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If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response. Not all submitted comments are published. Please see our commenting policy for details. Question What factors are associated with mental health outcomes among health care workers in China who are treating patients with coronavirus disease COVID?
Findings In this cross-sectional study of health care workers in 34 hospitals equipped with fever clinics or wards for patients with COVID in multiple regions of China, a considerable proportion of health care workers reported experiencing symptoms of depression, anxiety, insomnia, and distress, especially women, nurses, those in Wuhan, and front-line health care workers directly engaged in diagnosing, treating, or providing nursing care to patients with suspected or confirmed COVID Meaning These findings suggest that, among Chinese health care workers exposed to COVID, women, nurses, those in Wuhan, and front-line health care workers have a high risk of developing unfavorable mental health outcomes and may need psychological support or interventions.
Objective To assess the magnitude of mental health outcomes and associated factors among health care workers treating patients exposed to COVID in China. Design, Settings, and Participants This cross-sectional, survey-based, region-stratified study collected demographic data and mental health measurements from health care workers in 34 hospitals from January 29, , to February 3, , in China.
Health care workers in hospitals equipped with fever clinics or wards for patients with COVID were eligible. Main Outcomes and Measures The degree of symptoms of depression, anxiety, insomnia, and distress was assessed by the Chinese versions of the 9-item Patient Health Questionnaire, the 7-item Generalized Anxiety Disorder scale, the 7-item Insomnia Severity Index, and the item Impact of Event Scale—Revised, respectively.
Multivariable logistic regression analysis was performed to identify factors associated with mental health outcomes. Results A total of of contacted individuals completed the survey, with a participation rate of A total of Of all participants, A considerable proportion of participants reported symptoms of depression [ Nurses, women, frontline health care workers, and those working in Wuhan, China, reported more severe degrees of all measurements of mental health symptoms than other health care workers eg, median [IQR] Patient Health Questionnaire scores among physicians vs nurses: 4.
Multivariable logistic regression analysis showed participants from outside Hubei province were associated with lower risk of experiencing symptoms of distress compared with those in Wuhan odds ratio [OR], 0. Frontline health care workers engaged in direct diagnosis, treatment, and care of patients with COVID were associated with a higher risk of symptoms of depression OR, 1.
Conclusions and Relevance In this survey of heath care workers in hospitals equipped with fever clinics or wards for patients with COVID in Wuhan and other regions in China, participants reported experiencing psychological burden, especially nurses, women, those in Wuhan, and frontline health care workers directly engaged in the diagnosis, treatment, and care for patients with COVID Since the end of December , the Chinese city of Wuhan has reported a novel pneumonia caused by coronavirus disease COVID , which is spreading domestically and internationally.
Moreover, person-to-person transmission has been recorded outside mainland China. Facing this critical situation, health care workers on the front line who are directly involved in the diagnosis, treatment, and care of patients with COVID are at risk of developing psychological distress and other mental health symptoms. The ever-increasing number of confirmed and suspected cases, overwhelming workload, depletion of personal protection equipment, widespread media coverage, lack of specific drugs, and feelings of being inadequately supported may all contribute to the mental burden of these health care workers.
Previous studies have reported adverse psychological reactions to the SARS outbreak among health care workers. Psychological assistance services, including telephone-, internet-, and application-based counseling or intervention, have been widely deployed by local and national mental health institutions in response to the COVID outbreak. On February 2, , the State Council of China announced that it was setting up nationwide psychological assistance hotlines to help during the epidemic situation.
To address this gap, the aim of current study was to evaluate mental health outcomes among health care workers treating patients with COVID by quantifying the magnitude of symptoms of depression, anxiety, insomnia, and distress and by analyzing potential risk factors associated with these symptoms. Participants from Wuhan city the capital of Hubei province and other areas inside and outside Hubei province in China were enrolled in this survey to compare interregional differences.
This study aimed to provide an assessment of the mental health burden of Chinese health care workers, which can serve as important evidence to direct the promotion of mental well-being among health care workers. Approval from the clinical research ethics committee of Renmin Hospital of Wuhan University was received before the initiation of this study. Verbal informed consent was provided by all survey participants prior to their enrollment. Participants were allowed to terminate the survey at any time they desired.
The survey was anonymous, and confidentiality of information was assured. The study is a cross-sectional, hospital-based survey conducted via a region-stratified, 2-stage cluster sampling from January 29, , to February 3, To compare the interregional differences of mental health outcomes among health care workers in China, samples were stratified by their geographic location ie, Wuhan, other regions inside Hubei province, and regions outside Hubei province.
Because Wuhan was most severely affected, more hospitals in Wuhan were sampled. Hospitals equipped with fever clinics or wards for COVID were eligible to participate in this survey. A total of 20 hospitals in Wuhan 10 designated by the local government to treat COVID and 10 nondesignated , 7 hospitals in other regions of Hubei province, and 7 hospitals from 7 other provinces with a high incidence of COVID 1 hospital from each province were included.
In total, 34 hospitals were involved. One clinical department was randomly sampled from each selected hospital, and all health care workers in this department were asked to participate in this study. We focused on symptoms of depression, anxiety, insomnia, and distress for all participants, using Chinese versions of validated measurement tools. The total scores of these measurement tools were interpreted as follows: PHQ-9, normal , mild , moderate , and severe depression; GAD-7, normal , mild , moderate , and severe anxiety; ISI, normal , subthreshold , moderate , and severe insomnia; and IES-R, normal , mild , moderate , and severe distress.
These categories were based on values established in the literature. The cutoff score for detecting symptoms of major depression, anxiety, insomnia, and distress were 10, 7, 14 15, and 26, respectively. Participants who had scores greater than the cutoff threshold were characterized as having severe symptoms. The different technical titles of respondents refer to the professional titles certificated by the hospital.
Participants were asked whether they were directly engaged in clinical activities of diagnosing, treating, or providing nursing care to patients with elevated temperature or patients with confirmed COVID Those who responded yes were defined as frontline workers, and those who answered no were defined as second-line workers.
Data analysis was performed using SPSS statistical software version The original scores of the 4 measurement tools were not normally distributed and so are presented as medians with interquartile ranges IQRs.
The ranked data, which were derived from the counts of each level for symptoms of depression, anxiety, insomnia, and distress, are presented as numbers and percentages. The nonparametric Mann-Whitney U test and Kruskal-Wallis test were applied to compare the severity of each symptom between 2 or more groups.
In the study, among the health care workers [ The occupational and geographic data of nonrespondents were similar to those of respondents eTable 1 in the Supplement. Of the responding participants, The response rates for physicians and nurses were Of the participants, Most participants were women [ A total of participants Nearly all participants [ A considerable proportion of participants had symptoms of depression [ Nurses, women, frontline workers, and those in Wuhan reported experiencing more severe symptom levels of depression, anxiety, insomnia, and distress eg, severe depression among physicians vs nurses: 24 [4.
Compared with those working in tertiary hospitals, participants working in secondary hospitals were more likely to report severe symptoms of depression 53 [5. Similar to findings in severity of symptoms, participants who were nurses, women, frontline health care workers, and working in Wuhan had higher scores in all 4 scales compared with those who were physicians, men, second-line health care workers, and working in Hubei province outside Wuhan or outside Hubei province eg, median [IQR] PHQ-9 scores among physicians vs nurses: 4.
Compared with health care workers in tertiary hospitals, those in secondary hospitals reported higher scores on scales measuring symptoms of depression, anxiety, and insomnia median [IQR] PHQ-9 score, 4. However, frontline health care workers from tertiary and secondary hospitals reported equally high scores on all 4 scales eg, median [IQR] PHQ-9 score, 5. In pairwise comparisons, participants from Hubei province outside Wuhan and participants outside Hubei province reported similar levels of symptoms of depression, anxiety, insomnia, and distress but were all lower than that of health care workers in Wuhan, the origin of the epidemic eTable 2 in the Supplement.
Analyses of scores of 3 factors avoidance, intrusion, and hyperarousal derived from the IES-R are presented in eTable 3, eTable 4, and eTable 5 in the Supplement. Multivariable logistic regression analysis showed that, after controlling for confounders, being a woman and having an intermediate professional title were associated with severe symptoms of depression, anxiety, and distress eg, severe depression among women: OR, 1.
Compared with working in a tertiary hospital, working in secondary hospitals was associated with more severe symptoms of depression OR, 1. Working outside Hubei province was associated with a lower risk of feeling distressed than working in Wuhan OR, 0. Compared with working in second-line positions, working in the frontline directly treating patients with COVID appeared to be an independent risk factor for all psychiatric symptoms after adjustment depression, OR 1.
This cross-sectional survey enrolled respondents and revealed a high prevalence of mental health symptoms among health care workers treating patients with COVID in China.
Overall, Participants were divided in 3 groups Wuhan, other regions in Hubei province, and regions outside Wuhan province to compare interregional differences. Most participants were female, were nurses, were aged 26 to 40 years, were married, and worked in tertiary hospitals with a junior technical title. Nurses, women, those working in Wuhan, and frontline workers reported more severe symptoms on all measurements. Our Expert writes are available to research perfect thesis topic by subject along with words topic brief in just For A-Z custom thesis writing services be it analysis, thesis proposal, thesis chapters, conclusion or complete thesis writing service along with.
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