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      The Psychological and Mental Impact of Coronavirus Disease 2019 (COVID-19) on Medical Staff and General Public – A Systematic Review and Meta-analysis

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          Highlights

          • We included 62 studies from 17 countries assessing psychological distress of COVID-19

          • We found a high psychological burden among medical staff and the general public

          • However, the psychological distress was significantly higher among patients

          • We identified risk factors of psychological burdens to identify high-risk people

          • Professional medical services should be allocated to high-risk population

          • More self-help materials should be made available for people with milder impact

          Abstract

          The coronavirus disease 2019 (COVID-19) pandemic has caused enormous psychological impact worldwide. We conducted a systematic review and meta-analysis on the psychological and mental impact of COVID-19 among healthcare workers, the general population, and patients with higher COVID-19 risk published between 1 Nov 2019 to 25 May 2020. We conducted literature researching used Embase, PubMed, Google scholar and WHO COVID-19 databases. Among the initial search of 9207 studies, 62 studies with 162,639 participants from 17 countries were included in the review. The pooled prevalence of anxiety and depression was 33% (95% confidence interval: 28%-38%) and 28% (23%-32%), respectively. The prevalence of anxiety and depression was the highest among patients with pre-existing conditions and COVID-19 infection (56% [39%-73%] and 55% [48%-62%]), and it was similar between healthcare workers and the general public. Studies from China, Italy, Turkey, Spain and Iran reported higher-than-pooled prevalence among healthcare workers and the general public. Common risk factors included being women, being nurses, having lower socioeconomic status, having high risks of contracting COVID-19, and social isolation. Protective factors included having sufficient medical resources, up-to-date and accurate information, and taking precautionary measures. In conclusion, psychological interventions targeting high-risk populations with heavy psychological distress are in urgent need.

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          Most cited references 33

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          Survey of Insomnia and Related Social Psychological Factors Among Medical Staff Involved in the 2019 Novel Coronavirus Disease Outbreak

          Objective The outbreak of the 2019 novel coronavirus disease (COVID-19) not only caused particularly large public health problems, but also caused great psychological distress, especially for medical staff. We aimed to investigate the prevalence rate of insomnia and to confirm the related social psychological factors among medical staff in hospitals during the COVID-19 outbreak. Method Medical staff members in China were recruited, including frontline medical workers. The questionnaire, administered through the WeChat program, obtained demographic data and asked self-design questions related to the COVID-19 outbreak, insomnia/depressive/anxiety symptoms, and stress-related symptoms. We used a logistic regression analysis to examine the associations between sociodemographic factors and insomnia symptoms. Result There were a total of 1,563 participants in our study. Five-hundred-and-sixty-four (36.1%) participants had insomnia symptoms according to the Insomnia Severity Index (ISI) (total score ≥ 8). A multiple binary logistic regression model revealed that insomnia symptoms were associated with an education level of high school or below (OR = 2.69, p = 0.042, 95% CI = 1.0–7.0), being a doctor (OR = 0.44, p = 0.007, 95% CI = 0.2–0.8), currently working in an isolation unit (OR = 1.71, p = 0.038, 95% CI = 1.0–2.8), is worried about being infected (OR = 2.30, p < 0.001, 95% CI = 1.6–3.4), perceived lack of helpfulness in terms of psychological support from news or social media with regard to COVID-19 (OR = 2.10, p = 0.001, 95% CI = 1.3–3.3), and having very strong uncertainty regarding effective disease control (OR = 3.30, p = 0.013, 95% CI = 1.3–8.5). Conclusion Our study found that more than one-third of the medical staff suffered insomnia symptoms during the COVID-19 outbreak. The related factors included education level, an isolation environment, psychological worries about the COVID-19 outbreak, and being a doctor. Interventions for insomnia among medical staff are needed considering the various sociopsychological factors at play in this situation.
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            A Qualitative Study on the Psychological Experience of Caregivers of COVID-19 Patients

            Highlights • Studies on the psychological experience of nurses combating COVID-19 are lacking • We investigated the psychological experience of caregivers of COVID-19 patients • Nurses showed interweaving positive/negative emotions during outbreak of COVID-19 • Negative emotions are dominant in the early stages of the COVID-19 outbreak • Coping styles and psychological growth are important for maintaining mental health
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              The differential psychological distress of populations affected by the COVID-19 pandemic

              Coronavirus disease 2019 (COVID-19) initially outbroke in Wuhan, China in December 2019 and promptly became a pandemic worldwide within the following two months. The public health emergencies resulting from COVID-19 are negatively impacting the mental health of the population and increasing the incidence of psychological crises (Xiang et al., 2020). Early identification of populations in the first stages of psychological crisis will allow for the efficient implementation of interventional strategies (National Health Commission of China 2020). The clinical characteristics of psychological distress have not been well established across the populations affected by the COVID-19 pandemic, although a general increased level of mental distress has been reported from both the general public and frontline medical personnel (Kang et al., 2020; Qiu et al., 2020). Therefore, we designed a pilot and cross-sectional study to identify the characteristics of psychological distress across populations affected by the COVID-19 pandemic. The app-based, anonymous questionnaire was designed to survey the level of psychological distress, and the study was conducted in the Zhongshan, one of prefecture-level cities in Guangdong province, P. R. China, from February 15 to February 29, 2020. A total of 205 participants responded and completed the questionnaires. The Chinese version 9-item General Health Questionnaire (GHQ-9) and 7-item Generalized Anxiety Disorder (GAD-7) scale were employed to evaluate the prevalence and severity of psychological distress within patients newly recovery from COVID-19 infection, individuals under quarantine, and the general public. A total score of ≥10 for both the PHQ-9 and GAD-7 was defined as depression and anxiety respectively. The severity of psychological distress was classified with the standard thresholds: Minimal or none (0-4), Mild (5-9), Moderate (10-14), Severe (>15) for both the PHQ-9 and GAD-7. An increased prevalence of depression (29.2%) was found predominately in patients who experienced COVID-19 infection (p = 0.016), while the prevalence of anxiety was not statistically different across the three groups (p = 0.154) as shown in Table 1 . Trends for an increased prevalence of depression comorbid with anxiety (p = 0.086) were identified in both patients who experienced COVID-19 infection (21.1%) and the general public (22.4%) compared to those in quarantine. Both patients who experienced COVID-19 infection (19.3%) and the general public (14.3%) also had a greater proportion of severe depressive symptom (p = 0.002) as shown in Table 1. Moreover, patients who experienced COVID-19 infection and the general public more likely to demonstrate depressed mood (p = 0.038) and somatic symptoms (all p < 0.01) in the sub-items of the PHQ-9, compared to individuals under quarantine . Anxiety-like behavior, including becoming easily annoyed or irritable, manifested primarily in the general public and patients who experienced COVID-19 infection (p < 0.01). Table 1 Demographic and clinical characteristics of patients who experienced COVID-19 infection, individuals under quarantine, and the general public Patients who experienced COVID-19 infection (n=57) Individuals under quarantine(n=50) General public (n=98) F/χ2 P value Gender n (%) 6.57 0.037 Male 29 (50.9) 27 (54.0) 34 (34.7)a Female 28 (49.1) 23 (46.0) 64 (65.3)a Age (years) 46.9±15.37 b 36.2±10.91 29.6±12.69b 30.80 <0.001 Educational Level n (%)** 6.80 0.147 Junior middle school or less 17 (30.9) 13 (26.0) 41 (41.8) Senior middle school 15 (27.3) 16 (32.0) 16 (16.3) College or more 23 (41.8) 21 (42.0) 41 (41.8) Marital status n (%) 21.69 <0.001 Single 8 (14.3) 14 (28.0) 49 (50.0) Married 44 (78.6) 34 (68.0) 45 (45.9) Divorced or other 5 (7.1) 2 (4.0) 4 (4.1) Hometown n (%) 78.39 <0.001 Not Hubei province 18 (31.6) 43 (86.0) 92 (93.9) Hubei province 39 (68.4) 7 (14.0) 6 (6.1) Prevalence of Depression n (%) 21 (29.2)c 6 (9.8) 61 (34.7) 8.284 0.016 Prevalence of Anxiety n (%) 15 (20.8) 5 (10.2) 43 (19.6) 3.741 0.154 Depression comorbid with Anxiety n(%) 12 (21.1) 6 (8) 22 (22.4) 4.91 0.086 Severity of depressive symptomsn (%) 20.26 0.002 None 21 (36.8) 35 (70.0) 49 (50.0) Mild 18 (31.6) 10 (20.0) 15 (15.3) Moderate 7 (12.3) 3 (6.0) 20 (20.4) Severe 11 (19.3)d 2 (4.0) 14 (14.3) Severity of anxiety symptomsn (%) 8.86 0.182 None 31 (54.4) 36 (72.0) 60 (61.2) Mild 14 (36.8) 9 (18.0) 15 (15.3) Moderate 4 (26.7) 4 (8.0) * 7 (7.1) Severe 8 (32.0) 1 (2.0) * 16 (16.3) * Expected count less than 5; ** educational level of two respondents were not available a Significant difference between the general public and the other two groups (p value < 0.01); b Significant difference between group analysis with Bonferroni post-hoc analysis (all p values < 0.01); c Statistical significance compared to individuals under quarantine with adjusted p values (Bonferroni method); d Statistical significance compared to individuals under quarantine with adjusted p values (Bonferroni method) To the best of our knowledge, this is the first study aimed at exploring the psychological health across populations with different levels of exposure to the COVID-19 epidemic. Our study revealed differential levels of psychological distress in patients who experienced COVID-19 infection, individuals under quarantine, and the general public. The vulnerability to psychological distress across populations in the COVID-19 pandemic could be attributable to various factors, including gender, social support, specific experiences with COVID-19 infection, length of isolation, and amount of exposure to the media (Brooks et al., 2020, Li et al., 2020). The preliminary findings from our study suggest that timely identification of psychological distress and precise classifying of the mental health needs across populations will facilitate development of targeted psychological interventions for individuals in epidemics of emerging infectious diseases. Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have influence the work reported in this correspondence Uncited references Kang et al., 2019, Health, 2020.
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                Author and article information

                Contributors
                Journal
                Psychiatry Res
                Psychiatry Res
                Psychiatry Research
                Published by Elsevier B.V.
                0165-1781
                1872-7123
                7 June 2020
                7 June 2020
                Affiliations
                [a ]Department of Anesthesiology, The 965 th Hospital of Qinlian Support Army, Jilin, 132011 China
                [b ]Department of Psychology, 96605 Army Hospital, Jilin, 134000 China
                [c ]Department of Ophthalmology, The 965 th Hospital of Qinlian Support Army, Jilin, China
                [d ]Department of Anesthesiology, Daping Hospital, Army Medical University, Chongqing, 400042 China
                Author notes
                [* ]Corresponding author. 710875839@ 123456qq.com
                Article
                S0165-1781(20)31020-9 113190
                10.1016/j.psychres.2020.113190
                7276119
                © 2020 Published by Elsevier B.V.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

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