Acute psychological effects of Coronavirus Disease 2019 outbreak among healthcare workers in China: a cross-sectional study

The COVID-19 outbreak, originating in Wuhan, China, rapidly escalated into a global health emergency. Healthcare workers (HCWs), crucial in controlling outbreaks, are at high risk of infection and subsequent psychological distress. Previous outbreaks like SARS, Ebola, and MERS demonstrated the significant psychological impact on HCWs, including depression, anxiety, and PTSD. The COVID-19 outbreak presented unique challenges, including rapid transmission, unpredictable trajectory, high clinical burden, and initial shortages of protective resources, all potentially exacerbating psychological effects. While psychological intervention programs were launched in China, a lack of baseline data on risk factors hindered effective intervention. This study aimed to assess the acute psychological effects among HCWs during the early stages of the COVID-19 outbreak in China, identifying associated risk factors to inform effective interventions and future research.

The introduction adequately summarizes existing literature highlighting the psychological toll of infectious disease outbreaks on healthcare workers. It cites previous outbreaks (SARS, Ebola, MERS) and notes the lack of baseline data for COVID-19, justifying the current study's importance.

This cross-sectional study, conducted from January 20 to February 7, 2020, surveyed doctors and nurses in hospitals treating COVID-19 patients. Recruitment targeted Wuhan (the epicenter), other regions of Hubei province, and other provinces in China. Data were collected using an online survey tool (Yunxiang) with a minimum sample size of 1600 calculated based on the formula N = Z² p (1 − p) / d². After excluding incomplete or insufficient responses, 1897 completed questionnaires were analyzed. The study used validated questionnaires: PHQ-9 for depression, GAD-7 for anxiety, and IES-R for PTSD. Socioeconomic and occupational factors were also collected, including working position (frontline vs. second-line), training adequacy, resource availability, confidence in protection measures, and worry about infection. Statistical analysis included Chi-square tests and logistic regression to identify risk factors. The study was approved by the Clinical Research Ethics Committee of Renmin Hospital of Wuhan University.

Among the 1897 HCWs (82.5% female), the prevalence of depression, anxiety, and PTSD was 15.0%, 27.1%, and 9.8%, respectively. Risk factors identified through logistic regression included: female gender, working in Wuhan, frontline work, insufficient training/resources, lack of confidence in protection measures, and worry about infection. For anxiety and PTSD, nurses and those with intermediate technical titles showed higher risk compared to doctors and those with junior titles. Conversely, not working at the frontline was a protective factor. The study noted a higher prevalence of psychological effects among those who worried about infection.

This study provides crucial data on the acute psychological impact of the COVID-19 outbreak on HCWs in China. The high prevalence of depression, anxiety, and PTSD underscores the urgent need for comprehensive psychological support. The identified risk factors highlight the importance of adequate training, sufficient resources, and strategies to build confidence in protection measures. Focusing on frontline workers and those in high-risk areas like Wuhan is essential. The study's findings contribute to evidence-based interventions tailored to mitigate the psychological burden on HCWs during infectious disease outbreaks.

This study reveals substantial acute psychological distress among HCWs during the early COVID-19 outbreak in China. The identified risk factors— particularly frontline work, inadequate training, and resource scarcity— underscore the need for improved infection control protocols, comprehensive psychological support programs, and targeted interventions to reduce mental health burdens among HCWs. Future research should focus on longitudinal studies to track long-term psychological impacts and assess the effectiveness of interventions.

As a cross-sectional study, this research cannot establish causality. The reliance on self-reported data may introduce bias. The study's sample, while large, might not be fully representative of all HCWs in China. The study focused on the early phase of the outbreak, limiting insights into longer-term consequences.