The COVID-19 pandemic is a public health threat of international concern, intensifying peoples’ psychological risk and vulnerability by strengthening mental health stressors such as fear, panic and uncertainty. The unexpected fear of COVID-19 has been reported to be associated with suicide occurrences, similar to prior pandemics.

Identifying the factors associated with fear of COVID-19 could help us to develop better mental health strategy and practice to improve the situation here in Bangladesh. This was the first attempt to present a Geographic Information System (GIS)-based distribution of fear of COVID-19 across the country's administrative districts in a nationwide sample.

Data for a total of 10 067 individuals were collected by an online survey during the first wave of the pandemic (1 to 10 April 2020); data for 10 052 participants were finally analysed after excluding 15 transgender individuals. The survey questionnaire included items concerning sociodemographic, behavioural and health-related variables, COVID-19-related issues, and the Bangla Fear of COVID-19 Scale.

The mean fear of COVID-19 scores was 21.30 ± 6.01 (out of a possible 35) in the present sample. Female gender, highly educated, non-smoker, non-alcohol consumer, having chronic diseases, using social media, and using social media and not using newspapers as COVID-19 information sources were associated with a higher level of fear of COVID-19. Higher levels of fear of COVID-19 were found in districts of Magura, Panchagarh, Tangail, Sunamganj and Munshiganj; by contrast, Kushtia, Pirojpur, Chapainawabganj, Jhalokathi and Naogaon districts had lower fear of COVID-19. Based on the GIS-distribution, fear of COVID-19 was significantly associated with the district as well as in respect to its gender-based and education-level-based associations. However, fear of COVID-19 and COVID-19 cases were heterogeneously distributed across the districts; that is, no consistent association of higher COVID-19 cases with higher fear of COVID-19 was found.

This study being exploratory in nature may help to facilitate further studies, as well as directing governmental initiatives for reducing fear of COVID-19 in at-risk individuals. Providing adequate resources and mental health services in the administrative regions identified as highly vulnerable to fear of COVID-19 is recommended.