doi:10.3390/ijerph18084143engChong Y.Y.Chien W.T.Cheng H.Y.Lamnisos D.Lubenko J.Presti G.Squatrito V.Constantinou M.Nicolaou C.Papacostas S.Aydin G.Ruiz F.J.Garcia-Martin M.B.Obando-Posada D.P.Segura-Vargas M.A.Vasiliou V.S.McHugh L.Höfer S.Baban A.Neto D.D.da Silva A.N.Monestès J.-L.Alvarez-Galvez J.Blarrina M.P.Montesinos F.Valdivia Salas S.Ori D.Kleszcz B.Lappalainen R.Ivanovic I.Gosar D.Dionne F.Merwin R.M.Gloster A.T.Karekla M.Kassianos A.P.Patterns of psychological responses among the public during the early phase of COVID-19: A cross-regional analysisART-2021-126906This study aimed to compare the mediation of psychological flexibility, prosociality and coping in the impacts of illness perceptions toward COVID-19 on mental health among seven regions. Convenience sampled online survey was conducted between April and June 2020 from 9130 citizens in 21 countries. Illness perceptions toward COVID-19, psychological flexibility, prosociality, coping and mental health, socio-demographics, lockdown-related variables and COVID-19 status were assessed. Results showed that psychological flexibility was the only significant mediator in the relationship between illness perceptions toward COVID-19 and mental health across all regions (all ps = 0.001–0.021). Seeking social support was the significant mediator across subgroups (all ps range = <0.001–0.005) except from the Hong Kong sample (p = 0.06) and the North and South American sample (p = 0.53). No mediation was found for problem-solving (except from the Northern European sample, p = 0.009). Prosociality was the significant mediator in the Hong Kong sample (p =0.016) and the Eastern European sample (p = 0.008). These findings indicate that fostering psychological flexibility may help to mitigate the adverse mental impacts of COVID-19 across regions. Roles of seeking social support, problem-solving and prosociality vary across regions. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.2021http://zaguan.unizar.es/record/11863810.3390/ijerph18084143http://zaguan.unizar.es/record/118638oai:zaguan.unizar.es:118638International journal of environmental research and public health 18, 8 (2021), 4143 [19 pp]byhttp://creativecommons.org/licenses/by/3.0/es/info:eu-repo/semantics/openAccess