What Protects Us Against the COVID-19 Threat? Cultural Tightness Matters

doi:10.21203/rs.3.rs-144042/v1

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Research Article

What Protects Us Against the COVID-19 Threat? Cultural Tightness Matters

https://doi.org/10.21203/rs.3.rs-144042/v1

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published 22 Nov, 2021

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Background: The only previous studies that formulated a theoretical model of epidemics for psychological response relative to cultural perspectives have focused on the role of individualism–collectivism and have omitted analysis of tightness–looseness. This study explored the role of cultural tightness in relation to psychological disorders during the outbreak of the COVID-19 pandemic.

Methods: We recruited 1827 Chinese adolescents (M_age = 17.78 ± 1.94 years, 55.5% female) to participate a cross-sectional survey. Participants completed a series of questionnaires, including the scales of cultural tightness, risk perception of COVID-19 pandemic, perceived protection efficacy, anxiety and depression. A latent moderated structural equations model was used to analyse the mediating and moderating effects of risk perception regarding COVID-19, cultural tightness and perceived protection efficacy on psychological disorders.

Results: The results showed that greater risk perception of COVID-19 predicted greater psychological disorders, however cultural tightness moderated this positive relationship. The increase in psychological disorders with risk perception regarding COVID-19 was less pronounced among people who lived in tighter cultural areas. In addition, this moderating effect of cultural tightness was further mediated by perceived protection efficacy; that is, tight culture protects against psychological disorders by enhancing perceived protection efficacy.

Conclusion: This study enriched the theoretical framework of cultural tightness and indicated its importance in the field of mental health and health policies. It also emphasized the importance of tight culture as a protective factor against psychological disorders in case of COVID-19 outbreaks, providing valuable practical insight into psychological prevention for COVID-19 outbreaks.

Health Economics & Outcomes Research

Infectious Diseases

Health Policy

Cultural tightness

psychological disorders

risk perception

COVID-19

perceived protection efficacy

COVID-19, which was declared in January 2020 to be a public health emergency of international concern by WHO [1] has major impacts all over the world [2]. COVID-19 has been confirmed as a potentially fatal and infectious virus [3]. As the COVID-19 pandemic burgeons, the number of people infected from COVID-19 are sharply increasing [4]. Fear of this overwhelming infectious disease has caused distress that is an unprecedented threat to psychological coping, leading to clinical and sub-clinical disorders, including anxiety and depression [2, 5, 6]. COVID-19 not only directly leads to death but also produces psychological disorders among healthy people who are not suffering from it [7]. It is urgent to probe the factors that cause and relieve psychological disorders, and this effort would be crucial in protecting the public mental health in case of epidemic. This study explores factors from a socio-cultural psychology perspective that can contribute to relief for the psychological disorders triggered by the pandemic. Our research provided valuable practical insight into means of preventing psychological disorders and intervention during epidemics and pandemics in relation to socio-cultural psychology.

Risk perception of COVID-19 and psychological disorders

The emergence of COVID-19 has led to psychological disorders and conditions of anxiety and depression [8]. These reactions may originate in the risk perception of COVID-19. The theory of risk perception divides it into the two psychological dimensions of dread risk and unknown risk [9]. Dread risk perception would coincide with the rapid spread of COVID-19 [10] and its threat to life [8], while unknown risk perception would be aligned with the first appearance of COVID-19 [4]. Accordingly, faced with COVID-19, people perceive high risk in COVID-19, resulting in the assessment of the presence of COVID-19 as a harmful and life-threatening stress event. The transactional theory of stress and coping indicates that people constantly appraise stimuli within their environments, and when such stimuli are considered stressful (implying threat, harm, or challenge), distress is provoked [11-13]. Put simply, the risk perception of COVID-19 can create psychological disorders, especially for a potential risk of death [14].

Moderating role of cultural tightness

Tightness–looseness was first proposed by Pelto [15] as a set of unique cultural patterns that complement other measured cultural dimensions [15, 16]. Tightness-looseness is defined as a shared structure and refers to the extent to which social norms are pervasive, clearly defined, and reliably imposed [17]. Regions that have a culture with higher tightness tend to have historically suffered from famine, warfare, natural disaster, and disease [17]. Such disaster-prone regions have learned to save lives by establishing tight rules and order [18, 19]. That is, social threat creates tight culture. Tight culture has two core characteristics: strong social norms and low tolerance for deviant behavior [16]. Previous studies have shown that strict social norms and situational constraints in culturally tight areas reduce subjective well-being and induce anxiety and depression to some degree [18, 20]. However, it has also been found that the rules consciousness established by situational constraints in culturally tight areas is the background for the development of self-confidence and self-esteem [21, 22]. In this environment, tight culture may benefit mental health. In this study, we speculate that strict social norms in cultural tight may be an effective treatment for psychological disorders in the context of a pandemic.

To fight a pandemic, governments in tight areas tend to formulate more stringent social norms and intervention policies to contain the spread of the disease [17]. This tight programming may effectively inhibit the spread of the COVID-19, alleviating potential psychological disorders experienced as part of the risk perception of COVID-19. Further, tight areas can be expected to have a higher degree of situational constraint [17, 23], and individuals in such areas are naturally attuned to and support responses to situational demands in their tight culture system [17]. Thus, chronic individual psychological processes may be mirrored in the tight culture system [18]. First, people in tight areas have greater self-monitoring, reflecting their adaptability to chronic situational restrictions [18]. Thus, people may be able to quickly adapt to restrictions on going out due to the presence of disease, reducing their anxiety or depression due to isolation. In addition, people in areas with tight cultures have greater prevention self-guidance and better self-regulatory strength [18], which enables them to adjust negative affect. This leads people in epidemic contexts less likely to suffer psychological disorders. In short, the increased psychological disorders associated with increased risk perception of COVID-19 may be less pronounced among people in tight cultural areas. This study investigates the protective role that tight culture might play in this context.

Mechanisms underlying the effects of tight culture on psychological disorders

In general, individuals with higher perceived risk feel that they have less ability to cope with the virus [24]. Especially in the early stages of the outbreak, people feel insecure due to the sharp increase in cases of infection and in deaths, along with the scarcity of masks and disinfectant supplies, weakening perceived protection efficacy. Perceived protection efficacy is the belief that individuals and groups can protect themselves from COVID-19 [24]. However, not all people with high risk perception develop low perceived protection efficacy during a crisis event, as many social and psychological factors mutually affect perceived protection efficacy. In addition to the psychological factors, cultural factors, especially cultural tightness, may also have played a protective role in perceived protection efficacy.

First, tight areas developed strict and comprehensive intervention measures during the pandemic, which effectively slowed the spread of the virus and reduced the pace of increase of the number of infections and deaths, increasing the stability and controllability of the situation. This can be expected to have improved people’s confidence in fighting the pandemic and led people to believe that the government has the ability to protect them from COVID-19, perhaps mitigating the reduction in perceived protection efficacy owing to the risk perception of COVID-19. On the other side, in tight cultural areas, tolerance of deviation from norms is low, and severe sanctions are imposed on those who violate them [17, 18]. These social norms drive people to abide more strictly by the rules set by the government, including actively isolating themselves at home, maintaining social distance, and taking the initiative to adopt protective measures. This gives them and others a sense of security and makes people feel that they have the ability to protect themselves, as well as lifting perceived protection efficacy. Accordingly, people living in tight cultural areas can continue to experience higher perceived protection efficacy even in the context of greater risk perception due to COVID-19.

Protection–motivation theory proposes that the perceived threat of a health risk depends on psychological factors, including the ability to cope, and people with high perceived protection efficacy generate less psychological disorders [25]. Thus, we speculate that the inhibitory effects of tight culture in the positive prediction of risk perception on psychological disorders can be achieved by promoting perceived protection efficacy.

The present research

Tightness is a unique cultural factor and is a useful supplement to other cultural dimensions, and has received increasing attention from researchers. Studies of the influence of tight culture on psychological disorders in case of the pandemic outbreak have been constrained. To fill this gap, we build and examine a model that links cultural tightness and risk perception in COVID-19 with psychological disorders. This study explores the moderating effects of cultural tightness and its underlying mechanisms on psychological disorders. Following these corollaries, we proposed the following hypotheses. First, greater risk perception of COVID-19 leads to greater psychological disorders. Second, cultural tightness moderates the relationship between risk perception of COVID-19 and psychological disorders, such that the tighter the culture, the less positive the predictive effects of risk perception of COVID-19 on psychological disorders. Last, perceived protection efficacy mediates the moderating effect of cultural tightness on risk perception of COVID-19 and psychological disorders. In particular, cultural tightness can indirectly relieve people’s psychological disorders by weakening the negative predictive effects of risk perception of COVID-19 on perceived protection efficacy.

Participants and procedures

A survey was conducted in March and April 2020. In this study, participants at two high schools in Inner Mongolia and Liaoning Province and at two universities in Jiangsu and Anhui Province were sampled by cluster sampling. All participants were asked to complete an online questionnaire. Before doing so, all of the participants received an informed consent form that described the anonymity of the data, the voluntary nature of participation, and the participants’ ability to withdraw from the study at any time. A total of 1,827 students participated in this survey and every participant provided online consent form before completing the survey. Of the participants (M_age = 18.16 ± 2.23 years), 46.7% were male (M_age = 18.06 ± 2.26 years); 45.3% were secondary school students, and 54.7% were college students; 49.3% were from a city, 30.4% were from towns, and 20.3% were from villages; 18.6% presented with mild depression, 7.6% presented with moderate depression, 3.3% presented with moderate severe depression, and 2.4% presented with severe depression; 14.6% reported mild anxiety, 4.1% reported moderate anxiety, 1.9% reported moderate severe anxiety, and 1.6% reported severe anxiety. Table 1 displays demographic information of participants.

Table 1

Background characteristics of the participants (N = 1,827)
	Without depressive symptoms (N = 1244)	With depressive symptoms (N = 583)	p value
	n (%)	n (%)	p value
Sex			1.27
Male (N = 853)	592(47.6%)	261(44.8%)
Female (N = 974)	652(52.4%)	322(55.2%)
School type			< 0.05
High school (N = 827)	588(16.91%)	239(41%)
College (N = 1000)	656(83.09%)	344(59%)
Province			< 0.01
Anhui (N = 307)	204(16.4%)	103(17.7%)
Jiangsu (N = 412)	289(23.2%)	123(21.1%)
Liaoning (N = 421)	300(24.1%)	121(20.8%)
Inner Mongolia (N = 381)	271(21.8%)	110(18.9%)
Others (N = 306)	180(14.5%)	126(21.6%)
Location			0.48
City (N = 900)	624(50.2%)	276(47.3%)
Town (N = 556)	375(30.1%)	181(31%)
Village (N = 371)	245(19.7%)	126(21.6%)
Mean Age (SD)	18.159(1.944)	17.695(1.962)	< 0.05
	Without anxiety symptoms (N = 1421)	With anxiety symptoms (N = 406)	p value
	n (%)	n (%)
Sex			0.54
Male (N = 853)	658(46.3%)	195(48%)
Female (N = 974)	763(53.7%)	211(52%)
School type			0.07
High school (N = 827)	659(46.4%)	168(41.4%)
College (N = 1000)	762(53.6%)	238(58.6%)
Province			0.06
Anhui (N = 307)	228(16%)	79(19.5%)
Jiangsu (N = 412)	326(22.9%)	86(21.2%)
Liaoning (N = 421)	331(23.3%)	90(22.2%)
Inner Mongolia (N = 381)	311(21.9%)	70(17.2%)
Others (N = 306)	225(15.8%)	81(20%)
Location			0.18
City (N = 900)	714(50.2%)	186(45.8%)
Town (N = 556)	418(29.4%)	138(34.0%)
Village (N = 371)	289(20.3%)	82(20.2%)
Mean Age (SD)	18.12 (2.21)	18.30 (2.29)	0.16
Note. p value: Chi-square test and Mann-Whitney U test

Measures

Cultural tightness

The tightness–looseness scale was developed by Gelfand [17]. It was used in this study to measure the degree of individuals’ perception of the cultural tightness of the area in which they live using six items. Sample items include, “There are many social norms that people are supposed to abide by in the area where I live,” “There are very clear expectations for how people should act in most situations in the area where I live,” “In the area where I live,people agree upon what behaviors are appropriate versus inappropriate in most situations this country in the area where I live.” Participant responses were given on a 6-point Likert scale, anchored at 1 (strongly disagree) and 6 (strongly agree). A composite score was calculated, with higher numbers indicating that people feel that the culture in the area where they live is tighter (α = 0.81).

Risk perception of COVID-19

We used four items to assess individual risk perception for COVID-19, which were adapted from the Risk Perception of HIV Scale [26]. Two items assessed personal risk perception of COVID-19, namely, “I feel vulnerable to COVID-19 infection”, “I worry about being infected with COVID-19”. Another two items assessed risk perception for the family, namely, “I feel that my family is vulnerable to COVID-19 infection”, “I worry about my family being infected with COVID-19”. All items were rated on 5-point scale, anchored at 1 (never) to 5 (nearly every day). We summed the scores to create a risk perception of COVID-19 composite (α = 0.84), with higher scores reflecting higher risk perception for COVID-19.

Perceived protection efficacy

This study used three items to measure individual-perceived protection efficacy, following based on previous studies [24]. One item was related to personal perceived protection efficacy (e.g., “I feel confident that I can protect myself from COVID-19”), one item was related to perception of the local region’s protection efficacy (e.g., “I feel confident that my local area can protect itself from COVID-19”), one item was related to perception of the country’s protection efficacy (e.g., “I feel confident that my country can protect itself from COVID-19”). Each item was rated on a 5-point Likert scale, ranging from 1 (completely disagree) to 5 (completely agree). The perceived protection efficacy composite was created by summing the scores (α = 0.81), with higher scores indicating higher individual-perceived protection efficacy.

Psychological disorders

Anxiety and depression are commonly used as indicators for both the general population and in individual clinical practice to assess the level of psychological disorder [27, 28]. This study constructs psychological disorders as a latent variable composed of anxiety and depression. Anxiety symptoms were measured by applying the seven-item Generalized Anxiety Disorder Scale (GAD-7) [29]. The participants rated the frequency of anxiety symptoms over the previous 2 weeks on a 4-point Likert scale, with anchors at 1 (not at all) and 4 (nearly every day). The scores ranged between 7 and 28, with higher scores reflecting more serious anxiety symptoms. We set 12 as the cut-off score for screening for anxiety symptoms. In this study, this scale was found to exhibit substantial reliability (α = 0.99). To measure depressive symptoms, we adopted the nine-item Patient Health Questionnaire (PHQ-9) [30]. The participants assessed their frequency of depressive symptoms over the previous 2 weeks on a 4-point Likert scale, with anchors at 1 (not at all) and 4 (nearly every day). Composite depression scores were created (α = 0.92), with higher scores reflecting more serious depressive symptoms. We set 14 as the cut-off score for screening for depressive symptoms.

Data Analyses

The data analysis procedure was performed as follows: initially, Spearman correlation analyses were conducted using SPSS 24.0. We utilized Mplus 7.4 to conduct the formal statistical analyses. First, we built a latent moderated structural equations (LMS) model to test the moderating effects of cultural tightness on risk perception and psychological disorders. Second, to indicate the ways in which cultural tightness exerts the moderating effect, we set up a latent mediated-moderation structural model to determine whether perceived protection efficacy mediates the moderating effects of cultural tightness between risk perception and psychological disorders.

The overall fitness of the LMS model was assessed using a two-step method [31, 32]. First, we developed a structural model without the latent interaction, Model 0 (the null model, where latent interaction is not estimated). We utilized the χ²/df, the comparative fit index (CFI), Tucker–Lewis index (TLI), the root mean square error of approximation (RMSEA), and the standardized root mean residual (SRMR) to assess the fitness of this model. The acceptable criteria for the model were set as follows: CFI > 0.90, TLI > 0.90, RMSEA < 0.08, and SRMR < 0.08 [33]. Second, based on the good fit of Model 0, we built a structural model that included latent interaction, Model 1 (alternative model, latent interaction is estimated). The log-likelihood ratio test was used to compare the relative fit between Model 0 and Model 1 [34]. If the log-likelihood ratio test produces a significant value, this means that Model 0 represents a significant loss in fit relative to Model 1, meaning that Model 1 better fits the data [32].

Correlations between main variables

The associations among psychological disorders (anxiety, depression) and risk perceptions of COVID-19 were positive (r = 0.27 to 0.28) and with cultural tightness and perceived protection efficacy were negative (r = − 0.05 to − 0.24) (see Table 2).

Table 2

Spearman’s correlations among the main variables
	1	2		4	5	6	7	8	9
1 Sex	1
2 Age	0.04	1
3 Education	0.05*	0.89**	1
4 Province	0.06*	0.07*	0.04	1
5 Location	-0.04	0.17**	0.21**	-0.16**	1
6 Cultural tightness	-0.09**	-0.07**	-0.07*	-0.07**	-0.06*	1
7 Risk perception of COVID-19	0.07**	0.01	0.01	0.12**	-0.00	-0.03	1
8 Perceived protection efficacy	-0.04	-0.01	-0.02	-0.10**	-0.02	0.25**	-0.25**	1
9 Anxiety	0.01	0.04	0.03	0.06*	0.06*	-0.05*	0.27**	-0.20**	1
10 Depression	0.05*	0.08*	0.09**	0.07**	0.05*	-0.09**	0.28**	-0.24**	0.73**
Note. Sex was coded as 1 = male, 2 = female; school type was coded as 1 = high school, 2 = college; Province was coded as 1 = Anhui, 2 = Jiangsu, 3 = Liaoning, 4 = Inner Mongolia, 5 = others; location was coded as 1 = city, 2 = town, 3 = village. *p < .05, **p < .01.

Latent Moderating Effect Analyses

We investigated the moderating effects of cultural tightness on risk perception of COVID-19 and psychological disorders (see Fig. 1). First, we built Model 0 with latent variables cultural tightness and risk perception of COVID-19 as predictors, and the latent psychological disorders variable was set as the outcome. Sex, school type, province, education and age were controlled as covariates. The results showed that Model 0 had good fit (χ2/df = 3.74, CFI = 0.97, TLI = 0.96, RMSEA = 0.04 (0.03 − 0.04), SRMR = 0.03). Second, using Model 0, we added the latent interaction of cultural tightness and risk perception of COVID-19 to build Model 1. In Model 1, the latent variable cultural tightness, the latent variable risk perception of COVID-19, and the interaction of cultural tightness and risk perception of COVID-19 were predictors, and the latent variable of psychological disorders was the outcome. Third, we run the log-likelihood ratio test and found that it was significant (D = 37.79, df = 1, p < .001), so we concluded that Model 1 with the latent interaction was well-fitted. The change in R-squared (ΔR²) between Model 0 and Model 1 was 0.03.

In Model 1, greater risk perception of COVID-19 (β = 0.30, p < .001) and lower cultural tightness (β = −0.11, p < .001) predicted greater psychological disorders. Moreover, the interaction effect between risk perception of COVID-19 and cultural tightness (β = −0.15, p < .001) was a significant predictor for psychological disorders. Specifically, for low levels of cultural tightness (1 SD below average), greater risk perception of COVID-19 predicted greater psychological disorders (β = 0.31, p < .001). However, at high levels of cultural tightness (1 SD above average), the relationship between risk perception of COVID-19 and psychological disorders were less positive (β = 0.18, p < .001) (see Fig. 2).

Latent Mediated-moderating Effect Analyses

After evaluating the moderating effects of cultural tightness, we investigated whether the moderating effect of cultural tightness on risk perception of COVID-19 and psychological disorders was mediated by perceived protection efficacy. First, we ran Model 0 with the latent variable cultural tightness as a moderator, the latent variable risk perception of COVID-19 as an independent variable, the latent variable perceived protection efficacy as mediator, and the latent variable psychological disorders as the outcome. Sex, school type, province, education and age were controlled as covariates. The results showed that Model 0 is a good fit (χ2/df = 3.36, CFI = 0.97, TLI = 0.96, RMSEA = 0.04 (0.03 − 0.04), SRMR = 0.03). Second, as the basis for Model 0, we added the interaction between cultural tightness and risk perception of COVID-19 as predictors to build Model 1 (see Fig. 3). Third, we conducted a log-likelihood ratio test, and the results showed that Model 1 with an interaction term fit the data better than Model 0 (D = 42.89, df = 1, p < .001). The change in R-squared (ΔR²) between Model 0 and Model 1 was 0.04.

In Model 1, greater risk perception of COVID-19 (β = −0.22, p < .001) and lower cultural tightness (β = 0.31, p < .001) predicted lower perceived protection efficacy, and the interactions between risk perception of COVID-19 and cultural tightness predicted perceived protection efficacy (β = 0.08, p < .01) (see Table 3). Specifically, at low levels of cultural tightness (1 SD below the average), greater risk perception of COVID-19 predicted lower perceived protection efficacy (β = −0.28, p < .001). However, at high levels of cultural tightness (1 SD above the mean), the relationship between risk perception of COVID-19 and perceived protection efficacy became less negative (β = −0.15, p < .01) (see Fig. 4). Moreover, the lower perceptions of protection efficacy predicted greater psychological disorders (β = −0.14, p < .001). Thus, the moderating effect of cultural tightness on risk perception of COVID-19 and psychological disorders was mediated by perceived protection efficacy. In addition, the interactions between risk perception of COVID-19 and cultural tightness also directly and significantly predicted psychological disorders after perceived protection efficacy was added (β = −0.14, p < .001). Thus, the moderating effects of cultural tightness on risk perception of COVID-19 and psychological disorders were partially mediated by perceived protection efficacy.

Table 3

Fitness indices and standardized regression coefficients for the latent moderated structural equations model and latent mediated-moderation structural equations model
	Latent moderated structural equations model		Latent mediated-moderation structural equations model
	Model 0	Model 1	Model 0	Model 1
Model fitness indices
χ²	396.29		517.57
df	106		154
Log (L)	-26838.01	-26819.12	-33436.52	-33415.08
CFI	0.97		0.97
TLI	0.96		0.96
RMSEA	0.04		0.04
SRMR	0.03		0.03
Standardized regression coefficients
Risk perception → psychological disorders	0.29***	0.30***	0.26***	0.27***
Cultural tightness → psychological disorders	-0.10**	− 0.11***	-0.06	-0.07*
Risk perception × cultural tightness→ psychological disorders		− 0.15***		-0.14***
Tight culture → perceived protection efficacy			0.30***	0.31***
Risk perception × cultural tightness → perceived protection efficacy				0.08***
perceived protection efficacy→ psychological distress			-0.22***	-0.14***
Sex → psychological disorders	0.01	0.01	0.01	0.01
Age → psychological disorders	0.05	0.06	0.03	0.04
School type→ psychological disorders	-0.01	-0.02	0.01	0.00
Province → psychological disorders	0.01	0.01	0.00	0.00
Location → psychological disorders	0.02	0.02	0.01	0.02
ΔR²	0.03		0.04
Note. *p < .05, **p < .01, ***p < .001.

This study examined the effects of risk perception of COVID-19 on psychological disorders and found that increased psychological disorders was produced by higher risk perception of COVID-19. These results supported the findings of previous studies [35]. The negative impact caused by the amplification of risk perception of COVID-19 exceeded the direct impact of COVID-19 itself [36]. Therefore, even for people who do not suffer from COVID-19, the high risk perception caused by COVID-19 due to its high communicability also fueled psychological disorders.

Second, we explored the moderating role of cultural tightness between risk perception of COVID-19 and psychological disorders and found that cultural tightness moderates the positive predictive effect of risk perception of COVID-19 on psychological disorders. When people perceive their region to have a relatively tight culture, the increased psychological disorders triggered by risk perception of COVID-19 is reduced. Individuals in culturally tight areas who are chronically exposed to stronger situations have subjective experiences that indicate that their behavioral options are limited, their actions are subject to evaluation, and there are potential punishments that result from these evaluations [18]. Thus, self-regulatory strength is greater in culturally tight areas, which can prompt to inappropriate behavior to a certain extent [18], such as not believing rumors, reducing hoarding behavior, and paying less attention to negative news of the pandemic, leading to reduced psychological pressure or negative affect. Accordingly, psychological disorders could also be relieved.

Third, we investigated in depth the underlying mechanism of cultural tightness on psychological disorders. The hypothesized moderating role of cultural tightness was indirectly located through the mediating role of perceived protection efficacy. Specifically, the risk perception of COVID-19 was associated with decreased perceived protection efficacy, but this association was weaker among those who perceived that their region had relatively more cultural tightness. In addition, perceived protection efficacy significantly lessened individual psychological disorders. To our knowledge, tight areas put high value on COVID-19 response and formulated strict social isolation policies to combat it, such as forbidding gatherings and going out at will, requiring everyone to wear a mask wherever they go, deploying security checks and infrared thermometers, performing accurate positioning and tracking for people who need to leave their place of residence, and so on. In fact, within two months of the outbreak of COVID-19, outbreak response planning in some regions of China were able to effectively control the spread of the epidemic to a great degree [8, 37]. This greatly promoted perceived protection efficacy, which formed a buffer against the fear of COVID-19, and effectively prevented anxiety and depression.

Although this study found that, in China, tightening in the face of COVID-19 could alleviate psychological disorders, we do not encourage other countries to shift from looseness to tightness to alleviate psychological disorders in these circumstances. First, tight culture is a product of distal ecological and historical threat, including high population density, resource shortages, territorial conflicts, epidemics, and a harsh environment [17, 18]. We know that China is a culturally tight nation [38], therefore Chinese were able to quickly identify and accept the tight programming during the pandemic. However, countries that have experienced less ecological and historical threat tend to retain a loose culture, such as those of the United States and New Zealand [18]. Loose culture has existed in these countries for several hundred years, and people’s understanding, emotions, and behavior have developed under those circumstances. If a culture blindly shifts from looseness to tightness due to the pandemic, the psychological disorders created by the necessary cultural adaptation may be greater than that caused by the pandemic itself. Second, not all people in culturally tight countries will have reduced psychological disorders. We know that in addition to its tight culture, China also has a collectivist culture [39]. The tight culture of Chinese originated from this collectivism [22]. Thus, it may be the combined effects of tight and collectivist culture that produced psychological protection from the threat of COVID-19. Countries that are partial to individualism might not be able to use tightness as a buffer.

Implications

Our study provided a certain degree of theoretical enlightenment. First, it linked socio-cultural aspects to public mental health, such as the potential impact of culture on mental health in relation to the natural opportunities of the epidemic situation. This is a new attempt to understand people’s mental health in relation to socio-cultural psychology, providing a new perspective for understand the influencing factors of psychological disorders. Second, this study considered mental health from the perspective of cultural tightness, an important cultural dimension that has received increasing attention from researchers recently. Our study deepened the understanding of the concept of cultural tightness and broadened its theoretical framework. Third, earlier studies have shown that collectivism can protect against epidemic threat [24], and our study broadened the investigation of the cultural role from another dimension of culture, namely, cultural tightness, which deepened our understanding of the various dimensions of cultural roles. Last, previous work, showed no consistent conclusions regarding the influence of cultural tightness on mental health. This study found that tight culture can inhibit the increase of psychological disorder caused by risk perception that is conducive to mental health during an epidemic. We clarified the effects of cultural tightness on mental health under specific circumstances.

Our study also provided practical guidance for the mitigation of psychological disorders under the conditions of an epidemic. On the one hand, this study found that it a high risk perception of the virus led to psychological disorders. We provided empirical evidence for this psychological intervention to buffer against psychological problems by lessening the perception of risk during the pandemic outbreak, such as reducing attention to negative news, making rational judgments about this news, maintaining a regular schedule, and cultivating hobbies to divert inattention. On the other hand, pandemics such as SARS and H1N1 have been occurring frequently in recent years, and we found that cultural tightness had an inhibitory effect on psychological disorders in a Chinese sample during a pandemic. The present study can be a practical reference for measures to take for future new public health threats, and it also provided a reference for psychological intervention and health polies in the context of Chinese culture. This study suggests that during a disease outbreak, tight measures such as self-isolation and social distancing, maybe an efficient effort to debate with COVID-19 in China.

Some limitations of this study should be noted. First, the object of the study only included the student group, and future research should be developed to add samples from other groups to verify the universality of our research. Second, this study found that, after the perceived protection efficacy was added, the moderating effects of cultural tightness on risk perception of COVID-19 and psychological disorders persisted. This suggests that the protective efficacy only partially mediated the moderating effects of cultural tightness, such that still other factors mediated the moderating effect, such as hope, time perspectives and sense of control. Future research should explore this potential mechanism to better improve the understanding the impact of cultural tightness on mental health. Third, cultural tightness is not only an individual-level cultural orientation but a regional-level dimension as well. Because most samples in this study were drawn from only four provinces in China, we analyzed cultural tightness only on an individual level. Future research should take into account all of the provinces of China and verify the model from a group perspective. Fourth, this study was carried in a Chinese context, and its results are only applicable to China. Therefore, caution is necessary when the findings are generalized to other cultural backgrounds. Future research should test the generalization of our models in other cultural contexts.

This study explored the socio-cultural determinants of mental health in the pandemic by elucidating how cultural tightness affected psychological response and public mental health when facing the risk of COVID-19. It broadens the theoretical study of tight culture on mental health by expanding it to novel areas of socio-cultural psychology, and it also provides practical direction for psychological prevention during the COVID-19 pandemic. In the context of Chinese culture, a tighter cultural context and isolation policies may relieve public psychological disorders during the pandemic. It may be that a dose of protection efficacy can act as an antidote to public fear, anxiety, and depression in this type of situation.

Ethics approval and consent to participate

This study was conducted in compliance with the APA ethical standards and the Declaration of Helsinki and its later amendments in the treatment of human participants. All participants were informed of the purpose and procedure of the study prior to the survey. All participants completed the online informed consent before completing the survey. The Research Ethics Review Committee of Beijing Normal University approved this investigation (No. 202004270039).

Consent for publication

Not applicable.

Availability of data and materials

The datasets used and analysed during the current study are available from the corresponding author on reasonable request.

Competing interests

The authors declare that they have no competing interests.

Funding

This work was funded by the Fighting COVID-19 Research Fund, supported by Central University of Finance and Economics awarded to Yi Feng.

Authors’ contributions

ZQ, YF and DD designed the research framework. DD, ZC and PZ conducted the study. MZ and WG conducted the literature review. DD analyzed the data and drafted the manuscript. YF revised the manuscript. All authors read and approved the final manuscript.

Acknowledgements

We thanked all the students who participated in this study.

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What Protects Us Against the COVID-19 Threat? Cultural Tightness Matters

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Abstract

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Background

Methods

Participants and procedures

Measures

Cultural tightness

Risk perception of COVID-19

Perceived protection efficacy

Psychological disorders

Data Analyses

Results

Correlations between main variables

Latent Moderating Effect Analyses

Latent Mediated-moderating Effect Analyses

Discussion

Implications

Limitations And Future Directions

Conclusions

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References

Status:

Journal Publication

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