Generalized anxiety and sociodemographic correlates of COVID-19 risk perception in cancer patients: A theory-informed appraisal perspective

Cancer patients face dual vulnerabilities during pandemics, including clinical fragility and heightened psychological distress. This cross-sectional study examined associations between generalized anxiety and COVID-19 risk perception among cancer patients, with a particular focus on how threat and coping appraisals were differentially associated with anxiety. We also examined whether sociodemographic differences in appraisal components were statistically mediated by anxiety. Data were collected from 205 cancer patients in Dhaka, Bangladesh. COVID-19 risk perception was assessed using a newly developed 8-item scale (CRPS) comprising threat appraisal and coping appraisal subscales, pending external validation. Sociodemographic characteristics, particularly gender and education, were associated with generalized anxiety, whereas direct associations with COVID-19 risk perception were not observed. Anxiety showed consistent associations with COVID-19 risk perception, with a stronger association observed for threat appraisal (partial ρ = 0.54; regression path coefficient B = 0.80) than for coping appraisal (partial ρ = 0.24). Mediation analyses indicated that the association between anxiety and coping appraisal was statistically observed primarily in relation to perceived threat (indirect effect B = 0.45, 95% CI [0.33, 0.58]), whereas the direct association between anxiety and coping appraisal was not statistically significant within the model. Overall, these findings indicate that anxiety is differentially associated with components of COVID-19 risk perception, with stronger alignment observed for threat appraisal than for coping appraisal. The findings suggest that emotional distress may be more strongly aligned with perceived danger than with coping capacity, with implications for psychological support and risk communication in LMIC oncology settings.