Risk factors of psychological dimensions
Within the distinction of education level, participants with education
of bachelor and above showed significantly lower level of GSI (1.24±0.32
versus 1.37±0.37, P <0.05), PST (19.00±25.46 versus
24.06±21.19 , P <0.05), SOM (1.38±0.53 versus 1.34±0.40,P <0.05), O-C (1.35±0.49 versus 1.59±0.49,P <0.05), I-S (1.11±0.16 versus 1.38±0.48,P <0.05), HOS (1.17±0.00 versus 1.30±0.42,P <0.05), PAR (1.08±0.12 versus 1.23±0.32,P <0.05), and PSY (1.10±0.14 versus 1.28±0.39,P <0.05) compared with college educational level.
Meanwhile, participants with college educational level showed
significantly lower level of PST (19.00±25.46 versus 49.67±16.17,P <0.05), O-C (1.35±0.49 versus 2.57±0.85,P <0.05), I-S (1.11±0.16 versus 2.48±0.76,P <0.05), HOS (1.17±0.00 versus 2.28±0.67,P <0.05), PAR (1.08±0.12 versus 2.28±0.51,P <0.05), PSY (1.10±0.14 versus 1.93±0.95,P <0.05) than participants with high school and below
education level (Figure 3a, b).
In gender aspects, female subjects expressed significantly higher scores
in PSDI (2.43±0.56 versus 2.00±0.67, P <0.05), SOM
(1.42±0.43 versus 1.24±0.35), O-C (1.67±0.58 versus 1.50±0.39), DEP
(1.43±0.53 versus 1.31±0.29), and HOS (1.37±0.49 versus 1.26±0.39)
compared with male participants (Figure 4a, b).
No statistical significance was discovered among participants within
different age (Figure 5a, b) or marriage status (Figure 6a, b) for each
aspect and dimension of the measurements.
Discussion
The COVID-19 outbreak was thought to be the most prevalent and serious
epidemic since the end of December of 2019. Over 200 countries, areas or
territories were suffering from the virus and more than 2 million
persons infected by the acute infectious disease with over 130 thousand
confirmed death globally6 (World Health Organization, 2020). Owing to
the significant morbidity and mortality, the COVID-19 caused large scale
public panic and serious psychological health stress (Kavoor, 2020). The
WHO had emphasized the importance of psychological support and released
some advice to survivors and health care workers
(Bansal
et al., 2020; Cu et al., 2020; Mo et al., 2020). However, to our
knowledge, there is only a few researches focusing on mental health of
COVID-19 survivors and frontline healthcare workers. Thus it is
necessary to conduct scientific research to evaluate the mental health
status of the COVID-19 outbreak. This study was to assess psychological
health status of COVID-19 survivors, nurses, and hygienists in Wuhan,
China, analyze the risk factors to influence the outcome, and provide
help for mental health assistance for survivors and healthcare workers.
Results of the present research indicated that psychological health
status among all participants in Wuhan, China was not very serious, and
the main problems were anxiety and psychoticism. Possible reasons may be
as follows: 1. Our assessment time was set on over 2 months after the
outbreak when the worst situation has passed and under controlled
effectively in Wuhan, China. The COVID-19 has been intensively studied
through advanced medical scientific techniques and released to the
public in time, making participants very familiar with the new virus and
reducing their fear of the new virus; 2. The Chinese government and some
medical organizations have taken a serious of measures for psychological
support to the confirmed patients and healthcare professionals(National
Health Commission of the People’s Republic of China, 2020; Kang et al.,
2020); 3. Latest daily report was released by authorities, thus the
public could receive the specific trends of the epidemic situation. In
addition, energy propaganda was carried out by the mainstream media to
fight the virus epidemic, encouraging everyone to face it positively; 4.
The epidemic crisis was under control in China, and there was still
newly increased confirmed death cases. What’s more, the epidemic was
further expanded in other countries National Health Commission of the
People’s Republic of China, 2020). Under the background of
globalization, and a community of sharing future for mankind,
participants still felt anxiety to the COVID-19 and showed poor mental
status.
Our studies showed that
COVID-19
survivors suffered severe somatization, obsession-compulsion,
interpersonal sensitivity, anxiety, anger-hostility, paranoid ideation,
psychoticism, and highest PST score which meant they had worse
psychological status compared with healthcare workers. This was
consistent with a previous study about comparison of psychological
symptoms between Ebola survivors and healthcare workers (Ji et al.,
2017). Possible reasons were maybe the novel virus was characterized by
a high possibility of being infected, and high mortality which was a
life threatening event (Webster, 2020). Patients were forced isolation
in specific hospitals, which divided them from work, family, and
conventional daily life, so that to plumb the depths of loneliness,
humiliation, and even despair (Yao et al., 2020). Besides, some bad
media reported false news to mislead public which aggravated patients’
panic and anxiety (Chen et al., 2020). Results analysis showed that it
was important to construct an appropriate emergency response mechanism
of serious infectious disease and recovery system of post-traumatic
stress. Specific methods included establishing professional
psychological intervention team which consisted of all mental health
professionals, conducting online psychological counselling services (eg,
on WeChat), and so on (Bao et al., 2020; Liu et al., 2020; Xiao, 2020).
Under the guidance of government (National Health Commission of the
People’s Republic of China, 2020), we were required to pay attention to
patients’ mental health and psychological response. Psychological
evaluation, counseling, and supporting should be provided to recovered
patients.
This study showed that psychological status of healthcare workers
including nurses and hygienists was not very serious generally, and
nurses presented higher score in somatization than hygienists. It was
comparable to the previous study about comparison of hygienists and
nurses during the COVID-19 crisis (Lai et al., 2020). Possible reasons
probably were nurses contacted with patients directly and frequently
with wearing sealed personal protective equipment which made them
sultry, dyspnea, facial skin indentation or even damaged (Gheisari et
al., 2020). What was worse, they need to work longer hours than usual
without break or going to the toilet, causing high risk of infection.
Physical fatigue made a damage to the body and performed severe physical
symptoms (Li et al., 2003). However, nurses presented lower score in
phobic anxiety than hygienists which was contrary to previous study (Lai
et al., 2020). To our consideration, reason for this result may be the
hygienists were responsible for making treating plan for patients, and
they need to be very careful in each step because of the high mortality.
Facing too many death and feeling powerless may lead to phobic anxiety.
Though healthcare workers’ mental health was not serious, attention
should be paid to increasing levels of somatization,
obsession-compulsion, anxiety, and phobic anxiety. Psychological
counselling, disaster rescue knowledge training and simulation exercise,
formulation of relevant processes and emergency plans should be
implemented (Greenberg et al., 2020).
In this study, there was a negative correlation between the severity of
mental state and education level, which is consistent with a previous
study (Ji et al., 2017). These findings indicated education was an
import and effective aspect leading people to know virus correctly and
confront it positively. People with higher education level might think
more about the accepted news and information, instead of believing every
information they received, even rumors and false beliefs. More proper
education of the novel virus applied, less mental problems they would
have. Thus, we need to construct proper educational channels of major
infectious disease to the public.
Of note, female participants showed worse PSDI, somatization,
obsessive-compulsive, depression, and anger-hostility. It was consisted
with a previous study that women had more mental problems in the
COVID-19 outbreak (Lai et al., 2020). Reasons may be in face of sudden
change, women can’t be as calm as men. Women usually had rich inner
activities as facing such an emergency crisis, and they worried about
their family members or daily social interaction. This indicated us to
take particular attention to female survivors and healthcare workers,
more family and social support, and psychological intervention was
warranted.
We also interested in whether there was divergence in different ages and
marriage status. The results indicated no significant difference
possibly because: Within this sudden highly infectious virus, everybody
had the possibility of infection and death. The junior or senior,
married or unmarried, were similar in the face of the COVID-19.
Conclusions
In this survey study of COVID-19 survivors and healthcare workers in
Wuhan, China, mental distress is not very serious in general. Yet,
specific methods have to be implemented to promote survivors’ mental
well-being immediately. Meanwhile, healthcare workers warrant more
attention and intervention particularly. Furthermore, low-educated, and
women require meticulous attention. To solve these problems, we call for
a comprehensive emergency response plan and to be developed involving
not only medical facilities but also adequate psychological support.