Institute of Mental Health, National Clinical Research Center for Mental Disorders, Key Laboratory of Mental Health and Peking University Sixth Hospital, Peking University, Beijing, China.
Savaid Medical School, University of Chinese Academy of Sciences, Beijing, China.
JAMA Netw Open. 2020 Jul 1;3(7):e2014053. doi: 10.1001/jamanetworkopen.2020.14053.
People exposed to coronavirus disease 2019 (COVID-19) and a series of imperative containment measures could be psychologically stressed, yet the burden of and factors associated with mental health symptoms remain unclear.
To investigate the prevalence of and risk factors associated with mental health symptoms in the general population in China during the COVID-19 pandemic.
DESIGN, SETTING, AND PARTICIPANTS: This large-sample, cross-sectional, population-based, online survey study was conducted from February 28, 2020, to March 11, 2020. It involved all 34 province-level regions in China and included participants aged 18 years and older. Data analysis was performed from March to May 2020.
The prevalence of symptoms of depression, anxiety, insomnia, and acute stress among the general population in China during the COVID-19 pandemic was evaluated using the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Insomnia Severity Index, and Acute Stress Disorder Scale. Logistic regression analyses were used to explore demographic and COVID-19-related risk factors.
Of 71 227 individuals who clicked on the survey link, 56 932 submitted the questionnaires, for a participation rate of 79.9%. After excluding the invalid questionnaires, 56 679 participants (mean [SD] age, 35.97 [8.22] years; 27 149 men [47.9%]) were included in the study; 39 468 respondents (69.6%) were aged 18 to 39 years. During the COVID-19 pandemic, the rates of mental health symptoms among the survey respondents were 27.9% (95% CI, 27.5%-28.2%) for depression, 31.6% (95% CI, 31.2%-32.0%) for anxiety, 29.2% (95% CI, 28.8%-29.6%) for insomnia, and 24.4% (95% CI, 24.0%-24.7%) for acute stress. Participants with confirmed or suspected COVID-19 and their family members or friends had a high risk for symptoms of depression (adjusted odds ratios [ORs], 3.27 [95% CI, 1.84-5.80] for patients; 1.53 [95% CI, 1.26-1.85] for family or friends), anxiety (adjusted ORs, 2.48 [95% CI, 1.43-4.31] for patients; 1.53 [95% CI, 1.27-1.84] for family or friends), insomnia (adjusted ORs, 3.06 [95% CI, 1.73-5.43] for patients; 1.62 [95% CI, 1.35-1.96] for family or friends), and acute stress (adjusted ORs, 3.50 [95% CI, 2.02-6.07] for patients; 1.77 [95% CI, 1.46-2.15] for family or friends). Moreover, people with occupational exposure risks and residents in Hubei province had increased odds of symptoms of depression (adjusted ORs, 1.96 [95% CI, 1.77-2.17] for occupational exposure; 1.42 [95% CI, 1.19-1.68] for Hubei residence), anxiety (adjusted ORs, 1.93 [95% CI, 1.75-2.13] for occupational exposure; 1.54 [95% CI, 1.30-1.82] for Hubei residence), insomnia (adjusted ORs, 1.60 [95% CI, 1.45-1.77] for occupational exposure; 1.20 [95% CI, 1.01-1.42] for Hubei residence), and acute stress (adjusted ORs, 1.98 [95% CI, 1.79-2.20] for occupational exposure; 1.49 [95% CI, 1.25-1.79] for Hubei residence). Both centralized quarantine (adjusted ORs, 1.33 [95% CI, 1.10-1.61] for depression; 1.46 [95% CI, 1.22-1.75] for anxiety; 1.63 [95% CI, 1.36-1.95] for insomnia; 1.46 [95% CI, 1.21-1.77] for acute stress) and home quarantine (adjusted ORs, 1.30 [95% CI, 1.25-1.36] for depression; 1.28 [95% CI, 1.23-1.34] for anxiety; 1.24 [95% CI, 1.19-1.30] for insomnia; 1.29 [95% CI, 1.24-1.35] for acute stress) were associated with the 4 negative mental health outcomes. Being at work was associated with lower risks of depression (adjusted OR, 0.85 [95% CI, 0.79-0.91]), anxiety (adjusted OR, 0.92 [95% CI, 0.86-0.99]), and insomnia (adjusted OR, 0.87 [95% CI, 0.81-0.94]).
The results of this survey indicate that mental health symptoms may have been common during the COVID-19 outbreak among the general population in China, especially among infected individuals, people with suspected infection, and people who might have contact with patients with COVID-19. Some measures, such as quarantine and delays in returning to work, were also associated with mental health among the public. These findings identify populations at risk for mental health problems during the COVID-19 pandemic and may help in implementing mental health intervention policies in other countries and regions.
接触冠状病毒病 2019（COVID-19）和一系列强制性遏制措施的人可能会承受心理压力，但精神健康症状的负担和相关因素仍不清楚。
调查 COVID-19 大流行期间中国普通人群精神健康症状的流行率和相关风险因素。
设计、地点和参与者：这是一项大型的、横断面的、基于人群的在线调查研究，于 2020 年 2 月 28 日至 3 月 11 日进行，涉及中国所有 34 个省级行政区，参与者年龄在 18 岁及以上。数据分析于 2020 年 3 月至 5 月进行。
使用患者健康问卷-9、广泛性焦虑障碍-7、失眠严重程度指数和急性应激障碍量表评估 COVID-19 大流行期间中国普通人群中抑郁、焦虑、失眠和急性应激症状的发生率。使用 logistic 回归分析探讨人口统计学和 COVID-19 相关的风险因素。
在点击调查链接的 71227 人中，56932 人提交了问卷，参与率为 79.9%。排除无效问卷后，56679 名参与者（平均[SD]年龄，35.97[8.22]岁；27149 名男性[47.9%]）被纳入研究；39468 名受访者（69.6%）年龄在 18 至 39 岁之间。在 COVID-19 大流行期间，调查对象的精神健康症状发生率为：抑郁症状 27.9%（95%CI，27.5%-28.2%），焦虑症状 31.6%（95%CI，31.2%-32.0%），失眠症状 29.2%（95%CI，28.8%-29.6%），急性应激症状 24.4%（95%CI，24.0%-24.7%）。确诊或疑似 COVID-19 患者及其家庭成员或朋友患抑郁（调整后的优势比[ORs]，1.84-5.80）、焦虑（调整后的 ORs，1.26-1.85）、失眠（调整后的 ORs，1.35-1.96）和急性应激（调整后的 ORs，1.46-2.15）的风险较高。此外，有职业暴露风险的人群和居住在湖北省的人群患抑郁（调整后的 ORs，1.77-2.15）、焦虑（调整后的 ORs，1.54-1.82）、失眠（调整后的 ORs，1.20-1.42）和急性应激（调整后的 ORs，1.49-1.79）的风险也较高。集中隔离（调整后的 ORs，1.33-1.61）和居家隔离（调整后的 ORs，1.30-1.77）也与抑郁、焦虑、失眠和急性应激有关。工作时患抑郁（调整后的 OR，0.85-0.91）、焦虑（调整后的 OR，0.86-0.99）和失眠（调整后的 OR，0.81-0.94）的风险较低。
这项调查的结果表明，COVID-19 大流行期间中国普通人群的精神健康症状可能较为常见，尤其是感染人群、疑似感染人群以及可能与 COVID-19 患者接触的人群。一些措施，如隔离和延迟复工，也与公众的精神健康有关。这些发现确定了 COVID-19 大流行期间精神健康问题的高风险人群，并可能有助于在其他国家和地区实施精神健康干预政策。
