Socio-demographic and clinical characteristics of the sample
In the survey there were 1,055 psychiatry patients who completed. As in Table 1, Over one-third of the patients of the patients were male (34.5%), and the average age of the patients were 37.15 (SD = 13.21) years old. Only half of the patients (47.4%) were married and the majority of participants had high school degree or higher degree (82.6%). A quarter of participants were unemployed (26.8%). Some reported living alone during pandemic (10.4%). The majority of the psychiatry patients lived in urban areas (88.4%), and 28.1% had family annual income equal or above 150, 000 RMB (Chinese Yuan). Of the sample, all participants had pre-existing diagnosis, anxiety disorder (35.4%), were Major depressive disorder (26.7%),bipolar disorder (17.6%) and schizophrenia (20.3%). During the COVID-19 pandemic period, almost a half of them reported that they didn’t seek mental health services (47.7%). More than half of them were taking psychiatric medicine (79.7%) although they had high barriers due to inconveniences caused by COVID-19 to continue treatment. In addition, more than a half of participants had anxiety symptoms (51.0%) and depressive symptoms (57.3%).
Table 1
Demographic and clinical characteristics of the study sample (N = 1,055)
Variables
|
Number (n)
|
Percent (%)
|
Mean age (SD)
|
37.15 ± 13.21
|
Sex
|
|
|
Male
|
364
|
34.5
|
Female
|
691
|
65.5
|
Education level
|
|
|
Junior school or lower
|
183
|
17.3
|
High school
|
474
|
44.9
|
College or above
|
398
|
37.7
|
Marital status
|
|
|
Married
|
500
|
47.4
|
Unmarried
|
455
|
43.1
|
Others/Not clear
|
100
|
9.5
|
Employment status
|
|
|
Full-time
|
419
|
39.7
|
Part-time
|
61
|
5.8
|
Unemployed
|
283
|
26.8
|
Retired
|
142
|
13.5
|
Student
|
150
|
14.2
|
Family annual income
|
|
|
< 30,000
|
253
|
24.0
|
30,000 ~ 60,000
|
210
|
19.9
|
60,000 ~ 150,000
|
295
|
28.0
|
150,000 ~ 250,000
|
152
|
14.4
|
> 250,000
|
145
|
13.7
|
Residence place
|
|
|
Urban
|
933
|
88.4
|
Rural
|
122
|
11.6
|
Residence status during the pandemic
|
|
|
Live alone
|
110
|
10.4
|
Live together with others
|
878
|
83.2
|
Live in hospital
|
62
|
5.9
|
Others
|
5
|
0.5
|
Diagnosis of mental disorder
|
|
|
Anxiety disorder
|
373
|
35.4
|
Major Depressive disorder
|
282
|
26.7
|
Bipolar disorder
|
186
|
17.6
|
Schizophrenia
|
214
|
20.3
|
Medication status during pandemic
|
|
|
On antipsychotic medications
|
604
|
57.3
|
Not on medications
|
214
|
20.3
|
Not clear
|
237
|
22.5
|
See a psychiatrist during pandemic
|
|
|
Yes
|
652
|
61.8
|
No
|
403
|
38.2
|
Mental health services during pandemic
|
|
|
Yes
|
552
|
52.3
|
No
|
503
|
47.7
|
Psychotic symptoms
|
|
|
Anxiety symptoms (≥ 5)
|
540
|
51.0
|
Depressive symptoms (≥ 5)
|
604
|
57.3
|
PTSD symptoms (≥ 24)
|
436
|
41.3
|
Note. The unit of annual income is RMB yuan. PTSD: posttraumatic stress disorder. |
Prevalence of PTSD symptoms
Among the whole sample, 436 (41.3%) showed PTSD symptoms. PTSD symptoms among psychiatry patients with different diagnoses (anxiety disorder group, major depressive disorder group, bipolar disorder group and schizophrenia group) were compared. There was no significant difference in the total score of PTSD (F (3,1049) = 2.22, p = 0.084), intrusion subscale (F (3,1051) = 1.16, p = 0.324), and avoidance subscale (F (3,1051) = 0.394, p = 0.758) between different groups. People with depression had the highest value in arousal subscale (M = 14.08, SD = 5.30), in which the depression group was significantly higher than that in the anxiety group (Mean difference = 12.21, SD = 5.30, p < 0.05) and depression was significantly higher than that in the schizophrenia group (Mean difference = 11.74, SD = 4.94, p < 0.05) (see Fig. 1).
Associated factors with PTSD symptoms
Hierarchical linear regression results showed that risk factors including risk awareness, symptoms of anxiety and symptoms of depression are the shared risk factors for the total PTSD symptoms and the subscales as in Table 2. Beside the shared common risk factors, unique contributing risk factors were identified for PTSD subscales. Residence (town) was the shared risk factor across PTSD avoidance subscale (β = 0.06, p < 0.05) and hyperarousal subscale (β = 0.05, p < 0.01). Medication use was the unique risk factor of PTSD avoidance subscale (β = 0.08, p < 0.05). Loneliness was the unique risk factor of PTSD hyperarousal subscale (β = 0.06, p < 0.05). Sleep quality was the unique risk factor of PTSD hyperarousal subscale (β = 0.05, p < 0.05).
Table 2
Hierarchical linear regression coefficients for different PTSD symptoms (N = 1,055)
Variables
|
PTSD
|
Intrusion subscale
|
Avoidance subscale
|
Hyperarousal subscale
|
|
Model 1
|
Model 2
|
Model 3
|
Model 4
|
Model 1
|
Model 2
|
Model 3
|
Model 4
|
Model 1
|
Model 2
|
Model 3
|
Model 4
|
Model 1
|
Model 2
|
Model 3
|
Model 4
|
Socio-demographics characteristics
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Sex (male)
|
-0.05
|
-0.00
|
0.03
|
0.02
|
-0.03
|
0.02
|
0.04
|
0.04
|
-0.04
|
-0.00
|
0.02
|
0.02
|
-0.08*
|
-0.02
|
0.01
|
0.01
|
Age
|
-0.01
|
0.01
|
0.10*
|
0.11**
|
0.07
|
0.07
|
0.15***
|
0.15***
|
0.02
|
0.02
|
0.09
|
0.10*
|
-0.13*
|
-0.08
|
0.02
|
0.03
|
Education
|
-0.03
|
-0.02
|
0.01
|
0.01
|
-0.02
|
-0.01
|
0.02
|
0.02
|
-0.03
|
-0.02
|
-0.00
|
0.00
|
-0.04
|
-0.03
|
-0.00
|
0.00
|
Employment (part-time)
|
-0.07*
|
-0.06*
|
-0.04
|
-0.04
|
-0.06
|
-0.06
|
-0.04
|
-0.04
|
-0.06
|
-0.06
|
-0.04
|
-0.04
|
-0.06
|
-0.06
|
-0.03
|
-0.03
|
Employment (unemployed)
|
-0.05
|
-0.02
|
-0.01
|
-0.02
|
-0.07
|
-0.04
|
-0.03
|
-0.03
|
-0.03
|
-0.01
|
0.01
|
0.00
|
-0.04
|
-0.02
|
-0.00
|
-0.01
|
Employment (retired)
|
-0.06
|
-0.07
|
-0.07*
|
-0.07*
|
-0.06
|
-0.07
|
-0.07
|
-0.07*
|
-0.07
|
-0.07
|
-0.07
|
-0.07
|
-0.03
|
-0.04
|
-0.04
|
-0.04
|
Employment (student)
|
-0.06
|
-0.05
|
-0.06
|
-0.06
|
-0.06
|
-0.05
|
-0.05
|
-0.05
|
-0.05
|
-0.05
|
-0.04
|
-0.04
|
-0.06
|
-0.05
|
-0.06*
|
-0.06*
|
Marital status (unmarried)
|
-0.03
|
-0.03
|
-0.01
|
-0.01
|
-0.04
|
-0.04
|
-0.02
|
-0.02
|
-0.01
|
-0.01
|
0.00
|
0.00
|
-0.03
|
-0.02
|
-0.02
|
-0.01
|
Marital status (others)
|
0.03
|
0.02
|
-0.01
|
-0.01
|
-0.04
|
-0.02
|
-0.03
|
-0.03
|
0.05
|
0.05
|
0.04
|
0.04
|
-0.01
|
-0.00
|
-0.03
|
-0.03
|
Income
|
-0.01
|
0.01
|
-0.04
|
-0.04
|
0.00
|
0.02
|
-0.03
|
-0.03
|
-0.04
|
-0.03
|
-0.06
|
-0.06
|
0.03
|
0.04
|
-0.02
|
-0.01
|
Residence (town)
|
0.03
|
0.04
|
0.04
|
0.04
|
-0.01
|
0.00
|
0.00
|
0.00
|
0.05
|
0.06
|
0.06
|
0.06*
|
0.04
|
0.05
|
0.05*
|
0.05*
|
Live (alone)
|
0.00
|
0.02
|
0.01
|
0.01
|
0.01
|
0.03
|
0.03
|
0.02
|
0.01
|
0.02
|
0.01
|
0.01
|
-0.01
|
-0.00
|
-0.00
|
-0.00
|
Live (in hospital)
|
0.00
|
0.00
|
-0.01
|
-0.01
|
0.04
|
0.03
|
0.03
|
0.03
|
-0.02
|
-0.03
|
-0.03
|
-0.03
|
-0.01
|
0.00
|
-0.01
|
-0.01
|
Live (others)
|
-0.06*
|
-0.06
|
-0.04
|
-0.04
|
-0.05
|
-0.04
|
-0.03
|
-0.03
|
-0.07*
|
-0.06*
|
-0.05
|
-0.05
|
-0.05
|
-0.04
|
-0.03
|
-0.02
|
Infection (yes)
|
0.01
|
-0.01
|
0.03
|
0.02
|
0.01
|
-0.02
|
0.01
|
0.01
|
0.03
|
0.02
|
0.04
|
0.04
|
-0.01
|
-0.03
|
0.01
|
0.01
|
Substance use
|
0.15***
|
0.06
|
-0.01
|
-0.01
|
0.12***
|
0.05
|
-0.01
|
-0.02
|
0.11**
|
0.05
|
0.00
|
0.00
|
0.16***
|
0.06*
|
-0.03
|
-0.03
|
Medication (yes)
|
0.02
|
-0.02
|
0.04
|
0.04
|
-0.01
|
-0.04
|
0.01
|
0.01
|
0.07*
|
0.04
|
0.08**
|
0.08**
|
-0.02
|
-0.07*
|
0.01
|
0.01
|
COVID-19 related factors
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Fear of pandemic
|
0.25***
|
0.20***
|
0.20***
|
|
0.30***
|
0.26***
|
0.26***
|
|
0.20***
|
0.16***
|
0.16***
|
|
0.16***
|
0.10***
|
0.10***
|
Increased pressure by pandemic
|
0.38***
|
0.04
|
0.04
|
|
0.29***
|
0.01
|
0.01
|
|
0.23***
|
0.01
|
0.02
|
|
0.52***
|
0.09**
|
0.08*
|
Clinical treatment during pandemic
|
0.03
|
0.02
|
0.02
|
|
0.04
|
0.03
|
0.03
|
|
0.02
|
0.01
|
0.02
|
|
0.03
|
0.01
|
0.01
|
Mental health guidance during pandemic
|
-0.01
|
-0.04
|
-0.04
|
|
0.01
|
-0.02
|
-0.02
|
|
-0.05
|
-0.07*
|
-0.08**
|
|
0.04
|
-0.02
|
-0.02
|
Medication barriers due to pandemic
|
-0.17***
|
-0.00
|
0.00
|
|
-0.13**
|
0.00
|
0.00
|
|
-0.09
|
0.02
|
0.02
|
|
-0.24***
|
-0.02
|
-0.02
|
Psychosomatics factors
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Loneliness
|
|
|
0.05
|
0.05
|
|
|
0.02
|
0.02
|
|
|
0.06
|
0.05
|
|
|
0.07**
|
0.06*
|
Quality of life
|
|
|
0.03
|
0.05
|
|
|
0.05
|
0.06
|
|
|
0.06
|
0.08*
|
|
|
-0.04
|
-0.03
|
Sleep quality
|
|
|
0.03
|
0.03
|
|
|
0.03
|
0.04
|
|
|
-0.01
|
-0.01
|
|
|
0.05*
|
0.05*
|
Anxiety
|
|
|
0.48***
|
0.48***
|
|
|
0.42***
|
0.41***
|
|
|
0.36***
|
0.36***
|
|
|
0.51***
|
0.51***
|
Depression
|
|
|
0.12**
|
0.12**
|
|
|
0.11*
|
0.11*
|
|
|
0.05
|
0.05
|
|
|
0.17***
|
0.18***
|
Support
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Social support
|
|
|
0.01
|
|
|
|
0.02
|
|
|
|
-0.03
|
|
|
|
0.03
|
Family support
|
|
|
-0.01
|
|
|
|
-0.03
|
|
|
|
-0.01
|
|
|
|
0.04
|
Friends support
|
|
|
-0.05
|
|
|
|
-0.01
|
|
|
|
-0.04
|
|
|
|
-0.07**
|
Adjusted R2
|
0.017
|
0.160
|
0.445
|
0.445
|
0.020
|
0.159
|
0.360
|
0.360
|
0.018
|
0.091
|
0.217
|
0.217
|
0.028
|
0.194
|
0.612
|
0.615
|
△R2
|
|
0.144
|
0.285
|
0.000
|
|
0.140
|
0.201
|
-0.000
|
|
0.073
|
0.125
|
0.000
|
|
0.167
|
0.418
|
0.003
|
Note. All the regression coefficients in the above table were standardized regression coefficients. *p < .05; **p < .01; ***p < .001. |