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HEALTH SCIENCES • An. Acad. Bras. Ciênc. 97 (2) • 2025 • https://doi.org/10.1590/0001-3765202520231050 linkcopy

Open-access Frequency and method of seeking for information about COVID-19 and its relationship with psychological symptoms and stress levels

AuthorshipSCIMAGO INSTITUTIONS RANKINGS

Abstract

Elevated search for information could increase rumors and misinformation, which significantly impacted the daily lives and mental health of individuals. We tested the association between the frequency and methods of communication used and psychological symptoms. Cross-sectional study that included individuals with COVID-19 and individuals without the disease. Participants completed a questionnaire about the frequency with which were informed about COVID-19. The severity of depressive and anxious symptoms, and stress levels were assessed. The sample included 350 individuals (66% female, mean age 38.09 ± 14.18 years), and 32.6% had a confirmed COVID-19 diagnosis. Most of the sample was informed about COVID-19 almost always or always and the most common method used to search for information was the internet, followed by open TV, social media, WhatsApp, cable TV, radio, and newspaper. Individuals who sought information on social media had greater severity of depressive symptoms when compared to subjects who did not seek information on the media. Individuals who sought information via WhatsApp had lower anxiety symptoms and stress levels when compared to individuals who did not seek information via WhatsApp. The search for information had a negative impact on depressive symptoms and a decrease in anxiety symptoms.

Key words
anxiety; COVID-19; depression; information; pandemic; stress

INTRODUCTION

The COVID-19 pandemic emerged in late 2019 in Wuhan, Hubei province, and lasted until May 2023, leaving lasting effects still present. In March 2020, the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was declared by the World Health Organization (WHO) as a pandemic (World Health Organization 2020). SARS-CoV-2 belongs to the Coronaviridae family and the Betacoronavirus genus (Liu et al. 2020) and is described as an enveloped icosahedral symmetric particle, containing a single-stranded, non-segmented, positive-sense RNA genome (Gao et al. 2020). The respiratory system is the mainly affected by COVID-19. Symptoms observed initially involved lower respiratory tract infection, fever, dry cough, and dyspnea. Later, headache, dizziness, generalized weakness, vomiting, and diarrhea were also observed (Yuki et al. 2020).

Due to the efficient transmission of the SARS-CoV-2, several countries had instituted temporary travel restrictions and total isolation, intending to delay the spread of the COVID-19 within China and throughout the rest of the world (Fauci et al. 2020). With the establishment of the lockdown, an urgent need was seen by society to seek information regarding COVID-19 in order to understand the disease better, its main symptoms, and medications, as well as understand how the virus acted, and it was transmitted (Ferentz et al. 2020). In search for this information, a term stood out, the infodemic, which would be a significant increase in the amount of information associated with a specific subject, which can multiply exponentially quickly due to a specific event (Pan American Health Organization 2020).

In the information age, social networks and new digital platforms amplify the dissemination of content, which spreads rapidly, like a virus. During the COVID-19 pandemic, there was a significant increase in the search for information. However, alongside useful data, rumors and misinformation emerged, creating an information overload (Cinelli et al. 2020). This overload can increase levels of anxiety and stress in individuals (Zarocostas 2020). It is assumed that new communication channels, such as social media and instant messaging apps (e.g., WhatsApp), disseminate information more quickly than traditional media, which may have a greater emotional impact due to the speed and volume of these transmissions (Garcia & Duarte 2020, Allington et al. 2021).

The infodemic refers to the amount of information about a given subject, and due to this factor, the spread of false news and rumors becomes much more significant, and it can generate insecurity and uncertainty in the population (Zarocostas 2020). Therefore, this exponential increase in misinformation can significantly impact the day-to-day life of society on a large scale, harming public health (Zattar 2020) and reflecting on the mental health of individuals. This exacerbated concern can end up generating high levels of stress in individuals, which consequently threaten the mental health of the population, raising the rates of anxiety, depression, post-traumatic stress disorder (PTSD), and negative social behaviors that can affect daily life in several aspects (Cosic et al. 2020, Salari et al. 2020).

The pandemic and the consequent need for restrictive measures such as social isolation have significantly impacted the mental health of the world’s population, leading to long-lasting pathological emotional responses that can result in highly disabling mental disorders (Brooks et al. 2020, Pfefferbaum & North 2020). Therefore, the present study aimed to describe the frequency of information searches about COVID-19 and the means of communication used to search for information, in addition to testing the association between the frequency and the communication methods used with the severity of depressive symptoms, anxiety, and stress levels (Gao et al. 2020, Vahia et al. 2020).

Considering these factors, frequent exposure to information about COVID-19, particularly via social media and digital platforms, seems to be associated with elevated levels of depressive symptoms, anxiety, and stress. However, the medium through which this information is consumed may also play a distinct role in shaping these mental health outcomes.

MATERIALS AND METHODS

Ethical aspects

The ethics committee boards at Universidade do Extremo Sul Catarinense (UNESC) and Universidade Federal da Fronteira Sul (UFFS) approved the study under protocol numbers 4.172.382 and 4.298.662, respectively.

Study design

This cross-sectional study is aligned with an extensive study entitled: “Investigation of neuroinflammatory markers and neuronal damage and their relationships with neuropsychiatric disorders in COVID-19 positive individuals”.

Recruitment

Recruitment of participants took place between September 2020 and July 2021 in two locations: (1) University of the Extreme South of Santa Catarina (UNESC) and (2) Federal University of the Southern Frontier (UFFS).

Participants

The sample was selected for convenience. Individuals with COVID-19 (cases) were previously identified through the registration carried out by the health departments of the two cities (Chapecó and Criciúma) and referred to the study. Afterward, the research group contacted the subjects to assess their eligibility for inclusion in the study. The inclusion criteria for the group of individuals with COVID-19 were: (1) being over 18 years of age, (2) having the diagnosis of COVID-19 confirmed between four and six weeks before inclusion in the study, (3) residing in the south of Brazil. Exclusion criteria were: (1) having a diagnosis of bipolar disorder by (because the main aim of the more extensive study is to assess whether COVID-19 is a risk factor for Major Depressive Disorder) and (2) having any physical or cognitive condition that prevented participation in the study (for example, individuals who could not understand the instruments). Twenty participants were excluded due to a diagnosis of bipolar disorder, and one participant was excluded for having a physical or cognitive condition that hindered their participation.

Controls (individuals without COVID-19) were recruited about the included cases. This strategy was used so that the controls were as similar as possible to the cases regarding sociodemographic characteristics. The inclusion of a negative COVID-19 test result for the controls ensured that they had not been infected by the virus at the time of inclusion, establishing a clear distinction between cases and controls. Inclusion criteria for controls were: (1) being over 18 years of age, (2) presenting a negative result in the rapid test for COVID-19 at the time of inclusion in the study, and (3) residing in the south of Brazil. Exclusion criteria were the same as for the case group.

Instruments

Participants completed a demographic questionnaire including the following questions: gender, age, race, years of education, marital status, and current occupation.

The frequency with which individuals were informed about COVID-19 was assessed through the following question: “How often do you find out about the COVID-19 pandemic (search for news and information about it)?” which had the following questions: response options: “Never,” “rarely,” “almost always/often,” “always”. The response options were grouped as follows: “never/rarely” and “almost always/always” to facilitate the interpretation of data in this study.

The method used by individuals to seek information was questioned dichotomously (yes/no) for each of these methods: (1) radio, (2) open TV, (3) cable TV, (4) newspaper, (5) internet (for example news sites, youtube, etc.), (6) social media (Facebook, Instagram, Twitter), and (7) WhatsApp.

The severity of depressive symptoms was assessed using the Hamilton Depression Scale (HAM-D) (Hamilton 1967). The instrument consists of 17 questions that assess the severity of depressive symptoms. The total sum of the items indicates the severity of symptoms, where higher scores refer to greater severity. The minimum possible score is 0 and the maximum possible score is 52. For this study, the alfa de Cronbach for the HAM-D ranged from 0.66 to 0.78, reflecting moderate internal consistency. The scale’s sensitivity was 90% and specificity was 91%, based on a cut-off score of 9 points to detect depression (Freire et al. 2014). The severity of anxiety symptoms was assessed using the Hamilton Anxiety Scale (HAM-A). The instrument consists of 14 items assessing the severity of anxiety symptoms. Again, the sum of all items indicates the severity of symptoms, where higher scores refer to greater severity of symptoms (Hamilton 1959) The minimum possible score is 0 and the maximum possible score is 56.

Stress levels were assessed using the stress symptoms inventory. The inventory consists of an adaptation of items obtained from Checklist-90-R (Derogatis 1975). Checklist-90-R consists of 90 items, of which 24 were chosen for the stress inventory, with scores ranging from zero to five points for each item. Items that express stress symptoms were chosen, comparing them with stress items from the Stress Symptoms Inventory (Lipp & de Hoyos Guevara 1994). The identified items are related to symptoms of anxiety, depression, hostilities, and somatization but are not attributed only to a psychiatric disorder. The SCL-90-R was chosen because it is practical, easy to administer, and used for psychological assessment in individuals with different pathologies and assessed in general practice (Henna & Levit Zilberman 2016). The alfa de Cronbach for the SCL-90-R ranged from 0.73 to 0.88, demonstrating good reliability. However, no specific sensitivity or specificity values were reported for the SCL-90-R in the Brazilian validation study (Lanoli 2001). The minimum possible score for the stress inventory is 0 and the maximum possible score is 120. Higher scores indicate higher levels of stress. Trained psychologists administered the interview.

Statistical analysis

Statistical analysis was performed using SPSS 21. In the univariate analysis, sample characteristics were described by absolute and relative frequencies for categorical variables and by median and interquartile range (IQR) for continuous variables. For the bivariate analysis, the normality of the HAM-D, HAM-A scores, and stress levels was tested using the Shapiro-Wilk test, which indicated a non-normal distribution (p < 0.001). Therefore, comparisons between the groups were tested using the non-parametric Mann-Whitney U test, and the scores were presented as medians and interquartile ranges.

RESULTS

Sample characteristics

The total sample consisted of 350 individuals. The majority were female (66.0%), white (82.3%), and single (41.4%), with a median age of 36.00 years (IQR: 26.00 – 49.00) and a median of 15.00 years of education (IQR: 12.00 – 18.00). In the control group (n=199) and case group (n=96), the distribution of sex and education was similar. Females represented 63.8% of the control group and 67.7% of the case group. The median years of education were also close, with the control group having a median of 16.00 years (IQR: 13.00 – 18.00) and the case group 16.00 years (IQR: 12.00 – 20.00). However, a significant difference was observed in marital status (p=0.027), with more individuals in the case group being married or in a stable union. No significant differences were found in terms of age, race, or current occupation between the groups (Table I).

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Table I
Sociodemographic characteristics.

Frequency of information about COVID-19

Table II shows that the majority of the sample (70.7%) reported seeking information about COVID-19 almost always or always, with similar percentages observed in the control group (70.5%) and the case group (71.1%). A smaller proportion of participants reported rarely or never seeking information about COVID-19, accounting for 29.3% of the total sample, 29.5% in the control group, and 28.9% in the case group.

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Table II
Frequency media used for searching information about COVID-19.

Method of information about COVID-19

Table III presents the type of media used for searching information about COVID-19. The most frequently used media was the internet, with 67.1% of the total sample reporting its use, followed by open TV (47.4%) and social media (33.1%). The distribution was similar between controls and cases, with the internet being the most common source in both groups (66.4% of controls and 68.5% of cases). A smaller proportion of participants used newspapers (6.8% of the total sample) and cable TV (13.5%), with little variation between the groups. WhatsApp was used by 20.6% of the total sample, slightly more common among cases (24.3%) compared to controls (18.8%).

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Table III
Type of media used for searching information about COVID-19.

Comparison between the frequency of information about COVID-19 and the severity of depressive and anxiety symptoms and stress levels

Table IV shows that there was no difference between the subjects who sought information about COVID-19 never/rarely and those who sought information almost always/always concerning the severity of depressive symptoms (p=0.638), anxiety (0.368), and stress levels (p=0.331).

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Table IV
Association between the frequency of information about COVID-19 and the severity of depressive and anxiety symptoms and stress levels.

Comparison between the information method and the severity of depressive symptoms

Figure 2 shows that individuals who sought information via WhatsApp had lower anxiety symptoms (median: 4.00 [IQR: 1.00 – 10.00]) when compared to individuals who did not seek information via WhatsApp (median: 6.00 [IQR: 2.25 – 13.00], p= 0.015). There was no difference in the severity of anxiety symptoms between those who sought information on the radio (p=0.209), open TV (p=0.222), newspaper (p=0.187), cable TV (p=0.255), internet (p=0.942), and social media (p=0.066) compared to those who did not seek the respective source of information.

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Figure 2
Association between severity of anxiety symptoms and search for information about COVID-19 on WhatsApp. HAM-A: Hamilton Anxiety Scale.

Comparison between the information method and the severity of anxiety symptoms

Figure 1 shows that individuals who sought information on social media had greater severity of depressive symptoms (median: 5.00 [Interquartile Range (IQR): 2.00 – 10.00]) when compared to subjects who did not seek information on social media (median: 4.00 [IQR: 1.00 – 7.00], p=0.022). There was no difference in the severity of depressive symptoms between those who sought information on the radio (p=0.435), open TV (p=0.448), newspaper (p=0.476), cable TV (p=0.270), internet (p=0.633), and WhatsApp (p=0.198) compared to those who did not seek the respective source of information.

Figure 1
Association between the severity of depressive symptoms and seeking information about COVID-19 on social media. HAM-D: Hamilton Scale for Depression.

Comparison between the information method and stress levels

Figure a shows that individuals who sought information on cable TV had lower levels of stress (median: 10.00 [IQR: 6.50 – 26.00]) than individuals who did not seek information on cable TV (median: 19.50 [IQI: 10.00 – 30.00], p=0.038). Figure 3b shows that individuals who sought information via WhatsApp had lower levels of stress (median: 12.00 [IQR: 6.00 – 24.75]) than individuals who did not seek information via WhatsApp (median: 20.00 [IIQ: 10.00 – 31.00] p=0.003). There was no difference in terms of stress levels between those seeking information on the radio (p=0.734), open TV (p=0.804), newspaper (p=0.682), internet (p=0.348), and social media (p=0.200) compared to those who did not seek the respective source of information.

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Figure 3
Association between stress levels and seeking information about COVID-19 on a) cable TV and b) WhatsApp.

DISCUSSION

The COVID-19 pandemic had alarming implications for individual and collective health, leading to emotional and social impairment of the general population (de Azevedo Cardoso et al. 2023). The analyses carried out in the present study demonstrated an association between the search for information about COVID-19 and its relationship with severity of depressive/anxiety symptoms and stress levels. Disinformation fueled by rumors about COVID-19 can have potentially severe implications for public health, affecting the psychosocial issues of the population (Islam et al. 2020).

According to Table ll, 70.7% of the participants were informed about COVID-19 almost always or always. With the ease of obtaining electronic devices and the fast internet connection, the population has greater access to information in real-time and anywhere in the world. However, information spreads much faster on social media and unfiltered private networks like WhatsApp, Facebook, and Twitter. The information about the disease is often taken from preliminary analyzes and, therefore, is often erroneous and speculative. Thus, disseminating false information can lead to confusion, panic attacks, and anxiety (Patel et al. 2020).

Accessing information has always been challenging, and this can be used positively, leading to an easier spread of helpful information. Nevertheless, it also works in opposite ways. Based on Table lll it was possible to analyze that the most common method used to search for information was the internet (67.1%), which points to significant risk, considering that previous studies show that, through the social media, people share falsehoods much more than evidence-based information (Lewandowsky et al. 2012, Lazer et al. 2018). Then, open TV (47.4%), social media (33.1%), and WhatsApp (20.6%) appear, all of which have a high impact on viewing and disseminating information. Since the beginning of the pandemic, these media attempted to raise awareness and decrease anxiety among the public through live coverage of press conferences and town halls, in addition to presenting health guidelines and government instructions on websites, newspapers, magazines, and on social media platforms (Mheidly & Fares 2020).

Based on Table lV, it is possible to analyze that there was no difference between individuals who never/rarely sought information about COVID-19 and those who almost always/always sought information concerning the severity of depressive symptoms. Though, when relating the method of search for information and the severity of depressive symptoms, it was seen that subjects who used social media had worsening depressive symptoms when compared to subjects who used other search methods. Since the establishment of the lockdown, fake news, misinformation, and conspiracy theories about COVID-19 have become prevalent in social media (The Lancet Infectious Diseases 2020), generating anxiety and anguish, which, according to the WHO, are natural psychological responses to the condition that changes randomly (Kluge 2020). Misinformation, the increase in the number of new cases/deaths, and the widespread media attention have generated an increase in the fear, frustration, and anguish of the population in the face of that situation, resulting in a series of symptoms characteristic of mental disorders such as anxiety, phobia, panic, depressive behavior, obsession, irritability, delusions of having symptoms similar to COVID-19 and other paranoid ideas (Dubey et al. 2020). Social media has a significant role in disseminating urgent information during times of collective trauma events. However, several studies have suggested that media exposure in disasters can generate negative results concerning mental health (Zhao & Zhou 2020). One study reported that exposure to television with news related to the Iraq War and the 9/11 attack was prospectively associated with an increase in post-traumatic stress (PTS) symptoms (Silver et al. 2013). The use of social media can influence users’ cognitive, emotional, and behavioral outcomes, and that excessive exposure to social media in the face of that public health crisis may have led to an increase in acute stress and long-term psychological distress (Valkenburg & Peter 2013, Garfin et al. 2020). In addition to the significant challenges for health systems around the world, the increase in countless rumors, gossip, and misinformation resulted in damage to the mental health of the population (Tasnim et al. 2020), pointing out that the complexity of social media has the capacity to amplify the negative psychological consequences of exposure to disasters (Zhao & Zhou 2020). Social media generate a vast public space where users can communicate unfiltered information, giving rise to rumors, unlike traditional media (open or cable TV, newspaper, radio), in which information is strictly regulated to ensure credibility (Jones et al. 2017). This justifies the results of the present study, where there was no difference in the severity of depressive symptoms between those who sought information on the radio, open or cable TV, and newspapers (Figure 2) and a decrease in stress levels among individuals who sought information on the cable TV (Figure 5a).

The complexity of different methods for seeking information and their influences on the population’s emotional responses is reflected in the findings of this study. While the initial expectation was that frequent exposure to COVID-19 information, particularly through social media, would increase depressive symptoms, anxiety, and stress, the results revealed a more complex relationship. Social media use was associated with more severe depressive symptoms (Zarocostas 2020, Gao et al. 2020), but not with anxiety or stress. In contrast, seeking information via WhatsApp was linked to lower levels of anxiety and stress, while cable TV was associated with lower stress levels but not anxiety or depressive symptoms.

The differences observed between platforms may reflect the distinct ways in which information is consumed and processed. Social media, characterized by fast-paced and often unverified content, can contribute to information overload, heightening depressive symptoms as users are exposed to alarming or conflicting messages (Cinelli et al. 2020). Studies have shown that constant exposure to negative content on social media can increase emotional fatigue, which might explain the rise in depressive symptoms (Allington et al. 2021). However, the absence of significant effects on anxiety and stress could suggest that users have developed coping mechanisms to filter or ignore such content, though further research is needed to clarify this.

On the other hand, cable TV was associated with lower stress levels, likely due to the more structured nature of its content, which is typically filtered and curated by professionals before being broadcast. Traditional media, such as cable TV, tends to provide information in a more organized and coherent format, which may reduce feelings of overwhelm or uncertainty (Nabi et al. 2010). This could explain why individuals who relied on cable TV for information during the pandemic experienced less stress compared to those using other media.

WhatsApp, frequently used for communication with close social networks like family and friends, may also have contributed to lower anxiety and stress levels. Information exchanged within these trusted circles often comes with emotional support, which can buffer the psychological impact of stressful information (Pierce et al. 2020). While WhatsApp has been criticized for facilitating the spread of misinformation (Brennen et al. 2020), the supportive nature of interpersonal communication might explain the mental health benefits observed in this study.

These findings suggest that different communication methods influence mental health outcomes in distinct ways. While social media can exacerbate depressive symptoms due to the overwhelming and often conflicting information, cable TV and WhatsApp seem to play a more stabilizing role, reducing stress and anxiety through structured or socially supported information. Understanding these differences is essential for developing strategies to mitigate the negative mental health impacts of information consumption during public health crises (Zhao & Zhou 2020, Allington et al. 2021), as discussed earlier (Figures 3a, b).

In recent years, WhatsApp has been the most used instant messaging application in virtual communication between people worldwide. It has been helping families to check each other’s well-being (Nouwens et al. 2017). In addition, the use of this application was seen to promote and maintain social interactions during social isolation associated with COVID-19 measures, in addition to serving as a means of searching for information. The results of the present study point to a decrease in stress levels and severity of anxiety symptoms among individuals who sought information via WhatsApp (Figure 3b). The literature points to few results justifying the relationship between stress levels and its connection with instant messaging applications. However, it is known that online social and psychological support strategies through these platforms can mitigate stress, contributing to the improvement of this symptoms (O’Hara et al. 2014).

CONCLUSIONS

The search for information about COVID-19 had a notable impact on psychosocial well-being, with different platforms influencing mental health outcomes in distinct ways. While social media use was linked to increased depressive symptoms, other channels like cable TV and WhatsApp were associated with lower levels of stress and anxiety. These findings suggest that the method of information consumption plays a crucial role in shaping emotional responses during the pandemic. Further research is needed to explore how different communication platforms and the nature of the information shared can affect mental health, particularly in the context of global crises, to guide strategies for mitigating the psychological impacts of future public health emergencies.

Acknowledgements

This research was supported by grants from Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) (GZR) “MCTIC/CNPq/FNDCT/MS/SCTIE/Decit No 07/2020”, FAPESC (GZR), and UNESC (GZR and LBC). We thank all the people who participated in this study. Our research team, for their help in recruiting the patients. The whole UNESC and Federal University of the Southern Frontier, includes interviewers, research scientists, volunteers, managers, receptionists, and drivers. GZR is a 2 CNPq Research Fellow.

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Publication Dates

  • Publication in this collection
    11 Apr 2025
  • Date of issue
    2025

History

  • Received
    18 Sept 2023
  • Accepted
    27 Dec 2024
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