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Association of compliance with COVID-19 public health measures with depression


Although previous studies have demonstrated increased depression related to COVID-19, the reasons for this are not well-understood. We investigated the association of compliance with COVID-19 public health measures with depression. Data from the 2020 Korea Community Health Survey were analyzed. The main independent variable was compliance with rules based on three performance variables (social distancing, wearing a mask in indoor facilities, and outdoors). Depression was assessed using Patient Health Questionnaire-9 scores. Of 195,243 participants, 5,101 participants had depression. Bad and moderate performance scores for compliance were associated with depression (Bad score, men: adjusted odds ratio [aOR] = 2.24, 95% confidence interval [CI] = 1.29–3.87; women: aOR = 2.42, 95% CI = 1.42–4.13; moderate score, men: aOR = 1.31, 95% CI = 1.02–1.68; women: aOR = 1.28, 95% CI = 1.07–1.53). In the subgroup analysis, among the quarantine rules, not wearing a mask indoors was the most prominently associated with depression. In participants with a high level of education, non-compliance with quarantine rules was significantly associated with depression. People who do not comply with public health measures are more likely to be depressed. The preparation and observance of scientific quarantine rules can help mental health in the ongoing COVID-19 pandemic and another infectious disease pandemic that may come.


The coronavirus disease 2019 (COVID-19) outbreak, which started in 2019, has completely changed the lives of people around the world. According to the World Health Organization (WHO), as of June 2022, more than 500 million cases have occurred worldwide, and about 6.3 million people have died from COVID-191. While many governments seek treatments and vaccines, most governments around the world have implemented various forms of anti-epidemic policies to prevent the further spread of COVID-192,3. At the individual level, measures such as wearing a mask, measuring body temperature when entering a building, and sanitizing hands were implemented. Group-level controls were also implemented to restrict face-to-face interactions, such as recommending physical or social distancing and forcing employees to work from home4,5,6.

The outbreak of COVID-19 also has caused a variety of psychological problems such as panic disorder, anxiety, and depression that can occur after major economic crises or natural disasters7,8,9,10. In patients infected with COVID-19, anxiety symptoms and fears regarding uncertainty about treatment and health outcomes can affect their mental health11. A recent study of survivors of COVID-19 infection reported that markers related to the immune response were associated with anxiety and depression12, and the frequency of depressive symptoms ≥ 12 weeks after COVID-19 infection was reported to be 11–28%13. Furthermore, health care providers who have had direct contact with COVID-19 patients are more likely to experience anxiety and depression14.

The burden of mental health problems for the general population during COVID-19 continues to be reported, even when not under special circumstances, such as those infected with COVID-19 or the medical staff treating them15. Adverse mental health outcomes may arise from physical symptoms resembling COVID-19 infection mediated by the perceived impact of the pandemic and the absence of health information16. Moreover, public health interventions implemented in several countries, such as lockdown and quarantine measures, may have affected mental health, including causing anxiety and depression, during COVID-19 pandemic5,17. According to a previous study, mental health was affected by the strictness of quarantine policies and the number of deaths caused by COVID-19 in the Netherlands, UK, and France18.

The lack of interaction between people and restrictions on freedom may have significant impacts on the enjoyment of life as a human being19. Negative effects on the economic well-being and quality of life have been reported after national social distancing measures due to COVID-19, suggesting that public health interventions to prevent the spread of infection are affecting the lives of the general population as a whole20. Furthermore, these special circumstances, including isolation and social distancing, are likely to contribute to the frustration, boredom, and depressed mood of the general population19,21.

With regard to the mental well-being of the general population, a rapid public health response may be more helpful than a late public health response22. Moreover, adherence to social distancing and perceived effectiveness of social distancing are associated with lower levels of anxiety and depressive symptoms23. In addition, in Poland, where the use of a mask was not recommended in the early stages of COVID-19 pandemic, it was found that the level of depression and stress was higher compared to that in China, where masks were recommended24. These findings imply that, even if individual freedom is restricted, there is a positive effect on mental health if people perceive that implementing and observing quarantine rules is for the well-being of the community and their own health.

Taken together, not only isolation measures but also public health measures, such as social distancing and wearing masks, that restrict individual freedom can affect the mental health of the general population who have experienced the outbreak of COVID-19. However, considering that humans are beings with free will, it should be considered that the government's establishment of quarantine rules and the people's observance of them are different dimensions when considering public health measures in a pandemic situation.

Thus, this study evaluated the association of compliance with COVID-19 public health measures with depression in Korean adults. Furthermore, this study aimed to serve as a basis for preparing an efficient and effective response plan for public health policies, not only for the current crisis but also for other infectious diseases to come in the future, by estimating the impact of public health policies on mental health.


Study population and data

This study used data from the 2020 Community Health Survey (CHS) in South Korea. The CHS is a nationwide population-based survey, the purpose of which is to obtain the health data of South Korean citizens who are adults ≥ 19 years. This health data includes information about mental health, medical service usage, and diet. In particular, the 2020 CHS, conducted from August 16 to October 31, 2020, included data related to COVID-19, such as the practicing of social distancing. The Korea Disease Control and Prevention Agency conducts the CHS every year by visiting and interviewing selected family households. In CHS, stratified cluster sampling method and systematic sampling method were used to select sample area and sample household, respectively25. The dataset used in this study can be provided through a predetermined procedure after entering certain information on the CHS’s official website (

A total of 229,269 participants were involved in the 2020 CHS. In this study, participants whose answers were “Refused to respond,” “Don’t know,” or “Unmatched” in the survey (n = 34,026) were excluded. As a result, 195,243 participants (89,135 men and 106,108 women) were selected for this study. Since the CHS is a survey conducted by the government for public welfare, ethics approval for the CHS was waived by the Bioethics and Safety Act, 2015. This study adhered to the tenets of the Declaration of Helsinki and all methods were performed in accordance with the relevant guidelines and regulations.


Depression was the primary outcome of this study. The PHQ-9 is an instrument for screening, diagnosing, monitoring, and measuring the severity of depression26,27. The Korean version of PHQ-9 has been verified for validity and reliability in a population-based survey28. The PHQ-9 consists of 9 items measuring the frequency of depressive symptoms over the past two weeks, and each item is scored on a scale of 0–3. The sum of the scores ranges from 0–27, with higher scores indicating more severe depression. According to the definition of depression on the PHQ-9 test, participants with scores ≥ 10 in the PHQ-9 test were defined as having depression29. Participants with scores < 10 were defined as normal.

Compliance with COVID-19 public health measures

The main independent variable was compliance with COVID-19 public health measures, which was determined based on responses to questions regarding social distancing and wearing masks. Social distancing was evaluated by one question, “Do you practice social distancing by maintaining distance?” The answers to the question were either “Absolutely,” “Yes,” or “No.” Participants who answered “Absolutely” or “Yes” to the question were given one point, and those who answered “No” were given zero. The wearing of masks was evaluated based on two questions, “Do you wear a mask in indoor facilities?” and “Do you wear a mask outdoor when social distancing is difficult?” The possible answers to these two questions were “Absolutely,” “Yes,” or “No.” Those who answered “Absolutely” or “Yes” to the question regarding wearing a mask in indoor facilities were given one point and those who answered “No” were given zero. Those who answered “Absolutely” or “Yes” to the question regarding wearing a mask outdoors were given one point and others were given zero.

Based on these questions, the participants were given a COVID-19 compliance performance score. For each participant, the performance score was the sum of the points for the three questions above, hence the larger the score the better the compliance. Finally, we classified a performance score of 0 to 1 as bad, a score of 2 as moderate, and a score of 3 as good.


The covariates for this study included age (19–29, 30–39, 40–49, 50–59, 60–69, or ≥ 70 years), education level (did not graduate high school or graduated high school), employment status (white, pink, or blue collar or none), household income (low, middle low, middle high, or high), smoking status (yes or no), alcohol consumptions (once/month and more than or less than once/month), physical activity (high or low, with high indicating walked ≥ 30 min/day for ≥ 5 d/week), chronic disease history (hypertension and diabetes), and subjective health status (good, normal or bad). Subjective health status was categorized based on the response to the question, “How do you think of your own health status?”.

Statistical analysis

All analyses were conducted separately by sex to account for sex-specific differences in rates of depression30. To assess the differences between groups of participants with depression and groups of those without depression for each sex, chi-squared tests were performed for categorical variables. After adjusting for covariates, multiple logistic regression analysis was used to evaluate the association of compliance with COVID-19 public health measures, using the performance score, with depression for men and women. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. The association between the performance score for each question and depression in men and women was also evaluated. Finally, the association of the performance score with depression for each sex stratified by education level was evaluated. All analyses were performed using Statistical Analysis Software (SAS, version 9.4, SAS, Inc., Cary, NC, USA). To account for the complex and stratified sampling design, a weighted logistic regression procedure was used31. The p values were two-sided, and statistical significance was assumed when p < 0.05.

Ethics approval

Since the CHS is a survey conducted by the government for public welfare, ethics approval for the CHS was waived by the Bioethics and Safety Act, 2015.


Table 1 presents the general characteristics of male and female participants along with the performance scores. Among the 195,243 participants, the number of participants who had good COVID-19 quarantine rules performance score was 184,746 (94.62%), moderate score was 9,249 (4.74%), and bad score was 1,248 (0.64%). For each of these categories, the number of participants who showed depression based on the PHQ-9 scores was 4,684 (2.54%), 354 (3.83%), and 63 (5.05%), respectively (percentages reflect the number in each category). Among the 5,101 participants who showed depression, the number of men was 1,620 and that of women was 3,481.

Table 1 General characteristics of study subjects.

Table 2 shows the factors associated with depression. After adjusting for all covariates, those who showed bad performance scores were more likely to have depression than those who showed good performance scores. Using good performance score as the reference, the aORs for men were as follows: moderate, aOR = 1.31, 95% CI: 1.02–1.68; bad, aOR = 2.24, 95% CI: 1.29–3.87. Similarly, the ORs for women were as follows: moderate, aOR = 1.28, 95% CI: 1.07–1.53; bad, aOR = 2.42, 95% CI: 1.42–4.13.

Table 2 Factors associated with depression (PHQ − 9 ≥ 10).

Table 3 shows the association of social distancing and wearing mask with depression. Participants who did not practice social distancing in both men and women were more likely to show depression (Men: aOR = 1.31, 95% CI: 1.02–1.68; Women: aOR = 1.38, 95% CI: 1.15–1.66). Men and women who answered that they did not wear masks at indoor facilities had a higher risk of depression than those who answered that they wore masks (Men: aOR = 2.32, 95% CI: 1.33–4.03, Women: aOR = 1.85, 95% CI: 1.07–3.18). Among men, not wearing a mask when social distancing was difficult was significantly associated with depression (aOR = 1.82, 95% CI: 1.14–2.91).

Table 3 Association of social distancing and wearing mask with depression.

Table 4 shows the stratified analysis according to education level. In the case of the people who did not graduate high school, in both sexes, the performance score was not associated with depression. However, in the case of the people who graduated high school, the adjusted OR values of bad performance scores were largest in both sexes (Men: aOR = 2.45, 95% CI: 1.29–4.65, Women: aOR = 3.75, 95% CI: 1.73–8.13).

Table 4 Association between COVID-19 quarantine rules performance score and depression according to the education level.


Depression is a leading cause of disability worldwide, and the prevalence of depression in countries around the world has doubled since 202018,32. Furthermore, the prevalence of depressive symptoms (PHQ-9 score ≥ 10) in South Korea after COVID-19 pandemic (18.8%) is significantly higher than the rates of 6.1–6.7% reported in previous Korean studies that analyzed population-based data33. The increase in the prevalence of depressive symptoms in Korea is larger than the 9.1% increase reported in a US study34. Therefore, it is important to investigate factors related to depressive symptoms in Korea after commencement of the COVID-19 pandemic.

Under these circumstances, the present study investigated the association of compliance with COVID-19 public health measures with depression using PHQ-9. Our findings indicated that there was a significant association between compliance as measured by a performance score and depression. In other words, compared to those who completely followed the quarantine rules, those who did not follow even one were more likely to be depressed.

Several previous articles and studies have demonstrated that the number of people who have depression has increased worldwide due to COVID-1935. Some studies have explained that depression is caused due to social isolation, lower income, or fears of infection36,37,38. Direct biological effects from coronavirus have also likely contributed to the increased prevalence of depression during the COVID-19 pandemic. Previous studies have reported that coronavirus can directly penetrate the central nervous system or leave psychopathological sequelae through the immune system39,40. However, few studies have investigated the relationship between COVID-19 and depression by focusing on the compliance of quarantine measures that have become a daily routine because of COVID-19.

Several possible theories support our results. First, anxiety about disease transmission from not following quarantine guidelines can lead to depression. People who perceive themselves to be at higher risk of exposure to the virus are more likely to report symptoms indicative of depression41,42. In a subgroup analysis, the association between wearing a mask indoors and depression had a higher odds ratio in association with depression than not wearing a mask outdoors and not practicing social distancing. It is well known that wearing a mask can reduce the transmission of COVID-1943,44, and that the virus spreads better indoors than outdoors45. People who re-used masks had stronger beliefs about the severity of the COVID-19 disease and were more likely to experience depressive symptoms. In addition, a recent study reported that students who did not wear masks had greater psychological stress compared to those who wore masks46. Considering these points, people who do not wear a mask indoors are more likely to have depressive symptoms because of fear that they may contract an infectious disease even if they choose not to wear a mask.

Second, compliance with quarantine rules can provide an environment that is a little freer from the stress of COVID-19 pandemic. In other words, compliance with quarantine rules may be related to a decrease in the prevalence of depressive symptoms by reducing neuroinflammation possibly induced by stress47. Another possibility is that people's state of mind can also affect their mental health, such as depression, when making rules-following decisions. In other word, those people who followed the COVID-19 quarantine rules were happy, but those who did not follow the rules can become anxious, which can affect their mental health48.

Furthermore, the relationship between rule-following and mental health differed by education level. In the stratified analysis, bad COVID-19 quarantine rules performance score was significantly associated with depression among participants with higher education levels. However, there was no association between non-compliance with quarantine rules and depression in participants with lower education level. A possible explanation for these results is that education level affects hygiene practices and the will to follow the rules. This aspect requires further investigation.

There are several limitations to be considered in our study. First, owing to the cross-sectional design of the study, we cannot be confident that the PHQ-9 data collected specifically measure COVID-19-related depressive symptoms. This is because it is impossible to differentiate between pre-existing depressive symptoms and those recently caused by COVID-19. Second, as people may not have answered the survey honestly, nonrandom misclassification may have been produced31. This may have been the case because adherence to rules is a sensitive issue. One study showed that respondents sometimes lie in questionnaires, especially when a question is socially sensitive49. We were not able to adjust for this possibility in our study. Finally, the study’s cross-sectional nature did not allow us to clearly identify the direction of the relationship between compliance with COVID-19 public health measures and depression. Further longitudinal studies are required to establish a causal relationship. However, our results can be used as a basis for other related studies because our study used a methodology suitable for the dataset and adjusted for covariates associated with quarantine rule compliance and depressive symptoms.

Despite these limitations, this study has strengths. Our findings may be socially important. COVID-19 public health measures are currently major issues worldwide and it is clear that the prolonged COVID-19 pandemic has adverse effects on mental health50,51. Now is the time to study the effect of quarantine rules that we have to adapt to due to COVID-19 on mental health, and our research is at the starting line. Overall, non-compliance with quarantine rules was associated with depression, and this association was stronger with higher education levels. Further research on the mechanism by which the observance of quarantine rules helps mental health is necessary, and it is necessary to communicate and publicize information that observing quarantine rules can protect mental health as well as infection from COVID-19.


Men and women who do not comply with public health measures during COVID-19 pandemic are likely to be depressed. Furthermore, not wearing a mask indoors showed the highest association with depression. The association between non-compliance with quarantine rules and depression was more pronounced in participants with a high level of education. These results suggest that compliance with COVID-19 quarantine rules can help mental health. Therefore, it is necessary to make it known that the development of evidence-based quarantine rules that can reduce the transmission of COVID-19 and adherence to them can be beneficial to physical and mental health.

Data availability

The dataset used in this study is publicly available on the CHS’s official website (


  1. World Health Organization WHO Coronavirus (COVID-19) Dashboard (2022).

  2. Chu, I. Y., Alam, P., Larson, H. J. & Lin, L. Social consequences of mass quarantine during epidemics: A systematic review with implications for the COVID-19 response. J. Travel Med. 27, taaa192 (2020).

    PubMed  Article  Google Scholar 

  3. Davies, N. G., Kucharski, A. J., Eggo, R. M., Gimma, A. & Edmunds, W. J. Effects of non-pharmaceutical interventions on COVID-19 cases, deaths, and demand for hospital services in the UK: a modelling study. Lancet Public Health 5, e375–e385 (2020).

    PubMed  PubMed Central  Article  Google Scholar 

  4. Cheng, V. C. et al. The role of community-wide wearing of face mask for control of coronavirus disease 2019 (COVID-19) epidemic due to SARS-CoV-2. J. Infect. 81, 107–114 (2020).

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  5. Benke, C., Autenrieth, L. K., Asselmann, E. & Pané-Farré, C. A. Lockdown, quarantine measures, and social distancing: Associations with depression, anxiety and distress at the beginning of the COVID-19 pandemic among adults from Germany. Psychiatry Res. 293, 113462 (2020).

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  6. Schuchat, A. Public health response to the initiation and spread of pandemic COVID-19 in the United States, February 24–April 21, 2020. Morbid. Mortal. Week. Rep. 69, 551–556 (2020).

    CAS  Article  Google Scholar 

  7. Qiu, J. et al. A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: Implications and policy recommendations. Gen. Psychiatry 33, e100213 (2020).

    CAS  Article  Google Scholar 

  8. Xiong, J. et al. Impact of COVID-19 pandemic on mental health in the general population: A systematic review. J. Affect. Disord. 277, 55–64 (2020).

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  9. Hossain, M. M. et al. Epidemiology of mental health problems in COVID-19: a review. F1000Res 9, 636 (2020).

  10. Beaglehole, B. et al. Psychological distress and psychiatric disorder after natural disasters: Systematic review and meta-analysis. Br. J. Psychiatry 213, 716–722 (2018).

    PubMed  Article  Google Scholar 

  11. Hossain, M. M., Sultana, A. & Purohit, N. Mental health outcomes of quarantine and isolation for infection prevention: A systematic umbrella review of the global evidence. Epidemiol. Health 42, e2020038 (2020).

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  12. Mazza, M. G. et al. Anxiety and depression in COVID-19 survivors: Role of inflammatory and clinical predictors. Brain Behav. Immun. 89, 594–600 (2020).

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  13. Renaud-Charest, O. et al. Onset and frequency of depression in post-COVID-19 syndrome: A systematic review. J. Psychiatr. Res. 144, 129–137 (2021).

    PubMed  PubMed Central  Article  Google Scholar 

  14. Chew, N. W. S. et al. A multinational, multicentre study on the psychological outcomes and associated physical symptoms amongst healthcare workers during COVID-19 outbreak. Brain Behav. Immun. 88, 559–565 (2020).

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  15. Wang, C. et al. A longitudinal study on the mental health of general population during the COVID-19 epidemic in China. Brain Behav. Immun. 87, 40–48 (2020).

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  16. Wang, C. et al. A chain mediation model on COVID-19 symptoms and mental health outcomes in Americans. Asians Eur. Sci. Rep. 11, 6481 (2021).

    ADS  CAS  Google Scholar 

  17. Le, H. T. et al. Anxiety and depression among people under the nationwide partial lockdown in Vietnam. Front. Public Health 8, 589359 (2020).

    PubMed  PubMed Central  Article  Google Scholar 

  18. Hewlett, E., Takino, S., Nishina, Y. & Prinz, C. Tackling the Mental Health Impact of the COVID-19 Crisis: an Integrated, Whole-Of-Society Response (OECD Publishing, 2021).

    Google Scholar 

  19. Bai, Y. et al. Survey of stress reactions among health care workers involved with the SARS outbreak. Psychiatr. Serv. 55, 1055–1057 (2004).

    PubMed  Article  Google Scholar 

  20. Tran, B. X. et al. Impact of COVID-19 on economic well-being and quality of life of the Vietnamese during the national social distancing. Front. Psychol. 11, 565153 (2020).

    PubMed  PubMed Central  Article  Google Scholar 

  21. Venkatesh, A. & Edirappuli, S. Social distancing in covid-19: What are the mental health implications?. BMJ 369, m1379 (2020).

    PubMed  Article  Google Scholar 

  22. Lee, Y. et al. Government response moderates the mental health impact of COVID-19: A systematic review and meta-analysis of depression outcomes across countries. J. Affect. Disord. 290, 364–377 (2021).

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  23. Zhao, S. Z. et al. Social distancing compliance under COVID-19 pandemic and mental health impacts: A population-based study. Int. J. Environ. Res. Public Health 17, 6692 (2020).

    CAS  PubMed Central  Article  Google Scholar 

  24. Wang, C. et al. The association between physical and mental health and face mask use during the COVID-19 Pandemic: A comparison of two countries with different views and practices. Front. Psych. 11, 569981 (2020).

    Article  Google Scholar 

  25. Kim, S. H., Park, M., Jeong, S. H., Jang, S. I. & Park, E. C. Association between cohabitation status and sleep quality in families of persons with dementia in Korea: A cross-sectional study. J. Prev. Med. Public Health 54, 317–329 (2021).

    PubMed  PubMed Central  Article  Google Scholar 

  26. Kroenke, K., Spitzer, R. L. & Williams, J. B. The PHQ-9: validity of a brief depression severity measure. J. Gen. Intern. Med. 16, 606–613 (2001).

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  27. Löwe, B., Unützer, J., Callahan, C. M., Perkins, A. J. & Kroenke, K. Monitoring depression treatment outcomes with the patient health questionnaire-9. Med. Care 42, 1194–1201 (2004).

    PubMed  Article  Google Scholar 

  28. Han, C. et al. Validation of the Patient Health Questionnaire-9 Korean version in the elderly population: the Ansan Geriatric study. Compr. Psychiatry 49, 218–223 (2008).

    PubMed  Article  Google Scholar 

  29. BrookeLevis, A. B., & Thombs, B. D. Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: Individual participant data meta-analysis Meta-Analysis 3, 965 (2020).

  30. Weissman, M. M. et al. Sex differences in rates of depression: Cross-national perspectives. J. Affect. Disord. 29, 77–84 (1993).

    CAS  PubMed  Article  Google Scholar 

  31. Kim, S. H., Jeong, S. H., Park, E. C. & Jang, S. I. Association of cigarette type initially smoked with suicidal behaviors among adolescents in Korea From 2015 to 2018. JAMA Netw. Open 4, e218803 (2021).

    PubMed  PubMed Central  Article  Google Scholar 

  32. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: A systematic analysis for the Global Burden of Disease Study 2016. Lancet (London, England) 390, 1211–1259 (2017).

  33. Lee, H., Choi, D. & Lee, J. J. Depression, anxiety, and stress in Korean general population during the COVID-19 pandemic. Epidemiol. Health 44, e2022018 (2022).

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  34. Ettman, C. K. et al. Prevalence of depression symptoms in US adults before and during the COVID-19 pandemic. JAMA Netw. Open 3, e2019686 (2020).

    PubMed  PubMed Central  Article  Google Scholar 

  35. Li, W. et al. Progression of mental health services during the COVID-19 outbreak in China. Int. J. Biol. Sci. 16(10), 1732 (2020).

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  36. Pancani, L. M. M., Aureli, N. & Riva, P. Forced social isolation and mental health: A study on 1,006 Italians under COVID-19 lockdown. Front. Psychol. 12, 663799 (2021).

    PubMed  PubMed Central  Article  Google Scholar 

  37. Hyland, P. S. M. et al. Anxiety and depression in the Republic of Ireland during the COVID-19 pandemic. Acta Psychiatr. Scand. 142, 249–256 (2020).

    CAS  PubMed  Article  Google Scholar 

  38. Bueno-Notivol, J. et al. Prevalence of depression during the COVID-19 outbreak: A meta-analysis of community-based studies. Int. J. Clin. Health Psychol. IJCHP 21, 100196 (2021).

    PubMed  Article  Google Scholar 

  39. Wu, Y. et al. Nervous system involvement after infection with COVID-19 and other coronaviruses. Brain Behav. Immun. 87, 18–22 (2020).

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  40. Desforges, M. et al. Human coronaviruses and other respiratory viruses: Underestimated opportunistic pathogens of the central nervous system?. Viruses 12, 14 (2019).

    PubMed Central  Article  Google Scholar 

  41. Bressington, D. T. et al. Association between depression, health beliefs, and face mask use during the COVID-19 pandemic. Front. Psychol. 11, 571179 (2020).

    Article  Google Scholar 

  42. Nguyen, H. C. et al. People with suspected COVID-19 symptoms were more likely depressed and had lower health-related quality of life: The potential benefit of health literacy. J. Clin. Med. 9, 965 (2020).

    CAS  PubMed Central  Article  Google Scholar 

  43. Chu, D. K. et al. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: A systematic review and meta-analysis. Lancet (London, England) 395, 1973–1987 (2020).

    CAS  Article  Google Scholar 

  44. Howard, J. et al. An evidence review of face masks against COVID-19. Proc. Natl. Acad. Sci. USA 118, e2014564118 (2021).

    CAS  PubMed  PubMed Central  Article  Google Scholar 

  45. Moritz, S. et al. The risk of indoor sports and culture events for the transmission of COVID-19. Nat. Commun. 12, 5096 (2021).

    ADS  CAS  PubMed  PubMed Central  Article  Google Scholar 

  46. Qin, Z. et al. Prevalence and risk factors associated with self-reported psychological distress among children and adolescents during the COVID-19 pandemic in China. JAMA Netw. Open 4, e2035487 (2021).

    PubMed  PubMed Central  Article  Google Scholar 

  47. de Figueiredo, C. S. et al. COVID-19 pandemic impact on children and adolescents’ mental health: Biological, environmental, and social factors. Prog. Neuropsychopharmacol. Biol. Psychiatry 106, 110171 (2021).

    PubMed  Article  CAS  Google Scholar 

  48. Rainone, N. A., Watts, L. L., Mulhearn, T. J., McIntosh, T. J. & Medeiros, K. E. The impact of happy and sad affective states on biases in ethical decision making. Ethics Behav. 31, 284–300 (2021).

    Article  Google Scholar 

  49. Diskin A, F. D. Do They Lie in International Political Science Review, Vol. 2 407–4221981).

  50. Cullen, W., Gulati, G. & Kelly, B. D. Mental health in the COVID-19 pandemic. QJM Int. J. Med. 113, 311–312 (2020).

    CAS  Article  Google Scholar 

  51. Duan, L. & Zhu, G. Psychological interventions for people affected by the COVID-19 epidemic. Lancet Psychiatry 7, 300–302 (2020).

    PubMed  PubMed Central  Article  Google Scholar 

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We would like to thank the Korea Disease Control and Prevention Agency, which provided the data based on a nationwide survey.


This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (grant number: HI20C1130). Additionally, this work was supported by the National Research Foundation of Korea(NRF) grant funded by the Korea government (MSIT) (No. 2022R1F1A1062794).

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J.A.B., T.J.S., T.Y.L., S.H.K., and S.-I.J. were responsible for the conception and design of the study. J.A.B., T.J.S., and S.H.K. did the formal analysis and methodology. J.A.B., T.J.S, and T.Y.L. drafted and completed the manuscript. S.H.K. provided feedback on drafts of the manuscripts. S.H.K. and S.-I.J. is the corresponding of this research and supervised entire manuscript. All authors read and approved the final version of the manuscript.

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Correspondence to Sung-In Jang or Seung Hoon Kim.

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Byun, J.A., Sim, T.J., Lim, T.Y. et al. Association of compliance with COVID-19 public health measures with depression. Sci Rep 12, 13464 (2022).

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