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

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          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

          This cross-sectional study assesses the magnitude of mental health consequences and associated factors among health care workers treating patients exposed to coronavirus disease 2019 (COVID-19) in China.

          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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          Most cited references 10

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          Psychological effects of the SARS outbreak in Hong Kong on high-risk health care workers.

          To quantify stress and the psychological impact of severe acute respiratory syndrome (SARS) on high-risk health care workers (HCWs). We evaluated 271 HCWs from SARS units and 342 healthy control subjects, using the Perceived Stress Scale (PSS) to assess stress levels and a structured list of putative psychological effects of SARS to assess its psychological effects. Healthy control subjects were balanced for age, sex, education, parenthood, living circumstances, and lack of health care experience. Stress levels were raised in both groups (PSS = 18) but were not relatively increased in the HCWs. HCWs reported significantly more positive (94%, n = 256) and more negative psychological effects (89%, n = 241) from SARS than did control subjects. HCWs declared confidence in infection-control measures. In HCWs, adaptive responses to stress and the positive effects of infection control training may be protective in future outbreaks. Elevated stress in the population may be an important indicator of future psychiatric morbidity.
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            Severe acute respiratory syndrome (SARS) and healthcare workers.

            The recent outbreak of severe acute respiratory synt drome (SARS) was spread by international air travel, a direct result of globalization. The disease is caused by a novel coronavirus, transmitted from human to human by droplets or by direct contact. Healthcare workers (HCWs) were at high risk and accounted for a fifth of all cases globally. Risk factors for infection in HCWs included lack of awareness and preparedness when the disease first struck, poor institutional infection control measures, lack of training in infection control procedures, poor compliance with the use of personal protection equipment (PPE), exposure to high-risk procedures such as intubation and nebulization, and exposure to unsuspected SARS patients. Measures to prevent nosocomial infection included establishing isolation wards for triage, SARS patients, and step-down; training and monitoring hospital staff in infection-control procedures; active and passive screening of HCWs; enforcement of droplet and contact precautions; and compliance with the use of PPE.
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              Validity and reliability of Patient Health Questionnaire-9 and Patient Health Questionnaire-2 to screen for depression among college students in China

              This study examined the validity and reliability of the Patient Health Questionnaire-9 (PHQ-9) and Patient Health Questionnaire-2 (PHQ-2). The optimal cutoff score when screening for depression among Chinese college students was also determined.
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                Author and article information

                Journal
                JAMA Netw Open
                JAMA Netw Open
                JAMA Netw Open
                JAMA Network Open
                American Medical Association
                2574-3805
                23 March 2020
                March 2020
                23 March 2020
                : 3
                : 3
                Affiliations
                [1 ]Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
                [2 ]Department of Psychiatry, Renmin Hospital of Wuhan University, Wuhan, China
                [3 ]Department of Psychiatry, Wuhan Youfu Hospital, Wuhan, China
                [4 ]Department of Psychiatry, Jingmen No. 2 People’s Hospital, Jingmen, China
                [5 ]Department of Psychiatry, Wuhan Wudong Hospital, Wuhan, China
                [6 ]Department of Nursing, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
                Author notes
                Article Information
                Accepted for Publication:
                Published:10.1001/jamanetworkopen.2020.3976
                Open Access: CC-BY License JAMA Network Open
                Corresponding Authors: Zhongchun Liu, MD, Department of Psychiatry, Renmin Hospital of Wuhan University, 238 Jiefang Rd, Wuhan 430060, China ( zcliu6@ 123456whu.edu.cn ); Shaohua Hu, MD, Department of Psychiatry, First Affiliated Hospital, Zhejiang University School of Medicine, 79 Qingchun Rd, Hangzhou 310003, China ( dorhushaohua@ 123456zju.edu.cn ).
                Author Contributions:
                Concept and design:
                Acquisition, analysis, or interpretation of data:
                Drafting of the manuscript:
                Critical revision of the manuscript for important intellectual content:
                Statistical analysis:
                Obtained funding:
                Administrative, technical, or material support:
                Supervision:
                Conflict of Interest Disclosures:
                Funding/Support: National Key Research and Development Program of China
                Role of the Funder/Sponsor:
                Additional Contributions:
                Article
                zoi200192
                10.1001/jamanetworkopen.2020.3976
                7090843
                32202646
                Copyright 2020 Lai J et al. JAMA Network Open.

                This is an open access article distributed under the terms of the CC-BY License.

                Funding
                Funded by: National Key Research and Development Program of China
                Categories
                Research
                Original Investigation
                Online Only
                Psychiatry

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