key: cord-0782193-cdxpodfg authors: Ge, Fenfen; Wan, Mentong; Zheng, Anni; Luo, Guan; Zhang, Jun title: How to deal with the negative psychological impact of COVID-19 for people who pay attention to anxiety and depression date: 2020-06-23 journal: Precis Clin Med DOI: 10.1093/pcmedi/pbaa023 sha: 63c0576f9b3c3ec5e0eb47d019f7fd226bc57504 doc_id: 782193 cord_uid: cdxpodfg BACKGROUND: The fear of insecurity and uncertainty caused by 2019 coronavirus disease (COVID-19), the separation and loss of certain important relationships, and the great changes in lifestyle have awakened strong emotional response, which may cause psychological problems to the general population. However, there are few researches on how the people who pay attention to anxiety and depression coping with negative psychological during the epidemic or major disaster. This study aimed to identify what behaviors can effectively reduce negative emotions during the epidemic. METHODS: From February 1, to March 8 in 2020, we conducted a web-based survey and collected information on general demographic data. The probable depression, anxiety symptoms and coping behaviors was assessed by Patient Health Questionnaire-9 and Generalized anxiety disorder-7 and the self-made Coping Behaviors Questionnaires. RESULT: Among 17249 responders, 7923 and 9326 completed the assessment of depression and anxiety respectively, and all responders finished the assessment of the coping behaviors questionnaires. Our survey population had a high prevalence rate of possible depression disorders and anxiety disorders were34.66% and 56.93%, respectively. Those who are old, female, low education, low income, and cohabiting were more likely to suffer depression and/or anxiety. Students are a high-risk group suffering from depression and/or anxiety. After adjusting for social-demographic factors (e.g. age, sex), depression and anxiety were positively associated with self-injury, doing housework, and having sex or masturbating and negatively associated with singing, drawing, or writing, dating friends online, singing, attending lectures, and doing yoga. CONCLUSION: During the epidemic, our findings identify some spontaneous coping behaviors that can probably relieve the psychological impact of vulnerable groups during the COVID-19 epidemic. In addition to physical health, infectious disease (e.g. COVID-19, severe acute respiratory syndrome, SARS) also leads to some psycho-social problems. During the SARS outbreak, the higher stress levels, poor sleep and depressed mood were found among confirmed cases (Lee, Wing et al. 2004 ). There were 23.04% of medical staffs suffered anxiety during the COVID-19 (Huang, Han et al. 2020) . Besides of special groups (e.g. frontline responders and confirmed cases), the general population is also suffered from psychological pressure, such as anxiety and depression (Qiu, Shen et al. 2020) . All around the world, many general populations have to stay at home socially isolated to protect themselves from being infected, result in a distressed state (Horton 2020) . As more and more people work /study at home and restricted social activities, negative emotions experienced individuals are compounded (Van Bortel, Basnayake et al. 2016) . Previous studies found that elderly women with high education are more likely to perceive the threat of SARS and suffer from anxiety (Leung, Lam et al. 2003 individuals completed the evaluation of depression and anxiety, respectively. Patient Health Questionnaire-9 For depression assessment, we used patient health questionnaire (PHQ-9) which was a 9-item self-report depressive symptoms scale (Kroenke, Spitzer et al. 2001) . A score ≥10 was recommended to identify a likely depression disorder (Fine, Contractor et al. 2013, Blenkiron and Goldsmith 2019) . PHQ-9 has good reliability and validity among Chinese population(Zeng, He et al. 2013 , Wang, Bian et al. 2014 . The Cronbach's alpha value was 0.674 for Generalized anxiety disorder-7 We used generalized anxiety disorder (GAD-7) scale which was a 7-item anxiety tool to assess anxiety symptoms. A score ≥7 indicated clinically significant anxiety disorder (Spitzer, Kroenke et al. 2006, Blenkiron and Goldsmith 2019). GAD-7 was well-validated according to the DSM-IV diagnostic criteria and sensitive to general population (Kroenke, Spitzer et al. 2007 , Horton and Perry 2016 , Andreas and Brunborg 2017 , Tiirikainen, Haravuori et al. 2019 . Studies had shown that GAD-7 has good reliability and validity in China(Zeng, He et al. 2013 , Wang, Bian et al. 2014 ).The Cronbach's alpha value was 0.713 for GAD-7. Coping behavior questionnaire The analyses were done with R-software 3.6. ANOVA analysis was used to compare between two groups. Analyses were two-tailed with α=0.05. Logistic regression analysis was conducted with depression/anxiety as the outcome. Model 1-No adjusted. Model2-adjusted for sex, age, education, and income. The prevalence rate of depression and anxiety was 34.66% and 56.93%, respectively. Those who are older, female, low education, low income, and cohabiting were more likely to suffer depression and/or anxiety. Students are a high-risk group suffering from depression and/or anxiety. Our results suggested that 34.66% of respondents reported moderate and above depressive symptoms and 56.93% of respondents reported mild and above anxiety symptoms. According to the China Mental Health Survey, weighted 12-month prevalence of depressive disorders is 3.6% and weighted 12-month prevalence of anxiety disorders is 5.0%. in 2013 (Huang, Wang et al. 2019 ). Apparently, the report of depressive symptoms and anxiety symptoms previous studies have also found that above factors is related to attenuated risk of depression (Cramer, Lauche et al. 2013 , Carpena, Tavares et al. 2019 and anxiety (Kang 2007, Li and Goldsmith 2012) . However, we found that singing helps relieve symptoms of depression and anxiety, but listen to music does not have this effect. The phenomenon can be explained that compared to listening to music, singing is an active expression of emotions rather than but also activates the brain cortex, limbic system, endocrine system and nervous system (Kang, Scholp et al. 2018 ). Why do above factors can ease depression and/or anxiety? What do above factors have common and differential effects on depression and/or anxiety. The current study found that doing housework is associated with aggravating risk of depression and anxiety. Compared to physical activities (e.g. yoga, running and walking) housework tasks concentrate on the physiological costs (e.g. energy expenditure) instead of musculoskeletal load or physical relax. These energy costs are relevant since they lead to fatigue and may amplify the influences of housework (Habib, Fathallah et al. 2010 ). Garabiles's study found that fatigue have the highest strength in the depression network structure, which is common among Asian population (Garabiles, Lao et al. 2019 ). However, the relationship between housework and depression/anxiety should be careful consideration. Considering that females were found to spend more time on household activities than males in China cultural background. And in our research, females are at high risk for depression/anxiety. Considering the COVID-19 epidemic continues to widely spread, our results will provide some effective guidance for the general population who pay attention to psychological emotions and suffered negative psychological emotions. Our results have some clinical and policy implications. Firstly, it is necessary for mental health authorities to identify high-risk groups based on basic characteristics. For example, this result corresponds to previous researches that females were at higher risk of depression and/or anxiety (Lim, Tam et al. 2018) . Secondly, we found that doing yoga and singing can help relieve depression and anxiety symptoms. Meditation can only relieve depression symptoms, but not anxiety symptoms. However, growing evidences have suggested that meditation has positive influences on anxiety symptoms (Saeed, Antonacci et al. 2010 , Carpena, Tavares et al. 2019 , Saeed, Cunningham et al. 2019 ). This may be related to the shorted duration of the intervention and less frequency. Thus, we can tell how to conduct scientific and effective meditation through the online or organize online group meditation. do yoga, sing and meditation). In addition to self-management of disturbed emotion through positive coping behaviours, how to organize the mental health care for those people who will present psychiatric symptoms due to the COVID-19 pandemic is also very important. On the one hand, community-based and internet-based mental health services should be integrated into the national health system (Sani, Janiri et al. 2020 , Zhang, Wu et al. 2020 Effects of Exercise and Physical Activity on Anxiety Depressive Symptomatology among Norwegian Adolescent Boys and Girls: The Patient Health Questionnaire-9 (PHQ-9) Psychometric Properties and Correlates Patient-reported outcome measures in community mental health teams: pragmatic evaluation of PHQ-9, GAD-7 and SWEMWBS Sudarshan Kriya Yogic breathing in the treatment of stress, anxiety, and depression. Part II--clinical applications and guidelines The effect of a six-week focused meditation training on depression and anxiety symptoms in Brazilian university students with 6 and 12 months of follow-up Yoga for depression: a systematic review and meta-analysis The role of singing familiar songs in encouraging conversation among people with middle to late stage Alzheimer's disease Psychosocial singing interventions for the mental health and well-being of family carers of patients with cancer: results from a longitudinal controlled study Validation of the telephone-administered PHQ-9 against the in-person administered SCID-I major depression module Exploring comorbidity between anxiety and depression among migrant Filipino domestic workers: A network approach The influence of caregiver singing and background music on vocally expressed emotions and moods in dementia care: a qualitative analysis Full-time homemakers: workers who cannot "go home and relax Getting Out of Rumination: Comparison of Three Brief Interventions in a Sample of Youth Screening for depression in primary care: a Rasch analysis of the PHQ-9 Offline: 2019-nCoV—“A desperate plea” Mental health survey of 230 medical staff in a tertiary infectious disease hospital for COVID-19 Prevalence of mental disorders in China: a cross-sectional epidemiological study A Review of the Physiological Effects and Mechanisms of Singing Disembodiment in online social interaction: impact of online chat on social support and psychosocial well-being The PHQ-9 -Validity of a brief depression severity measure Anxiety disorders in primary care: Prevalence, impairment, comorbidity, and detection Post-COVID-19 global health strategies: the need for an interdisciplinary approach Factors associated with psychosis among patients with severe acute respiratory syndrome: a case-control study The effects of yoga on anxiety and stress Prevalence of Depression in the Community from 30 Countries between Group singing improves depression and life quality in patients with stable COPD: a randomized community-based trial in China Singing teaching as a therapy for chronic respiratory disease--a randomised controlled trial and qualitative evaluation Singing classes for chronic obstructive pulmonary disease: a randomized controlled trial China coronavirus: WHO declares international emergency as death toll exceeds 200 Affective temperament, attachment style, and the psychological impact of the COVID-19 outbreak: an early report on the Italian general population A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: implications and policy recommendations Exercise, yoga, and meditation for depressive and anxiety disorders Depression and Anxiety Disorders: Benefits of Exercise, Yoga, and Meditation Mental health during and after the COVID-19 emergency in Italy A brief measure for assessing generalized anxiety disorder -The GAD-7 Psychometric properties of the 7-item Generalized Anxiety Disorder Scale (GAD-7) in a large representative sample of Finnish adolescents Psychosocial effects of an Ebola outbreak at individual, community and international levels Effects of Yoga on Stress Among Healthy Adults: A Systematic Review