Psychological distress and compliance with sanitary measures during the Covid-19 pandemic

Irwin Hecker; Solène Wallez; Honor Scarlett; José Luis Ayuso-Mateos; Richard Bryant; Giulia Caggiu; Claudia Conflitti; Katalin Gémes; Josep Maria Haro; Vincent Lorant; Roberto Mediavilla; Ellenor Mittendorfer-Rutz; Anna Monistrol-Mula; Matteo Monzio Compagnoni; Papoula Petri-Romão; Irene Pinucci; Marit Sijbrandij; Jutta Stoffers-Winterling; Henrik Walter; Murielle Mary-Krause; Maria Melchior

doi:10.1371/journal.pone.0317272

Psychological distress and compliance with sanitary measures during the Covid-19 pandemic

Irwin Hecker
, Solène Wallez
, Honor Scarlett
, José Luis Ayuso-Mateos
, Richard Bryant
, Giulia Caggiu
, Claudia Conflitti
, Katalin Gémes
, Josep Maria Haro
, Vincent Lorant
, Roberto Mediavilla
, Ellenor Mittendorfer-Rutz
, Anna Monistrol-Mula
, Matteo Monzio Compagnoni
, Papoula Petri-Romão
, Irene Pinucci
, Marit Sijbrandij
, Jutta Stoffers-Winterling
, Henrik Walter
, Murielle Mary-Krause

Maria Melchior^*

^*Corresponding author for this work

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

Background This study aims to understand the relationship between the experience of psychological distress and compliance with COVID-19 sanitary measures. We testeed whether this relationship was modified by individuals’ gender and socioeconomic status (i.e., educational level and employment). Methods Data from four European cohort studies (n = 13,635), were analysed using an Individual Participant Data (IPD) meta-analytic approach. Mixed effect models were employed to examine associations between mental health difficulties and compliance with sanitary measures, as well as effect modification by socioeconomic status. Statistical models were stratified by gender. Results We found a statistically significant association between mental health difficulties and increased compliance with sanitary measures in women, while amongst men the statistically significant association observed was opposite. Moreover, there was a statistically significant interaction between participants’ educational level and mental health difficulties amongst men only, indicating especially low compliance levels with COVID-19 sanitary measures amongst individuals with only primary schooling and who reported psychological distress. Conclusion The association between psychological distress and compliance with sanitary measures is complex–positive in women, negative in men. Men experiencing mental health difficulties, especially those with lower educational attainment, exhibit low levels of compliance with sanitary measures. These results suggest that psychological distress and its possible consequences should be considered when designing measures addressing infectious disease spread.

Original language	English
Article number	e0317272
Pages (from-to)	1-14
Number of pages	14
Journal	PLoS ONE
Volume	20
Issue number	7
Early online date	31 Jul 2025
DOIs	https://doi.org/10.1371/journal.pone.0317272
Publication status	Published - Jul 2025

Bibliographical note

Publisher Copyright:
© 2025 Hecker et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Funding

Funding: This study was funded by the EU Horizon 2020 H2020-SC1-PHE- CORONAVIRUS-2020-2 funded RESPOND (Improving the Preparedness of Health Systems to Reduce Mental Health and Psychosocial Concerns resulting from the COVID-19 Pandemic) project (Grant Agreement 101016127). The TEMPO cohort study was funded by the French National Research Agency (ANR), the Interministerial Agency for Drug and Addictive Behaviors (MILDECA), the French National Cancer Institute (INCA), the MINDCOVID study received funding from the Instituto de Salud Carlos III, ISCIII, FPU and the Generalitat de Catalunya, the Covid and I study received funding from the King Baudouin Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Hecker, I., Wallez, S., Scarlett, H., Ayuso-Mateos, J. L., Bryant, R., Caggiu, G., Conflitti, C., Gémes, K., Haro, J. M., Lorant, V., Mediavilla, R., Mittendorfer-Rutz, E., Monistrol-Mula, A., Compagnoni, M. M., Petri-Romão, P., Pinucci, I., Sijbrandij, M., Stoffers-Winterling, J., Walter, H., ... Melchior, M. (2025). Psychological distress and compliance with sanitary measures during the Covid-19 pandemic. PLoS ONE, 20(7), 1-14. Article e0317272. https://doi.org/10.1371/journal.pone.0317272

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title = "Psychological distress and compliance with sanitary measures during the Covid-19 pandemic",

abstract = "Background This study aims to understand the relationship between the experience of psychological distress and compliance with COVID-19 sanitary measures. We testeed whether this relationship was modified by individuals{\textquoteright} gender and socioeconomic status (i.e., educational level and employment). Methods Data from four European cohort studies (n = 13,635), were analysed using an Individual Participant Data (IPD) meta-analytic approach. Mixed effect models were employed to examine associations between mental health difficulties and compliance with sanitary measures, as well as effect modification by socioeconomic status. Statistical models were stratified by gender. Results We found a statistically significant association between mental health difficulties and increased compliance with sanitary measures in women, while amongst men the statistically significant association observed was opposite. Moreover, there was a statistically significant interaction between participants{\textquoteright} educational level and mental health difficulties amongst men only, indicating especially low compliance levels with COVID-19 sanitary measures amongst individuals with only primary schooling and who reported psychological distress. Conclusion The association between psychological distress and compliance with sanitary measures is complex–positive in women, negative in men. Men experiencing mental health difficulties, especially those with lower educational attainment, exhibit low levels of compliance with sanitary measures. These results suggest that psychological distress and its possible consequences should be considered when designing measures addressing infectious disease spread.",

author = "Irwin Hecker and Sol{\`e}ne Wallez and Honor Scarlett and Ayuso-Mateos, \{Jos{\'e} Luis\} and Richard Bryant and Giulia Caggiu and Claudia Conflitti and Katalin G{\'e}mes and Haro, \{Josep Maria\} and Vincent Lorant and Roberto Mediavilla and Ellenor Mittendorfer-Rutz and Anna Monistrol-Mula and Compagnoni, \{Matteo Monzio\} and Papoula Petri-Rom{\~a}o and Irene Pinucci and Marit Sijbrandij and Jutta Stoffers-Winterling and Henrik Walter and Murielle Mary-Krause and Maria Melchior",

note = "Publisher Copyright: {\textcopyright} 2025 Hecker et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.",

year = "2025",

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Hecker, I, Wallez, S, Scarlett, H, Ayuso-Mateos, JL, Bryant, R, Caggiu, G, Conflitti, C, Gémes, K, Haro, JM, Lorant, V, Mediavilla, R, Mittendorfer-Rutz, E, Monistrol-Mula, A, Compagnoni, MM, Petri-Romão, P, Pinucci, I, Sijbrandij, M, Stoffers-Winterling, J, Walter, H, Mary-Krause, M & Melchior, M 2025, 'Psychological distress and compliance with sanitary measures during the Covid-19 pandemic', PLoS ONE, vol. 20, no. 7, e0317272, pp. 1-14. https://doi.org/10.1371/journal.pone.0317272

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T1 - Psychological distress and compliance with sanitary measures during the Covid-19 pandemic

AU - Hecker, Irwin

AU - Wallez, Solène

AU - Scarlett, Honor

AU - Ayuso-Mateos, José Luis

AU - Bryant, Richard

AU - Caggiu, Giulia

AU - Conflitti, Claudia

AU - Gémes, Katalin

AU - Haro, Josep Maria

AU - Lorant, Vincent

AU - Mediavilla, Roberto

AU - Mittendorfer-Rutz, Ellenor

AU - Monistrol-Mula, Anna

AU - Compagnoni, Matteo Monzio

AU - Petri-Romão, Papoula

AU - Pinucci, Irene

AU - Sijbrandij, Marit

AU - Stoffers-Winterling, Jutta

AU - Walter, Henrik

AU - Mary-Krause, Murielle

AU - Melchior, Maria

N1 - Publisher Copyright: © 2025 Hecker et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PY - 2025/7

Y1 - 2025/7

N2 - Background This study aims to understand the relationship between the experience of psychological distress and compliance with COVID-19 sanitary measures. We testeed whether this relationship was modified by individuals’ gender and socioeconomic status (i.e., educational level and employment). Methods Data from four European cohort studies (n = 13,635), were analysed using an Individual Participant Data (IPD) meta-analytic approach. Mixed effect models were employed to examine associations between mental health difficulties and compliance with sanitary measures, as well as effect modification by socioeconomic status. Statistical models were stratified by gender. Results We found a statistically significant association between mental health difficulties and increased compliance with sanitary measures in women, while amongst men the statistically significant association observed was opposite. Moreover, there was a statistically significant interaction between participants’ educational level and mental health difficulties amongst men only, indicating especially low compliance levels with COVID-19 sanitary measures amongst individuals with only primary schooling and who reported psychological distress. Conclusion The association between psychological distress and compliance with sanitary measures is complex–positive in women, negative in men. Men experiencing mental health difficulties, especially those with lower educational attainment, exhibit low levels of compliance with sanitary measures. These results suggest that psychological distress and its possible consequences should be considered when designing measures addressing infectious disease spread.

AB - Background This study aims to understand the relationship between the experience of psychological distress and compliance with COVID-19 sanitary measures. We testeed whether this relationship was modified by individuals’ gender and socioeconomic status (i.e., educational level and employment). Methods Data from four European cohort studies (n = 13,635), were analysed using an Individual Participant Data (IPD) meta-analytic approach. Mixed effect models were employed to examine associations between mental health difficulties and compliance with sanitary measures, as well as effect modification by socioeconomic status. Statistical models were stratified by gender. Results We found a statistically significant association between mental health difficulties and increased compliance with sanitary measures in women, while amongst men the statistically significant association observed was opposite. Moreover, there was a statistically significant interaction between participants’ educational level and mental health difficulties amongst men only, indicating especially low compliance levels with COVID-19 sanitary measures amongst individuals with only primary schooling and who reported psychological distress. Conclusion The association between psychological distress and compliance with sanitary measures is complex–positive in women, negative in men. Men experiencing mental health difficulties, especially those with lower educational attainment, exhibit low levels of compliance with sanitary measures. These results suggest that psychological distress and its possible consequences should be considered when designing measures addressing infectious disease spread.

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Psychological distress and compliance with sanitary measures during the Covid-19 pandemic

Abstract

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