Abstract
Purpose: This article presents national survey data related to the mental health of participants (N = 13,824) from every province in the People’s Republic of China, in the period of early February, during the early days of the outbreak of the COVID-19 virus. The goal was to examine stress and anxiety levels, even as the virus was spreading across the country. This goal was facilitated by data collected specifically from Wuhan city, which was the geographical epicenter of the outbreak, Hubei, the province in which Wuhan is located, and the rest of China. Methods: The survey included a series of validated measures of mental health, as well as measured constructs such as stress and anxiety, depression, sleep, workplace wellness and social cohesion. To the extent possible, the measures had been previously validated in China and were available in Simplified Chinese, although some measures were created for the unique characteristics of the viral outbreak. The survey was distributed electronically through a network of researchers. Results: The measures were generally reliable, with expected inter-correlations. The factor structure of the Symptom Checklist-90 items was generally consistent with its conceptual dimensions. Mostly importantly, the study revealed a gradient of mental health outcomes, with participants from the city of Wuhan having the highest scores on most mental health measures, with the great Hubei province similar or slightly lower, and the rest of China having elevated, but lower scores on most outcomes. Sleep disturbance also revealed a similar gradient, with participants in the epicenter reporting the most sleep disturbance. Discussion: These results reveal the ability to capture the mental health of citizens during a viral outbreak, and the sensitivity of measures to the mental challenges such an outbreak brings. The gradient of responses revealed the spreading effect of the COVID-19 outbreak, and suggests that worse mental health is highly likely to be an outcome as a pandemic spreads. These results suggest that health officials need to attend to not only the physical and direct effects of a viral pandemic, but also to the importance of the mental health of their citizens.
Highlights
In the context of a global viral pandemic, there is necessarily a primary focus on issues such as rates of transmission of the virus, strategies to reduce the spread of infection, efforts to produce vaccines, and methods to respond to the physical consequences of becoming ill
The study revealed a gradient of mental health outcomes, with participants from the city of Wuhan having the highest scores on most mental health measures, with the great Hubei province similar or slightly lower, and the rest of China having elevated, but lower scores on most outcomes
The methodology was a rapid deployment national survey, which yielded data from all of the provinces of China and permitted specific comparisons of groups of participants based on their geographical proximity to Wuhan city, which was the epicenter of the outbreak
Summary
In the context of a global viral pandemic, there is necessarily a primary focus on issues such as rates of transmission of the virus, strategies to reduce the spread of infection, efforts to produce vaccines, and methods to respond to the physical consequences of becoming ill. The current study is the first major survey of mental health outcomes associated with the COVID-19 coronavirus outbreak. This outbreak began in Wuhan city, in the province of Hubei, in the People’s Republic of China. The first reports of this virus emerged in December 2019, and on January 11, 2020 the first known death from the viral outbreak was identified, by this time it is likely that dozens of people had been infected. On January 23 the city of Wuhan was isolated by Chinese authorities, and on January 30 the World Health Organization declared a “public health emergency of international concern”. By March 11 the World Health Organization declared an international pandemic
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