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Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019

Educational Objective
Review what factors are associated with mental health outcomes among health care workers in China who are treating patients with coronavirus.
1 Credit CME
Key Points

Question  What factors are associated with mental health outcomes among health care workers in China who are treating patients with coronavirus disease 2019 (COVID-19)?

Findings  In this cross-sectional study of 1257 health care workers in 34 hospitals equipped with fever clinics or wards for patients with COVID-19 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-19.

Meaning  These findings suggest that, among Chinese health care workers exposed to COVID-19, 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.

Abstract

Importance  Health care workers exposed to coronavirus disease 2019 (COVID-19) could be psychologically stressed.

Objective  To assess the magnitude of mental health outcomes and associated factors among health care workers treating patients exposed to COVID-19 in China.

Design, Settings, and Participants  This cross-sectional, survey-based, region-stratified study collected demographic data and mental health measurements from 1257 health care workers in 34 hospitals from January 29, 2020, to February 3, 2020, in China. Health care workers in hospitals equipped with fever clinics or wards for patients with COVID-19 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 22-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 1257 of 1830 contacted individuals completed the survey, with a participation rate of 68.7%. A total of 813 (64.7%) were aged 26 to 40 years, and 964 (76.7%) were women. Of all participants, 764 (60.8%) were nurses, and 493 (39.2%) were physicians; 760 (60.5%) worked in hospitals in Wuhan, and 522 (41.5%) were frontline health care workers. A considerable proportion of participants reported symptoms of depression (634 [50.4%]), anxiety (560 [44.6%]), insomnia (427 [34.0%]), and distress (899 [71.5%]). 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: 4.0 [1.0-7.0] vs 5.0 [2.0-8.0]; P = .007; median [interquartile range {IQR}] Generalized Anxiety Disorder scale scores among men vs women: 2.0 [0-6.0] vs 4.0 [1.0-7.0]; P < .001; median [IQR] Insomnia Severity Index scores among frontline vs second-line workers: 6.0 [2.0-11.0] vs 4.0 [1.0-8.0]; P < .001; median [IQR] Impact of Event Scale–Revised scores among those in Wuhan vs those in Hubei outside Wuhan and those outside Hubei: 21.0 [8.5-34.5] vs 18.0 [6.0-28.0] in Hubei outside Wuhan and 15.0 [4.0-26.0] outside Hubei; P < .001). 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], 0.62; 95% CI, 0.43-0.88; P = .008). Frontline health care workers engaged in direct diagnosis, treatment, and care of patients with COVID-19 were associated with a higher risk of symptoms of depression (OR, 1.52; 95% CI, 1.11-2.09; P = .01), anxiety (OR, 1.57; 95% CI, 1.22-2.02; P < .001), insomnia (OR, 2.97; 95% CI, 1.92-4.60; P < .001), and distress (OR, 1.60; 95% CI, 1.25-2.04; P < .001).

Conclusions and Relevance  In this survey of heath care workers in hospitals equipped with fever clinics or wards for patients with COVID-19 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-19.

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Article Information

Accepted for Publication: March 2, 2020.

Published: March 23, 2020. doi:10.1001/jamanetworkopen.2020.3976

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2020 Lai J et al. JAMA Network Open.

Corresponding Authors: Zhongchun Liu, MD, Department of Psychiatry, Renmin Hospital of Wuhan University, 238 Jiefang Rd, Wuhan 430060, China (zcliu6@whu.edu.cn); Shaohua Hu, MD, Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Rd, Hangzhou 310003, China (dorhushaohua@zju.edu.cn).

Author Contributions: Drs Liu and S. Hu had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Lai, Ma, and Y. Wang contributed equally and share first authorship. Drs Liu and S. Hu contributed equally as senior authors.

Concept and design: Liu, S. Hu.

Acquisition, analysis, or interpretation of data: Lai, Ma, Y. Wang, Cai, J. Hu, Wei, Wu, Du, Chen, Li, Tan, Kang, Yao, Huang, H. Wang, G. Wang.

Drafting of the manuscript: Lai, Ma, Y. Wang, Liu, S. Hu.

Critical revision of the manuscript for important intellectual content: Lai, Cai, J. Hu, Wei, Wu, Du, Chen, Li, Tan, Kang, Yao, Huang, H. Wang, G. Wang, Liu, S. Hu.

Statistical analysis: Ma, Y. Wang, Liu, S. Hu.

Obtained funding: Liu, S. Hu.

Administrative, technical, or material support: Lai, Cai, J. Hu, Wei, Wu, Du, Chen, Li, Tan, Kang, Yao, Huang, H. Wang, G. Wang.

Supervision: G. Wang, Liu, S. Hu.

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was supported by grants 2018YFC1314600 and 2016YFC1307100 from the National Key Research and Development Program of China.

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We thank all the participants who contributed to our work.

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