*4.2. Mediating Effect of Risk Perception on the Association between Perceived Social Support and Active Coping with COVID-19*

A higher level of risk perception fully mediated the association between lower perceived support and a higher level of active coping with COVID-19. Although a previous study indicated that financial security predicted better coping strategies against COVID-19 [14], the association between perceived social support and active coping with COVID-19 may be different. Perceived social support represents satisfaction with the general support provided by family, friends, and colleagues/classmates, and this represents broader domains than financial support. In addition, although it did not investigate infective respiratory diseases, a previous study demonstrated that a higher level of social support was associated with a lower perceived risk of breast cancer [34]. O'Sullivan reported that individuals with a higher level of perceived social support may feel that they are relatively safe, leading to optimism bias, which causes them to believe that they are less likely to experience negative events [35]. Individuals with such bias may underestimate their risk of COVID-19; however, further studies are needed to test the effects of optimism bias on risk perception.

In the current study, we found that a higher level of risk perception was associated with a higher level of active coping with COVID-19. A previous study investigated the association between risk perception and coping strategies in patients with diabetes, and found that those who had a low premorbid perception of risks often engaged in diabetes-related risky behaviors [36]. In addition, a systematic review demonstrated that healthcare workers' risk perception influenced their behavior towards patients and facilitated risk-mitigating strategies for emerging acute respiratory infection diseases [37]. Further prospective studies may provide a better understanding of the temporal relationship between risk perception and active coping in relation to infective respiratory diseases.

The above findings revealed the importance of risk perception on active coping with COVID-19; however, perceived social support can compromise the level of risk perception, leading the interference in active coping with COVID-19. It manifested the controversial

role of perceived social support. Previous study reported that higher level of perceived social support was associated with less sleep disturbance and suicidal thought, indicating the protective effect of perceived social support from mental burden [26]. It implicated that interventions in risk perception and perceived social support are both important for publics during the COVID-19 pandemic. Specific support to facilitate social interaction is crucial for those who are socially isolated or quarantined due to infection. Telecommunication or online gathering should also be promoted for the time in need of social distancing. Whereas, intervention to enhance publics' risk perception should not be neglected. Medical information, news, and governmental policies regarding COVID-19 pandemic should also be announced widely to enhance the risk perception of publics [17].
