset P, Pitanupong J. Bipolar patients’quality
of life in Songklanagarind hospital. J Psychiatr Assoc ailand
2017;62:229-308.
25. Agrasuta T, Pitanupong J. Perceived stigma in patient with
schizophrenia and caregiver in Songklanagarind hospital.
Songkla Med J 2017;35:37-45.
26. Pitanupong J, Rueangwiriyanan C. Caregiver burdens in
patients with schizophrenia and related factors. J Ment Health
ai 2019;27:95 106.
27. Fengyi H, Wanqiu T, Li J, Ling Z, Xinling Z, Yiran Z, et al. Do
psychiatric patients experience more psychiatric symptoms
during COVID-19 pandemic and lockdown? A case-control
study with service and research implications for immunopsychiatry.
Brain Behav Immun 2020;87:100-6.
28. Liao Q, Cowling B, Lam W, Ng D, Fielding R. Anxiety, worry
and cognitive risk estimate in relation to protective behaviors
during the 2009 Inuenza A/H1N1 pandemic in Hong Kong:
Ten cross-sectional surveys. BMC Infect Dis 2014;14:169.
29. Leung G, Lam T, Ho L, Ho S, Chan B, Wong I, et al. impact
Volume 73, No.1: 2021 Siriraj Medical Journal
https://he02.tci-thaijo.org/index.php/sirirajmedj/index
9
Original Article
SMJ
of community psychological responses on outbreak control
for severe acute respiratory syndrome in Hong Kong. J Epidemiol
Community Health 2003;57:857-63. Res 2020;289:113098.
30. Tull M, Edmonds K, Scamaldo K, Richmond J, Rose J, Gratz
K. Psychological outcomes associated with stay-at-home orders
and the perceived impact of COVID-19 on Daily Life. Psychiatry
Res 2020;289:113098.
31. Xiang Y, Yang Y, Li W, Zhang L, Zhang Q, Cheung T, et al.
Timely mental health care for the 2019 novel coronavirus
outbreak is urgently needed. Lancet Psychiatry 2020;7:228-9.
