key: cord-0937763-rijrr8cp authors: Zhang, Jinjia; Song, Shibin; Zhang, Min; Wang, Rongying title: Influencing factors for mental health of general practitioners in Hebei Province under the outbreak of COVID‐19: A cross‐sectional study date: 2021-09-08 journal: Int J Clin Pract DOI: 10.1111/ijcp.14783 sha: fe2ad123728215ce5ca175cde3235329b77c7606 doc_id: 937763 cord_uid: rijrr8cp OBJECTIVE: This study aimed to understand the mental health status of general practitioners (GPs) in Hebei Province during the outbreak of coronavirus disease 2019, analyse influencing factors, and establish and evaluate the risk prediction model. METHODS: During February 25‐29, 2020, a self‐designed questionnaire was used to conduct an online survey of GPs in Hebei Province. The survey included a questionnaire on GPs' basic information, a questionnaire on GPs' working hardware and software facilities, and a questionnaire on GPs' mental health condition. A total of 1040 participants returned the completely filled valid questionnaire, and the answers were analyzed using the χ (2) test, Wilcoxon rank‐sum test and logistic regression with SPSS 20.0 software. Based on the results of binary logistic regression analysis, a risk prediction model was established, and the receiver operating characteristic curve was used to evaluate the model. RESULTS: The results showed that 44.2% (460/1040) of GPs expressed anxiety after the outbreak. Absence of prescreening clinics, fever clinics or isolated observation rooms in primary medical institutions; persons in the administrative area required to be isolated; low sleep quality of GPs and less than 6 hours of sleep per day of GPs were risk factors affecting the mental health status of GPs. Also, epidemic‐related training and adequate protective equipment were the protective factors for the mental health status of GPs. CONCLUSION: The government should strengthen the infrastructure construction of community institutions, equip them with sufficient epidemic protection equipment, ensure the rest time of GPs and strengthen mental health training to ensure the mental and physical health of GPs. consequences, including cognitive changes, emotional changes, physical responses and behavioural changes. 10 In addition, the overload of epidemic information has a huge impact on public psychology, causing anxiety, worry and depression. Front-line medical staff face excessive work pressure and also are prone to psychological disorders, severe psychological stress response and post-traumatic stress disorder because of the uncertainty of disease risk and inadequate protective measures in the early stage. The importance of primary healthcare has been recognised in the context of SARS. 11 Major public health incidents indicate that maximising primary healthcare capacity and protecting primary healthcare workers are the key to ensuring the maximum impact of primary health institutions. 12 A cross-sectional survey was conducted during February [25] [26] [27] [28] [29] 2020 , in which GPs in Hebei Province were selected to participate in the survey. A total of 1040 participants returned the completely filled questionnaire. The survey was designed in accordance with the ethical principles set by the Declaration of Helsinki. The questionnaire was anonymous. The informed consent form is located on the introduction page, and participants express their consent by clicking the "Start" button. The questionnaire used in this study was based on research purposes and designed after consulting the relevant literature. The questionnaire was entered into the Internet platform (star network platform) powered by www.wjx.cn. The entry settings of the questionnaire were modified after the pre-survey and then the questionnaire was published in the WeChat group, which was the most widely used social networking software in China. The same internet protocol address could only be answered once. The questionnaire consisted of three main parts: a questionnaire on GPs' basic information, a questionnaire on the working hardware and software facilities and a questionnaire on GPs' mental health condition. This study used the Self-Assessed Anxiety Scale (SAS) to assess the mental health of GPs. SAS is a clinical measurement tool developed by Zung in 1971 to assess subjective symptoms of anxiety in patients. 16 The Chinese version of SAS has good reliability and validity. 17 It consists of 20 items. The evaluation time span is 1 week. Each item is divided into 1-4 grades according to the feeling of the latest week. The cumulative score of each item is the SAS total score. The higher the total score, the higher the anxiety level. The sum of the scores of the 20 items is the total score. The integral part of the total score × 1.25 is taken as the standard score, and the value is divided by the standard score 50; a score of ≥50 indicates the existence of anxiety. 18 Statistical analysis was performed using SPSS 20.0 statistical software. Enumeration data were expressed in relative numbers. The χ 2 test was used for intergroup comparison, while the Wilcoxon ranksum test was used for rank data comparison. The logistic regression analysis was used for multivariate analysis. According to the results of binary logistic regression analysis, the risk prediction model was established and the joint predictors were obtained. The receiver operating characteristic (ROC) curve was used to evaluate the model. A P value less than .05 was considered statistically significant. Table 1 . • Several studies focused on the mental health of medical staff in general hospitals during COVID-19. However, no study explored the mental health of GPs. • The anxiety of GPs is obvious during the outbreak of COVID-19. • It is necessary to strengthen working hardware and software facilities, ensure the quality and time of sleep to improve the mental health of GPs. GPs were divided into two groups based on their anxiety scores: whether GPs received epidemic-related training; sleep quality after the outbreak; and sleep time after the outbreak (P < .05, Table 1 ). GPs' emotions were used as the dependent variable (assignment: no Table 2 ). Establishment of risk prediction model: Based on the results of binary logistic regression analysis, the risk prediction model was obtained by logit transformation:P = 1 1 + e −(1.496+1.225X 1 −1.815X 2 +0.419X 3 −1.505X 4 +0.963X 5 +1.163X 6 ) , and the joint predictor (L) was obtained as follows: L = X 1 − 1.482X 2 + 0.342X 3 − 1.229X 4 + 0.786X 5 + 0.949X 6 , where X 1 denotes whether preview triage area, fever clinics or isolation room set was complete; X 2 denotes whether protective supplies were sufficient; X 3 denotes whether anyone needed isolation observation in the area under jurisdiction; X 4 denotes whether epidemic-related training was provided; X 5 denotes the sleep quality after the epidemic and X 6 denotes the sleep time after the epidemic. Evaluation of risk prediction model: The ROC curve showed that the combined predictors were more effective compared with a single factor in predicting mental health disorders among GPs in Hebei Province in the case of COVID-19, and the area under the curve of this model was 0.768 (95% CI: 0.736 −0.800, P < .001). According to the Youden index (sensitivity + specificity −1), the threshold value of the best prediction was 0.350, the sensitivity was 71.4% and the specificity was 88.3%, as shown in Figure 1 . COVID-19 is a public health emergency of international concern, 5 which can cause huge physical and psychological damage to people. The psychological trauma lasts for a long time, and stress disorder even appears after the event. 19 As the foundation of the health service system, primary medical institutions are the first line of defense for the prevention and control of this public health concern. Compared with general population, GPs have more chances to be where GPs were eager to receive further information and training on pandemic preparedness to relieve stress during the pandemic; face-to-face guidance and training was considered the most appro- Severe cases may lead to post-traumatic stress disorder. 19, 26 Our study showed that low sleep quality and short sleep duration were risk factors affecting the mental health status of GPs. However, Sleep can be a cause or an effect of stress. Sleep disturbance is a primary symptom of major depressive disorder. 27 Stress negatively affect the body's ability to fall and stay asleep. 28 So more prospective longitudinal studies are needed to explore the independent bidirectional association between sleep disturbance and mental health. Single factor assessment of the probability of the occurrence of In short, the anxiety of GPs is obvious during the outbreak of COVID-19. 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