The COVID-19 pandemic has led to >6 million deaths. Anti-mask movements may decrease the effects of preventive measures. Psychological factors that may be related to anti-mask behaviour are not well researched.

This study aims to determine the psychological correlates of anti-mask attitudes and behaviour in an online general population sample, focusing on the possible role of claustrophobia.

Data on attitudes and behaviour toward mask-wearing were collected from an online sample of 3709 people. Predictors of both anti-mask attitudes and behaviour were assessed with linear and logistic regression analyses.

Few people (3.3%) were overtly opposed to mask-wearing; mask opposition was more common in men than women. Predictors of negative attitude toward mask-wearing and low adherence to mask-related measures were similar and included male gender, lower education, lower income, being employed, having had COVID-19 and lower COVID-19-related anxiety. Psychopathology measures did not show a prediction, whereas claustrophobia had a significant prediction that was over and above those of other predictors. Avoidance behaviour had similar predictors, except for higher COVID-19-related anxiety.

Although low adherence to mask-wearing during the pandemic was not related to having a mental disorder, it may partly be caused by psychological factors. Those who had a negative attitude also reported lower adherence behaviour, and were characterised by being male, having lower education, being employed and having lower COVID-19-related anxiety; claustrophobia was a strong predictor of attitude. Understanding psychological factors responsible for low adherence may help to decrease morbidity and mortality in future pandemics.

Amid the COVID-19 pandemic the trend points to universal use of protective face masks. The impact posed on verbal and non-verbal communication by masks is yet another challenge to be addressed in clinical care.

To reflect on the consequences of face mask and covering use on communication in the clinical setting, including mental health settings.

Pubmed and Google Scholar literature search using terms face mask / face covering and communication / emotion.

There is a lack of literature on the impact of protective face masks and coverings on communication in clinical settings. Face masks and coverings may have a significant impact on patient-healthcare professional relationship due to disruption of verbal (poorer quality of speech transmission) and non-verbal communication (emotional expression and recognition) with consequences on: 1) clarity of communication with potential for misunderstanding clinical information, advice and prescriptions posing safety issues, 2) emotion perception, expression and reciprocity, 4) perception of healthcare professionals’ empathy and therefore, 3) patient satisfaction, 4) quality of care, and 5) clinical outcomes. Difficulties in communication between the patients´family or other carers and healthcare providers and between healthcare professionals are likewise challenged. People with hearing impairment, children and people with mental illness may be especially vulnerable to these difficulties in communication.

Protective face masks and coverings are undoubtedly important in preventing spread of COVID-19, nonetheless mental healthcare professionals should take into account their significant impact on verbal and non-verbal communication in clinical care. Alternative strategies to enhance communication and rapport may be warranted.