key: cord-0857371-bxzprauu authors: Zhu, Zhou; Xu, Shabei; Wang, Hui; Liu, Zheng; Wu, Jianhong; Li, Guo; Miao, Jinfeng; Zhang, Chenyan; Yang, Yuan; Sun, Wenzhe; Zhu, Suiqiang; Fan, Yebin; Hu, Junbo; Liu, Jihong; Wang, Wei title: COVID-19 in Wuhan: Immediate Psychological Impact on 5062 Health Workers date: 2020-02-23 journal: nan DOI: 10.1101/2020.02.20.20025338 sha: d37a760a6ae9f4df3da850e9a71b88d340c54588 doc_id: 857371 cord_uid: bxzprauu BACKGROUND: The outbreak of COVID-19 has laid unprecedented psychological stress on health workers (HWs). We aimed to assess the immediate psychological impact on HWs at Tongji Hospital in Wuhan, China. METHODS: We conducted a single-center, cross-sectional survey of HWs via online questionnaires between February 8th and 10th, 2020. We evaluated stress, depression and anxiety by Impact of Event Scale-Revised (IES-R), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder 7-item (GAD-7), respectively. We also designed a questionnaire to assess the effect of psychological protective measures taken by Tongji Hospital. Multivariate logistic regression was used to identify predictors of acute stress, depression, and anxiety. RESULTS: We received 5062 completed questionnaires (response rate, 77.1 percent). 1509 (29.8 percent), 681 (13.5 percent) and 1218 (24.1 percent) HWs reported stress, depression and anxiety symptoms. Women (hazard ratio[HR], 1.31; P=0.032), years of working> 10 years (HR, 2.02; P<0.001), concomitant chronic diseases (HR, 1.51; P<0.001), history of mental disorders (HR, 3.27; P<0.001), and family members or relatives confirmed or suspected (HR, 1.23; P=0.030) were risk factors for stress, whereas care provided by hospital and department administrators(odds ratio [OR], 0.76; P=0.024) and full coverage of all departments with protective measures (OR, 0.69; P=0.004) were protective factors. CONCLUSIONS: Women and those who have more than 10 years of working, concomitant chronic diseases, history of mental disorders, and family members or relatives confirmed or suspected are susceptible to stress, depression and anxiety among HWs during the COVID-19 pandemic. Psychological protective measures implemented by the hospital could be helpful. At the end of 2019, the COVID-19 emerged in Wuhan City, Hubei Province, China. The rapid escalation of COVID-19 epidemic has resulted in a World Health Organization (WHO)-declared public health emergency of international concern. The global total number of COVID-19 cases has been several times that of SARS, and the death toll has also exceeded that of SARS 1 . As the source area of COVID-19 epidemic, Wuhan has the majority of confirmed cases and deaths worldwide. Nowadays, information is spreading more rapidly and extensively than it was in 2003 when SARS broke out, which might exacerbate public fear, panic, and distress. Frontline health workers (HWs) were saving lives while encountering an increasing workload and risk of infection. In the early stage of COVID-19 epidemic, it was reported that infected HWs accounted for 29 percent of all hospitalized COVID-19 patients 2 . Also, quarantined frontline HWs might be facing potential social isolation, and unquarantined HWs experiencing social discrimination. Therefore, they are susceptible to complex emotional reactions and psychological distress 3 . Furthermore, the mental health problems of HWs would impair their attention, cognitive functioning, and clinical decision-making 4, 5 , consequently increase the occurrence of medical errors and incidents, and ultimately put patients at risk. It was also well known that acute stress in disasters could have a lasting effect on the overall wellbeing [6] [7] [8] . Hence, the mental health problems of HWs in COVID-19 epidemic have become an urgent public health concern. Tongji Hospital, one of the biggest tertiary hospitals in Wuhan, has been designated by the government as "the specific hospital for the treatment of severe patients with COVID-19 in Wuhan". and specificity (88.0 percent) 11 . GAD-7 Scale was used to identify anxiety disorders. A cutoff score nomograms were formulated based on the results of multivariate logistic regression analysis using the R packages "rms", "Hmisc" and "ggplot2" in R 3.5.2 (http://www.r-project.org/). The performances of the nomograms were measured by Concordance statistics (C-statistics) and assessed by calibration curves. Bootstraps with 1000 resamples were applied to these activities. The higher C-statistics indicated better ability to distinguish HWs with different risks of three outcomes. We considered the risk screening models as a useful clinical tool particularly when the C-statistic is higher than 0.70 14 . The calibration curves were used to compare the observed probability with the predicted probability. Dots on the calibration plot would be close to a 45° diagonal line if the model calibration is correct. The funders had no role in the design and conduct of the study; collection, analysis, management and interpretation of the data; and preparation, review, or approval of the manuscript. Wei Wang had full access to the raw data and did the statistical analyses. With approval from all authors, Wei Wang had the final decision to submit. . CC-BY-NC-ND 4.0 International license It is made available under a author/funder, who has granted medRxiv a license to display the preprint in perpetuity. is the (which was not peer-reviewed) The copyright holder for this preprint . There were 3, 7 and 13 influencing factors associated with anxiety symptoms in Group 1, 2 and 3 respectively, which were also presented in Supplementary Appendix Tables S3, S6 and S9. Similarly, these factors were also found associated with psychological stress outcome: master degree or higher level; occupation; current work place; parent status; reasonable work shift arrangement (all P values＜0.05). There were 2, 8 and 12 influencing factors with psychological stress in Group 1, 2 and 3 respectively, which were also presented in Supplementary Appendix Tables S3, S6 and S9. We created three nomograms to predict the risk of three outcomes ( Figure 1 ). Each variable was projected upward to the value of the Points line to get the score of each parameter. The total score was . CC-BY-NC-ND 4.0 International license It is made available under a author/funder, who has granted medRxiv a license to display the preprint in perpetuity. is the (which was not peer-reviewed) The copyright holder for this preprint . calculated by adding each score and located on the Total Points line. The risk was obtained according to the total score by drawing vertical lines to the Risk line. The C-statistics for depression, anxiety and psychological stress nomograms were 0.779 (95% CI, 0.775-0.783), 0.765 (95% CI, 0.761-0.769) and 0.766 (95% CI, 0.762-0.770), respectively. The calibration curves were plotted in Figure 2 . Dots on the plots were very close to the 45° diagonal line, which suggested that the three nomograms were well-calibrated. . CC-BY-NC-ND 4.0 International license It is made available under a author/funder, who has granted medRxiv a license to display the preprint in perpetuity. is the (which was not peer-reviewed) The copyright holder for this preprint . https://doi.org/10.1101/2020.02.20.20025338 doi: medRxiv preprint Consistent with the results of previous studies in SARS-affected and H1N1 influenza-affected hospitals, our study showed that nurses and medical technicians presented higher rates of psychological stress than doctors, probably because they have more and closer contact with patients 21, 22 . Meanwhile, in line with the results of previous studies in the SARS isolation unit, we also found that HWs in isolation wards have a more pronounced risk of stress 23 . Those who had two or more children showed a higher risk of stress, probably owing to their heavier family responsibilities. To make matters worse, the majority of HWs are female (85.0 percent in this study), since a large number of studies have confirmed the plight of working women 19 . Priority consideration should be given to female HWs. In our study, the exercise habit was associated with a lower risk of anxiety symptoms, suggesting that physical activity helps alleviate psychological impact caused by catastrophic events. Nevertheless, only 857 (16.9 percent) participants had exercise habits, indicating that the importance of exercise should be highlighted among HWs in China. Finally, we developed three effective, easy-to-use clinical screening tools to identify high-risk individuals of acute stress, depression, and anxiety among HWs. Further studies are needed to improve and validate these models. Tongji Hospital's experience suggests that psychological impact on HWs can be alleviated by timely implementation of psychological protective measures. We acknowledge all participants of this project and investigators for collecting data. . CC-BY-NC-ND 4.0 International license It is made available under a author/funder, who has granted medRxiv a license to display the preprint in perpetuity. is the (which was not peer-reviewed) The copyright holder for this preprint . . It is made available under a author/funder, who has granted medRxiv a license to display the preprint in perpetuity. is the The copyright holder for this preprint . CC-BY-NC-ND 4.0 International license It is made available under a author/funder, who has granted medRxiv a license to display the preprint in perpetuity. is the (which was not peer-reviewed) The copyright holder for this preprint . https://doi.org/10.1101/2020.02.20.20025338 doi: medRxiv preprint . CC-BY-NC-ND 4.0 International license It is made available under a author/funder, who has granted medRxiv a license to display the preprint in perpetuity. is the (which was not peer-reviewed) The copyright holder for this preprint . Clinical Characteristics of 138 Hospitalized Patients With Novel Coronavirus-Infected Pneumonia in Wuhan, China The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus. 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