Psychological health, sleep quality, and coping styles to stress facing the COVID-19 in Wuhan, China

In December 2019, the novel coronavirus pneumonia broke out in Wuhan, China, rapidly spreading nationwide. The sudden epidemic disrupted daily life and threatened physical and psychological health. High infectivity, mortality, and limited early understanding of the virus led to widespread psychological problems. Strict home isolation and prohibition of gatherings limited social interaction to the internet, where negative news further aggravated psychological burdens. Mental health problems impaired medical professionals’ attention, cognition, memory, and confidence, increasing the risk of errors. Anxiety, depression, and insomnia also affected infected patients and the general public. Recognizing the importance of mental health during the epidemic, the National Health Commission of China issued the National Guideline for Psychological Crisis Intervention for 2019-nCoV, highlighting a nationwide mission. However, little information was available on the epidemiology and psychological features of communities. This study conducted a cross-sectional survey to describe Wuhan residents’ psychological reactions to the COVID-19 epidemic to inform mental health interventions.

Design and setting: Cross-sectional online survey conducted in Wuhan, China, from February 18 to February 28, 2020, using the SurveyStar platform. Sampling: Convenience sampling. Sample size: 1242 valid questionnaires. Consent and data quality: Electronic informed consent required prior to access; each device allowed one submission; built-in logic checks identified invalid responses; data were auto-entered and checked by two independent researchers. Inclusion criteria: Age ≥18 years; residing in Wuhan during the COVID-19 outbreak; provided electronic informed consent. Exclusion criteria: Pre-existing psychological or sleep-related diseases; current medications for mental or sleep illnesses; logical errors in questionnaire. Measures: - Anxiety: Generalized Anxiety Disorder 7-item scale (GAD-7), total 0–21; ≥5 indicates anxiety. Reliability: Cronbach’s alpha 0.901; validated in Chinese populations. - Depression: Patient Health Questionnaire-9 (PHQ-9), total 0–27; ≥5 indicates depression. Reliability: Cronbach’s alpha 0.869; validated. - Sleep quality: Athens Insomnia Scale (AIS), 8 items scored 0–3; total ≥5 indicates insomnia. Reliability: Cronbach’s alpha 0.797. - Coping styles: Simplified Coping Style Questionnaire (SCSQ), 20 items (active 1–12; passive 13–20), 0–3 Likert scale. Coping tendency determined by Z-standardized active minus passive scores; differential >0 indicates positive (active) coping; ≤0 indicates passive coping. Reliability: Cronbach’s alpha 0.916 (active) and 0.808 (passive). Statistical analysis: SPSS v22. Descriptive statistics (frequencies, percentages). Chi-square tests for associations between demographics and outcomes. Multivariate logistic regression models estimated associations between demographic/behavioral factors and anxiety, depression, sleep disorder, and passive coping style. Two-tailed P<0.05 considered significant. Variables examined included gender, age, marital status, residence (urban/rural), education, occupation (medical staff/others), monthly income, frequency of online video communication, and exercise.

- Sample characteristics: N=1242 (men 30.27%, women 69.73%). - Prevalence: Anxiety 27.5% (346/1242); Depression 29.3% (364/1242); Sleep disorder 30.0% (~30.6% in Table 2; 380/1242); Passive coping style 29.8% (370/1242). - Bivariate associations (selected): • Anxiety higher among females vs males (29.7% vs 22.4%, P=0.008); age >30 vs ≤30 (35.8% vs 24.5%, P<0.001); married vs unmarried (37.0% vs 22.7%, P<0.001); urban vs rural (30.6% vs 22.0%, P=0.001); bachelor’s+ vs college/below (29.7% vs 23.8%, P=0.033); medical staff vs others (35.2% vs 23.6%, P<0.001); higher income associated with more anxiety (P<0.001). More frequent online video communication and regular exercise associated with lower anxiety (P=0.037 and P=0.010). • Depression associated with urban residence (31.4% vs 24.2%, P=0.007), higher education (32.3% vs 23.1%, P=0.001), medical staff (34.4% vs 26.4%, P=0.003), higher income (P<0.001), more frequent online video communication (P<0.001), and lack of exercise (32.0% vs 21.4%, P<0.001). • Sleep disorder higher among age >30 (38.3% vs 27.7%, P<0.001), married (36.7% vs 27.4%, P=0.001), urban (34.3% vs 23.9%, P<0.001), bachelor’s+ (33.3% vs 24.6%, P=0.002), medical staff (36.6% vs 27.0%, P<0.001), higher income (P<0.001), more frequent online communication (P=0.006), and lack of exercise (34.3% vs 22.0%, P<0.001). • Passive coping style associated with lower education (37.4% college/below vs 26.3% bachelor’s+, P<0.001) and lack of exercise (32.5% vs 23.5%, P=0.001). - Multivariate logistic regression: • Anxiety: Female (OR=1.62, 95% CI 1.21–2.16, P=0.001); married (OR=1.75, 95% CI 1.27–2.41, P=0.001); monthly income 1000–5000 CNY (OR=1.44, 95% CI 1.03–2.01, P=0.035) and >5000 CNY (OR=1.47, 95% CI 1.16–2.07, P=0.046); no physical exercise (OR=1.45, 95% CI 1.08–1.93, P=0.013). • Depression: Monthly income 1000–5000 CNY (OR=1.83, 95% CI 1.36–2.45, P<0.001) and >5000 CNY (OR=1.45, 95% CI 1.04–2.01, P=0.027); online communication vs none: 0–2 times/day (OR=1.47, 95% CI 1.03–2.09, P=0.012), ≥2 times/day (OR=1.68, 95% CI 1.19–2.38, P=0.003); no physical exercise (OR=1.71, 95% CI 1.28–2.29, P<0.001). • Sleep disorder: Female (OR=1.36, 95% CI 1.03–1.79, P=0.022); bachelor’s degree and above (OR=1.40, 95% CI 1.05–1.86, P=0.001); monthly income 1000–5000 CNY (OR=2.61, 95% CI 1.94–3.50, P<0.001) and >5000 CNY (OR=2.14, 95% CI 1.55–2.95, P<0.001); no physical exercise (OR≈1.85 as common risk factor noted). • Passive coping style: No physical exercise (OR=1.71, 95% CI 1.29–2.27, P<0.001); urban residence (OR=0.75, 95% CI 0.57–0.99, P=0.039; lower odds of passive coping vs rural); bachelor’s degree and above (OR=0.54, 95% CI 0.41–0.70, P<0.001; lower odds of passive coping vs lower education). - Overall: Psychological status and sleep quality were poorer during the COVID-19 epidemic compared with pre-epidemic, and nearly one-third exhibited passive coping.

The study documents substantial psychological burden among Wuhan residents during the early COVID-19 outbreak, with over one-quarter experiencing anxiety or depression and about one-third reporting sleep disorders. These findings align with other reports from across China, suggesting widespread mental health impacts beyond Wuhan and underscoring the urgency of population-level psychological interventions. Behavioral factors such as lack of physical exercise consistently increased the risk of anxiety, depression, sleep disorders, and passive coping, pointing to modifiable targets for intervention. Socio-demographic factors also played roles: women and married individuals had higher odds of anxiety; higher income was associated with greater risks of anxiety, depression, and sleep problems; higher education was linked to increased sleep disorder risk but was protective against passive coping; urban residence was protective against passive coping. More frequent online communication was associated with higher odds of depression relative to none, indicating that the nature and content of online engagement during lockdown may influence mood. The findings support the need for robust psychosocial support systems, accessible counseling, promotion of regular physical activity during lockdowns, and dissemination of balanced, positive public health information to mitigate psychological distress. Compared with general population estimates and with data from the SARS epidemic, the observed prevalence of anxiety and depression appears higher, highlighting the extraordinary psychological toll of COVID-19 and the importance of timely mental health responses by healthcare centers and authorities.