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.