How Did Leisure Attitudes and Behavior Affect Mental Disorder during the Pandemic? Comparison of the Current Status and Temporal Change

Ⅰ. Introduction

During the COVID-19 pandemic, governments implemented many non-pharmaceutical interventions, such as social distancing, lockdowns, and border closures. While these measures effectively prevented the spread of the virus (Kim et al., 2022), they were also associated with mental health problems such as depression and anxiety (Cao et al., 2022). Indeed, prolonged restrictive measures can affect mental health and risk perceptions (Bodas and Peleg, 2021; WHO, 2020).

Many policymakers have highlighted the importance of leisure activities in promoting mental health recovery and addressing the aftermath of the COVID-19 pandemic. As leisure activities positively impact physical, social, emotional, and cognitive well-being (Caldwell, 2005; Weng and Chiang, 2014), the World Health Organization (WHO) recommends regularly engaging in leisure activities to maintain mental and physical health.

Several studies (e.g., Takiguchi et al., 2023; Yurcu, 2021) have focused on the relationship between leisure activities and mental health during the pandemic. However, these studies have tended to analyze leisure attitudes at specific points in time. It is essential to consider the impact of changes in leisure attitudes on mental health, mainly since risk perceptions related to infectious diseases may decrease as the pandemic continues (Kim et al., 2022). Therefore, this study measures leisure attitudes at two points in time This is done through multiple surveys conducted with a time lag on mental health that consider the impact of attitude changes. For mental health problems like depression, examining the overall changes in leisure attitudes and behaviors during the pandemic is crucial rather than analyzing attitudes and behaviors at a single point in time.

Leisure attitudes are a crucial determinant of leisure activity engagement, which can alleviate depression and stress. Previous research (e.g., Choi and Yoo, 2017; Kim et al., 2015; Ragheb, 1980; Takiguchi et al., 2023) has demonstrated that a positive leisure attitude increases participation in leisure activities, positively affecting mental health. Therefore, it is crucial to analyze the relationship between changes in leisure attitudes and behaviors during the pandemic to understand the impact of leisure activities on depression and anxiety created by the pandemic, commonly called COVID-19 blues.

This study focuses on leisure attitudes and their changes over one year during the COVID-19 pandemic. Notably, we aim to examine the relationship between mental health and leisure attitudes (and attitude changes) during the COVID-19 pandemic, considering the differences between the peak and a year after the peak by examining changes over time.

Due to COVID-19 trends and government responses, it is essential to analyze changes in leisure attitudes over time, including changes in attitudes and behaviors at a single point in time and compared to the pre-pandemic era. As the pandemic continues, individuals' risk perceptions and attitudes toward the importance of leisure activities may change, directly influencing their behaviors.

According to the concept of anchoring dependence in behavioral economics, even if individuals hold the same attitude at a given moment-whether someone who was previously negative becomes positive or someone who was positive becomes negative-their behaviors and levels of depression can differ significantly.

Therefore, relying solely on changes measured at a single point in time makes it challenging to accurately assess the pandemic's impact. An analysis that includes changes relative to the past is essential for a more nuanced understanding of the current situation and will play a crucial role in elucidating the effects of changes in leisure attitudes and behaviors on mental health.

Additionally, this study aims to investigate how current behavior and changes in behavior mediate the relationship between attitudes and mental health. We examine the direct effect of attitudes and attitude changes on depression and the indirect impact of behaviors and behavior changes mediated by attitudes based on the Theory of Planned Behavior (Ajzen, 1985). Since attitudes directly impact depression, we assume an incomplete mediation structure rather than a complete one.

To achieve this goal, we conducted our analysis using PLS-SEM (Partial Least Squares Structural Equation Modelling) based on data from the same sample (n=287) that responded to two surveys. The first survey was conducted during the initial peak of the COVID-19 pandemic in Seoul, Korea, and the second survey was conducted one year later. PLS-SEM addresses the potential correlations over time between variables. Furthermore, this flexible model allows us to estimate direct and indirect relationships between variables.

The structure of this study is as follows. In the literature review, we review related studies to examine (1) the changes in leisure attitudes during the pandemic, (2) the relationship between leisure attitudes and behaviors, and (3) the relationships between leisure attitudes, behaviors, and mental health. The methodology section describes the conceptual framework, data collection process, and analysis methodology. We then investigate leisure attitudes and changes in attitudes. Additionally, we analyze the mediating effect of leisure behaviors and changes in behaviors between attitude and mental health using PLS-SEM. Finally, we present and discuss our findings and their implications in the discussion section.

Ⅱ. Literature Review

Ⅲ. Methodology

1. Conceptual Framework

Existing literature has established a significant relationship between attitudes, behaviors, and mental health, highlighting the interplay between these variables in various contexts. Research by Ajzen and Driver (1992) and Beville et al. (2014) emphasizes that attitudes serve as crucial determinants of behavior, suggesting that individuals' perceptions and feelings towards leisure can significantly influence their engagement in leisure activities.

Furthermore, studies such as those by Craik and Pieris (2006) and Passmore (2003) have demonstrated that behaviors, particularly leisure activities, can have profound effects on mental health outcomes, illustrating the potential for positive leisure engagement to alleviate symptoms of depression and anxiety.

Additionally, the connections between attitudes and mental health have been underscored in works by Choi and Yoo (2017), Ragheb (1980), and Takiguchi et al. (2023), which reveal that positive leisure attitudes are linked to better mental health.

Based on these existing studies, the research model presented in <Figure 1> is proposed to explore the relationship between leisure attitudes, behaviors, and mental health in the context of the pandemic.

Figure 1.

Proposed research model

The proposed model assumes the following: (1) Urban residents' current leisure attitudes and attitude changes after the COVID-19 outbreak can explain leisure behavior, behavioral changes, and mental health. If this can be explained, we will explore which variables (current attitude or attitude change) have a stronger effect or an opposing effect. (2) We will examine whether current behavior and behavior changes mediate the relationship between leisure attitudes (both current attitude and attitude changes) and mental health.

Therefore, the research hypotheses are as follows:

Hypothesis 1: Current leisure attitudes and attitude changes significantly influence current behavior, behavioral changes, and mental health.

Hypothesis 2: Current leisure behavior and behavior changes mediate the relationship between leisure attitudes and mental health.

2. Data and Measures

The primary data¹⁾ for this study were collected through two online surveys targeting residents aged 20 and older. The surveys were carried out by a specialized research institute (http://www.entrustsurvey.com/) during two distinct periods-first, at the peak of the COVID-19 pandemic in Korea, and second, one year later-to assess changes in people's leisuire attitudes and behaviors over time.

The first survey was conducted from September 23 to October 7, 2020, and involved 534 participants. The second survey was conducted from October 8 to October 26, 2021, revisited the same sample. Of the 534 participants in the first survey, 287 responded to the second survey, resulting in a final sample of 287 participants used for analysis.

The survey adopted a quota sampling technique which classified participants based on gender and age to minimize potential bias. This approach was guided by prior research on infectious diseases (Bawazir et al., 2018; Jang and Baek, 2019). In quota sampling, the overall sample is divided into predefined categories, and participants are selected within each category to ensure representativeness.

To further reduce systematic error, the age criterion was set to include only individuals aged 20 and older. This decision excluded younger individuals, given that adults often exert considerable influence over the outdoor activities and travel decisions of minors.

<Table 1> shows the demographic characteristics of the participants. The sample consisted of individuals in their 20s (17.5%), 30s (34.8%), 40s (35.9%), 50s and over (11.8%). Gender distribution in the sample included 140 males (48.7%) and 147 females (51.3%).

Table 1.

Demographic characteristics

This study applied a total of 49 measurement variables, including 16 variables for current attitudes and attitude changes related to leisure, 16 variables for current behaviors and behavior changes, 12 variables for mental health, and 5 variables for demographic characteristics.

We selected eight major places where urban residents enjoy leisure activities (entertainment facilities, shopping centers, restaurants/cafes, etc.) as exogenous variables based on previous studies (e.g., Bayarsaikhan et al., 2021). A leisure attitude refers to negative or positive thoughts and preferences about using leisure facilities. Leisure attitudes determined people's selection of urban leisure activities after COVID-19 and were measured on a Likert-type 11-point scale (-5: negative thoughts; +5: positive thoughts). In addition, two variables were used to measure leisure attitudes: the current attitudes and attitude change. Here, the attitude change variable was generated by calculating the value of the second survey leisure attitude (min: -5; max: +5) minus the first survey measurement value (min: -10; max: +10).

We used endogenous variables such as leisure behavior and mental health variables. Leisure behavior refers to the frequency of using various leisure facilities for leisure activities following the COVID-19 pandemic. It was measured on an 11-point Likert-type scale (-5: less used, +5: more used). Behavioral changes for leisure facilities were calculated similarly to the attitude change variable: the current behavior measurement value (min:-5; max:+5) from the second survey was subtracted from the value of the first survey (min:-10; max: +10).

Mental health refers to the depression, anxiety, and stress caused by COVID-19. This variable was measured using a Likert-type 4-point scale (0: not disturbed; 3: almost daily disturbed). Mental health was measured by assessing the level of depression, anxiety, and stress after the outbreak of the COVID-19 pandemic using the PHQ-9 scale (Patient Health Questionaire-9). PHQ-9 is a depression diagnostic tool designed based on PRIME-MD (Primary Care Evaluation of Mental Disorders), a treatment guideline and diagnostic tool for mental health diagnosis (Spitzer, et al., 1999). It has been widely used in academic research, policy-making, and medical diagnosis and has recently been applied to the COVID-19 pandemic (Ju et al., 2023; Verma, 2020). Finally, the proposed model included five personal characteristic factors as control variables: gender, age, education, income, and marital status.

This study utilized inferential statistics on a sample categorized by demographic characteristics, specifically age, and gender, through a non-probabilistic quota sampling method. While descriptive statistics focus on sample representativeness, inferential statistics prioritize the adequacy of variation within the data. <Table 2> shows the descriptive statistics of the measured variables, confirming that all variance values are sufficient for inferential analysis.

Table 2.

Descriptive statistics

Ⅳ. Results

1) Assessment of the structural model: The results of our proposed model assessment are presented in <Table 3>. We found no problems with multicollinearity in the structural model, with outer VIF ranging from 1.000 to 3.881 and inner VIF ranging from 1.000 to 3.025 (<5) (see Appendix). Furthermore, we examined the explanatory power of the structural model using R-Square values. All R² values were higher than the 0.10 level proposed by Falk and Miller (1992) (ATT: 0.307; MH = 0.107; BH1 = 0.679; BH2 = 0.124; and ATT1 = 0.483, respectively).

Table 3.

PLS-SEM results

We also used the Normed Fit Index (NFI) (Bentler and Bonnett, 1980) and the standardized Root Mean Square Residuals (SRMR) (Hu and Bentler, 1999) to assess the structural model fit. The value of NFI should be more than 0.08. In the case of exploratory research, over 0.50 is considered a good fit (Henseler et al., 2016; Raza et al., 2020). The NFI value of our proposed model is 0.558, which is an acceptable level. Furthermore, the standardized root mean square ratio (SRMR) should be less than 0.08 or 0.10 (Hair et al., 2017; Domínguez-Quintero et al., 2020). The SRMR value of the proposed model is 0.086, so it is considered acceptable. <Table 2>, <Figure 2> presents the results of the path coefficients between the variables in the proposed model.

Figure 2.

Results of the pls-sem model

2) Attitude-behavior: The findings reveal that leisure attitude significantly impacts leisure behavior. Specifically, the current leisure attitude (ATT1) positively influenced both current behavior (BH1) (β= 0.318, p<0.01) and behavior change (BH2) (0.214, p<0.01). Meanwhile, when attitude change (ATT2) was more positive than current attitude, current behavior was negative (-0.272, p<0.01), and behavior change (BH2) was not significant. Furthermore, attitude change (ATT2) was positively associated with current attitude (ATT1) (0.671, p<0.01), and similarly, behavior change (BH2) was positively related to current behavior (BH1) (0.753, p<0.01).

3) Attitude-mental health; behavior-mental health: Our findings indicated that leisure attitude and leisure behavior significantly influence mental health. Specifically, current leisure attitude had a negative effect on mental health (-0.134, p<0.1), but improved attitude change (ATT2) had a positive (0.155, p<0.1) relationship with mental health. Therefore, the effects of these two factors on mental health differ: declining current attitudes increase mental health issues, but an improvement in attitude can improve mental health.

Furthermore, the association between leisure behavior and mental health varied based on current behavior and behavior change. Specifically, current behavior (BH1) positively influenced mental health (0.363, p<0.01), while no significant relationship was found between behavior change (BH2) and mental health. These results suggest that individuals who frequently use leisure facilities had increased mental health issues, such as anxiety and stress; however, this did not depend on change of leisure attitudes.

4) Attitude-behavior-mental health: The results indicate a significant association between leisure attitude, behavior, and mental health. Specifically, current attitude (ATT1) had a negative direct effect (-0.134) on mental health (MH). However, when current behavior (BH1) was applied as a mediator, current attitude had a positive indirect effect (0.115) on mental health (MH). Conversely, attitude change (ATT2) had a positive impact (0.155) on mental health (MH), but the path to mental health (MH) through behavior (BH1) was found to have a negative effect (-0.099) on mental health (MH). This suggests that if attitudes toward the use of leisure facilities become more positive, mental illnesses may increase as the use of leisure facilities increases.

Meanwhile, if current attitudes improve, mental illnesses decrease as the behavior of using leisure facilities increases. Furthermore, behavioral change (BH2) was not significant in the current attitude (ATT1), behavioral change (BH2), mental health (MH2) pathway, attitude change (ATT2), behavioral change (BH2), or mental health (MH) pathway. The effect of behavioral change [f(BH2)² = 0.004] was more significant than the effect of current behavioral change [f(BH1)² = 0.047]. Therefore, the role of a mediator of leisure behavior has been demonstrated within the model framework proposed in this study.

5) Control variables: Finally, education negatively impacted leisure behavior (-0.084, p<0.1) and had no significant correlation with mental health. In addition, leisure behavior as a mediator in the relationship between education and mental health had a negative effect (-0.041, p<0.1). In other words, rather than adopting the hypothesis that people with higher education levels have low mental health due to stress, their mental health worsens due to their limited leisure activities.

Meanwhile, marital status negatively impacted leisure behavior and mental health. Gender had a positive direct effect (0.125, p<0.05) on mental health (see, Gim, 2022). In addition, gender had a positive direct impact on mental health (0.125, p<0.05), while gender, current behavior, and mental health pathways had a negative indirect effect on mental health (-0.018, p<0.1). Therefore, mental disorders were higher in women; however, mental disorders were lower when the women had a positive attitude toward leisure and took part in more leisure behavior.

Ⅴ. Discussion and Conclusions

This study investigated the impact of leisure attitudes and behaviors concerning the use of urban leisure facilities on mental health during the COVID-19 pandemic. It aimed to compare changes in their effects on mental health, with a focus on attitude and behavior changes, considering the possibility that perceived risk related to the pandemic may either decrease or increase due to concerns over prolonged periods. To achieve this objective, data were analyzed from the same sample of individuals who participated in two surveys conducted during the initial peak of the COVID-19 pandemic in Korea and one year later. PLS-SEM was employed for data analysis. The main findings of the study are outlined below.

First, our results showed that leisure attitudes impact leisure behavior. These findings are consistent with previous studies (e.g., Han and Sa, 2022), indicating that the more positive an individual's leisure attitudes, the greater their participation in leisure activities. Furthermore, we have demonstrated that the effect of urban residents' leisure attitudes on their leisure behavior during the pandemic may vary over time. Specifically, when comparing the impact of current leisure attitudes and changes in attitudes, the more an individual's leisure attitude has improved, the less likely they were to engage in leisure activities, suggesting the influence of habit.

During the initial peak of the COVID-19 pandemic, restrictions on using leisure facilities were strengthened due to social distancing measures (Gim, 2022), resulting in an overall increase in risk-averse attitudes towards leisure activities. However, after one year of the pandemic, attitudes towards using leisure facilities gradually became more positive as restrictions on their operation and use were partially lifted due to increased vaccination rates and the implementation of "With Corona" policies (Lee et al., 2023). As a result, planners of urban leisure spaces must develop strategies to improve leisure attitudes to promote leisure activities and the use of leisure facilities.

Another finding was that both leisure attitudes and leisure behaviors had a significant effect on mental health. Although some previous studies (e.g., Takiguchi et al., 2023; Yurcu, 2021) have investigated the relationship between attitude and mental health, it is commonly acknowledged that leisure attitudes and leisure activities positively affect mental health.

Meanwhile, our results show that increasing leisure attitudes and behaviors toward leisure facilities at the pandemic's peak a year ago negatively affected mental health. This seems that early in the pandemic, sudden changes such as the closure of leisure facilities, restrictions on their operation, and the lack of leisure activities significantly affected people's attitudes and behaviors towards using leisure facilities, which negatively affected their mental health. It can be implied that the effect of leisure attitudes on an individual's mental health during a special situation, such as a pandemic, may vary depending on the time interval and the specific context.

In contrast, current leisure attitudes have a positive effect on mental health. This suggests that individual mental health has improved as the pandemic has progressed over the past year, with people adapting to new changes and developing a positive attitude towards leisure facilities. Therefore, increasing people's positive leisure attitudes effectively reduces mental illnesses such as long-term depression and anxiety.

Leisure attitudes have a positive effect on mental health. However, when leisure behavior is mediated, the increase in leisure behavior negatively affects mental health. These results have two important implications. First, leisure behavior is an essential mediator in the relationship structure, where leisure attitudes affect mental health within our proposed model framework. Second, despite previous studies (e.g., Craik and Pieris, 2006) showing that leisure attitudes and activities positively impact mental health, our unexpected results suggest that individuals who participate in leisure activities with a positive attitude towards leisure facilities during the pandemic may experience negative consequences that lead to poor mental health.

In other words, the more positive people's behavior is toward using leisure facilities, the more they may be exposed to the virus and worry about their health and safety. This may limit their ability to fully participate in leisure activities, leading to dissatisfaction and disappointment. Therefore, efforts to increase leisure activities during exceptional circumstances like the pandemic can adversely affect mental health. As a result, policymakers need to prioritize balancing the benefits of leisure activities with the risk of virus exposure. Furthermore, they should consider leisure behavior and attitudes to improve citizens' mental health.

The findings of this study demonstrate that leisure attitudes and behaviors do not always have a positive impact on mental health. In the early stages of the pandemic, an increase in leisure behavior was found to have a negative effect on mental health. This can be interpreted as resulting from the restriction of leisure activities and fears of virus exposure caused by the sudden changes in circumstances, which led to psychological stress.

However, one year later, as people adapted to the new environment, leisure attitudes and behaviors began to positively influence mental health. These results suggest that while the sudden changes during the early stages of the pandemic negatively impacted the relationship between leisure activities and mental health, time and environmental adaptation can lead to positive changes.

Policy implications emphasize that leisure attitudes play a critical role in influencing behaviors and mental health. Therefore, it is necessary to develop programs aimed at improving citizens' leisure attitudes. Specifically, strategies should be designed to promote leisure activities while minimizing risks related to virus exposure.

Furthermore, it is essential to introduce integrated programs that combine leisure activities and mental health support to enhance psychological resilience and establish long-term systems for managing stress and anxiety.

This study has some limitations and provides suggestions for further research. First, this study analyzed the structural relationship based on limited variables, which may have resulted in insufficient explanatory power of the endogenous variable. Therefore, omitted variable bias could arise from missing variables, such as physical health, in the attitude-behavior-health relationship. Future studies should aim to reduce errors by considering a broader range of variables.

Second, this study only included data from the first peak of the COVID-19 pandemic in Korea and one year later. Future research should take into account that results may vary depending on the time frame chosen or the interval between points when measuring attitude changes. There may also be differences in accessibility to leisure facilities based on spatial distribution characteristics. Since Korea implemented 'social distancing' measures instead of a nationwide lockdown to prevent the spread of COVID-19, there may be limitations in the impact analysis.

Third, this study used a sample-based approach, and therefore, it may not fully capture the characteristics of all regions. Future research should incorporate more regionally representative variables and samples to improve the representativeness of findings and better account for spatial variation in leisure accessibility and behaviors.

Finally, this study only quantitatively analyzed the relationship between leisure attitudes, leisure behavior, and mental health. Qualitative research is required to confirm the analysis results as a follow-up study. Overall, the limitations in the study design highlight the need for further exploration of these relationships in diverse contexts and with a more comprehensive set of variables.

Acknowledgments

This work was supported by the Ministry of Education of the Republic of Korea and the National Research Foundation of Korea (NRF-2021S1A3A2A01087370).

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