Background The COVID-19 pandemic has been declared an international public health emergency, and it may have long-lasting effects on people’s mental health. There is a need to identify effective health behaviors to mitigate the negative mental health impact of COVID-19. Objective The objectives of this study were to (1) examine the regional differences in mental health and COVID-19–related worry, attention to news, and stress, in light of the state-level prevalence of COVID-19 cases; (2) estimate the associations between mental health and COVID-19–related worry, attention to news, and stress and health behavior engagement (ie, physical activity, mindfulness meditation); and (3) explore the mediating effect of health behavior engagement on the associations between mental health and COVID-19–related worry, attention to news, and stress. Methods A cross-sectional survey was distributed to a sample of US adult paying subscribers to the Calm app (data were collected from April 22 to June 3, 2020). The survey assessed COVID-19–related worry, attention to news, and stress; health behavior engagement; and mental health (ie, perceived stress, posttraumatic stress disorder, and anxiety and depression). Statistical analyses were performed using R software. Differences in COVID-19–related worry, attention to news, and stress and mental health by location were assessed using t tests and chi-square tests. Logistic and ordinary least squares models were used to regress mental health and health behavior on COVID-19–related worry, attention to news, and stress; moreover, causal mediation analysis was used to estimate the significance of the mediation effects. Results The median age of the respondents (N=8392) was 47 years (SD 13.8). Participants in the Mid-Atlantic region (New Jersey, New York, and Pennsylvania) reported higher levels of stress, more severe depression symptoms, greater worry about COVID-19, paying more attention to COVID-19–related news, and more stress related to social distancing recommendations than participants living in other regions. The association between worry about COVID-19 and perceived stress was significantly mediated by changes in physical activity ( P <.001), strength of meditation habit ( P <.001), and stopping meditation ( P =.046). The association between worry about COVID-19 and posttraumatic stress disorder symptoms was significantly mediated by changes in physical activity ( P <.001) and strength of meditation habit ( P <.001). Conclusions Our findings describe the mental health impact of COVID-19 and outline how continued participation in health behaviors such as physical activity and mindfulness meditation reduce worsening of mental health due to the COVID-19 pandemic. These data have important implications for public health agencies and health organizations to promote the maintenance of health habits to reduce the residual mental health burden of the COVID-19 pandemic.
【저자키워드】 COVID-19, coronavirus, mental health, mHealth, Health Behavior, mindfulness meditation, 【초록키워드】 public health, Perceived stress, Anxiety, Depression, Stress, physical activity, social distancing, COVID-19 pandemic, Symptom, Symptoms, Health, Mediation analysis, New York, association, Analysis, cross-sectional survey, mental health burden, Health Organization, chi-square tests, Posttraumatic Stress, R software, median age, worsening, participant, T Test, international public health, disorder, agency, Effect, regions, recommendation, mitigate, implication, objective, effective, difference, severe depression, Result, greater, identify, performed, was used, collected, significantly, reported, were used, changes in, long-lasting, promote, reduce, New, mediation effects, ordinary least square, prevalence of COVID-19, were assessed, 【제목키워드】 survey, activity, Impact, user, meditation, Attention, Effect, New, Mobile,