This is the first study to report the prevalence of anxiety and depression among neurological doctors and nurses in Hunan Province during the outbreak of COVID–19. Our study found that the SAS scores of the neurological staff was higher than the Chinese national norms, symptoms of anxiety and depression were more prevalent among neurological nurses than doctors. The shortage of protective equipment was the main factor influencing the anxiety of medical staff in the neurology department.
In dealing with this large-scale public health emergency, healthcare workers experienced both physical and psychological pressure. A retrospective clinical study of 138 hospitalized patients from Zhongnan Hospital of Wuhan University found that novel coronavirus pneumonia caused by hospital-related transmission was common, 40 (29%) healthcare workers were presumed to have been infected in hospitals. Of these patients with nosocomial infections, 31(77.5%) were from the general wards, seven (17.5%) were from the emergency department, and two (5%) were from the intensive care unit (ICU) . What is worse, at least 3000 medical workers across the Chinese mainland have been infected with novel coronavirus during the nationwide outbreak, according to the epidemiological characteristics of the outbreak of 2019 novel coronavirus disease (COVID–19) in China . As the number of infected medical staff members increases, medical workers have been experiencing psychological disorders such as anxiety, depression, and sleep disturbances .
This SARS-like coronavirus has the ability to use the cell entry receptor, angiotensin-converting enzyme 2 (ACE2), and replicate in human cells of multiple human organs including nervous system [24, 25], leading to abnormally high blood pressure and increasing the risk of cerebral hemorrhage. In China, the presence of 2019-nCoV in the cerebrospinal fluid was confirmed by gene sequencing of a 56-year-old patient with COVID–19 in Beijing . The neurological symptoms of patients with COVID–19 have been described in some studies. Some patients were admitted to the hospital with symptoms of sudden slurred speech, limb paralysis, headache, epilepsy, or confusion [27, 28]. As general wards away from the front line, departments of neurology, are also considered high-risk. In our study, 210 (34.3%) medical workers thought that the department of neurology was a high-risk place for COVID–19; the proportion of holding this attitude was greater in nurses than in doctors. Only 67 medical workers agreed that the current protective measures were adequate to prevent infection, accounting for 10.9% of the total. Volunteer medical workers have been recruited from other departments to assist the frontline medical personnel. Many of the neurological staff were willing to treat or care for infected patients, and the proportion holding this attitude was also higher in nurses than in doctors. We found that nurses and female medical workers were more likely to develop anxious symptoms; younger workers and those who had lower occupational titles were more prone to anxiety and depression. Our findings generally consistent with other study on COVID–19 and previous studies on SARS in 2003 [29, 30, 31], which reported that women and nurses reported more severe symptoms of anxiety and distress. Nurses play a critically important role in the battle against COVID–19; they have a higher risk of infection due to their close contact with patients during nursing work. According to the Shanghai Women’s Federation, over 50% of doctors and over 90% of nurses fighting the virus in Wuhan were women . In our study, almost half of the doctors were women, and 98% of the nurses were women. Women may be more prone to anxiety, possibly due to the high risk of infection, heavy pressure from family, and effects of female hormones. Moreover, 59% of all nurses had junior titles or below, indicating fewer work experiences. Similarly, medical workers aged below 40 years and having lower occupational titles faced mental health disorders of anxiety and depression, probably due to insufficient experience in dealing with this public health emergency.
The fear of uncertainty of the coronavirus transmission routes and the dissemination of negative information about the infection of medical staff have resulted in great anxiety among medical workers. We found that worry about the shortage of protective equipment was independently associated with anxiety. Younger age was an independent risk factor for depression. Since the outbreak, there has been a shortage of medical protective supplies such as medical protective clothing, N95 masks, medical masks, protective masks, and goggles that are urgently needed for the prevention and control of the epidemic, which has severely threatened the safety of health care workers. During the outbreak of COVID–19, primary protection measures were recommended in the neurology clinic and wards, while secondary protection measures were used for high-risk exposed personnel when dealing with suspected patients to alleviate the shortage of supplies . Nonetheless, primary protective measures like surgical masks remained in seriously short supply in neurology departments. It is difficult for neurological workers to differentiate and screen patients with manifestations of the neurological system as the initial symptoms without fever and pulmonary disorders, which may lead to inadvertent exposure of medical staff to the virus.
Multifaceted interventions should also be undertaken to relieve anxiety and depression among medical workers in neurology department. First, preliminary checking and differentiating diagnosis of suspected cases should be firmly implemented to ensure the safety out of the front line. Second, employees in department of neurology should acquire in-depth knowledge of infection prevention to improve compliance with hand disinfection and personal protective measures. Third, with the opening of outpatient appointments, hospitals should also pay attention to the medical workers out of the frontline and provide adequate protective equipment to reduce their risk of infection. Fourth, we can learn from the experiences of the Second Xiangya Hospital in Hunan Province and establish such resources as online courses and psychological assistance hotline teams to guide medical workers in dealing with common mental health problems, and various group activities to help staff release stress . Workers with psychological disorders can also use online psychological self-help intervention systems to reduce symptoms of anxiety and depression . Fifth, our government should strengthen support for and safeguard the legitimate rights and interests of medical workers during epidemic control and in the future.
This study was several limitations. First, the participants were all from Hunan Province, limiting the generalization of our findings to other studies. Second, it’s limited by its use of the SAS and SDS to measure symptoms of anxiety and depression, which was different from a clinical diagnosis. Third, the study was cross-sectional, and no cause-effect relationship can thus be established between the attitude toward COVID–19 and mental health disorders. Fourth, due to the limited time for designing the questionnaire, the attitude toward COVID–19 only includes three simple questions, lacking multi-dimensional measures.