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RESEARCH ARTICLEAcute mental health responses during theCOVID-19 pandemic in AustraliaJill M. Newby1,2*, Kathleen O’Moore2, Samantha TangID2, Helen Christensen2,Kate Faasse11 School of Psychology, UNSW Sydney, Sydney, New South Wales, Australia, 2 Black Dog Institute, UNSWSydney, Sydney, New South Wales, Australia* j.newby@unsw.edu.auAbstractThe acute and long-term mental health impacts of the COVID-19 pandemic are unknown.The current study examined the acute mental health responses to the COVID-19 pandemicin 5070 adult participants in Australia, using an online survey administered during the peakof the outbreak in Australia (27th March to 7th April 2020). Self-report questionnaires examined COVID-19 fears and behavioural responses to COVID-19, as well as the severity ofpsychological distress (depression, anxiety and stress), health anxiety, contamination fears,alcohol use, and physical activity. 78% of respondents reported that their mental health hadworsened since the outbreak, one quarter (25.9%) were very or extremely worried aboutcontracting COVID-19, and half (52.7%) were worried about family and friends contractingCOVID-19. Uncertainty, loneliness and financial worries (50%) were common. Rates of elevated psychological distress were higher than expected, with 62%, 50%, and 64% ofrespondents reporting elevated depression, anxiety and stress levels respectively, and onein four reporting elevated health anxiety in the past week. Participants with self-reported history of a mental health diagnosis had significantly higher distress, health anxiety, andCOVID-19 fears than those without a prior mental health diagnosis. Demographic (e.g.,non-binary or different gender identity; Aboriginal and Torres Strait Islander status), occupational (e.g., being a carer or stay at home parent), and psychological (e.g., perceived risk ofcontracting COVID-19) factors were associated with distress. Results revealed that precautionary behaviours (e.g., washing hands, using hand sanitiser, avoiding social events) werecommon, although in contrast to previous research, higher engagement in hygiene behaviours was associated with higher stress and anxiety levels. These results highlight the serious acute impact of COVID-19 on the mental health of respondents, and the need forproactive, accessible digital mental health services to address these mental health needs,particularly for those most vulnerable, including people with prior history of mental healthproblems. Longitudinal research is needed to explore long-term predictors of poor mentalhealth from the COVID-19 pandemic.PLOS ONEPLOS ONE | https://doi.org/10.1371/journal.pone.0236562 July 28, 2020 1 / 21a1111111111a1111111111a1111111111a1111111111a1111111111OPEN ACCESSCitation: Newby JM, O’Moore K, Tang S,Christensen H, Faasse K (2020) Acute mentalhealth responses during the COVID-19 pandemic inAustralia. PLoS ONE 15(7): e0236562. https://doi.org/10.1371/journal.pone.0236562Editor: Joel Msafiri Francis, University of theWitwatersrand, SOUTH AFRICAReceived: May 1, 2020Accepted: July 7, 2020Published: July 28, 2020Peer Review History: PLOS recognizes thebenefits of transparency in the peer reviewprocess; therefore, we enable the publication ofall of the content of peer review and authorresponses alongside final, published articles. Theeditorial history of this article is available here:https://doi.org/10.1371/journal.pone.0236562Copyright: © 2020 Newby et al. This is an openaccess article distributed under the terms of theCreative Commons Attribution License, whichpermits unrestricted use, distribution, andreproduction in any medium, provided the originalauthor and source are credited.Data Availability Statement: The data cannot bepublicly shared as the dataset contains potentiallyidentifying and sensitive participant information.Data will be made available upon request. For alldata requests, please contact the correspondingIntroductionThe novel Coronavirus (COVID-19) first emerged in Wuhan, China in December 2019, andhas since evolved into a global pandemic. As of April 27th 2020, there are more than 2.87 million confirmed cases and 198,668 deaths globally with 6,720 confirmed cases, and 83 deathsfrom COVID-19 in Australia [1]. The COVID-19 pandemic has caused unprecedented disruption to the way most people live, work, study, socialise, and access health care; with widespreadtravel bans, border closures, lockdowns, social distancing, isolation and quarantine measuresenforced by many countries. These changes and their ramifications (e.g., unemployment,social isolation), along with fears of COVID-19 are likely to have significant and long-termimpacts on the mental health of the community. Research into past pandemics, such as the2003 outbreak of Severe Acute Respiratory Syndrome (SARS), has shown higher rates of illnessfears, psychological distress (e.g., depression, anxiety, stress), insomnia and other mentalhealth problems (e.g., posttraumatic stress) in people with pre-existing mental illness, frontline health care workers [2], and survivors of severe and life-threatening cases of the disease[3–6].High quality research into the mental health impacts of COVID-19 is urgently needed [7]to inform evidence-based policy decisions, prevention efforts, treatment programs and community support systems, particularly for those who are most vulnerable and those who are atrisk of experiencing poor mental health outcomes during and after this pandemic. In markedcontrast to the rapidly growing literature into the physical health consequences of COVID-19,there is currently limited information about the mental health impacts of the COVID-19 outbreak in the general population. However, some recent research has emerged from countriessuch as China [8–11], Italy [12, 13], India [14, 15], Mexico [16], the United Kingdom [17],USA [18] and Spain [19–21]. In a cross-sectional survey of 52,730 participants in China conducted between the 31st January to the 10th February 2020 [11], 29.3% of respondents experienced mild to moderate psychological distress, and 5.1% experienced severe distress. Inanother survey of 1210 members of the general public (half of whom were students) conductedbetween 31st January to 2nd February 2020, Wang et al. [8] found that over half (53.8%) of participants rated the psychological impact of the COVID-19 outbreak as moderate to severe,three quarters were worried about their family members contracting COVID-19, and ratesof moderate to severe depression, anxiety and stress were 16.5%, 28.8%, and 8.1% respectively.In a follow-up survey four weeks later, rates of depression, anxiety and stress remainedunchanged [22]. In another survey of 7236 self-selected volunteers from 3rd to 17th February2020, Huang & Zhao [23] found that 20.1%, 35.1%, and 18.2% of respondents reported symptoms of depression, generalised anxiety disorder (GAD), and insomnia on self-report measures. Outside of China, rates of psychological distress have varied across countries andcontexts in online mental health surveys, although high rates of psychological distress havebeen found in countries such as Mexico (50.3% reported psychological distress as moderate tosevere) [16], Spain (72% had elevated psychological distress on the GHQ-12) [19], in India(25%, 28%, and 11.6% had moderate to extremely severe depression, anxiety and stress symptoms respectively) [24] during the COVID-19 pandemic.Together these studies demonstrate the elevated psychological distress in the general community during the initial COVID-19 outbreak. These studies also give some early insights intofactors that may increase a person’s vulnerability to experiencing poor mental health duringthe pandemic. Preliminary evidence suggests that i) demographic factors (younger participants, females, college students, and those with low educational attainment) [17, 25], ii) occupational factors (migrant workers, nurses), iii) health-related factors (history of chronic illness,poor self-rated health [8]), and iv) greater exposure to COVID-19 and the worst affectedPLOS ONE Acute mental health responses during the COVID-19 pandemic in AustraliaPLOS ONE | https://doi.org/10.1371/journal.pone.0236562 July 28, 2020 2 / 21author together with the UNSW Human ResearchAdvisory Panel (HREAPC@psy.unsw.edu.au) withthe study approval number (3330).Funding: This study was funded by a MRFF CareerDevelopment Fellowship to JMN. The funders hadno role in study design, data collection andanalysis, decision to publish, or preparation of themanuscript.Competing interests: The authors have declaredthat no competing interests exist.regions of the outbreak [11], are associated with higher distress levels. In contrast, engaging inprecautionary behaviours (e.g., hand hygiene, wearing a mask) have been associated withlower distress [8, 22]. As COVID-19 has spread internationally, more research is urgentlyneeded to explore the mental health impacts of the outbreak, and to identify groups who arevulnerable to poorer mental health in other countries.To our knowledge there are no published findings on the mental health of the general community during the COVID-19 pandemic in Australia. However, we conducted a previousonline survey of the knowledge, attitudes, behaviours and risk perceptions of 2174 peoplefrom the general community, shortly after the first death occurred from COVID-19 and whenconfirmed COVID-19 cases were low in Australia (March 2nd -9th 2020) [26]. In that study, wefound one in three participants were very or extremely concerned about an outbreak, and thatparticipants perceived their risk of personally contracting COVID-19 as relatively high (ratedas 70% likelihood of contracting the virus). Moreover, most participants (61%) expected thatthey would experience moderate to severe symptoms of COVID-19 if they contracted thevirus. We did not measure mental health outcomes, or how afraid individuals were of personally contracting COVID-19. Therefore, the current study extended our previous survey andinvestigated the mental health of Australian residents during a 12-day period from 27th Marchto 7th April 2020, which is now considered to be the time of the peak in new cases, and thesteady decline in new cases.There were several restrictions in place at the time of recruitment, including 1.5 metresocial distancing rules [27], and international travel bans. Pubs, hotels, gyms, indoor sporting,cinemas and entertainment venues were closed, restaurants and cafes were restricted to takeaway or home delivery, religious gatherings and funerals were limited to very small groups(one person per 4 square meter), and there were restrictions to entering aged care homes. Asof 25th March 2020 [28], three days prior to recruitment, outdoor events or gatherings werelimited to groups of no more than 10 people (with 1.5 metre social distancing). From 28thMarch 2020, all travellers arriving in Australia from overseas were required to undergo a mandatory 14-day quarantine in designated accommodation. From the 31st March (3 days intorecruitment), further restrictions were implemented, limiting movement out of the home,except for shopping for essentials, receiving medical care, undertaking daily exercise or areattending work or school. Gatherings in public were limited to 2 people, except where members of the same household. On the first day (27th March) of the study recruitment period,there was a total of 3378 confirmed cases and 13 deaths related to COVID-19 in Australia, and328 newly diagnosed cases. Over the next two days, there was an increase of 785 new cases inAustralia. Finally, over the remaining days of the study, the number of daily new cases steadilydeclined, with 93 new cases reported on the last day of recruitment (7th April 2020). There wasa total of 5988 confirmed cases (including 3392 active cases) and 49 deaths at the end of thesurvey period.Drawing from past research [8, 11, 22] we assessed demographic characteristics, fears ofCOVID-19, risk perceptions and behavioural responses to the outbreak, psychological distress(depression, anxiety, stress), and alcohol use. We included measures of health anxiety and contamination fears due to their potential role in influencing behaviour, health service use, andanxious reactions to viral outbreaks [29–32]) as well as physical activity levels, and loneliness,due to the expected negative impacts of social distancing measures on these variables, and dueto their important role in mental and physical health [33, 34]. Finally, we assessed financialworries, as we expected unemployment, and financial insecurity, which have already resultedfrom this outbreak, to have significant, negative impacts on mental health [7, 35]. Our primaryaim was to provide the first snapshot of the mental health of the general community duringthe initial COVID-19 outbreak (and enforcement of social distancing laws) in Australia. ThePLOS ONE Acute mental health responses during the COVID-19 pandemic in AustraliaPLOS ONE | https://doi.org/10.1371/journal.pone.0236562 July 28, 2020 3 / 21second aim was to explore the relationship between specific demographic and sample characteristics with depression, anxiety and stress, to identify factors that are associated withincreased vulnerability for poorer mental health during the COVID-19 pandemic. While weacknowledge that the data from an online survey may not be representative of the entire population, they provide an important opportunity to i) identify vulnerable groups who are at riskof poorer mental health during COVID-19, ii) determine the socio-demographic and psychological factors that predict psychological distress, and iii) examine whether the findings frompast pandemics, and from China, apply to the Australian context during the COVID-19 pandemic. Based on research from past pandemics, and Chinese research, we expected thatbetween 20–35% would worry about contracting COVID-19 and experience elevated psychological distress, and that specific demographic variables including younger age, being a student, unemployed, female, or with lower educational attainment would predict higher distresslevels in the current cohort. We also expected people with lived experience of prior mentalhealth diagnoses would have higher rates of distress and would be vulnerable to poorer mentalhealth during the current pandemic. Finally, we predicted that engaging in precautionaryhygiene behaviours would be associated with lower distress.Materials and methodsRecruitmentParticipants were recruited for the online survey via social media posts, with Facebook advertisements targeting all users with i) current country of residence as Australia, and ii) age listedas 18 or above (see S1). Data was collected for 12 days from Friday 27th March to April 7th,2020. The survey was administered via the Qualtrics survey platform. Each response camefrom a unique IP address to minimise duplicate entries.Ethics approval and consentThe study was approved by the UNSW Human Research Ethics Advisory Panel and theUNSW Human Research Ethics Committee (approval number 3330). All respondents provided electronic informed consent before participating.ParticipantsIn total, 5,971 people viewed the participant information page and consent form. Of these, 579did not complete the consent form, and a further 323 completed only some of the survey questions before discontinuing. This resulted in a final sample of 5071 participants with sufficientdata (>70% complete) to include in the analysis. The structured questionnaire took approximately 15 minutes to complete (median time taken: 15.9 minutes).MeasuresDemographics. Information was collected on participants’ age group, gender, ethnicity,Aboriginal and Torres Strait Islander status, their highest level of education, carer status (forchildren, and/or someone with a disability, illness or frail aged) and state of residence withinAustralia. We also assessed participants’ employment status (including whether they hadrecently lost their job due to COVID-19), the industry of their main job, and the frequency atwhich they had worked from home during the past week (not at all, a little, sometimes, most ofthe time, all of the time).General health and mental health. Participants were asked whether they had a chronicillness (Yes, No, Unsure, Prefer not to say), and completed a single-item measure assessing theirPLOS ONE Acute mental health responses during the COVID-19 pandemic in AustraliaPLOS ONE | https://doi.org/10.1371/journal.pone.0236562 July 28, 2020 4 / 21self-rated health [36], with responses on a 5-point scale from Poor to Excellent. Participantswere asked whether they had ever been diagnosed with a mental health problem such asdepression and anxiety (Yes, No, Unsure, Prefer not to say), and whether they were currentlyreceiving treatment for a mental health problem including medications, counselling, or psychological therapy (Yes, No, Unsure, Prefer not to say).Mental health. Participants were asked to complete single item measures of i) how lonelythey were feeling, ii) how worried they were about their financial situation, and iii) how uncertain they were feeling about the future, on a 5-point scale (not at all, a little, moderately, very,extremely). They were then asked to rate how the COVID-19 outbreak had impacted theirmental health. “Since the COVID-19 outbreak, my mental health has been. . .”, and choosebetween 5 response options: A lot worse, A little worse, Stayed the same, A little better, A lotbetter.The survey included several validated self-report screening instruments including i) the21-item Depression Anxiety Stress Scales [37], a validated measure of depression, anxiety andstress symptoms, ii) the Whiteley-6 [38], a brief validated measure of health anxiety severity,iii) the Contamination Obsessions and Washing Compulsions subscale of the revised versionof Padua Inventory of Obsessions and Compulsion [39], and iv) a specific measure of behavioural responses to the pandemic based on our prior study [26], and past research investigating behavioural responses to pandemics [40, 41]. Finally, we assessed physical activity levelsusing the Physical Activity Vital Sign [42] which assessed i) the number of days in the pastweek they engaged in moderate to strenuous activity, and ii) the average number of minutesthey exercised at this level, and screened for hazardous alcohol use using the Modified AlcoholUse Disorders Identification Test (AUDIT-C) [43]. All questionnaire responses were anchoredto the past week, except for the AUDIT-C (past month), and the Padua contamination subscale(general). The mental health and lifestyle questionnaires were administered in randomisedorder to minimise responding biases.COVID-19 variables, fears and perceived risk. Participants were asked about their ownCOVID-19 status (I have caught COVID-19 in the past and am now recovered, I currently haveCOVID-19 [confirmed with a diagnostic test], I suspect I have COVID-19, I do not have COVID-19 and have not experienced it, Unsure, or Other (open text)). They also indicated whether theywere in self isolation (Yes—I am in voluntary self-isolation, Yes—I am in forced self-isolation,No). Participants were also asked i) whether any of their family or friends had contractedCOVID-19 (Yes, No, Unsure), and ii) how concerned or worried they were that their friends orfamily members would contract COVID-19 (not at all, a little concerned, moderately concerned, very concerned, extremely concerned).Participants were asked five questions relating to their perceived risk from, and worryabout, COVID-19. The first question assessed how concerned or worried respondents wereabout catching COVID-19 on a 5-point scale (not at all concerned, a little concerned, moderately concerned, very concerned, extremely concerned). They then rated how likely they thoughtit was that they would catch the virus on a visual analogue scale (VAS) from 0 (not at all likely)to 100 (extremely likely). They were asked how much they thought they could do personally toprotect themselves from catching the virus (perceived behavioural control), on a 0 (couldn’t doanything) to 100 (could do a lot) visual analogue scale. Perceived illness severity was assessedby asking respondents how severe they thought their symptoms would be if they did catchCOVID-19 (response options were: no symptoms, mild symptoms, moderate symptoms, severesymptoms, severe symptoms requiring hospitalisation, and severe symptoms leading to death).Finally, participants were asked about how much information they had seen, read or heardabout coronavirus (nothing at all, a little, a moderate amount, a lot).PLOS ONE Acute mental health responses during the COVID-19 pandemic in AustraliaPLOS ONE | https://doi.org/10.1371/journal.pone.0236562 July 28, 2020 5 / 21Health-protective behaviours. To assess social distancing, hygiene and buying behaviours, participants were asked whether they had engaged in a total of 16 behaviours during theprevious week (see Table 2). Response options for each item were not at all, a little, some of thetime, most of the time, all of the time, and not applicable. Items were generated based on ourprevious study of COVID-19 [26] and from previous research examining health-protectivebehaviours in response to influenza, SARS and Middle East Respiratory Syndrome (MERS)outbreaks [e.g., 41].Statistical analysesFirst, we conducted descriptive analyses to describe demographic, sample and clinical characteristics. Second, we conducted chi square analyses (for categorical variables) and independentsamples t tests (for dimensional variables) to compare participants with, and without a priormental health diagnosis, and participants in self-isolation versus those not in self isolation ontheir questionnaire responses. Third, we conducted separate linear regression analyses toexplore the demographic, occupational, and psychological predictors of DASS-21 depression,anxiety and stress severity. We entered demographic predictor variables (gender, age, occupational status, education, Aboriginal and/or Torres Strait Islander and carer status) in the firststep. In the second step, we entered general health variables including chronic illness, mentalhealth diagnosis history, and self-rated health. In the third step, we entered uncertainty aboutthe future, loneliness, worry about finances. In the final step, we added COVID-19 variables(whether they were in self-isolation, hygiene behaviours, exposure to COVID-19 information,risk perceptions including perceived likelihood, perceived control, and severity of illness, concern/worry about contracting COVID-19, and concern/worry about loved ones contractingCOVID-19. We used a stepwise regression analysis approach to explore the unique varianceaccounted for by demographic and occupational characteristics, followed by health variables,and then COVID-19-specific variables.ResultsDemographicsDemographic characteristics of the sample are depicted in Table 1. Overall, the sample wasmostly female (86%), identified as being Caucasian (75%), mainly spoke English at home(91%), and ranged in age from 18 to over 75. Participants were from various states and territories of Australia, with the majority living in the most populated states of New South Wales,Victoria or Queensland. Sixty five percent were working in a paid job, and approximately onethird were carers (for children, or people with a disability, illness, or the elderly). Respondents’self-rated health was measured on a scale from poor (1) to excellent (5), with a mean of 3.0(SD = 0.97). The majority of participants rated their health as ‘good’ (37.7%), ‘very good’(24.4%) or ‘fair’ (24.4%); relatively few participants rated their health as ‘poor’ (5.3%)’ or ‘excellent’ (5.3%). Seventy percent of respondents reported that they had been diagnosed with amental health problem such as depression and anxiety in the past, and 45% reported being incurrent mental health treatment (counselling, medications, therapy).Health-related informationOnly eight participants (0.2%) reported that they themselves currently have or have hadCOVID-19, 9.2% were unsure, and 1.2% suspected they had COVID-19. Approximately 4.8%reported their family or friends had caught COVID-19, and 8.2% were unsure. Almost halfPLOS ONE Acute mental health responses during the COVID-19 pandemic in AustraliaPLOS ONE | https://doi.org/10.1371/journal.pone.0236562 July 28, 2020 6 / 21Table 1. Demographic characteristics of the sample. Demographic VariablesN (%)GenderMale656 (12.9)Female4348 (85.8)Non-binary42 (0.8)Different identity8 (0.2)Prefer not to say15 (0.3)StateNew South Wales1669 (32.9)Victoria1236 (24.4)Queensland878 (17.3)South Australia407 (8.0)Western Australia490 (9.77)Tasmania215 (4.2)Australian Capital Territory141 (2.8)Northern Territory31 (0.6)Age Group18–24268 (5.3)25–34773 (15.2)35–441016 (20.0)45–541190 (23.5)55–641207 (23.8)65–74497 (9.8)75+51 (1.0)Not stated67 (1.3)EthnicityCaucasian (White / European)3812 (75.2)Aboriginal and/or Torres Strait Islander77 (1.5)Asian79 (1.7)Mixed ethnicity or other307 (6.1)Prefer not to say or missing794 (15.7)Highest EducationLess than High school (Year 12 or equivalent)275 (5.4)High school only: completed (Year 12)419 (8.3)Certificate, or diploma1485 (29.3)Bachelor’s degree or higher2888 (57.0)Not stated2 (0.0)English main language spoken at homeYes4628 (91.3)Employment (tick all that apply)I am a permanent employee2194 (43.3)I am working on a fixed term contract362 (7.1)I have a casual job432 (8.5)I am self-employed388 (7.7)I am an independent contractor118 (2.3)I am an at home parent221 (4.4)I am a student395 (7.8)I am a carer129 (2.5) (Continued)PLOS ONE Acute mental health responses during the COVID-19 pandemic in AustraliaPLOS ONE | https://doi.org/10.1371/journal.pone.0236562 July 28, 2020 7 / 21Table 1. (Continued) Demographic VariablesN (%)I am retired646 (12.7)I am seeking work203 (4.0)I am not working and on disability benefits258 (5.1)I am not working as I have lost my job due to COVID19314 (6.2)I am not working for other reasons341 (6.7)Industry of main jobHealth care or social assistance1039 (32.2)Education and training613 (19.0)Administration and social support168 (5.5)Professional, scientific and technical services242 (7.5)Retail trade137 (4.2)Other1109 (31.6)Carer statusCarer for children1196 (23.6)Carer for person with disability, illness or who is frail aged772 (15.2)IsolationNo2475 (48.8)Yes-voluntary self-isolation2472 (48.8)Yes–forced self-isolation120 (2.4)COVID-19 diagnosisNo/Never4534 (89.4)Unsure/Other462 (9.2)Current diagnosis (confirmed with diagnostic test)5 (0.1)Suspect I have COVID-1963 (1.2)I have had COVID-19 in the past and now recovered3 (0.1)Family/friends diagnosed with COVID-19Yes242 (4.8)No4411 (87.0)Unsure414 (8.2)Lifetime mental health diagnosisaYes3581 (70.8)No1351 (26.7)Unsure99 (1.9)Prefer not to say38 (0.7)Current mental health treatmentYes2288 (45.1)No2747 (54.2)Unsure13 (0.3)Prefer not to say21 (0.4)Current chronic illnessbYes1941 (38.3)No2584 (51.0)Unsure362 (7.1)Prefer not to say34 (0.7)Missing148 (2.9)Self-rated health (in general)aExcellent269 (5.3) (Continued)PLOS ONE Acute mental health responses during the COVID-19 pandemic in AustraliaPLOS ONE | https://doi.org/10.1371/journal.pone.0236562 July 28, 2020 8 / 21(48.8%) reported being in voluntary self-isolation, 2.4% reported being in ‘forced self-isolation’and 48.8% were not self-isolating.COVID-19 fears and perceived riskLevel of concern and worry about the possibility of contracting COVID-19 was moderate(M = 2.84, SD = 1.07, range 1–5, where 1 = not at all, 5 = extremely concerned). A small proportion reported being ‘not at all concerned’ (7.6%), 35% reported being ‘a little’ concerned, 31.4%were ‘moderately concerned’, 17.2% were ‘very concerned’, and 8.5% were ‘extremely concerned’about contracting COVID-19. Respondents’ ratings of the perceived likelihood of contractingCOVID-19 was moderate (M = 48.25, SD = 24.84; scale from 0 to 100). Perceived behaviouralcontrol, or the belief that personal protective behaviours could help prevent infection, had amean score of 71.64 (SD = 19.69). With regard to perceived severity of symptoms if they caughtcoronavirus, only 0.3% of respondents indicated that they would experience no symptoms;with mild (19.6%) and moderate (43.9%) symptoms most commonly expected. However, onein three respondents perceived the illness severity to be high: with 20.1% indicating theythought they would experience severe symptoms, severe symptoms requiring hospitalisation(12.0%), or severe symptoms leading to death (4.1%). In terms of the amount of informationparticipants had been exposed to about the coronavirus in the past week, most participants(75%) reported having ‘a lot’ of exposure to information, 21.6% reported a ‘moderate amount’,whereas very few reported a little (3.3%) or no information at all (0.1%).COVID-19 fears (others)Participants’ overall level of concern and worry about friends and loved ones contractingCOVID-19 was moderate (M = 3.53, SD = 1.03, range 1–5, where 1 = not at all, 5 = extremelyconcerned). A small proportion reported that they were ‘not at all concerned’ (1.6%), 16.5%reported being ‘a little’ concerned, 29.2% were ‘moderately concerned’, 33.1% were ‘very concerned’, and 19.6% ‘extremely concerned’ about their friends or family members contractingCOVID-19.Health-protective behavioursThe percentage of respondents who reported having engaged in a range of distancing andhygiene behaviours during the past week is presented in Table 2. During the previous week,handwashing and social distancing (avoiding social events and gatherings) were the most common behaviours.Table 1. (Continued) Demographic VariablesN (%)Very good1236 (24.4)Good1910 (37.7)Fair1235 (24.4)Poor270 (5.3) a: have you ever been diagnosed with a mental health problem such as depression or anxiety?b: do you have a chronic illness?c. n = 4920.https://doi.org/10.1371/journal.pone.0236562.t001PLOS ONE Acute mental health responses during the COVID-19 pandemic in AustraliaPLOS ONE | https://doi.org/10.1371/journal.pone.0236562 July 28, 2020 9 / 21Mental healthMore than three quarters of participants reported that their mental health had been worsesince the outbreak, with 55.1% selecting ‘a little worse’, and 22.9% selecting ‘a lot worse’. Asmall proportion reported improvements in their mental health since the outbreak (5.5%) (seeFig 1). A chi square analysis revealed that there was a significant difference in the impact ofCOVID-19 on mental health for participants with and without a prior mental health diagnosis(χ2 (4) = 141.44, p