Multilevel Determinants of COVID-19 Fear in South Korea: Examining the Interplay of Individual and Community-Level...

The global COVID-19 pandemic caused substantial psychological burden, resulting in a 25% increase in the prevalence of anxiety and depressive disorders worldwide. This study examined factors associated with the multifaceted fear of COVID-19 among South Korean adults, providing crucial insights for culturally tailored public health interventions. We utilized a cross-sectional secondary data analysis from the 2022 Korea Community Health Survey (n = 228,470) and the Korean Statistical Information Service. Using multilevel linear regression, we evaluated three pre-specified primary community-level hypotheses: the proportion of one-person households, the density of internal medicine clinics by jurisdiction, and unmet healthcare needs. Results revealed that a higher proportion of one-person households correlated with increased fear, while a greater density of internal medicine clinics by jurisdiction was linked to reduced fear. To estimate these community-level associations, we adjusted for individual-level covariates. Exploratory analyses of these covariates suggested that factors such as female sex, older age, higher education, living with a spouse, economic activity, and better self-rated health were associated with heightened COVID-19 fear. These findings emphasize the need for culturally sensitive mental health support, community-based initiatives, and strategic healthcare resource allocation in Asian communities to strengthen resilience during future health crises.