Psychological intervention in Fangcang shelter hospitals for COVID-19 in China.

Abstract

In January 2020, an outbreak of coronavirus disease 2019 (COVID-19) occurred in Wuhan, China.1 From 24 January to 14 February 2020, the total number of confirmed COVID-19 cases in Wuhan increased dramatically 51-fold.2 During the same period, 16 Fangcang shelter hospitals (FSH), established by converting public venues into large temporary hospitals, were used in Wuhan to admit patients with mild symptoms of COVID-19.3 The FSH provided more than 14 000 beds and timely treatment for the mild cases, as well as breaking down transmission of the virus. It has been suggested that the FSH were a major reason for the successful control of COVID-19 in China.3 In the FSH, due to social isolation, uncertainty, fear of virus transmission, and overwhelming negative news portrayals in mass media coverage,4 the psychological unwellness of both COVID-19 patients and health-care workers (HCW) was prominent. Our baseline cross-sectional survey with 372 COVID-19 patients in FSH and 742 frontline HCW who were engaged in direct contact with COVID-19 patients observed a high proportion of psychological effects among them. We used three self-administered instruments: the nine-item Patient Health Questionnaire (PHQ-9; cut-off point 5), the seven-item Generalized Anxiety Disorder (GAD-7; cut-off point 5), and the Insomnia Severity Index (ISI; cut-off point 8), to assess symptoms of depression, anxiety, and insomnia among participants. We found that 67.7%, 53.0%, and 48.7% of the COVID-19 patients, and 60.5%, 54.2%, and 42.6% of the frontline HCW suffered symptoms of depression, anxiety, and insomnia, respectively. Multiple psychological intervention measures were carried out in the FSH. First, we set up publicity and education exhibition board areas to convey psychological information, including common psychological problems, coping methods, and ways to obtain online and offline psychological services, to both COVID-19 patients and HCW. All the COVID-19 patients and HCW in the FSH had access to these areas. Second, 11 hospitals and institutions jointly developed a free online psychological support system that was loaded as a ‘mini-program’ into the most popular instant messenger (WeChat) in China. The system was first available on 11 February 2020 and consisted of three sections. The psychological information section presented popular science readings about common psychological unwellness that may occur during a public emergency, and the latest encouraging facts on COVID-19. The online assessment section provided several self-administrated tools to assess the psychological fitness, and could give an overall explanation and suggestions for users according to the results of the scales. The psychological intervention section provided an online behavioral and sleep cognitive therapy system, as well as a portal for online consulting through which psychologists and psychiatrists could be reserved for remote video consultations. Both patients and HCW had free access to use the system via WeChat. Third, nurses in the FSH were trained with basic psychological nursing skills in February, such as listening to the patient patiently, showing interest in the content of the conversation, and understanding the patient's situation and feelings. Fourth, at least one psychiatrist was assigned to each FSH. The psychiatrists participated in joint rounds and visits, provided timely monitoring of the psychological status of patients, and provided proper psychological intervention for those in need. Finally, Balint group support was applied among HCW to relieve and overcome their psychological unfitness and one-on-one online or offline psychological consultations were also provided for HCW. The online and offline psychological assistance covered about 12 000 patients and HCW in 14 FSH. Based on the psychological intervention experience from FSH in Wuhan, including both online and offline psychological intervention practice, the National Health Commission of China published a work plan for psychological intervention in FSH on 5 March 2020.5 This work plan was the first plan designed to guide the organization and provision of psychological interventions in FSH. As the number of COVID-19 cases continues to grow around the world, several countries have established FSH to admit more patients. The experiences of psychological interventions in FSH for COVID-19 in China may have implications for other countries. The protocol for the research project has been approved by the Clinical Research Ethics Committee of Renmin Hospital of Wuhan University (WDRY2020-K004), and it conformed to the provisions of the Declaration of Helsinki. Dr Liu reports grants from the National Key R&D Program of China (2018YFC1314600), outside the submitted work.