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“The better you feel, the harder you fall”: Health perception biases and mental health among Chinese adults during the COVID-19 pandemic

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Abstract

The health risks of the current COVID-19 pandemic, together with the drastic mitigation measures taken in many affected nations, pose an obvious threat to public mental health. To assess predictors of poor mental health in the context of the COVID-19 pandemic, this study first implements survey-based measures of health perception biases among Chinese adults during the pandemic. Then, it analyzes their relation to three mental health outcomes: life satisfaction, happiness, and depression (as measured by the CES−D). We show that the health overconfidence displayed by approximately 30% of the survey respondents is a clear risk factor for mental health problems; it is a statistically significant predictor of depression and low levels of happiness and life satisfaction. We also document that these effects are stronger in regions that experienced higher numbers of confirmed COVID-19 cases and deaths. Our results also offer clear guidelines for the implementation of effective interventions to temper health overconfidence, particularly in uncontrollable situations like the COVID-19 pandemic.

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... Specifically, when designing fertility-enhancing programs or policies, appropriate use of the internet is highly encouraged, which could be achieved via governmental education programs on health literacy. A good starting point for such health interventions is suggested in China's new Basic Healthcare and Health Promotion Law (enacted on June 1, 2020), which addresses health issues via information campaigns, the promotion of healthy lifestyles, and the integration of health education into the national curriculum (Nie et al., 2022). Considering the negative impacts of IU on attitudes toward traditional gender roles, the government should create education programs or undertake other measures, such as encouraging men to engage more in homework and childrearing, to reduce possible conflicts between traditional and modern social norms and concepts (Tong et al., 2021), optimize the division of labor by gender within the family and promote marital satisfaction. ...
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Using longitudinal data from the 2014–2018 China Family Panel Studies, we investigate the impact of internet use (IU) on fertility among reproductive-age women. We find that IU reduces the number of children born, with more pronounced effects among those with a moderate level of education, those aged 16–19, rural residents, and those who are married. These results are robust to alternative IU measures and a series of estimation approaches that control for endogeneity. IU participation affects the number of children born through decreased marital satisfaction, changed attitudes toward traditional gender roles, a reduction in the importance placed on ancestral lines, deteriorated health and reduced fertility preferences.
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... The degree to which this occurred, as well as the origins of the misinformation here (32), were not queried and remain unknown. However, this type of misinformation has real-world consequences; inaccurate beliefs related to COVID-19 risks and consequences correspond to reduced willingness to become vaccinated against the virus (33) and persons who were overconfident in their misinformation showed elevated risk for developing mental health-related consequences during the pandemic (34). Thus, the data collected here suggest that the inaccurate beliefs held by large percentages of respondents had the potential to be detrimental to both them and the persons around them. ...
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Background: The current outbreak of COVID-19 coronavirus infection among humans in Wuhan (China) and its spreading around the globe is heavily impacting on the global health and mental health. Despite all resources employed to counteract the spreading of the virus, additional global strategies are needed to handle the related mental health issues. Methods: Published articles concerning mental health related to the COVID-19 outbreak and other previous global infections have been considered and reviewed. Comments: This outbreak is leading to additional health problems such as stress, anxiety, depressive symptoms, insomnia, denial, anger and fear globally. Collective concerns influence daily behaviors, economy, prevention strategies and decision-making from policy makers, health organizations and medical centers, which can weaken strategies of COVID-19 control and lead to more morbidity and mental health needs at global level.
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The December, 2019 coronavirus disease outbreak has seen many countries ask people who have potentially come into contact with the infection to isolate themselves at home or in a dedicated quarantine facility. Decisions on how to apply quarantine should be based on the best available evidence. We did a Review of the psychological impact of quarantine using three electronic databases. Of 3166 papers found, 24 are included in this Review. Most reviewed studies reported negative psychological effects including post-traumatic stress symptoms, confusion, and anger. Stressors included longer quarantine duration, infection fears, frustration, boredom, inadequate supplies, inadequate information, financial loss, and stigma. Some researchers have suggested long-lasting effects. In situations where quarantine is deemed necessary, officials should quarantine individuals for no longer than required, provide clear rationale for quarantine and information about protocols, and ensure sufficient supplies are provided. Appeals to altruism by reminding the public about the benefits of quarantine to wider society can be favourable.
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This paper investigates if and how overconfidence at the individual level changes over the course of a life. We provide age profiles of a novel continuous overconfidence measure and the probability of being overconfident, conditioning on personality traits (including the Big 5 and optimism), economic preferences, cognitive ability, and the individual’s socio-economic status. Our empirical work relies on representative panel data sets from Germany, and individuals’ both self-assessed and actual percentile in the monthly gross wage distribution are incorporated in our measure of overconfidence. We find that both the level of relative placement and the overplacement probability increase with age up to one's fifties.
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The motivational value of confidence postulates that individual effort provision is increasing in beliefs on one’s own ability. This relation is supposed to also hold for overconfident individuals who have exaggerated ability beliefs. We present the first empirical evidence on the existence of a motivational value of absolute confidence that many microeconomic models with overconfident agents build on. Moreover, we document that negative debiasing information on individual ability diminishes effort provision – a result that is of obvious relevance for many contexts such as labor relations or learning at school. We also offer a strategy for identifying significant absolute overconfidence at the individual level.
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Scientists Making a Difference is a fascinating collection of first-person narratives from the top psychological scientists of the modern era. These readable essays highlight the most important contributions to theory and research in psychological science, show how the greatest psychological scientists formulate and think about their work, and illustrate how their ideas develop over time. In particular, the authors address what they consider their most important scientific contribution, how they got the idea, how the idea matters for the world beyond academic psychology, and what they would like to see as the next steps in research. The contributors, who were chosen from an objectively compiled list of the most eminent psychological scientists, provide a broad range of insightful perspectives. This book is essential reading for students, researchers and professionals interested in learning about the development of the biggest ideas in modern psychological science, described firsthand by the scientists themselves.
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Due to its fast economic growth and lifestyle changes, China is experiencing a rapid epidemiological transition from communicable to noncommunicable diseases (NCDs). Mental disorder such as depression is an important yet often neglected NCD and is becoming a growing cause of disability, suicides, and disease burden. This paper provides the first nationally representative estimate of the medical cost attributable to depression and depressive symptoms among the adult population in China. On the basis of the 2012 China Family Panel Studies survey, our results indicate that these mental health conditions have significant impacts on the individual medical expenditure, and they jointly contribute to 14.7% of total personal expected medical spending in China, with depression and depressive symptoms accounting for 6.9% and 7.8%, respectively. Given that patients with mental illness face multiple psychological and institutional barriers in seeking appropriate treatment, the high depression-induced medical costs may be primarily driven by the cost-shifting effect from mental health care to general health care, as mental disorders often coexist with other NCDs such as diabetes and hypertension. As an implication, our study calls for an urgent reform of China's mental health and insurance systems to remove the policy-induced obstacles for the access to mental health care resources.
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Overconfidence has been studied in 3 distinct ways. Overestimation is thinking that you are better than you are. Overplacement is the exaggerated belief that you are better than others. Overprecision is the excessive faith that you know the truth. These 3 forms of overconfidence manifest themselves under different conditions, have different causes, and have widely varying consequences. It is a mistake to treat them as if they were the same or to assume that they have the same psychological origins.
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Comparing self-reports to administrative records, we find that survey respondents are significantly more likely to under-report mental illnesses compared to other health conditions. This behavior is consistent with the existence of stigma of mental illnesses. We show that stigma can play a role in determining health-seeking behavior.
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Economists have been concerned about issues of overconfidence at least since Adam Smith (1776, Book I, Chapter X), who wrote in The Wealth of Nations: “The over-weening conceit which the greater part of men have of their own abilities, is an ancient evil remarked by the philosophers and moralists of all ages.” Titans of modern economics have had similar reactions to the “ancient evil.” Daniel Kahneman recently told an interviewer that if he had a magic wand that could eliminate one human bias, he would do away with overconfidence. As Shariatmadari (2015) reports: “Not even he [Kahneman] believes that the various flaws that bedevil decision-making can be successfully corrected. The most damaging of these is overconfidence: the kind of optimism that leads governments to believe that wars are quickly winnable and capital projects will come in on budget despite statistics predicting exactly the opposite.” Kahneman argues that overconfidence “is built so deeply into the structure of the mind that you couldn’t change it without changing many other things.” Evidence concerning the prevalence of overconfidence is widespread and robust. Some of the results have even become fairly well-known in popular culture, like the findings that most drivers believe they are safer than a typical driver, or that
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Evidence from both psychology and economics indicates that individuals give statements that appear to overestimate their ability compared to that of others. We test three theories that predict such relative overconfidence. The first theory argues that overconfidence can be generated by Bayesian updating from a common prior and truthful statements if individuals do not know their true type. The second theory suggests that self-image concerns asymmetrically affect the choice to receive new information about one's abilities, and this asymmetry can produce overconfidence. The third theory is that overconfidence is induced by the desire to send positive signals to others about one's own skill; this suggests either a bias in judgement, strategic lying, or both. We formulate this theory precisely. Using a large data set of relative ability judgements about two cognitive tests, we reject the restrictions imposed by the Bayesian model and also reject a key prediction of the self-image models that individuals with optimistic beliefs will be less likely to search for further information about their skill because this information might shatter their self-image. We provide evidence that personality traits strongly affect relative ability judgements in a pattern that is consistent with the third theory of social signalling. Our results together suggest that overconfidence in statements is more likely to be induced by social concerns than by either of the other two factors.
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Self-assessed general health (SAH) is one of the most frequently employed health measures in social science research. Its generic nature means it captures elements of health that more guided measures cannot, and its brevity makes it possible for health information to be included in crowded multifaceted surveys. However, a shortcoming of SAH is that it provides little guidance to researchers as to what individuals are thinking of when they assess their health - when a survey respondent reports that their health is "poor", is it because they are in pain, tired, depressed, unable to climb stairs, or something else entirely? This limits the possible inference from empirical research. It also means that important determinants and consequences of health can be missed if they are only weakly reflected in SAH. Given the continued use of SAH, it is important to better understand its structure. In this paper we use household panel data from Australia to answer two related questions: (i) what components of health does SAH most strongly represent? and (ii) does the use of SAH conceal important health effects? To answer the first question, we use a detailed health instrument and take a rigorous econometric approach to identify the health dimensions most strongly reflected in SAH. To answer the second question, we estimate the causal effects of income on SAH and on disaggregated health measures using instrumental-variables models. We find that some health dimensions - especially vitality - are consistently important to an individual when they assess their health, while other dimensions are inconsequential. We demonstrate that this fact provides insight in to why some studies find weak income gradients in SAH. Instrumental-variable regression results show that shocks to household income have no effect on SAH, but strongly improve several dimensions of health that are less commonly measured.
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IN SOME APPLICATIONS of the general linear model, the usual assumptions of homoscedastic disturbances and fixed coefficients may be questioned. When these requirements are not met, the loss in efficiency in using ordinary least squares (OLS) may be substantial and, more importantly, the biases in estimated standard errors may lead to invalid inferences. This has caused a number of writers to propose models which relax these conditions and to devise estimators for their more general specifications, e.g., Goldfeld and Quandt (8) for heteroscedasticity and Hildreth and Houck (11) for random coefficients. However, because the effect of introducing random coefficient variation is to give the dependent variable a different variance at each observation, models with this feature can be considered as particular heteroscedastic formulations for the purpose of detecting departure from the standard linear model. A test for heteroscedasticity with the same asymptotic properties as the likelihood ratio test in standard situations, but which can be computed by two least squares regressions, thereby avoiding the iterative calculations necessary to obtain maximum likelihood estimates of the parameters in the full model, is considered in this paper. The approach is based on the Lagrangian multiplier
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I utilize data from the World Value Survey to construct individual confidence measures for a large crosssection of individuals from 12 countries and study how confidence relates to basic economic attitudes. I find that more confident individuals (i) are more risk-taking and entrepreneurial; (ii) exhibit positive attitude towards competition; (iii) participate in more networks; and (iv) are more actively involved in cooperative interactions. The economic impact of confidence varies significantly across cultures. I also show that confidence increases with income and education and deceases with age; men are more confident than women; and confident people exhibit higher level of happiness. The results provide insights into the nature of competitive behavior, the origin of cooperation, and the evolution of confidence.
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This article proposes a new method of obtaining identification in mismeasured regressor models, triangular systems, and simultaneous equation systems. The method may be used in applications where other sources of identification, such as instrumental variables or repeated measurements, are not available. Associated estimators take the form of two-stage least squares or generalized method of moments. Identification comes from a heteroscedastic covariance restriction that is shown to be a feature of many models of endogeneity or mismeasurement. Identification is also obtained for semiparametric partly linear models, and associated estimators are provided. Set identification bounds are derived for cases where point-identifying assumptions fail to hold. An empirical application estimating Engel curves is provided.
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The CES-D scale is a short self-report scale designed to measure depressive symptomatology in the general population. The items of the scale are symptoms associated with depression which have been used in previously validated longer scales. The new scale was tested in household interview surveys and in psychiatric settings. It was found to have very high internal consistency and adequate test- retest repeatability. Validity was established by pat terns of correlations with other self-report measures, by correlations with clinical ratings of depression, and by relationships with other variables which support its construct validity. Reliability, validity, and factor structure were similar across a wide variety of demographic characteristics in the general population samples tested. The scale should be a useful tool for epidemiologic studies of de pression.
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Background: This paper briefly outlines the work of economist Richard Layard and his proposed policy solutions to increase happiness within society. Layard's work is influencing policy and has particular relevance for mental health policy and service development. Aims: The focus of the paper lies in a critique of Layard's work in three areas. The first is that Layard's approach does little to tackle the structural inequalities within society, which are known to be prime indicators of mental ill health. The second critique is that Layard's proposals form a misguided attempt to use therapy as a way of compensating for a breakdown in community. The third and related critique is that Layard's proposals suggest a medicalization of social issues in ways that individualize social problems. The paper ends with a reflection upon broader questions not addressed within Layard's analysis. Conclusions: The paper concludes that Layard's proposal, though in many respects attractive, may have fundamental flaws and these are open to sociological analysis and critique.
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Positive illusions, though often beneficial (Taylor & Brown, 1988), can diminish the pleasure of outcomes. This prediction follows from decision affect theory. We investigated this prediction by measuring the confidence that recreational basketball players felt while making shots and the pleasure they felt with subsequent outcomes. Results showed that most players were overconfident. Those who were more overconfident tended to experience less enjoyment with their outcomes. Using individual parameter estimates from decision affect theory, we estimated how each player would have felt if their self assessments had been accurate. For the vast majority, better calibration would have led to greater pleasure. In a second study, we randomly assigned players to a debiasing treatment condition or a control condition. Relative to the control players, debiased players were better calibrated and derived greater average pleasure from the task. Copyright © 2004 John Wiley & Sons, Ltd.
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Decision makers have a strong tendency to consider problems as unique. They isolate the current choice from future opportunities and neglect the statistics of the past in evaluating current plans. Overly cautious attitudes to risk result from a failure to appreciate the effects of statistical aggregation in mitigating relative risk. Overly optimistic forecasts result from the adoption of an inside view of the problem, which anchors predictions on plans and scenarios. The conflicting biases are documented in psychological research. Possible implications for decision making in organizations are examined.
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There is increasing interest in the “economics of happiness”, reflected by the number of articles that are appearing in mainstream economics journals that consider subjective well-being (SWB) and its determinants. This paper provides a detailed review of this literature. It focuses on papers that have been published in economics journals since 1990, as well as some key reviews in psychology and important unpublished working papers. The evidence suggests that poor health, separation, unemployment and lack of social contact are all strongly negatively associated with SWB. However, the review highlights a range of problems in drawing firm conclusions about the causes of SWB; these include some contradictory evidence, concerns over the impact on the findings of potentially unobserved variables and the lack of certainty on the direction of causality. We should be able to address some of these problems as more panel data become available.