Association between state stay-at-home orders and risk reduction behaviors and mental distress amid the COVID-19 pandemic

The 2019 Coronavirus Disease (COVID-19) pandemic has triggered stay-at-home orders in 43 states since March 19, 2020. Evidence is limited on how these orders affect peoples' behaviors and mental distress. We used a nationally representative survey of 1094 American adults collected between March 19 and March 31, 2020 to compare risk-reduction behaviors and mental distress in states with and without orders. Risk reduction behaviors included hand washing, wearing face mask and social distancing, and the mental distress was assessed by the four-item version of the Patient Health Questionnaire (PHQ-4). We predicted the probability of a person adopting risk reduction behaviors and the mental distress status using the number of days since their state issued the order relative to those in the non-order states, controlling for COVID-19 prevalence in the state, self-reported symptoms and demographic characteristics. The analysis was conducted in April 2020. Results show that the probability of adopting risk reduction behaviors increased between 8 (avoidance of people with high risk, 87% to 95%) and 27 (use of face mask, 18% to 45%) percentage points in the response period. Mental distress increased by 1.0 point on the PHQ-4 score (from 2.4 to 3.5 point) in the first week and started to drop afterwards. In summary, stay-at-home orders were associated with a differential increase in risk-reduction behaviors. People's mental distress rose in the first week under order and dropped afterwards. While in need for confirmation in longitudinal data, these results suggest that residents are responsive to orders.