The prevalence and influencing factors for anxiety in medical workers fighting COVID-19 in China: A cross-sectional survey

  1. Chen-Yun Liu
  2. Yun-zhi Yang
  3. Xiao-Ming Zhang
  4. Xinying Xu
  5. Qing-Li Dou
  6. Wen-Wu Zhang

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Abstract

Background

The COVID-19 outbreak caused by the SARS-Cov-2 virus has been sustained in China since December 2019, and could become a pandemic if we do not contain it. The mental health of frontline medical staff is a concern. In this study, we aimed to identify the influencing factors on medical worker anxiety in China during the COVID-19 outbreak.

Methods

We conducted a cross-sectional study to estimate the prevalence of anxiety among medical staff from 10 th February 2020 to 20 th February 2020 in China using the Zung Self-rating Anxiety Scale (SAS) to assess anxiety, using the criteria of normal (≤49), mild (50-59), moderate (60- 70) and severe anxiety (≥70). We used multivariable linear regression to determine the factors (e.g., having direct contact treating infected patients, being a medical staff worker from Hubei province, being a suspect case) for anxiety. We also used adjusted models to confirm independent factors for anxiety after adjusting for gender, age, education and marital status.

Results

Of 512 medical staff from China, 164 healthcare workers (32.03%) had had direct contact by treating infected patients. The prevalence of anxiety was 12.5%, with 53 workers suffering from mild (10.35%), seven workers from moderate (1.36%) and four workers from severe anxiety (0.78%). After adjusting for sociodemographic characteristics (gender, age, education and marital status), medical staff who had had direct contact treating infected patients saw higher anxiety scores than those who had not had direct contact (βvalue=2.33, CI: 0.65 −4.00; p=0.0068). Similar things were observed in medical staff from Hubei province, compared with those from other parts of China (β value=3.67, CI: 1.44 −5.89; p=0.0013). The most important variable was suspect cases with high anxiety scores, compared to non-suspect cases (βvalue=4.44, CI: 1.55 −7.33; p=0.0028).

Conclusion

Our results highlight that government authorities should make early detection of the high risk of anxiety among medical staff a priority, and implement appropriate psychological intervention programs, to prevent medical staff from developing psychological disorders that could potentially exert an adverse effect on combating the COVID-19 epidemic.

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  1. ScreenIT

    SciScore for 10.1101/2020.03.05.20032003: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementConsent: Informed consent was provided by subjects before study commencement.
    IRB: Ethical considerations: Ethical approval from the ethics committee of the People’s Hospital of Baoan District, Shenzhen (Certificate: BYL20200202) was obtained, with written consent provided by all participants.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All analyses were conducted using EmpowerStats (http://www.empowerstats.com, X&Y Solutions, Inc., Boston, MA) and software package R (http://www.r-project.org).
    http://www.r-project.org
    suggested: (R Project for Statistical Computing, RRID:SCR_001905)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study has some limitations. First, the questionnaires were dispatched non-randomly via WeChat, so a selective-bias exists in our study, and the number of medical staff from Hubei was in a minority (14.26%), which means that our study does not completely reflect the entire mental health picture of Chinese medical staff in quarantine. Second, we did not collect data during the early stages of the epidemic, when anxiety score levels could have been different. A previous study reported that the prevalence of psychological disorders presented differently from the start to the end of the outbreak18. Third, our study used a cross-sectional design that cannot determine causality for factors and outcome. In addition, a comprehensive assessment, including demographic factors, such as years of experience, having children or not and a history of mental disorders, would be beneficial in analyzing potential anxiety factors. However, our study also has some strengths. To our knowledge, this is the first study to assess anxiety levels among medical staff in China during the period of COVID-19, and we used comprehensive data statistical analyses to make our results reliable.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  2. Version published to 10.1101/2020.03.05.20032003v1 on medRxiv
  3. Version published to 10.1017/s0950268820001107