Objectives: Citizens who perceive SARS-CoV-2 as a threat may experience heightened anxiety of the severe illness caused by COVID-19. This study investigated the trends in anxiety and performance of preventive measures among Taiwanese citizens during the early stages of the COVID-19 pandemic. Methods: This study employed an anonymous online survey to investigate anxiety and preventive behavior practice in adults during the early stages of the COVID-19 pandemic. The 6-item state version of the State-Trait Anxiety Inventory (STAI-6) was used to measure symptoms of anxiety. The preventive measures consisted of 12 items divided into three categories: Personal protection, cough etiquette, and social distance and voluntary quarantine. The three time periods studied were the lockdown in Wuhan, China (from January 23 to February 7), the week when enhanced border protections and in-person mask purchase systems were introduced and the first citizen tested positive for SARS-CoV-2 without symptoms (from February 8 to February 16), and the 10 days following the first death from COVID-19 in Taiwan (from February 27 to March 9). The Cochran-Armitage trend test and the Jonckheere trend test were used to analyze changes in the degree of anxiety and the adoption of preventive measures in the early stages of the epidemic. An analysis of covariance was performed to examine the relationship between changes in anxiety and engagement in preventive behaviors after control for sex, age, education, and income. Results: The percentages of the participants with moderate to high levels of anxiety during the three time periods were 45%, 50%, and 55%, respectively. The percentages of those who practiced preventive measures often or always during the three time periods were 46%, 58%, and 66%, respectively. Significant increases were found both in levels of anxiety and in performance of preventive measures over the three time periods, but no differences across sex, age, education, or income groups were found. Changes in anxiety and performance of preventive behaviors were significantly associated during the three periods. Conclusions: The results revealed that as the pandemic spread, citizens' anxiety, and performance of preventive measures increased significantly for each sex, age, education level, and income group.
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