Abstract
During the outbreak of coronavirus disease 2019 (COVID-19), people are under the dual pressure of interpersonal isolation and concerns about infection. An evaluation of people's psychological status and risk factors is needed to conduct target interventions. This was a nationwide, multicenter, cross-sectional study using quota and snowball sampling methods during the COVID-19 epidemic in China. Participants' characteristics and experiences were obtained by an online questionnaire and telephone review. Psychological distress and sleep problems were measured by the Generalized Anxiety Disorder-7, the Patient Health Questionnaire-9, and the Insomnia Severity Index. A total of 23,500 participants were recruited, and 19,372 valid questionnaires were received from 11 centers. Overall, 11.0-13.3% of the participants had anxiety, depression, or insomnia symptoms, and 1.9-2.7% had severe symptoms. The prevalence of psychological and sleep problems has increased. Working as frontline medical staff (Odds Ratio OR=3.406), living in Hubei Province (OR=2.237), close contacts with COVID-19 (OR=1.808), and age 35-49years (OR=1.310) were risk factors for anxiety symptoms; no outside activity for 2weeks (OR=2.167) and age 35-49years (OR=1.198) were risk factors for depression symptoms; and living in Hubei Province (OR=2.376), no outside activity for 2weeks (OR=1.927), and age 35-49years (OR=1.262) were risk factors for insomnia symptoms. Only 1.9% of participants received counseling during the epidemic. Psychological and sleep problems increased during interpersonal isolation due to COVID-19. Current psychological interventions are far from sufficient.
Highlights
Psychological distress and sleep problems are important public health issues when epidemics and disasters occur, and these effects can be long lasting
Based on the preinvestigation results, areas were stratified by the number of confirmed patients, and psychological distress and sleep problems were measured by the Generalized Anxiety Disorder-7 scale (GAD-7, Cronbach’s α = 0.90) [11], the Patient Health Questionnaire-9 (PHQ-9, Cronbach’s α = 0.89) [12], and the Insomnia Severity Index (ISI, Cronbach’s α = 0.83) [13]
The results showed that 13.3% (n = 2,577, 95% CI: 12.8–13.8) of participants had ISI scores ≥15, which indicated that they had insomnia symptoms, and 2.7% (n = 523, 95% CI: 2.5–2.9) of participants had ISI scores ≥22, indicating severe insomnia symptoms
Summary
Psychological distress and sleep problems are important public health issues when epidemics and disasters occur, and these effects can be long lasting. Several studies have analyzed psychological health status in China during COVID-19, most of these studies have focused on online social network users and have applied only snowball sampling or convenience sampling, which may decrease their overall representativeness [7,8,9]. We conducted this large-scale, nationwide, multicenter, cross-sectional study using a population-based representative sampling procedure to explore the psychological impact of interpersonal isolation and the stress of infection among a wide range of people.
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