Fear Perception of the COVID-19 Pandemic in Peru

Abstract

Objective: To determine the fear perception according to factors associated with the COVID-19 pandemic in Peru. Methods: An analytical cross-sectional study was conducted based on a virtual questionnaire. The main question was "how much fear people had of COVID-19?", using a scale from zero (without fear) to 10 (very fear). This scale was divided into tertiles, and the upper tertile was the reference category (compared to the middle and lower tertiles). Statistical significances between fear perception of COVID-19 and sociodemographic data were calculated. Results: A total of 3887 participants responded the questionnaire about fear perception. In the multivariate analysis was found that women (adjusted prevalence ratio (aPR): 1.37; 95% confidence interval (CI) : 1.26-1.48; p<0.001), people aged 20-29 (aPR: 1.84; 95% CI: 1.06-1.50; p=0.005), 30-39 (aPR: 1.53; 95% CI : 1.28-1.82; p<0.001), 50-59 (aPR: 1.43; 95% CI: 1.12-1.84; p=0.005), and with 60 or more years (aPR: 1.46; 95% CI: 1.03-2.07; p=0.032), as well as respondents who had some risk for complications due to COVID-19 (aPR: 1.49; 95% CI: 1.32-1.69; p<0.001) were very afraid of the disease. On the other hand, people affiliated with evangelical religions (aPR: 0.79; 95% CI: 0.65-0.96; p=0.018), agnostics (aPR: 0.80; 95% CI: 0.68-0.94; p=0.008), atheists (aPR: 0.67; 95% CI: 0.48-0.95; p=0.024), and health professionals (aPR: 0.81; 95% CI: 0.70-0.93; p=0.003) were less afraid of COVID-19. Conclusion: There was a notorious fear perception of the COVID-19 pandemic by the Peruvian population. In this context, the fear was associated with important variables. Thus, the provision of further emotional support services for this population should be considered in the face of the current pandemic.

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Electronic Journal of General Medicine
2021, 18(3), em285
e-ISSN: 2516-3507
https://www.ejgm.co.uk/ Original Article OPEN ACCESS
Fear Perception of the COVID-19 Pandemic in Peru
Christian R. Mejia 1*, J. Franco Rodriguez-Alarcon 2,3, Jean J. Vera-Gonzales 4, Vania L. Ponce-Lopez 5,
Scherlli E. Chamorro-Espinoza 6, Alan Quispe-Sancho 7,8, Rahi K. Marticorena-Flores 6, Elizabeth S. Varela-Villanueva 6,
Paolo Pedersini 9, Marcos Roberto Tovani-Palone 10**
1 Universidad Continental, Lima, PERU
2 Asociación Médica de Investigación y Servicios en Salud, Lima, PERU
3 Facultad de Medicina Humana, Universidad Ricardo Palma, Lima, PERU
4 Universidad Nacional Federico Villarreal, Lima, PERU
5 Universidad Nacional de Cajamarca, Cajamarca, PERU
6 Universidad Nacional Hermilio Valdizán, Huánuco, PERU
7 Escuela Profesional de Medicina Humana, Universidad Nacional de San Antonio Abad del Cusco, Cusco, PERU
8 ASOCIEMH CUSCO Asociación Científica de Estudiantes de Medicina Humana del Cusco, Universidad Nacional de San Antonio Abad del Cusco, Cusco, PE RU
9 IRCCS Fondazione Don Carlo Gnocchi, Milan, ITALY
10 Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, BRAZIL
*Corresponding Author: christian.mejia.md@gmail.com
**Corresponding Author: marcos_palone@hotmail.com
Citation: Mejia CR, Rodriguez-Alarcon JF, Vera-Gonzales JJ, Ponce-Lopez VL, Chamorro-Espinoza SE, Quispe-Sancho A, Marticorena-Flores RK,
Varela-Villanueva ES, Pedersini P, Tovani-Palone MR. Fear Perception of the COVID-19 Pandemic in Peru. Electron J Gen Med. 2021;18(3):em285.
https://doi.org/10.29333/ejgm/9764
ARTICLE INFO
ABSTRACT
Received: 10 Dec. 2020
Accepted:
27 Jan. 2021
Introduction: Fear is a natural response to something unknown. In the current scenario, it is important to assess
it
in relation to the coronavirus disease-19 (COVID-19) pandemic in Latin American countries.
Objective:
To determine the fear perception according to factors associated with the COVID-19 pandemic in
Peru.
Methods:
An analytical cross-sectional study was conducted based on a virtual questionnaire. The main
question
was
“how much fear people had of COVID-19?”, using a scale from zero (without fear) to 10 (very fear). This
scale
was
divided into tertiles, and the upper tertile was the reference category (compared to the middle and
lower
tertiles).
Statistical significances between fear perception of COVID-19 and sociodemographic data
were
calculated.
Results:
A total of 3887 participants responded the questionnaire about fear perception. In the
multivariate
analysis
was found that women (adjusted prevalence ratio (aPR): 1.37; 95% confidence interval (CI) : 1.26-
1.48;
p<0.001),
people aged 20-29 (aPR: 1.84; 95% CI: 1.06-1.50; p=0.005), 30-39 (aPR: 1.53; 95% CI : 1.28-1.82;
p<0.001),
50
-59 (aPR: 1.43; 95% CI: 1.12-1.84; p=0.005), and with 60 or more years (aPR: 1.46; 95% CI: 1.03-2.07; p=0.032),
as
well
as respondents who had some risk for complications due to COVID-19 (aPR: 1.49; 95% CI: 1.32-1.69;
p<0.001)
were
very afraid of the disease. On the other hand, people affiliated with evangelical religions (aPR: 0.79; 95%
CI:
0.65
-0.96; p=0.018), agnostics (aPR: 0.80; 95% CI: 0.68-0.94; p=0.008), atheists (aPR: 0.67; 95% CI: 0.48-
0.95;
p=0.024),
and health professionals (aPR: 0.81; 95% CI: 0.70-0.93; p=0.003) were less afraid of COVID-19.
Conclusion:
There was a notorious fear perception of the COVID-19 pandemic by the Peruvian population. In
this
context,
the fear was associated with important variables. Thus, the provision of further emotional
support
services
for this population should be considered in the face of the current pandemic.
Keywords: fear, perception, COVID-19, pandemic, Peru
INTRODUCTION
Coronavirus disease-19 (COVID-19) has generated a
pandemic that has affected almost all countries in the world,
being declared a global health emergency [1,2]. This pandemic
has had a great impact on the society, as well as it has tested
the capacity of the best health systems, including those of
France (1st), Italy (2rd), and Spain (7th) [3]. Regarding the
situation in Latin America, Brazil, Colombia, and Peru are the
countries with the highest number of affected people,
respectively. Peru currently ranks sixth among the countries
with the largest number of confirmed cases of COVID-19 cases
in the world, accounting for more than 800,000 cases of the
disease and 32,000 deaths [4].
The current scenario has created several economic and
political problems [5], which together with the spread of the
disease may cause great fear in the population. In this context,
it is worth mentioning that in the last 30 years at least 30
infectious diseases have appeared, with different etiologies
and forms of transmission [6]. Among these diseases, we
highlight the novel 2009 influenza A (H1N1) (2009), severe acute
respiratory syndrome (SARS) (2002), and Middle East
respiratory syndrome (MERS) (2012) [7]; however, the situation
due to COVID-19 has been more catastrophic than in all of them
[8].

2 / 6 Mejia et al. / ELECTRON J GEN MED, 2021;18(3):em285
The emergence of fear has been reported in serious
epidemic, such as Ebola, period when the population was so
anxious to the point of people accepting to use unauthorized
or experimental drugs [9]. On the other hand, it is worth
remembering that the same did not happen in the H1N1 post-
pandemic period, in which restrictive measures were
accomplished only by people with respiratory diseases or
chronic diseases that affect the immune system while the rest
of the population did not fully comply with these
recommendations and did not even perceive risks of
transmission to their family members [10].
At present, the COVID-19 emergency is leading to serious
health problems, including stress, anxiety, depressive
symptoms, and fear [11,12]. Mental health issue during the
pandemic has been addressed by several studies with the main
objective of verifying the impact on people’s emotional state in
order to prepare appropriate interventions [13-15]. To
understand the psychological and psychiatric impacts of a
pandemic, the emotions involved in it, such as fear, must be
considered and observed [16]. For all these reasons, it should
be important to measure the fear generated by this pandemic
in the population. Therefore, the objective of this research
study is to determine the fear perception according to factors
associated with the COVID-19 pandemic in Peru.
METHODS
Study Design
This is an analytical and multicenter cross-sectional study
conducted in 20 cities of 17 departments in Peru: Arequipa,
Ayacucho, Cajamarca, Cerro de Pasco, Chiclayo, Chimbote,
Cusco, Huancayo, Huánuco, Ica, Iquitos, Lima, Piura, Pucallpa,
Puno, Tacna, and Trujillo. It should be noted that they
correspond to the largest and most important cities and
departments in the country. Thus, this investigation included a
wide sample, which represents different characteristics of the
Peruvian population.
Population and Sample
In this research, we include people residing in some of the
cities mentioned above, who showed interest in participating
in the study and who had or not comorbidities related to
complications of COVID-19 (such as, being elderly, cancer
patient, or with any hypertensive disease). A total of 596
participants were excluded from the study, given that they did
not answer the main question (about fear perception), or they
had different nationality and/or were minors.
The type of sampling was non-probabilistic aiming to
maintain the homogeneity in each of the locations of the study.
An initial calculation of a minimum of 2867 respondents was
performed to find a minimum percentage difference of 4%
(48% versus 52%), with a confidence level of 95%, power of
99%, for a single sample (depending on the chosen design).
Variables and Assessment Tools
The main variable of the study was the fear perceived by
the participants related to COVID-19, which was obtained in a
quantitative form, using a scale from zero (indicating “not
afraid”) to 10 (indicating “very afraid”). After completion of
data collection, the studied population was divided into
tertiles according to the obtained scores (Tertile of least fear
perception - composed by people who had a score of 0-3 points
in the questionnaire; Middle tertile- composed by people who
had a score of 4-5 points; Tertile of highest fear perception-
composed by people who had a score of 6-10 points). The
variable was also dichotomized into two categories: with a lot
of fear (6-10 points) or with little fear (0-5 points).
The considered sociodemographic data were gender (male
or female), degree of education (up to secondary education or
technical/higher education), age (18-19 years, 20-29 years, 30-
39 years, 40-49 years, 50-59 years, and 60 years or older),
religion (catholic, evangelical, christian, adventist, Jehovah’
switness, latter-days, mormon, buddhist, other religions,
agnostics, and atheists), the city of respondents (according to
the cities previously mentioned), and type of respondent
(without risk of complications due to COVID-19 - without
comorbodities, with risk of complications due to COVID-19,
healthcare staff, and healthcare staff considered at risk).
Procedures and Ethics
An electronic version of the questionnaire was sent to the
participants through creation of a form using Google Drive.
After that, we performed a quality control of the data and those
that did not meet the selection criteria were excluded.
Thereafter, the data were encoded and tabulated in a Microsoft
Excel spreadsheet (Microsoft, Redmond, CA, USA). A second
filtering of the information and the quality control for each
study site were also performed using the spreadsheet. After
that, the data was exported to the STATA version 11.1
(StataCorp, College Station, TX). Research ethics were carefully
considered, and ethical approval was granted before data
collection. Moreover, all respondents were previously
informed about the purpose and the objectives of the research
and their participation was voluntary for the study.
Data Analysis
A table of frequencies and percentages of the crossing
between the three levels of fear intensity and the other
variables were created. In this case, statistical significances
were calculated with Chi-square test. Tables of the bivariate
and multivariate models were constructed using generalized
linear models, with the Poisson distribution and a logarithmic
link function, and models for robust variance adjusted
according to the city of respondents. Crude and adjusted
prevalence ratios (aPR), 95% confidence interval (CI), and p-
values (statistical significance p <0.05) were calculated.
RESULTS
A total of 3887 participants were divided into tertiles
according to their perceived fear. 1275 (32.8%) had little fear,
1277 (32.8%) had moderate fear, and 1335 (34.4%) a lot of fear.
When these 3 groups were compared by variables, we found
that there were statistically significant differences by sex
(p<0.001), age categorized (p<0.001), religion (p<0.001), and
respondent type (p<0.001) (Table 1).
In the bivariate analysis, we found that women (p<0.001),
participants aged 20-29 (p-0.018), 30-39 (p<0.001), 40-49
(p=0.018) 50-59 (p<0.001), 60 years or older (p=0.001), and
respondents with some risk for complications (p<0.001) were
very afraid of COVID-19. In contrast, participants of the
evangelical religions (p=0.006), agnostics (p=0.001), atheists
(p=0.006), buddhists (p=0.042), people from other religions
(p=0.041), and health personnel (p=0.032) were less afraid
(Table 2).

Mejia et al. / ELECTRON J GEN MED, 2021;18(3):em285 3 / 6
Table 1.
Fear perception according to socio-educational characteristics before the COVID-19 pandemic in Peru
Variables
Fear perception
p-value
Little
Moderate
A lot
Sex
Male
688 (40.1%)
543 (31.7%)
484 (28.2%)
<0.001
Female
575 (26.7%)
730 (33.9%)
848 (39.4%)
Education level
Technical or university
1048 (32.6%)
1054 (32.8%)
1114 (34.6%)
0.867
Up to secondary level
212 (33.2%)
212 (33.2%)
214 (33.6%)
Age categorized
18-19 years old
202 (34.6%)
223 (38.3%)
158 (27.1%)
<0.001
20-29 years old
819 (33.4%)
805 (32.9%)
825 (33.7%)
30-39 years old
118 (31.1%)
105 (27.7%)
156 (41.2%)
40-49 years old
59 (29.8%)
69 (34.9%)
70 (35.3%)
50-59 years old
37 (23.0%)
54 (33.5%)
70 (43.5%)
60 years or older
27 (30.0%)
14 (15.6%)
49 (54.4%)
Religion
Catholic
741 (28.9%)
860 (33.5%)
964 (37.6%)
<0.001
Evangelist
165 (35.7%)
161 (34.9%)
136 (29.4%)
Agnostics
154 (43.1%)
108 (30.3%)
95 (26.6%)
Atheists
91 (48.4%)
53 (28.2%)
44 (23.4%)
Christian
28 (38.4%)
25 (34.2%)
20 (27.4%)
Adventist
15 (30.0%)
22 (44.0%)
13 (26.0%)
Jehovah’s witness
1 (16.7%)
1 (16.7%)
4 (66.6%)
Latter-days
9 (37.5%)
4 (16.7%)
11 (45.8%)
Mormon
7 (36.8%)
4 (21.1%)
8 (42.1%)
Buddhist
6 (50.0%)
5 (41.7%)
1 (8.3%)
Another
33 (44.0%)
20 (26.7%)
22 (29.3%)
Type of respondent
No risk
876 (32.5%)
898 (33.3%)
925 (34.3%)
<0.001
At risk
51 (20.1%)
65 (25.6%)
138 (54.3%)
Healthcare personnel
324 (37.0%)
295 (33.7%)
256 (29.3%)
More health risks
7 (41.2%)
5 (29.4%)
5 (29.4%)
Note:
p-values were obtained with Chi-square test
Table 2. Bivariate analysis of the factors associated with being very afraid of the COVID-19 pandemic in Peru
Variables
Prevalence ratio
95% Confidence intervals
p-values
Female
1.39
1.28-1.51
<0.001
Primary or secondary education
0.97
0.84-1.14
0.797
Age categorized
18-19 years old
Comparison category
20-29 years old
1.24
1.04-1.47
0.018
30-39 years old
1.52
1.27-1.81
<0.001
40-49 years old
1.32
1.06-1.65
0.014
50-59 years old
1.61
1.25-2.06
<0.001
60 years or older
1.98
1.98-3.01
0.001
Religion
Catholic
Comparison category
Evangelist
0.77
0.64-0.93
0.006
Agnostics
0.71
0.58-0.87
0.001
Atheists
0.62
0.44-0.88
0.006
Christian
0.74
0.49-1.10
0.138
Adventist
0.70
0.39-1.26
0.239
Jehovah’s witness
1.59
0.69-3.68
0.278
Latter-days
1.22
0.82-1.80
0.327
Mormon
1.18
0.82-1.70
0.397
Buddhist
0.22
0.05-0.95
0.042
Another
0.74
0.55-0.99
0.041
Type of respondent
No risk
Comparison category
At risk
1.60
1.36-1.89
<0.001
Health personnel
0.85
0.74-0.99
0.032
More health risks
0.86
0.45-1.62
0.632
The
dependent variable is the perceived fear of the COVID-19 pandemic. This variable was crossed with other variables using generalized
linear
models (with the Poisson distribution and a logarithmic link function, and models for robust variance adjusted according to the city of respondents)

4 / 6 Mejia et al. / ELECTRON J GEN MED, 2021;18(3):em285
In the multivariate analysis, we found that women (aPR:
1.37; 95% CI: 1.26-1.48; p<0.001), participants aged 20-29 (aPR:
1.26; 95% CI: 1.06-1.50; p=0.008), 30-39 (aPR: 1.53; 95% CI: 1.28-
1.82; p<0.001), 50-59 years old (aPR: 1.43; 95% CI: 1.12-1.84;
p=0.005), with 60 years or older (aPR: 1.46; 95% CI: 1.03-2.07;
p=0.032), and respondents with some risk for complications
(aPR: 1.49; 95% CI: 1.32-1.69; p<0.001) were very afraid of
COVID-19. On the other hand, evangelical participants (aPR:
0.79; CI 95%: 0.65-0.96; p=0.018), agnostics (aPR: 0.80; 95% CI:
0.68-0.94; p=0.008), atheists (aPR: 0.67; 95% CI: 0.48-0.95;
p=0.024), and healthcare personnel (aPR: 0.81; 95% CI: 0.70-
0.93; p=0.003) were less afraid (Table 3).
DISCUSSION
This cross-sectional study analyzed the association
between fear perception of COVID-19 and the
sociodemographic data in the Peruvian population. The
multivariate analysis showed that women, people aged 20-29,
30-39, 50-59 years, and respondents who had some risk for
complications due to COVID-19 had much fear of the disease.
On the other hand, people affiliated with evangelical religions,
agnostics, atheists, and healthcare personnel had little fear.
In our study, the fact that women were the most fearful of
the COVID-19 pandemic could be explained taking in account
that women present greater subjective distress related to a
public health crisis [17]. Furthermore, in most households,
women are the ones who care most for others [18], which may
become more evident in the context of the pandemic due to
increasing fear. According to the Economic Commission for
Latin America and the Caribbean (ECLAC), women do their
housework and care for others independently of remuneration
[19].
Another relevant point in the present study is that three of
the older age groups had increased fear, including young
adults, mature adults, and older adults compared to the group
of younger participants (18-19 years). Indeed, it was found in a
global research that the older the age, the greater is the risk of
mortality, complications, and poor prognosis related to COVID-
19, which would explain the increased fear in these age groups
[20-23]. So it is important to provide emotional support to
people who are older, prioritizing older adults and those with
some other risk factor, whether physical or mental; because if
these groups do not know how to manage their fears, they
could not only have thoughts about death, but they can also
perform “bad” acts out of fear [24].
We also found that catholics, evangelicals, agnostics, and
atheists were less afraid of COVID-19. In this sense, it is worth
noting that some religions, such as Christianity, have very
dogmatic views, which associate life after death with the moral
actions of human beings and the going of the soul to a place of
reward or punishment [25]. A study carried out on anxiety in the
face of death, concern about the time and fear associated with
suffering from an illness, established that having religious
beliefs and thinking about life after death generated greater
anxiety [26].
Moreover, we observed that respondents with some risk for
complications due to COVID-19 were more afraid in the face of
government measures during the quarantine period, which
coincides with what was reported in a study that included 1210
respondents from 194 cities in China. In this Chinese study was
found that history of chronic diseases was significantly
associated with higher scores in the Impact of Event Scale -
Revised (IES-R), and in the DASS subscale regarding stress,
Table 3.
Multivariate analysis of the factors associated with being very afraid of the COVID-19 pandemic in Peru
Variables
Prevalence ratio
95% Confidence intervals
p-values
Female
1.37
1.26-1.48
<0.001
Primary or secondary education
0.96
0.83-1.09
0.492
Age categorized
18-19 years old
Comparison category
20-29 years old
1.26
1.06-1.50
0.008
30-39 years old
1.53
1.28-1.82
<0.001
40-49 years old
1.22
0.96-1.54
0.097
50-59 years old
1.43
1.12-1.84
0.005
60 years or older
1.46
1.03-2.07
0.032
Religion
Catholic
Comparison category
Evangelist
0.79
0.65-0.96
0.018
Agnostics
0.80
0.68-0.94
0.008
Atheists
0.67
0.48-0.95
0.024
Christian
0.77
0.53-1.11
0.160
Adventist
0.70
0.42-1.16
0.162
Jehovah’s Witness
1.89
0.91-3.92
0.089
Latter-days
1.23
0.83-1.81
0.302
Mormon
1.19
0.87-1.64
0.283
Buddhist
0.25
0.05-1.13
0.071
Another
0.81
0.61-1.08
0.159
Type of respondent
No risk
Comparison category
At risk
1.49
1.32-1.69
<0.001
Healthcare personnel
0.81
0.70-0.93
0.003
More health risks
0.75
0.38-1.47
0.397
The
dependent variable is the perceived fear of the COVID-19 pandemic. This variable was crossed with other variables using generalized
linear
models
(with the Poisson distribution and a logarithmic link function, and models for robust variance adjusted according to the city
of
respondents)

Mejia et al. / ELECTRON J GEN MED, 2021;18(3):em285 5 / 6
anxiety, and depression [17]. Another study involving older
adults from Mexico, a direct association was found between
presence of comorbidities (cancer, systemic arterial
hypertension, diabetes, hypercholesterolemia, depression,
cerebral infarction, and cardiovascular disease) and positive
self-rated health, while there was indirect association between
presence of comorbidities and depressive symptoms [27].
Complementary to this, the results of a research that included
patients diagnosed with type 2 diabetes mellitus from the
Jonuta Community Hospital, in the Tabasco state, showed that
68.6% of the assessed patients had mild anxiety and 14.3%
moderate anxiety, and a greater tendency towards depression
was observed in those who experienced more anxiety [28]. In
this sense, the creation of psychosocial support programs for
people with comorbidities should be of paramount importance
given that many of them may have better knowledge about
COVID-19 and its complications, which could result in mental
health disorders, putting them at greater risk.
In our study, it is also important to highlight the finding that
healthcare personnel were less afraid of COVID-19; however
this does not always occur similarly in different professional
categories. In a cross-sectional study involving health workers
from the Hospital of King Khalid University in Saudi Arabia was
found that the mean anxiety score regarding MERS-CoV was
similar for physicians as well as for other health workers;
however, non-physicians expressed higher levels of anxiety
toward the risk of transmitting MERS-CoV to their families [29].
Although the results obtained in this research are
interesting, they may have been influenced by the fact that
when the survey was carried out, there were not so many
confirmed cases of infection or complication due to COVID-19
in Peru. In addition, there should be other important variables
that may influence the fear of people related to coping with the
pandemic, such as knowledge about the subject matter and
perception of protective measures. This is also very important
to be studied in health professionals from Peru.
Furthermore, the present study had the limitation of not
being able to infer/extrapolate the results to the entire
population of Peru, since a multi-stage sampling would be
necessary to accomplish this objective. We cannot achieve this
objective due to the fact that Peru was under quarantine and
curfew at the time of the online surveys, as well as with traffic
restriction and closing of important institutions. However, the
findings of this study are quite relevant, given that they
correspond to primary results of an investigation conducted
during the COVID-19 containment period, which corresponds
to the first report of fear perception of thousands of Peruvians
in relation to COVID-19. Despite this, the importance of further
research is stressed, with more population, variables, and
logistics.
CONCLUSION
Based on our findings, we conclude that there is an
important fear perception related to the COVID-19 pandemic
by the Peruvian population. The fear was associated with
female sex, older age groups, some religious groups, people
with some risk for complications, and healthcare professionals.
We think that our results in the Peruvian population may open
up new perspectives in order to investigate disorders related to
mental health, such as depression, stress, and anxiety due to
the current pandemic.
Author contributions: All authors have sufficiently contributed to the
study, and agreed with the results and conclusions.
Funding: N o funding source is reported for this study.
Declaration of interest: No conflict of interest is declared by authors.
Acknowledgements: We thank the COVID-19-GIS-Peru research group
to be able to spread the survey in the most important cities throughout
the national territory.
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