In this study, we found that those who were front-line medical personnel, suffered from chronic diseases, with present symptom of SARS-CoV-2 infection or contact history had 112%, 93%, 40% and 15% increase risk of higher anxiety level; while those with knowledge about personal protective measures or wore masks had 75% and 29% lower risk of higher anxiety level respectively. We developed a risk score to assess the total effect of observed significant factors on anxiety disorder, and found that each one increase of the risk score was associated with increase in anxiety index score, as well as increased risk of anxiety disorder.
Compared with previous studies, similar information may be derived by previous experiences with corona virus infections. Front-line medical personnel may develop psychiatric disorders after coping with stressful community events [7, 10–13]. This fact could be attributed to medical workers have been facing enormous pressure, including a high risk of infection and inadequate protection from contamination, overwork, frustration, discrimination, isolation, patients with negative emotions, a lack of contact with their families, and exhaustion [14]. Some demographic factors may also influence mental health during the COVID-19 pandemic. Individuals with contact history had an increased risk of anxiety disorder for the reason that they not only had to undergo the high possibility of being infectious, but also had to experience alienation in their neighborhood resulting in a hardened mental impact. Particular precautionary measures (e.g., wearing masks) were associated with a lower psychological impact of the outbreak and lower levels of stress, and anxiety [15]. Because the adoption of self-protective measures can effectively reduce the risk of infection.
We developed a risk score to assess the total effect of factors on anxiety disorder. The results from linear regression models and logistic models consistently showed the significant association between the developed risk score and anxiety index score/disorder. The AUC of 0.73 confirmed the risk score on prediction of anxiety disorder. In addition, the cut-off point of 3.5 indicated that individual who was with more than three observed significant related factors had higher risk of suffering from anxiety disorder during the COVID-19 pandemic. The risk factors (e.g., front-line medical personnel, exposure of wild animals, contact history, and chronic disease) are related with elevated risk scores (Supplemental Figure S3). Particular precautionary measures (e.g., wearing masks) and knowledge about personal protective measures may have a protective effect on risk scores (Supplemental Figure S3). This suggests a worldwide response should focus on the mental health impacts of the specific population and strengthen the publicity of self-protection.
We observed several notable risk factors associated with elevated anxiety in the Chinese population during the COVID-19 outbreak. For example, those with chronic diseases were observed to have higher risk for anxiety disorder, which were similar with those reported in the previous studies [6, 16]. One possible reason is individuals with chronic diseases are more likely to activate psychological stress reactions including hypochondriasis and somatization when faced with external threats. This might play an important role in the development of anxiety disorder. Moreover, the general public with game exposure had a greater likelihood of anxiety during the pandemic. Exposure to live commercial and private poultry is a potential risk factor for infection with novel influenza viruses [17].
There are over 92 million confirmed cases of COVID-19 across the globe. In addition to physical injuries caused by SARS-CoV-2 infections, psychological injuries should also be concerned. Our finding observed the anxiety disorder in Chinese population during the COVID-19 pandemic, and helped to reveal anxiety-related factors. It emphasized the importance of psychosocial intervention to reduce the anxiety during the COVID-19, especially among individuals with chronic diseases and front-line medical staff. The risk score we developed can help to easily screen out individuals with high risk of anxiety disorder through simple questions, in order to take reasonable psychological interventions in time.
Strengths and Limitations
This study has several strengths. First, the sample size of our cross-sectional study was considerably large, which enabled us to estimate the association between uncommon risks and anxiety disorder with sufficient statistical power. Second, we performed multiple methods to identify and confirm the anxiety-related risks, and developed a simple way to assess anxiety disorder during the special period.
There are also some limitations. Similar with most previous psychological studies, data we collected is based on self-reported online questionnaires, which can cause response bias although it was easy to obtain. However, we have carried out quality control including setting up similar questions in the questionnaire and performing logical checks to ensure the reliability of the data. Although we observed the significant associations between some risks and anxiety, we should also note that the data cannot be used to infer causality due to the cross-sectional design.