Psychiatry Research 288 (2020) 112954

Contents lists available at ScienceDirect

Psychiatry Research
journal homepage: www.elsevier.com/locate/psychres

Generalized anxiety disorder, depressive symptoms and sleep quality during T

COVID-19 outbreak in China: a web-based cross-sectional survey
Yeen Huanga,b, Ning Zhaoa,b,
⁎

a
The 6th Affiliated Hospital of Shenzhen University Health Science Center, Nanshan Hospital Affiliated to Shenzhen University, Shenzhen, 518052, People's Republic of
China
b
Department of Rehabilitation Medicine, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, 518052, People's Republic of China

ARTICLE INFO ABSTRACT

Keywords: China has been severely affected by Coronavirus Disease 2019(COVID-19) since December, 2019. We aimed to
COVID-19 assess the mental health burden of Chinese public during the outbreak, and to explore the potential influence
Mental health factors. Using a web-based cross-sectional survey, we collected data from 7,236 self-selected volunteers assessed
Anxiety with demographic information, COVID-19 related knowledge, generalized anxiety disorder (GAD), depressive
Depressive symptoms
symptoms, and sleep quality. The overall prevalence of GAD, depressive symptoms, and sleep quality of the
Sleep
public were 35.1%, 20.1%, and 18.2%, respectively. Younger people reported a significantly higher prevalence
of GAD and depressive symptoms than older people. Compared with other occupational group, healthcare
workers were more likely to have poor sleep quality. Multivariate logistic regression showed that age (< 35
years) and time spent focusing on the COVID-19 (≥ 3 hours per day) were associated with GAD, and healthcare
workers were at high risk for poor sleep quality. Our study identified a major mental health burden of the public
during the COVID-19 outbreak. Younger people, people spending too much time thinking about the outbreak,
and healthcare workers were at high risk of mental illness. Continuous surveillance of the psychological con-
sequences for outbreaks should become routine as part of preparedness efforts worldwide.

1. Introduction In addition to physical damage, COVID-19 also has a serious impact

on the mental health of the public. In January 20, China confirmed
Coronavirus Disease 2019 (COVID-19, also known as 2019-nCoV), a human-to-human transmission of COVID-19 and some medical staff in
cluster of acute respiratory illness with unknown causes, has occurred Wuhan had been infected (XINHUANET, 2020). Since then, the public
in Wuhan, Hubei Province, China since December 2019 has shown anxiety-related behaviors, causing a significant shortage of
(Wuhan Municipal Health Commission, 2020; Paules et al., 2020; medical masks and alcohol across the country. On the night of January
Wang et al., 2020). As of March 25, 2020, a total of 81,846 COVID-19 31, due to a news that “Shuanghuanglian oral liquid” could suppress
cases in China have been confirmed and 3,287 Chinese died from the COVID-19 (People's daily of China, 2020), the public rushed to phar-
disease. Internationally, sporadic cases exported from Wuhan were re- macies overnight to buy this drug. In addition, many front-line medical
ported in 193 countries (such as 69,176 cases in Italy, 42,058 cases in staff work more than 16 hours a day on average, causing them to not
Spain, and 53,588 cases in United States), 5 continents, and 1 inter- getting enough sleep. Unfortunately, a 37-year-old Japanese govern-
national conveyance (712 cases in “Diamond Princess”) (World Health ment worker who was in charge of isolated returnees from Wuhan was
Organization, 2020a). On January 23, Wuhan city closed all access found to have died from apparent suicide (The Japan Times, 2020).
routes to stop the spread of disease. Seven days later, the World Health Evidence indicated that COVID-19 is a distinct clade from the be-
Organization (WHO) declared the COVID-19 as a Public Health Emer- tacoronaviruses related to human severe acute respiratory syndrome
gency of International Concern (PHEIC) (World Health (SARS) and Middle East respiratory syndrome (MERS) (Zhu et al.,
Organization, 2020b). On March 11, the WHO declared the COVID-19 2020). Several studies showed that mental health problems could occur
outbreak could be characterized as a “pandemic” as the virus spreads in both healthcare workers and SARS survivors during the SARS epi-
increasingly worldwide. demic (Lee et al., 2007; Lu et al., 2006; McAlonan et al., 2007). Post-

⁎
Corresponding author: The 6th Affiliated Hospital of Shenzhen University Health Science Center, Nanshan Hospital Affiliated to Shenzhen University, Shenzhen,
518052, People's Republic of China.
E-mail address: zhaoning2018@email.szu.edu.cn (N. Zhao).

https://doi.org/10.1016/j.psychres.2020.112954
Received 20 March 2020; Received in revised form 26 March 2020; Accepted 26 March 2020
Available online 12 April 2020
0165-1781/ © 2020 Elsevier B.V. All rights reserved.
Y. Huang and N. Zhao Psychiatry Research 288 (2020) 112954

traumatic stress disorder (PTSD) and depressive disorders were the 2.4.2. COVID-19 related knowledge
most prevalent long-term psychological condition (Mak et al., 2009). This section was evaluated by two items: (1) Time spent focusing on
Similar results have been reported in the previous study of MERS the COVID-19, which measured the average time spent focusing on the
(Lee et al., 2018). Based on the above research evidence, we have COVID-19 outbreak information every day; (2) Knowledge of the
reason to speculate that the psychological condition of the public may COVID-19, which was assessed based on the following six judgment
also be affected during COVID-19 outbreak. questions about COVID-19 related knowledge: a. Inhalation of droplets
Therefore, using a web-based cross-sectional study, we aimed to from sneezing, coughing, or talking to an infected person could cause
assess the mental health burden of Chinese public during COVID-19 infection; b. Contact with something contaminated by an infected
outbreak, and to explore the potential influence factors. We hope that person could lead to infection; c. The incubation period of the virus
our study findings will provide data support for the targeted interven- does not exceed 14 days; d. Contact with an asymptomatic person might
tions on psychological health in Chinese public during the outbreak. also lead to infection; e. There are already targeted drugs that could
cure the disease; f. Taking “Shuanghuanglian Oral Liquid” could pre-
2. Methods vent infection of this disease. Of the above six questions, one point was
given for each correct answer, and no points were given for each in-
2.1. Study design and participants correct or uncertain answer. Participants with scores ≥5 points, equal
to 4 points, and ≤3 points were considered to quite understand, gen-
To prevent the spread of Severe Acute Respiratory Syndrome erally understand, and do not understand.
Coronavirus 2 (SARS-CoV-2) through droplets or contact, we used a web-
based cross-sectional survey based on the National Internet Survey on 2.4.3. Generalized anxiety disorder
Emotional and Mental Health (NISEMH), an ongoing, online health-re- We used Chinese version of GAD-7 (Generalized Anxiety Disorder-7)
lated behavior survey of Chinese population, to collected data. This web- scale to assess subject's anxiety symptoms. The GAD-7 has been pre-
based survey of the COVID-19 was sent on the Internet through the viously used in Chinese populations, and found to have good reliability
WeChat public platform and the mainstream media. All Chinese people (Cronbach's alpha=0.90) (Tong et al., 2016; Wang et al., 2018). Seven
using WeChat or other social tools may see this survey, and answered the items assessed the frequency of anxiety symptoms over the past two
questionnaire by scanning the Quick Response code (QR code) of the weeks on a 4-point Likert-scale ranging from 0 (never) to 3 (nearly
questionnaire address or clicking the relevant link. To encourage the re- every day). The total score of GAD-7 ranged from 0 to 21, with in-
cruitment of potential participants, all participants in the survey can re- creasing scores indicating more severe functional impairments as a
ceive a report on their mental health after completing the evaluation. This result of anxiety (Spitzer et al., 2006). For the purpose of this study, we
web-based questionnaire was completely voluntary and non-commercial. defined a GAD-total score of 9 points or greater as the presence of an-
xiety symptoms (Wang et al., 2018).
2.2. Data collection

Participants answered the questionnaires anonymously on the 2.4.4. Depressive symptoms

Internet from February 3 to, 2020 to February 17, 2020. All subjects The Center for Epidemiology Scale for Depression (CES-D) in
reported their demographic data, COVID-19 related information, and Chinese version was used to identify whether participants had
completed three standardized questionnaires which assessed their
Table 1
generalized anxiety disorder (GAD), depressive symptoms, and sleep
Demographic characteristics of study sample (N=7,236).
quality. In order to ensure the quality of survey, we set the response
range of some items (e.g., the age range was limited to 6-80 years old, Variable n (%)
some items needed to be answered in reverse) and encouraged parti-
Total 7236 (100.0)
cipants to answer carefully through questionnaire explanations. In ad- Gender
dition, questionnaires that were completed <1 minute or >60 minutes Male 3284 (45.4)
would be excluded from analysis. Finally, a total of 7,236 participants Female 3952 (54.6)
who completed the questionnaires were included in the analysis. Age (Mean ± SD) 35.3 ± 5.6
< 35 years 3155 (43.6)
≥ 35 years 4081 (56.4)
2.3. Ethical statement Occupation
Healthcare workersa 2250 (31.1)
This study was conducted in accordance with the Declaration of Enterprise or institution workersb 1809 (25.0)
Helsinki, and was approved by the Ethics Committee of Huazhong Teachers or studentsc 1404 (19.4)
Othersd 1773 (24.5)
University of Science and Technology Union Shenzhen Hospital. Time spent focusing on the COVID-19e
Electronic informed consent was obtained from each participant prior <1 hour 1454 (20.1)
to starting the investigation. Participant could withdraw from the 1-2 hours 2627 (36.3)
survey at any moment without providing any justification. ≥3 hours 3155 (43.6)
Knowledge of the COVID-19
Do not understand (score ≤3 points) 398 (5.5)
2.4. Measures General understand (score 4 points) 1136 (15.7)
Quite understand (score ≥5 points) 5702 (78.8)
2.4.1. Demographic information
Demographic variables included gender (male or female), age, and Abbreviations: n, number; SD, Standard deviation; COVID-19, 2019 Corona
occupation. Occupation included the following four types: (1) Virus Disease.
a
Included doctors, nurses and health administrators.
Healthcare workers, which included doctors, nurses, and health-related b
Included enterprise employees, national/provincial/municipal institution
administrators; (2) Enterprise or institution workers, which consisted of
workers and other relevant staff.
enterprise employees, national/provincial/municipal institution c
Included teachers or students from universities, middle schools, or ele-
workers, and other relevant staff; (3) Teachers or students, which in- mentary schools.
cluded teachers or students from universities, middle schools, or ele- d
Includer freelancers, retiree, social worker and other relevant staff.
mentary schools; and (4) Others, which consisted of freelancers, re- e
Average time spent focusing on the COVID-19 outbreak information every
tirees, social workers, and other relevant staff. day.

2
Y. Huang and N. Zhao Psychiatry Research 288 (2020) 112954

Table 2 sleep quality stratified by gender, age, and occupation were reported,
Prevalence of GAD, depressive symptoms, and sleep quality during COVID-19 and Chi-square test (χ2) was used to compare the differences between
outbreak in Chinese population stratified by gender (N=7,236). groups. Third, univariate and multivariate logistic regression models
Variables Total Male Female χ2 P-value were performed to explore potential influence factors for GAD, de-
(N=7236) (N=3284) (N=3952) pressive symptoms, and sleep quality during COVID-19 outbreak. Odds
n (%) n (%) n (%) ratio (OR), adjusted odds ratio (AOR), and 95% confidence interval
(95% CI) were obtained from logistic regression models. All data were
GADa 2.89 0.089
No 4696 (64.9) 2092 (63.7) 2394 (65.9) analyzed using Statistical Package for Social Sciences (SPSS) version
Yes 2540 (35.1) 1192 (36.3) 1348 (34.1) 24.0. P-values of less than 0.05 were considered statistically significant
Depressive 3.67 0.055 (2-sided tests).
symptomsb
No 5782 (79.9) 2625 (80.0) 3155 (79.8)
Yes 1454 (20.1) 657 (20.0) 797 (20.2) 3. Results
Sleep qualityc 2.59 0.108
Good 5919 (81.8) 2660 (81.0) 3259 (82.5)
3.1. Demographic characteristics
Poor 1317 (18.2) 624 (19.0) 693 (17.5)

Abbreviations: n, number, GAD, generalized anxiety disorder. The characteristics of participants were shown in Table 1. Of the
a
GAD was defined as individuals who scored ≥ 9 points. 7,236 samples analyzed, 3,284 (45.4%) were males and 3,952 (54.6%)
b
Depressive symptoms included individuals who scored > 28 points. were females, and the mean (standard deviation) age of the participants
c
Poor sleep quality was defined as individuals who scored > 7 points. was 35.3 ± 5.6 years. Among these samples, 2,250 (31.1%) of partici-
pants were healthcare workers, 3,155 (43.6%) of participants spent 3
depressive symptoms (Zhang et al., 2010), and the Chinese version of hours or more a day focusing on the COVID-19 outbreak, and 5,702
this scale has been validated and extensively utilized in Chinese po- (78.8%) of participants quite understand knowledge of the COVID-19.
pulation (Zhang et al., 2010; Zhang and Li, 2011). Twenty items as-
sessed the frequency of depressive symptoms over the past two weeks
3.2. Prevalence of GAD, depressive symptoms, and sleep quality during
on a 4-point Likert-scale ranging from 0 (rarely or none of the time) to 3
COVID-19 outbreak stratified by gender, age, and occupations
(most or all of the time). The score range of the CES-D was 0-60 points,
and higher scores indicated more severe depressive symptomatology
The prevalence of GAD, depressive symptoms, and sleep quality
(Radloff, 1977). In our study, CES-D scores greater than 28 points in-
stratified by gender, age, and occupations were shown in Table 2,
dicated depressive symptoms.
Table 3, and Table 4, respectively. The overall prevalence of GAD,
depressive symptoms, and sleep quality were 35.1%, 20.1%, and
2.4.5. Sleep quality 18.2%, respectively. There was no statistically significant difference in
The Chinese version of the PSQI (Pittsburgh Sleep Quality Index) the prevalence of GAD, depressive symptoms, and sleep quality by
scale was used to assess the subject's sleep quality over the past two gender (P>0.05, as shown in Table 2). The prevalence of GAD and
week (Liu et al., 1996). The PSQI scale contains seven components depressive symptoms was significantly higher in participants younger
(subjective sleep quality, sleep duration, sleep latency, habitual sleep than 35 years than in participants aged 35 years or older (P<0.001, as
efficiency, use of sleep medications, sleep disturbance, and daytime shown in Table 3). Compared with other occupational groups, health-
dysfunction), and the score for each component rangs from 0 to 3 care workers (23.6%) reported the highest rate of poor sleep quality
points. The global PSQI score ranges from 0 to 21, with higher scores (P<0.001, as shown in Table 4).
indicating more severe sleep disorder (Buysse et al., 1989). The Chinese
version of PSQI has been demonstrated to be reliable and valid in 3.3. Association of influence factors with GAD, depressive symptoms, and
Chinese population (Liu et al., 1996), and a global PSQI score greater sleep quality during COVID-19 outbreak
than 7 points indicates poor sleep quality.
The associations of potential influence factors with GAD, depressive
2.4.6. Statistical analysis symptoms, and sleep quality during COVID-19 outbreak were presented
First, descriptive analyses were conducted to describe the demo- in Table 5. In the univariate logistic regression models, age (OR=1.77,
graphic characteristics and COVID-19 related knowledge in Chinese 95% CI: 1.38-1.95) and time spent focusing on the COVID-19
population. Second, the prevalence of GAD, depressive symptoms, and (OR=1.91, 95% CI: 1.77-2.15) were significantly associated with GAD

Table 3
Prevalence of GAD, depressive symptoms, and sleep quality during COVID-19 outbreak in Chinese population stratified by age (N=7,236).
Variables Total (N=7236) Age < 35 year (N=3155) Age ≥ 35 year (N=4081) χ2 P-value
n (%) n (%) n (%)

GADa 20.67 <0.001

No 4696 (64.9) 1956 (62.0) 2740 (67.1)
Yes 2540 (35.1) 1199 (38.0) 1341 (32.9)
Depressive symptomsb 13.91 <0.001
No 5782 (79.9) 2458 (77.9) 3324 (81.5)
Yes 1454 (20.1) 697 (22.1) 757 (18.5)
Sleep qualityc 0.58 0.446
Good 5919 (81.8) 2575 (81.6) 3344 (81.9)
Poor 1317 (18.2) 580 (18.4) 737 (18.1)

Abbreviations: n, number, GAD, generalized anxiety disorder.

a
GAD was defined as individuals who scored ≥ 9 points.
b
Depressive symptoms included individuals who scored > 28 points.
c
Poor sleep quality was defined as individuals who scored > 7 points.

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Y. Huang and N. Zhao Psychiatry Research 288 (2020) 112954

Table 4
Prevalence of GAD, depressive symptoms, and sleep quality during COVID-19 outbreak in Chinese population stratified by Occupations (N=7,236).
Variables Total (N=7236) Healthcare workers Enterprise or institution workers Teachers or students Others (N=1773) χ2 P-value
(N=2250) (N=1809) (N=1404)
n (%) n (%) n (%) n (%) n (%)

a
GAD 2.36 0.501
No 4696 (64.9) 1448 (64.4) 1179 (65.2) 911 (64.9) 1158 (65.3)
Yes 2540 (35.1) 802 (35.6) 630 (34.8) 493 (35.1) 615 (34.7)
Depressive symptomsb 2.71 0.439
No 5782 (79.9) 1804 (80.2) 1445 (79.9) 1109 (79.0) 1424 (80.3)
Yes 1454 (20.1) 446 (19.8) 364 (20.1) 295 (21.0) 349 (19.7)
Sleep qualityc 98.82 <0.001
Good 5919 (81.8) 1719 (76.4) 1579 (87.3) 1203 (85.7) 1418 (80.5)
Poor 1317 (18.2) 531 (23.6) 230 (12.7) 201 (14.3) 355 (20.0)

Abbreviations: n, number, GAD, generalized anxiety disorder.

a
GAD was defined as individuals who scored ≥ 9 points.
b
Depressive symptoms included individuals who scored > 28 points.
c
Poor sleep quality was defined as individuals who scored > 7 points.

in Chinese public. Similarly, age was associated with depressive 4. Discussion

symptoms (OR=1.80, 95% CI: 1.35-2.01), but not with sleep quality
(OR=0.69, 95% CI: 0.35-1.05). Occupations were related to sleep Our web-based study shows a high prevalence of GAD and poor
quality during COVID-19 outbreak in Chinese public (OR=1.48, 95% sleep quality in the Chinese public during COVID-19 outbreak. Anxiety
CI: 1.15-1.95). symptoms were more likely to occur in people younger than 35 years
In the multivariate logistic regression models, the above associa- and those who spent too much time focusing on the outbreak.
tions weakened but there were still statistical difference. Participants Compared with other professions, healthcare workers were associated
under 35 years were more likely to have GAD than those 35 years and with higher risk for poor sleep quality. Our findings provided data
older (AOR=1.65, 95% CI: 1.49-2.02). Besides, participants who were support for accurately understanding the source of public's panic during
concerned about the COVID-19 outbreak for 3 hours or more were more COVID-19 outbreak.
likely to develop GAD than those less than 1 or 2 hours (AOR=1.83, The data in this study suggested that public's levels of anxiety-re-
95% CI: 1.53-2.19). Similarly, participants under 35 were associated lated symptoms increased when a major infectious disease occurred.
with higher risk for depressive symptoms than those 35 years and older Similar to the psychological burden caused by SARS (Su et al., 2007),
(AOR=1.77, 95% CI: 1.58-2.07). Compared with other occupation we found that 1/3 participants showed anxiety disorders, and this mood
participants, healthcare workers were more likely to report poor sleep was not different between male and female during COVID-19 outbreak,
quality (AOR=1.32, 95% CI: 1.18-1.88). which was different from previous research that women were more
likely to have anxiety than men (Guo et al., 2016; Gao et al., 2020). In
addition, nearly 1/5 participants had depressive symptoms and sleep

Table 5
Results of univariate and multivariate logistic regression analyses (N=7,236).
Variables GAD Depressive symptoms Sleep quality
OR (95% CI) AOR (95% CI) OR (95% CI) AOR (95% CI) OR (95% CI) AOR (95% CI)

Gender
Male 1.00 1.00 1.00 1.00 1.00 1.00
Female 1.32 (0.90-1.69) 1.22 (0.86-1.64) 1.30 (0.82-2.07) 1.24 (0.77-1.99) 0.89 (0.57-1.39) 0.82 (0.52-1.29)
Age
< 35 years 1.77 (1.38-1.95)* 1.65 (1.49-2.02)* 1.80 (1.35-2.01)* 1.77 (1.58-2.07)* 0.69 (0.35-1.05) 0.68 (0.42-1.11)
≥ 35 years 1.00 1.00 1.00 1.00 1.00 1.00
Occupations
Healthcare workersa 1.30 (0.83-2.04) 1.30 (0.82-2.08) 1.15 (0.67-1.99) 1.02 (0.58-1.81) 1.48 (1.15-1.95)* 1.32 (1.18-1.88)*
Enterprise or institution workersb 0.85 (0.52-1.38) 0.91 (0.55-1.49) 0.80 (0.44-1.47) 0.80 (0.44-1.49) 0.60 (0.33-1.11) 0.59 (0.32-1.10)
Teachers or studentsc 1.51 (0.91-2.53) 1.41 (0.80-2.50) 1.24 (0.67-2.31) 0.94 (0.47-1.88) 0.69 (0.35-1.35) 0.87 (0.42-1.82)
Othersd 1.00 1.00 1.00 1.00 1.00 1.00
Time spent focusing on the COVID-19e
<1 hour 1.00 1.00 1.00 1.00 1.00 1.00
1-2 hours 0.96 (0.59-1.57) 1.01 (0.61-1.64) 0.71 (0.40-1.27) 0.74 (0.41-1.32) 0.90 (0.50-1.62) 0.81 (0.44-1.49)
≥3 hours 1.91 (1.77-2.15)* 1.83 (1.53-2.19)* 0.98 (0.57-1.68) 1.11 (0.63-1.93) 1.18 (0.68-2.07) 1.02 (0.57-1.82)
Knowledge of the COVID-19
Do not understand 1.00 1.00 1.00 1.00 1.00 1.00
General understand 0.73 (0.32-1.71) 0.68 (0.29-1.60) 0.97 (0.32-2.97) 0.90 (0.29-2.76) 1.06 (0.35-3.21) 0.92 (0.30-2.82)
Quite understand 0.93 (0.45-1.93) 0.80 (0.38-1.69) 1.30 (0.49-3.47) 1.12 (0.42-3.02) 1.29 (0.48-3.42) 1.15 (0.42-3.14)

Abbreviations: GAD, generalized anxiety disorder; OR, odds ratio; AOR, adjusted odds ratio; 95% CI, 95% confidence interval; COVID-19, 2019 Corona Virus Disease.
a
Included doctors, nurses and health administrators.
b
Included enterprise employees, national/provincial/municipal institution workers and other relevant staff.
c
Included teachers or students from universities, middle schools, or elementary schools.
d
Includer freelancers, retiree, social worker and other relevant staff.
e
Average time spent focusing on the COVID-19 outbreak information every day.
⁎
P<0.001.

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Y. Huang and N. Zhao Psychiatry Research 288 (2020) 112954

problems, indicating that the uncertainty of the epidemic progression 5. Conclusion

would cause greater psychological pressure on the public. The possible
reason for these mental problems may be related to the “hypochondriac In conclusion, we identified a major mental health burden of the
concerns” (worry about being infected) (Furer et al., 1997) and feared Chinese public during the COVID-19 outbreak, and younger people,
that the epidemic was hard to control. people spending too much time thinking about the outbreak, and
After multivariate logistic regression analyses, we found that age healthcare workers were at a high risk of displaying psychological is-
and time spent focusing on COVID-19 may be potential risk factors for sues. Previously, when SARS occurred in China, the awareness re-
the psychological problems of the public. Younger participants (< 35 garding public's mental health related to the epidemic was low, and no
years) were more likely to develop anxiety and depressive symptoms targeted psychological guidelines was available to the public, which
during COVID-19 outbreak than older participants (≥ 35 years). Our was in need during the pandemic period. Therefore, ongoing surveil-
results were similar to those of a previous study in Taiwan during SARS lance and monitoring of the psychological consequences for outbreaks
outbreak (Su et al., 2007). In addition, we assessed the average time of epidemic-potential, life-threatening diseases, establishing early tar-
participants spent focusing on the COVID-19 outbreak each day, and geted mental health interventions, should become routine as part of
found that people who spent too much time thinking about the out- preparedness efforts worldwide.
break (≥ 3 hours) were more likely to develop anxiety symptoms. The
manifestation of this panic mood may be related to the body's normal Author statement contributors
protective response to the stress caused by the epidemic
(Maunder et al., 2003). Ning Zhao conceptualized and designed the study, review and re-
Since January 20, 2020, Zhong Nanshan (the renowned Chinese vised the manuscript, and approved the final manuscript as submitted.
respiratory expert who discovered the SARS virus) confirmed that there Yeen Huang designed the data collection instruments, coordinated and
must be human-to-human transmission of COVID-19 (XINHUA- supervised data collection, carried out the initial analyses, and inter-
NET, 2020), more than 40,000 medical staff have given up the Spring preted the data, drafted the initial manuscript, and approved the final
Festival holiday and voluntarily applied to fight against the outbreak in manuscript as submitted. Ning Zhao and Yeen Huang agree to be ac-
Hubei Province (National Health Commission of the People's Republic countable for all aspects of the study.
of China, 2020). Meanwhile, most healthcare workers in China have
returned to work to cope with the further development of the disease. Role of the funding source
Our findings showed that nearly one in four healthcare workers had
sleep problems, which was significantly higher than other occupational This work was supported by the National Natural Science
groups. One possible reason is that the working time and labour in- Foundation of China. The funder had no role in the design and conduct
tensity of healthcare workers will increase in the face of severe epi- of the study; management, collection, analysis, and interpretation of the
demic (such as SARS and MERS), causing them not to have enough time data; preparation, review, or approval of the manuscript; and decision
to rest, and to be prone to chronic stress and psychological distress to submit the manuscript for publication.
(Lu et al., 2006; Lee et al., 2018; McAlonan et al., 2007). In severe
cases, a post-traumatic stress disorder (PTSD) symptoms may even Declaration of competing interest
occur, which is highly correlated with poor sleep (Kobayashi et al.,
2007). None.
Fortunately, the Chinese government has taken many strong na-
tional measures in time to avoid further spread of the COVID-19 out- Acknowledgements
break, including requiring uninfected people to isolate themselves at
home, prohibiting all gathering activities, and forcing everyone to wear The authors would like to thank all the participants in our study. In
medical masks to enter public places. However, there is still lack of addition, we express our heartfelt respect to all healthcare workers who
relevant research on the targeted intervention of the public's psycho- are fighting the COVID-19 pandemic on the front line. Finally, we thank
logical problems during the COVID-19 outbreak. We filled this research Ms. Qiaohong Chen for providing professional language help.
gap by analyzing the prevalence of mental health burden in Chinese
public stratified by demographic characteristics and exploring related Supplementary materials
influential factors. Several appropriate interventions are recommended
as follows: First, psychological interventions should be directed to Supplementary material associated with this article can be found, in
vulnerable populations which include the suspected and diagnosed the online version, at doi:10.1016/j.psychres.2020.112954.
patients, young people, and healthcare workers, especially physicians
and nurses working directly with patients or quarantined people. References
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