The Impact of “Three Zones” Closed-off Management in Communities on Individuals’ Mental Health and Lifestyle During the COVID-19 Pandemic

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durations, the fear of being infected, the possible shortage of supplies, the lack of punctual updates from public health authorities, the economic losses, and the post-pandemic stigma put people under additional strain (Brooks et al., 2021). According to a survey of 56,679 people in China, 34.1 percent of those who experienced quarantine reported at least one psychological symptom, such as anxiety, sadness, insomnia, or acute stress, significantly greater than those who were not quarantined (Wang et al., 2021). Another online survey of 18,000 people in Italy shows that 37% of participants suffer from posttraumatic stress because of the lockdown, and approximately 20% suffer from depression, anxiety, or high-sensitivity stress (Rossi et al., 2020). Besides, a survey of Norwegian adolescents reveals higher depressive symptoms and less optimistic future life expectations during the pandemic (von Soest, et al., 2022). A globally representative sample from countries in Europe, North Africa, West Asia, and the Americas shows that quarantine harms public mental health and emotions, with a more significant proportion of individuals suffering from psychosocial and emotional disorders . The psychological effect of home confinement during the COVID-19 pandemic is pervasive and substantial and may be long-term. Individuals' eating behavior is also being impacted by home quarantine (Souza et al., 2022). One point of view is that people eat healthier to strengthen their immune systems and protect themselves against COVID-19. For example, Molina-Montes et al. (2021) examined the COVID-19 confinement impact on adults' eating behaviors in 16 European countries. They found that people's compliance with the Mediterranean diet (MedDiet) attained rapid growth in all countries during the confinement, with the most significant increase in Greece and Macedonia, meaning that people were more willing to form healthy eating habits. A study in Spain also found that during the home confinement period, 57.2% of people increased their fresh food intake (López-Moreno et al., 2020). Another point of view is that people who are worried about COVID-19 may consume more alcohol and eat more unhealthy meals (such as snacks and cakes) to make themselves feel better. Ammar et al. (2020) found in an international survey that people's food consumption and dietary patterns became un-healthier during the lockdown. Yang et al. (2021) also found that 38.2% of the population had more snacks in China's early stages of COVID-19 confinement. In addition, Janssen et al.'s (2021) research on the frequency of food consumption before and during the pan-demic among 2,680 residents in Denmark, Germany, and Slovenia showed that the total consumption of fresh food decreased, while the consumption of food with a longer shelf life increased.
Additionally, people's daily routine of physical exercise and sleep has also been disturbed during the quarantine (Massar et al., 2022;Salehinejad et al., 2021). People have much less time for physical activities due to stringent restrictions on going outside (Bu et al., 2021). Based on wearable app data,  discovered that Canadians experienced significant declines in high-intensity exercise, low-intensity exercise, and walking steps during the lockdown. It took six weeks for high-intensity practice to return to pre-pandemic levels, while low-intensity exercise and step counts remained significantly lower than pre-pandemic levels. The international online survey by Ammar et al. (2020) showed a sharp decline in physical activity at any level of intensity during home quarantine. In addition, data from Spain and China indicate that 45.9% and 54.3% of individuals engage in less physical activity during lock-downs (López-Moreno et al., 2020;Yang et al., 2021). Although studies have shown that people slept more and spent more time in bed during periods of lockdown Yang et al., 2021), the incidence of sleep disorders was higher than usual. According to statistics, during the COVID-19 pandemic, the global prevalence of sleep disorders was 40.49% (Jahrami et al., 2022). People's sleep quality also worsened during home confinement, with a study in Spain finding that approximately 40.7% of people experienced negative changes in sleep quality (López-Moreno et al., 2020).
In summary, previous research mainly focused on the effects of home quarantine on mental health and lifestyle in the early phases of the COVID-19 pandemic. However, with the continued expansion of the pandemic and people's comprehension of the novel coronavirus, it needs a better understanding of how "three zones" closed-off management in communities, a new strategy for pandemic prevention and control, impact individuals' mental health and lifestyle. Shenzhen, which is geographically close to Hong Kong and has the third highest GDP in China, announced "three zones" closed-off management in communities for the entire city from March 14 to March 20, 2022. So this allows us to answer that question. We first evaluated individuals' mental health and lifestyle changes before and during the community lockdown. And then, we analyzed the impact of lock-down zones, controlled zones, and precautionary zones on individuals' mental health and lifestyle. This study's findings contribute to the literature on home quarantine and give valuable supplements and references for enhancing public health measures during the pandemic.

Participants
From March 18 to March 20, 2022, this study distributed 417 online questionnaires to Shenzhen residents in different areas through WeChat groups. After excluding incomplete questionnaires, 200 valid questionnaires were received for an effective response rate of 47.96%.

Warwick-Edinburgh Mental Wellbeing Scale, WEMWBS
The Warwick-Edinburgh mental well-being scale is an effective mental health measuring instrument (Tennant et al., 2007). This study followed Trabelsi et al.'s (2021) methodology and identified 7-items that may have greater clinical significance. Each item uses a Likert 5-point scale, and the overall score ranges between 7 and 35 points. The higher the participants' scores, the more positive their mental health is. A score of 17 or less suggests an in-creased risk of depression, 18-20 indicates the possibility of depression, 21-27 shows positive mental health, and 28-35 means very positive mental health.

Unhealthy Eating Behavior Survey
The questionnaire for the study on unhealthy eating behavior was developed by Ammar et al. (2020). The questionnaire consists of five questions or prompts on "eating unhealthy food," "binge eating," "snacking between meals," "binge alcohol drinking," and " numbers of main meals per day." The first four questions are on a four-point scale (Never = 0; Sometimes = 1; Often = 2; Always = 3); the options and points for "number of meals" are as follows: "1-2" = 1; "3" = 0; "4" = 1; "5" = 2; ">5" = 3. The more meals people have daily, the higher the chances they will develop obesity and diabetes, so additional meals and snacks between the main meals are seen as unhealthy eating behaviors (Harder-Lauridsen et al., 2017). Adding the scores for each item yields a total score ranging from 0 to 15, showing the partici-pants' unhealthy eating habits. The more a person scores, the less healthy their eating habits are.

International Physical Activity Questionnaire Short Form, IPAQ-SF
The International Physical Activity Questionnaire is a cost-effective method for assessing physical activity. The questionnaire mainly contains the time and frequency of individuals' vigorous physical activities, moderate physical activities, and walking per week. Vigorous physical activities include exercise during which people find breathing harder than usual, such as weightlifting, digging, aerobics, and fast cycling. Moderate physical activities are when people find breathing slightly more complicated than usual, such as light-load exercise, cycling at a uniform speed, or tennis doubles, excluding walking (Craig et al., 2003). According to the official IPAQ-SF guidance, exercises of different intensities are assigned various metabolic equivalents (METs): vigorous physical activities = 8.0 METs, moderate physical activities = 4.0 METs, and walking = 3.3 METs. Therefore, the total number of weekly physical activities can be calculated by adding the METs for each exercise. In addition, sedentary time was measured in this study.

Pittsburgh Sleep Quality Index, PSQI
The Pittsburgh sleep quality index is an assessment of sleep quality that has been extensively validated in ass.ccsenet.org Asian Social Science Vol. 18, No. 11 2022 different cultures and populations (Buysse et al., 1989). This study uses 14 questions covering sleep quality, bedtime, quantity, sleep efficiency, sleep disorders, hypnotic drugs, and daytime dysfunction, which are the seven components of sleep quality. Each part contains 0-3 points. The total score from the sum of scores for each piece ranges from 0-21. The lower the scores that people obtain the better their sleep quality.

Statistical Analysis
In this study, a Shapiro-Wilks normality test based on SPSS 26.0 revealed that the data did not conform a normal distribution. So we used the Wilcoxon signed rank test to analyze individuals' mental health and lifestyle changes before and during the community lockdown. The effect size of the parametric test was calculated using = /√ . ES can be interpreted as follows: small (0.10-0.30), medium (0.30-0.50), large (>0.5), and its statistical significance is set at P < 0.05 (Rosenthal, et al., 1994). Finally, we use regression analysis to examine the impact of lockdown zones, controlled zones, and precautionary zones on people's mental health and lifestyle changes.

Demographics
Of the total 200 participants, the average was 34.8 years old. Women accounted for 61.5%. A total of 61.0% of the participants were in precautionary zones. Nearly 70% were from the districts of Nanshan and Futian. A total of 67.5% were married or living with partners. Approximately 66.5% had a bachelor's degree or more. 56.0% of the population had an average monthly income greater than 8,000. 65.0% had received three vaccination doses, and 92.0% were in a healthy state (Table 1). In addition, the number of family members significantly dropped from 3.09 before the community lockdown to 2.97 (Z = 2.863, p = 0.004, ES = 0.202).

Comparison of Positive Mental Health and Lifestyle Before and During Lockdown
The positive mental health and lifestyle before and during the lockdown are compared in Table 2. First, there is a critical decline in all measurements of positive mental health compared to the days before the lockdown, and the effect sizes were all medium. Positive responses to the prompts, "I've been feeling optimistic about the future" and "I've been feeling relaxed", declined by 10.2% (Z = 6.733, p < 0.001, ES = 0.476) and 10.8% (Z = 5.989, p < 0.001, ES = 0.423), respectively. The total score of positive mental health decreased by 8.5% (Z = 7.762, p < 0.001, ES = 0.549), with a relatively large effect size. Overall, during the community lockdown, there was a reduction in positive mental health, and residents expressed worries about the future. In terms of unhealthy eating behaviors, the scores for "unhealthy diet/food" and "eating out of control" had decreased by 13.2% when compared to the days prior to lock-down (Z = 3.378, p = 0.001, ES = 0.301; Z = 2.126, p = 0.034, ES = 0.150). While there were no significant differences in the frequency of "snacks between meals or a late-night snack," the score for "binge alcohol consumption" dropped by 44.4% ( Regarding sleep quality, except for hypnotic drugs, other components of the sleep quality index experienced rapid changes during the lockdown of the community. On the one hand, bedtimes were earlier (6%, Z = 5.505, p = 0.001, ES = 0.389) while bedtimes were longer (51.6%). On the other hand, the Pittsburgh Sleep Quality Index scores, which measure the quality of sleep, increased by 12.2%, 30.3%, 8.4%, 14.3%, and 10.2%, respectively. Overall, despite spending more time in bed and going to bed earlier, people's overall sleep quality declined.

The Impact of "Three Zones" on Individuals' Mental Health and Lifestyle
In implementing the "three zones" closed-off management in Shenzhen, the prevention and control intensity in the precautionary zones is the weakest and closest to normal living, providing an opportunity for this study to conduct a quasi-natural experiment. Therefore, we designated the samples from the precautionary zones as the control group and the samples from the lockdown and controlled zones as the experimental group. We applied the principle of differences-in-differences. The following regression model was established to examine the impact of lockdown zones, controlled zones, and precautionary zones on people's mental health and lifestyle changes.
Δy i =α + β 1 Lockdown zones + β 2 Controlled zones + X i + Dummy district +ε i (1) In this model, i means residents. The independent variable Δy i represents the changes in scores for mental health, lifestyle, and other variables, which are the measurements before lockdown minus the corresponding number after lockdown, including changes in positive mental health, unhealthy eating behaviors, physical activity, sleep quality, and sedentary time. Since the change in scores for physical activity is starkly different from other variables, we used the formula ln(x + √1 + 2 ) for logarithmic processing. Lockdown zones and controlled zones are the main focused independent variables of this study, which are dummy variables representing the lockdown and controlled zones; if the community where the resident is located is a lockdown zones, lockdown zones is equal to 1; otherwise, it is 0; if the community where the resident is located is the controlled zones, controlled zones is equal to 1; otherwise, it is 0. In addition, we controlled for residents' characteristic variables X i , including vaccination, age, sex, education, marital status, work, income, and health condition. Since various districts of Shenzhen may have different policies or ways to implement policies, and the economic development, ass.ccsenet.org Asian Social Science Vol. 18, No. 11 2022 industrial structure, and overall residential characteristics vary from district to district, we also controlled the urban fixed effect Dummy district to eliminate the impact of these factors. Table 3 presents descriptive statistics on changes in individuals' mental health and lifestyle in the "three zones." The controlled zone ranked first in terms of changes in positive mental health, followed by the lockdown zones and precautionary zones; the lock-down zones ranked first in terms of changes in unhealthy eating behavior, sedentary time, and sleep quality index; and the precautionary zones ranked first in terms of changes in physical activity. The regression results are shown in Table 4. The results in the first column demonstrate the impact of various zones on residents' positive mental health changes. Compared with the precautionary zone, the controlled zones had a significantly positive impact on individuals' positive mental health changes. In other words, compared with people in precautionary zones, residents in controlled zones suffered a relatively significant decline in positive mental health. In contrast, the lockdown zones showed no sign of affecting mental health. The results in the second column show no difference among individuals in the three zones regarding changes in unhealthy eating behavior. The results in the third column show that, compared with precautionary zones, residents in controlled zones were more active in physical activity. At the same time, there was no change among residents of lockdown zones. We also examined the impact of the lockdown and controlled zones on individuals' sedentary time. In the fourth column, compared with individuals in the precautionary zones, residents in lockdown zones spent more time sitting, while the controlled zones showed no effect. Finally, the last column shows the impact of changes in the sleep quality index. Compared with precautionary zones, lockdown zones have a significantly negative impact on individuals' sleep quality. Compared with people in precautionary zones, residents in lockdown zones have better sleep quality, while the controlled zones show no effect.

Discussion
This study aimed to explore the impact of "three zones" closed-off management in communities on individuals' mental health and lifestyle during the COVID-19 pandemic. The study's results showed significant changes in positive mental health and eating behaviors, physical activity, and sleep.
First, the total score for positive mental health during lockdown dropped by 8.5% compared to before the lockdown, especially regarding two items: "I've been feeling optimistic about the future" and "I've been feeling relaxed." The resurgence of the pandemic revived many uncertainties in the future, making it difficult for people to be relaxed and optimistic. This conclusion is consistent with previous research . Although there was a decrease in positive mental health during the lockdown, the average score for this meas-urement was still higher than 15.8 , which indicates that the community lockdown had little impact on people's psychological health and that the general public maintained positive mental health. Especially as cities resumed normal operations and students returned to campus, people's overall mental health also recovered. Further analysis showed that controlled zones significantly impacted people's positive mental health changes compared to the precautionary zones. In other words, compared with people in precautionary zones, residents in controlled zones suffered a relatively significant decrease in positive mental health. This is mainly the result of the "three zones" strategy. Although residents in lockdown zones had to accept not leaving their homes, people in controlled zones faced the risk of lockdown at any time despite being under relatively looser restrictions, which led to a more significant fluctuation psychologically and a worse mental condition. Given this, the local authorities should not lose sight of people's psychological states and release information on time to help free them from worry.
Second, the scores for unhealthy eating behavior during the lockdown dropped by 5.4% compared with those before the lockdown. People tended to consume significantly less unhealthy food and avoid binge eating and drinking, which confirms that the pandemic pushed people to eat healthier to strengthen their immunity and prevent COVID-19 infections (Molina-Montes et al., 2021). It is important to note that the score for "How many main meals do you eat a day?" significantly increased, reflecting that people's eating habits become erratic during the lockdown. This could be because people's time is no longer constricted and limited during home isolation, making it difficult to eat at a regular hour. Further analysis found that there was no significant difference in the unhealthy eating behavior of people in the three zones, probably because Shenzhen's policies provided supplies, such as the delivery of medicines, express, and groceries (including fresh vegetables). Regard-less of which zones people lived in, their healthy eating behaviors were not significantly affected.
Third, consistent with previous studies , the scores for physical activity, whether vigorous physical activities, moderate physical activities or just walking, decreased significantly during the lockdown, among which the decline in walking was the most prominent, reaching approximately 45.3% of the population. Sedentary time rose from 5.39 hours/day before the lockdown to 6.56 hours/per day during the lockdown, an increase of approximately 21.7%. It is explained that people have limited outdoor space during a community-wide lockdown and can only stay at home most of the time. According to the World Health Organization (WHO, 2010), adults aged 18-64 should engage in at least 150 minutes of moderate physical activity or at least 75 minutes of vigorous physical activity per week. The duration and intensity of residents' physical exercise during the lockdown were well below the World Health Organization recommendations. Further analysis found that compared with the precautionary zones, residents in the controlled zones were more engaged in physical activities, which may be how to deal with psychological fluctuations, while residents in the lockdown zones had more sedentary time than those in the precautionary zones. For people in controlled zones, increased physical activity meant no considerable change in sedentary time. Physical activity boosts immunity, reduces inflammation, and is effective in preventing and treating secondary diseases such as heart disease and diabetes. Therefore, the government should encourage residents to continue to engage in physical exercise and reduce their sedentary time under pandemic restrictions.
Finally, the scores for sleep quality increased by 10.2% compared with before the system was implemented, indicating that people's overall sleep quality worsened. Although time in bed and sleep duration rose dramatically, the bedtime, or the sleep latency time, also skyrocketed by approximately 51.6%. There is an excellent possibility that people suffer from poor diet and mood, stress at work, financial insecurity working from home, and experiencing difficulties falling asleep. Further analysis found that residents' sleep quality in the lockdown zone was much worse than that of residents in the precautionary zones. This is mainly because residents in lockdown zones were at home all day and had no space to exercise; besides, they had more sedentary time and might be addicted to Tiktok or mobile games. All these lead to worse sleep quality.

Conclusions
"Three zones" closed-off management in communities has played an important role in containing the spread of the pandemic and reducing the infection rate. However, it has also profoundly impacted an individual's mental health and lifestyle. The limitation of this study is the relatively limited sample size, which can be further expanded in the future to support the findings of this study. In addition, quarantine led to the suspension of a large number of business activities, which caused financial losses for many people. Future studies should include the variable of economic status in the overall regression analysis to examine its effect on public mental health and lifestyle.