|Year : 2020 | Volume
| Issue : 3 | Page : 76-81
Psychological effects of COVID-19 on the general population: A national cross-sectional survey of china mainland
Jianming Guo1, Lianming Liao2, Qinghua Guan1, Lianrui Guo1, Zhu Tong1, Yingfeng Wu1, Jian Zhang1, Yongquan Gu1
1 Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University, Beijing, China
2 Center of Laboratory Medicine, Union Hospital of Fujian Medical University, Fuzhou, Fujian, China
|Date of Submission||15-Jun-2020|
|Date of Decision||13-Jul-2020|
|Date of Acceptance||15-Jul-2020|
|Date of Web Publication||26-Aug-2020|
Dr. Yongquan Gu
Department of Vascular Surgery, Xuanwu Hospital, Institute of Vascular Surgery, Capital Medical University, Beijing
Source of Support: None, Conflict of Interest: None
OBJECTIVE: We sought to determine the psychological impact of the COVID-2019 outbreak on general population in China.
MATERIALS AND METHODS: In 20–22 February 2020, an online survey was implemented using an internet survey tool to collect the information and analyze the effects of the outbreak on the mental health of public population around China.
RESULTS: A total of 6471 person responded the survey. About 3.46% of the respondents reported middle and high levels of anxiety while 0.62% of the respondents reported middle and high levels of depression since the COVID-19 outbreak. Respondents who were female younger or had middle-level education were more likely to have anxiety and depression than those who were male, older or had high-level education, respectively.
CONCLUSIONS: The prevalence of COVID-19-related anxiety was higher among female and younger respondents, and those with low education. Preventing, detecting, and intervention to mental health conditions should be an important component of public health policy during COVID-19 outbreak.
Keywords: Anxiety, China, COVID-19, depression, infectious disease outbreak
|How to cite this article:|
Guo J, Liao L, Guan Q, Guo L, Tong Z, Wu Y, Zhang J, Gu Y. Psychological effects of COVID-19 on the general population: A national cross-sectional survey of china mainland. Vasc Invest Ther 2020;3:76-81
|How to cite this URL:|
Guo J, Liao L, Guan Q, Guo L, Tong Z, Wu Y, Zhang J, Gu Y. Psychological effects of COVID-19 on the general population: A national cross-sectional survey of china mainland. Vasc Invest Ther [serial online] 2020 [cited 2020 Sep 19];3:76-81. Available from: http://www.vitonline.org/text.asp?2020/3/3/76/293523
| Introduction|| |
The outbreaks of highly infectious diseases always bring negative psychosocial impacts to the general population.,, The Coronavirus Disease 2019 (COVID-19) epidemic, which was first detected in Wuhan City, Hubei province, has rapidly spread to other places in China and even other countries. As of March 6, 2020, China had 80,718 confirmed cases of COVID-19 and 3045 deaths. Due to its initially unfamiliarity, relatively high mortality rate and high infection rate, it is predictable that COVID-19 would provoke anxiety and depression among public, and the mental health impact of the COVID-19 outbreak was expected to be relatively high. The level of perceived disaster-related risk will be influenced by a person's level of awareness and knowledge related to the disaster. Social psychology theory believes that attitudes can affect behaviors. During the 2014 Ebola outbreak, rumors about the disease led to panic-buying, with many people purchasing unnecessary suits and face masks for protection against the disease.
As inaccurate information spread rapidly online and the World Health Organization (WHO) has given dire warnings, saying the virus poses a bigger threat than terrorism, anxiety, and depression of the general population were expected to be serious. To address this gap of knowledge, we explored levels of stress symptoms among general population around China with an online survey tool. We hoped to some specific psychological pressure information, for strengthen psychological preparations and provide timely assistance to public.
| Materials and Methods|| |
Online survey design
This cross-sectional survey was open to all netizens in China mainland area. Ethical approval was obtained from the Institutional Review Board of the Xuanwu Hospital Capital Medical University. Participates were invited to complete an online psychological questionnaire through a WeChat App online survey tool, which can send online invitations through social media. The participants' identities were kept confidential.
Participants were required to fulfill the online questionnaire for their demographic data (age, gender, place of residence, occupation, income, marital status, and education background) and psychological status. Middle-level education was defined as primary or high school education. Higher education was defined as obtaining a bachelor degree or above.
For psychological distress evaluation, the internationally recognized self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used.,
The SAS scale consists of 20 questions that assess how respondents feel during the previous week. Each question has a score of 1–4. Higher scores indicate higher levels of anxiety. A SAS score of 50–59 points, 60–69 points, and 70 or more indicates mild anxiety, moderate anxiety, and severe anxiety, respectively.
The SDS scale is a 20-item self-report questionnaire that covers affective, psychological, and somatic symptoms associated with depression. Each item has a score from 1 to 4. The total score ranges from 20 to 80. Higher scores indicate higher levels of depression: 50–59 for mild depression, 60–69 for moderate depression, and 70 or more for severe depression.
Data collection and statistical methods
Responses were downloaded from the online survey tool as a spreadsheet and anonymized. Given the exploratory nature of the study, the statistical analysis was largely descriptive. Data were processed by SPSS (20.0) software package (SPSS Inc, Chicago, IL, USA). SAS and SDS score were expressed as mean and standard deviation. Mann–Whitney U-test was used to compare the difference in SDS and SDS scores between the groups. For the data that did not conform to the normal distribution, rank sum test was performed. P < 0.05 was considered statistically significant.
| Results|| |
The survey started from February 20, 18:30 and ended at February 22, 18:30. The respondents' demographic profile is presented in [Table 1]. Altogether, 6471 respondents completed the survey. Among them, 2986 (46.14%) were male and 2502 (38.66%) were aged 40 years or older. There were 4689 (72.46%) participants who had married. Fourth-fifths of them (5215, 80.59%) had a bachelor's degree or above. There were respondents from all provinces except Tibet Autonomous Region of China mainland [Table 2], and the top five regions were Beijing (1235, 19.09%), Hubei (1041, 10.41%), Henan (769, 11.88%), Shanghai (535, 8.27%), and Zhejiang (421, 5.82%). Two thousand nine hundred and twenty-one (45%) respondents' household income are 9000 and above each month [Table 1].
Presentation of psychological stress
Among all of the participants, 5029 (77.72%) reported they have felt anxious or panic during COVID-19 outbreak, and 1442 (22.28%) reported they had never experienced anxiety. About three-quarters of them (3239, 64.41%) thought they had no suitable methods to solve their psychological stress and had to endure or addressed them by themselves. Most of the participants (4565, 70.55%) thought that psychological interventions were necessary. Near one-half of the participants (2936, 45.37%) believed that psychological interventions should be available to the public soon after the outbreak to alleviate their psychological stress [Table 3].
About 3.46% and 0.62% of the respondents reported they had high levels of anxiety symptoms (i.e., a SAS score of 60 or more) and depression symptoms, respectively (i.e., a SDS score of 60 or more) following the outbreak of COVID-19 [Table 4]. We compared stress between the male and female respondents [Table 5]. The median SDS score of the male was 32, while that of the female was 33. The SDS scores of the female were significantly higher than those of the male (U = 50,50,728, Z = −2.035, P = 0.042). The median SAS score of the male was 39, and that of the female was 40. The SAS scores of the female were significantly higher than those of the male (U = 49,31,238, Z = −3.635, P < 0·0005).
|Table 4: Self-rating depression scale and self-rating anxiety scale score distribution|
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|Table 5: Participants male and female self-rating depression scale and self-rating anxiety scale score distribution|
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We then compared the SDS scores between respondents with different education backgrounds [Table 6]. The median SDS score of the respondents with middle-level education was 34, and that of the respondents with higher education was 32. Lower education was significantly associated with higher SDS scores (U = 29,72,422, Z = −5.094, P < 0·0005). The median SAS score of the respondents with middle education was 40, and that of the respondents with higher education was 39. There was no significant difference about SAS score between the two groups (U = 32,67,810, Z = −0.121, P = 0.903).
|Table 6: Participants low education and higher education self-rating depression scale and self-rating anxiety scale score distribution|
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Finally, we compared SDS score and SAS score between participants aged 40 years and under and those over 40 years of age [Table 7]. The median SDS score in respondents aged 40 years and under was 33, and that of the respondents over 40 years was 31. The former had significant higher SDS scores than the later (U = 45,91,977, Z = −5.103, P < 0·0005). The median SAS score of respondents aged 40 years and under was 40, and that of respondents over 40 years was 39. In addition, the former had significant higher SAS scores than the later (U = 45,04,038, Z = −6.312, P < 0.0005).
|Table 7: Participants under 40 and over 40 self-rating depression scale and self-rating anxiety scale score distribution|
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| Discussion|| |
In the present report, we present our most recent online survey on the psychological impact of the COVID-19 outbreak on general population in China around the peak of the epidemic. Among all of the participants, 5029 (77.72%) reported they have felt anxious or panic during COVID-19 outbreak, and 1442 (22.28%) reported they had never experienced anxiety. About 3.46% and 0.62% of respondents reported they had high levels of anxiety symptoms (i.e., a SAS score of 60 or more) and depression symptoms (i.e., a SDS score of 60 or more) respectively following the outbreak of COVID-19. Improving our understanding of public psychological stress and the factors associated with those stress should be helpful.
The level of perceived disaster-related risk will be influenced by a person's level of awareness and knowledge related to the disaster. In 2003, Blendon et al. compared the public's response to severe acute respiratory syndrome (SARS) in Canada and United states. They found, even at a relatively low level of spread among the population, the SARS outbreak had a significant psychological and economic impact. Programs aimed at raising such knowledge and awareness that influence peoples' perceptions may help a society to become better prepared and be more in control of a disaster situation. On March 5, 2020, the China National Health Commission and the Ministry of Civil Affairs issued official suggestions that strengthen on the importance of psychological assistance and social services in response to COVID-19 epidemic. Soon several multidisciplinary professional mental health teams were established and provide psychological assistance and social services to the people affected by the epidemic. These measures effectively mitigated the psychological effects caused by the epidemic.
There are several notable findings in the present survey. First, we found that more than three quarters of participants (77.72%) reported they have felt anxious or panic. As to the source of mental pressure, 3606 (55.73%) respondents attributed it to the rapid increase of infected cases, 2623 (40.53%) to the lack of personal protective substances such as masks and disinfectants, and 1797 (27.77%) to social media. The WHO has been battling misinformation about the coronavirus, warning rumors are spreading more rapidly than the disease itself. The WHO describes the overabundance of information about the coronavirus as an “infodemic.” Some information is accurate, but much of it is not – and it can be difficult to tell what's what. Misinformation can spread unnecessary fear and panic, as we found that 27.77% of the respondents said their mental pressure was due to reading information from media.
Second, we found that respondents who were more than 40-year-old have lower levels of stress compared to younger respondents. This may be due to the fact that the older participants have experienced SARS which is the most recent outbreak of highly infectious disease in China. SARS occurred in mid-November 2002 in Guangdong Province and killed 349 patients in mainland China by the end of the epidemic. As 18 years had passed since the outbreak of SARS, public older than 40 years have experienced SARS epidemic and are thus more ready for COVID-19 mentally than younger generation. In addition, we speculate that the younger respondents' level of fear and worry related to an infectious disease outbreak may be greater because they live with their children and may have greater family responsibilities. Moreover, we also found that the participants with lower education had higher SDS scores. It is possibly because that the participants with lower education are more affected by infodemic.
There were some limitations in this study. The sample size was small as a nationwide cross-sectional study. Considering the exigencies background of COVID-19 epidemic, there was no highly individualized public-specific scale, only internationally recognized SDS and SAS scale available. Due to the relatively simple and low sensibility, the SDS and SAS scales do not include index for some specific psychological pressures. However, the findings do provide valuable information for policy makers and mental health professionals worldwide regarding the psychological impact of an infectious disease outbreak, which may assist them in making preparations psychologically for possible outbreaks in regions outside China.
Recently, two comments were published regarding potential COVID-19-related mental health in China. Kang et al. pointed out that presently mental health care for the patients and health professionals directly affected by the 2019-nCoV epidemic has been under-addressed, although psychological intervention teams have been set up in a few hospital and the several psychological assistance hotline teams providing telephone guidance to help deal with mental health problems were also available. Our survey found 64.41% of participants could not find a suitable solution to their psychological distress and could only endure or resolve it on their own. Moreover, psychological intervention was necessary. Indeed, 45.37% respondents believed that psychological intervention should be implemented at the moment of epidemic outbreak to alleviate psychological distress.
| Conclusions|| |
During COVID-19 epidemic, Chinese population was under great psychological pressure and with high risk of psychological distress, especially for those who are female and young and those with middle-level education. Timely psychological support and intervention should be provided to the public to alleviate their anxiety and improve their general mental health.
Financial support and sponsorship
This work is supported by The National Key R&D Program of China (2017YFC110410, 2018YFC2000704). Beijing municipal administration of hospitals climbing talent training program (DFL20150801), Beijing outstanding talents project (2016000020124G108), Beijing healthcare system specialist training program (2014-3-059), Beijing Municipal Administration of Hospitals Incubating Program (PX2018035), and Beijing Municipal Administration of Hospitals' Youth Program (QML20180804).
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]