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Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019.
JAMA Netw Open. 2020 03 02; 3(3):e203976.JN

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.

Authors+Show Affiliations

Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China.Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China.Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China.Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.Department of Psychiatry, Wuhan Youfu Hospital, Wuhan, China.Department of Psychiatry, Jingmen No. 2 People's Hospital, Jingmen, China.Department of Psychiatry, Wuhan Wudong Hospital, Wuhan, China.Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China.Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China.Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China.Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China.Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.Department of Nursing, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China.Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China.Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32202646

Citation

Lai, Jianbo, et al. "Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019." JAMA Network Open, vol. 3, no. 3, 2020, pp. e203976.
Lai J, Ma S, Wang Y, et al. Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Netw Open. 2020;3(3):e203976.
Lai, J., Ma, S., Wang, Y., Cai, Z., Hu, J., Wei, N., Wu, J., Du, H., Chen, T., Li, R., Tan, H., Kang, L., Yao, L., Huang, M., Wang, H., Wang, G., Liu, Z., & Hu, S. (2020). Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Network Open, 3(3), e203976. https://doi.org/10.1001/jamanetworkopen.2020.3976
Lai J, et al. Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. JAMA Netw Open. 2020 03 2;3(3):e203976. PubMed PMID: 32202646.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019. AU - Lai,Jianbo, AU - Ma,Simeng, AU - Wang,Ying, AU - Cai,Zhongxiang, AU - Hu,Jianbo, AU - Wei,Ning, AU - Wu,Jiang, AU - Du,Hui, AU - Chen,Tingting, AU - Li,Ruiting, AU - Tan,Huawei, AU - Kang,Lijun, AU - Yao,Lihua, AU - Huang,Manli, AU - Wang,Huafen, AU - Wang,Gaohua, AU - Liu,Zhongchun, AU - Hu,Shaohua, Y1 - 2020/03/02/ PY - 2020/3/24/entrez PY - 2020/3/24/pubmed PY - 2020/4/2/medline SP - e203976 EP - e203976 JF - JAMA network open JO - JAMA Netw Open VL - 3 IS - 3 N2 - 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. SN - 2574-3805 UR - https://www.unboundmedicine.com/medline/citation/32202646/Factors_Associated_With_Mental_Health_Outcomes_Among_Health_Care_Workers_Exposed_to_Coronavirus_Disease_2019_ L2 - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/10.1001/jamanetworkopen.2020.3976 DB - PRIME DP - Unbound Medicine ER -