Context, Proximity, and Individual Risk for Early-Pandemic Fear of Covid-19 Infection: A Multilevel Analysis of American Adults in March 2020

Main Article Content

Kevin M Fitzpatrick, PhD Casey Harris, PhD Grant Drawve, PhD Caitlin Tidwell, MA


Background: The current study explores how characteristics of individuals, their communities, and their relative exposure to nearby Covid-19 cases are associated with specific fears or perceived threat/risk of the virus itself during the early stages of the pandemic in March 2020.

Aims: Drawing from research emphasizing the intersectional relationships between individual social vulnerabilities, community characteristics, and Covid-19 outbreak locales, we test several hypotheses predicting fear.

Method: Using data from a large-scale survey of 10,368 U.S. adults from March 2020, we construct a series of hierarchical linear and logistic regression models that nest individuals within their residential counties in order to account for key socio-demographic characteristics of individuals, communities, and each respondent’s geographic proximity to Covid-19 cases.

Results: Results show that individual fear and perceived risk to oneself and family is predicted by individual social vulnerabilities, the type of community in which respondents live, and the relative presence of the virus in nearby places.

Conclusion: Our findings highlight the importance of understanding fear, particularly as a possible mediator for both mental and physical health outcomes. Likewise, we emphasize ongoing efforts aimed at understanding how different groups and communities respond to fear and/or concern over Covid-19 as the pandemic remains ongoing.


Article Details

How to Cite
FITZPATRICK, Kevin M et al. Context, Proximity, and Individual Risk for Early-Pandemic Fear of Covid-19 Infection: A Multilevel Analysis of American Adults in March 2020. Medical Research Archives, [S.l.], v. 10, n. 10, oct. 2022. ISSN 2375-1924. Available at: <>. Date accessed: 06 dec. 2022. doi:
Research Articles


1. Dong E, Du H, Gardner L. An interactive web-based dashboard to track Covid-19 in real time. The Lancet Infectious Diseases. 2020; 20(5): 533-534.
2. Crane A., Matten D. COVID‐19 and the Future of CSR Research. Journal of Management Studies. 2020; 10.1111/joms.12642. doi:10.1111/joms.12642
3. Nicola M., Alsafi Z, Sohrabi C, Kerwan A, Al-Jabir A, Iosifidis C, Agha, R. The socio-economic implications of the coronavirus pandemic (Covid-19 ): A review. International Journal of Surgery (London, England). 2020; 78: 185-193. doi:10.1016/j.ijsu.2020.04.018
4. Shadmi E, Chen Y, Dourado I, Faran-Perach I, Furler J, Hangoma P, Willems S. (2020). Health equity and Covid-19 : global perspectives. International Journal for Equity in Health. 2020; 19(1): 104. doi:10.1186/s12939-020-01218-z
5. Brownson RC, Burke TA, Colditz GA, Samet JM. Reimagining Public Health in the Aftermath of a Pandemic. American Journal of Public Health 2020; 110(11): 1605-1610. doi:10.2105/AJPH.2020.305861
6. Miller IF, Becker AD, Grenfell BT, Metcalf CJE. Disease and healthcare burden of Covid-19 in the United States. Nature Medicine. 2020; 26(8): 1212-1217. doi:10.1038/s41591-020-0952-y
7. Tulenko K, Vervoort D. Cracks in the System: The Effects of the Coronavirus Pandemic on Public Health Systems. The American Review of Public Administration. 2020; 50(6-7): 455-466. doi:10.1177/0275074020941667
8. Pies R. Is the Country Experiencing a Mental Health Pandemic? 2020; In (Vol. 37): Psychiatric Times.
9. Rogers K. Mental health is one of the biggest pandemic issues we'll face in 2021. 2021; Retrieved from -2021-stress-wellness/index.html
10. Fitzpatrick KM, Harris C, Drawve G. Facing new fears during the Covid-19 pandemic: The State of America’s mental health. Journal of Anxiety Disorders. 2020; 75: 102291.
11. Kontoangelos K, Economou M, Papageorgiou C. Mental health effects of Covid-19 pandemia: a review of clinical and psychological traits. Psychiatry Investigation. 2020; 17(6): 491.
12. Ornell F, Schuch JB, Sordi AO, Kessler FHP. “Pandemic fear” and Covid-19 : mental health burden and strategies. Brazilian Journal of Psychiatry. 2020; 42(3): 232-235.
13. Torales J, O’Higgins M, Castaldelli-Maia JM, Ventriglio A. The outbreak of Covid-19 coronavirus and its impact on global mental health. International Journal of Social Psychiatry. 2020; 0020764020915212.
14. Rodríguez-Hidalgo, Antonio J, Yisela Pantaleón Y, Dios I, Falla D. Fear of Covid-19 , stress, and anxiety in university undergraduate students: a predictive model for depression. Frontiers in psychology. 2020; 11: 591797.
15. de Paiva T, Pedro LE, de Freitas RL, Abad A, da Silva JA, Antonelli-Ponti M, Bastos S, Mármora CHC, Campos LAM, Paiva S. da Sila JA. Psychological impacts related to stress and fear during the Covid-19 pandemic: cardiovascular diseases, diabetes and psychological disorders as risk factors. World Journal of Neuroscience. 2020; 10(4): 191-205.
16. Kobayashi K, Chin K, Umezawa S, Ito S, Yamamoto H, Nakano S, Takada N, Hatori N, Tamura K. Influence of stress induced by the first announced state of emergency due to coronavirus disease 2019 on outpatient blood pressure management in Japan. Hypertension Research. 2022; 45(4): 675-685.
17. Reizer A, Koslowsky M, Geffen L. Living in fear: The relationship between fear of Covid-19 , distress, health, and marital satisfaction among Israeli women. Health Care for Women International. 2020; 41(11-12): 1273-1293.
18. Fitzpatrick KM, Harris C, Drawve G. Fear of Covid-19 and the mental health consequences in America. Psychological trauma: Theory, Research, Practice, and Policy. 2020; 12: S17–S21
19. Fofana NK, Latif F, Sarfraz S, Bashir MF, Komal B. Fear and agony of the pandemic leading to stress and mental illness: an emerging crisis in the novel coronavirus (Covid-19 ) outbreak. Psychiatry Research. 2020; 291: 113230.
20. Lee SA, Crunk EA. Fear and psychopathology during the Covid-19 crisis: neuroticism, hypochondriasis, reassurance-seeking, and coronaphobia as fear factors. OMEGA-Journal of Death and Dying. 2020; 0030222820949350.
21. Chang KC, Strong C, Pakpour AH, Griffiths MD, Lin CY. Factors related to preventive Covid-19 infection behaviors among people with mental illness. Journal of the Formosan Medical Association. 2020;119(12): 1772-1780.
22. Harper CA, Satchell LP, Fido D, Latzman RD. Functional fear predicts public health compliance in the Covid-19 pandemic. International Journal of Mental Health and Addiction. 2020; 27: 1–14.
23. Ibrahim SME, Mahmoud MAM. Relationship Between Knowledge, Preventive Practices and Fear from Covid-19 among Middle Aged and Older Adults: During the Novel Coronavirus Outbreak. American Journal of Nursing Science. 2020; 9(5): 333.

24. Yıldırım M, Geçer E, Akgül Ö. The impacts of vulnerability, perceived risk, and fear on preventive behaviours against Covid-19 . Psychology, Health & Medicine. 2020; 1-9.
25. Grabovschi C, Loignon C, Fortin M. Mapping the concept of vulnerability related to health care disparities: a scoping review. BMC Health Services Research. 2013; 13: 94-94.
26. Mechanic D, Tanner J. Vulnerable people, groups, and populations: societal view. Health Affairs. 2007; 26(5): 1220-1230.
27. Shi L, Stevens GD, Lebrun LA, Faed P, Tsai J. Enhancing the measurement of health disparities for vulnerable populations. Journal of Public Health Management and Practice. 2008; 14(6): S45-S52.
28. Hutchins SS, Fiscella K, Levine RS, Ompad DC, McDonald M. Protection of racial/ethnic minority populations during an influenza pandemic. American Journal of Public Health. 2009; 99(S2): S261-S270.
29. Schweda A, Weismüller B, Bäuerle A, Dörrie N, Musche V, Hetkamp M, Skoda EM. Phenotyping mental health: Age, community size, and depression differently modulate Covid-19 -related fear and generalized anxiety. Comprehensive Psychiatry. 2020; 152218.
30. The Harris Poll. Retrieved from The American Heart Association. 2020; -fears-approximately-half-of-hispanics-and-black-americans-would-fear-going-to-the-hospital-if-experiencing-symptoms-of-a-heart-attack-or-stroke#_ftn2
31. Alcendor DJ. Racial disparities-associated Covid-19 mortality among minority populations in the US. Journal of Clinical Medicine. 2020;9(8): 2442.
32. Hooper MW, Nápoles AM, Pérez-Stable EJ. Covid-19 and racial/ethnic disparities. Journal of the American Medical Association. 2020; 323(24): 2466-2467.
33. Iacobucci G. Covid-19 : Increased risk among ethnic minorities is largely due to poverty and social disparities, review finds. BMJ: British Medical Journal (Online). 2020; 371.
34. Tirupathi R, Muradova V, Shekhar R, Salim SA, Al-Tawfiq JA, Palabindala V. Covid-19 disparity among racial and ethnic minorities in the US: A cross sectional analysis. Travel Medicine and Infectious Disease. 2020; 38: 101904.
35. Aldridge RW, Lewer D, Katikireddi SV, Mathur R, Pathak N, Burns R., Abubakar I. Black, Asian and Minority Ethnic groups in England are at increased risk of death from Covid-19 : indirect standardisation of NHS mortality data. Wellcome Open Research. 2020; 5(88): 88.

36. Tai DBG, Shah A, Doubeni CA, Sia IG, Wieland ML. The disproportionate impact of Covid-19 on racial and ethnic minorities in the United States. Clinical Infectious Diseases. 2020; ciaa815:
37. Wang, ML, Behrman P, Dulin A, Baskin ML, Buscemi J, Alcaraz KI, Fitzgibbon M. Addressing inequities in Covid-19 morbidity and mortality: research and policy recommendations. Translational Behavioral Medicine. 2020; 10(3): 516-519.
38. Bazargan M, Cobb S, Assari S. Discrimination and Medical Mistrust in a Racially and Ethnically Diverse Sample of California Adults. Annals of Family Medicine. 2020; 19(1): 4.
39. Essien UR, Venkataramani A. Data and Policy solutions to Address Racial and Ethnic Disparities in the Covid-19 Pandemic. Jama Health Forum. 2020;
40. Louis-Jean J, Cenat K, Njoku CV, Angelo J, Sanon D. Coronavirus (Covid-19 ) and racial disparities: a perspective analysis. Journal of Racial and Ethnic Health Disparities. 2020; 7(6): 1039-1045.
41. Mavragani A, Gkillas K. Covid-19 predictability in the United States using Google Trends time series. Scientific Reports. 2020; 10(1): 1-12.
42. Sasaki N, Kuroda R, Tsuno K, Kawakami N. Exposure to media and fear and worry about COVID‐19. Psychiatry and Clinical Neurosciences. 2020;
43. Trnka R, Lorencova R. Fear, anger, and media-induced trauma during the outbreak of Covid-19 in the Czech Republic. Psychological Trauma: Theory, Research, Practice, and Policy. 2020; 12(5): 546–549.
44. Ahmad AR, Murad HR. The impact of social media on panic during the Covid-19 pandemic in Iraqi Kurdistan: online questionnaire study. Journal of Medical Internet Research. 2020; 22(5): e19556.
45. Bendau A, Petzold MB, Pyrkosch L, Maricic LM, Betzler F, Rogoll J, Plag J. Associations between Covid-19 related media consumption and symptoms of anxiety, depression and Covid-19 related fear in the general population in Germany. European Archives of Psychiatry and Clinical Neuroscience. 2020; 1-9.
46. Ermolaev VV, Sorokoumova EA, Voroncova J, Nasonova DK, Chetverikova AI. Psychological features of social fears associated with the Covid-19 content of news feed in Russia. EurAsian Journal of BioSciences. 2020; 14(1).
47. Hossain MT, Ahammed B, Chanda SK, Jahan N, Ela MZ, Islam MN. Social and electronic media exposure and generalized anxiety disorder among people during Covid-19 outbreak in Bangladesh: A preliminary observation. Plos One. 2020; 15(9): e0238974.
48. Liu C, Liu Y. Media exposure and anxiety during Covid-19 : The mediation effect of media vicarious traumatization. International Journal of Environmental Research and Public Health. 2020; 17(13): 4720.
49. Mertens G, Gerritsen L, Duijndam S, Salemink E, Engelhard IM. Fear of the coronavirus (Covid-19 ): Predictors in an online study conducted in March 2020. Journal of Anxiety Disorders. 2020; 102258.
50. Bratu S. The Fake News Sociology of Covid-19 Pandemic Fear: Dangerously Inaccurate Beliefs, Emotional Contagion, and Conspiracy Ideation. Linguistic and Philosophical Investigations. 2020; (19): 128-134.
51. Lee JJ, Kang KA, Wang MP, Zhao SZ, Wong JYH, O'Connor S, Shin S. Associations Between Covid-19 Misinformation Exposure and Belief With Covid-19 Knowledge and Preventive Behaviors: Cross-Sectional Online Study. Journal of Medical Internet Research. 2020; 22(11): e22205.
52. Moghanibashi-Mansourieh A. Assessing the anxiety level of Iranian general population during Covid-19 outbreak. Asian Journal of Psychiatry. 2020; 102076.
53. Nguyen THD, & Vu DC. Impacts of the Covid-19 pandemic upon mental health: Perspectives from Vietnam. Psychological Trauma: Theory, Research, Practice, and Policy. 2020; 12(5): 480.
54. Lin CY, Broström A, Griffiths MD, Pakpour AH. Investigating mediated effects of fear of Covid-19 and Covid-19 misunderstanding in the association between problematic social media use, psychological distress, and insomnia. Internet Interventions. 2020; 21: 100345.
55. Nekliudov NA, Blyuss O, Cheung KY, Petrou L, Genuneit J, Sushentsev N, Tudor-Williams G. Excessive media consumption about Covid-19 is associated with increased state anxiety: Outcomes of a large online survey in Russia. Journal of Medical Internet Research. 2020; 22(9): e20955.
56. Finch WH, Finch ME. Poverty and Covid-19 : rates of incidence and deaths in the United States during the first 10 weeks of the pandemic. Frontiers in Sociology. 2020; 5: 47.
57. Cheng KJG, Sun Y, Monnat SM. COVID‐19 Death Rates Are Higher in Rural Counties With Larger Shares of Blacks and Hispanics. The Journal of Rural Health. 2020; 36(4): 602-608.

58. Karaye IM, Horney JA.. The impact of social vulnerability on Covid-19 in the US: an analysis of spatially varying relationships. American Journal of Preventive Medicine. 2020; 59(3): 317-325.
59. Reznik A, Gritsenko V, Konstantinov V, Khamenka N, Isralowitz R. Covid-19 fear in Eastern Europe: Validation of the Fear of Covid-19 Scale. International Journal of Mental Health and Addiction. 2020; 12: 1–6
60. Salisu AA, Akanni LO. Constructing a global fear index for the Covid-19 pandemic. Emerging Markets Finance and Trade. 2020; 56(10), 2310-2331.
61. Surgo Ventures. The Covid-19 Community Vulnerability Index (CCVI). 2020; Accessed July 31, 2020.
62. Wilson R, Din, A. Understanding and Enhancing the U.S. Department of Housing and Urban Development’s ZIP Code Crosswalk Files. The Housing-Health Connection. 2018; 20(2):
63. Kogan JN, Edelstein BA. Modification and psychometric examination of a self-report measure of fear in older adults. Journal of Anxiety Disorders. 2004; 18(3), 397-409.
64. Tzeng HM, Yin CY. A crisis: fear toward a possible H5N1 pandemic. Journal of Nursing Care Quality. 2008; 23(2): 177-183.
65. Reardon SF, Firebaugh G. Measures of multigroup segregation. Sociological Methodology. 2002; 32(1): 33-67.
66. Anselin L, Syabri I, Kho Y. GeoDa: An introduction to spatial data analysis. Geographical Analysis. 2006; 38(1): 5 – 22.
67. Bryk AS, Raudenbush SW. Hierarchical Linear Models: Applications and Data Analysis Methods. 1992; Thousand Oaks, CA: Sage Publications, Inc.
68. Ulmer JT, Johnson B. Sentencing in context: A multilevel analysis. Criminology. 2004; 42(1): 137-178.
69. Kreft IGG, De Leeuw J, Aiken LS. The effect of different forms of centering in hierarchical linear models. Multivariate Behavioral Research. 1995; 30(1): 1-21.
70. Palluck EL, Green SA, Green PG.The contact hypothesis re-evaluated. Behavioural Public Policy. 2019; 3(2): 129-158. doi:10.1017/bpp.2018.25
71. ArcGIS Pro (Version 2.6). ESRI Inc.