The outbreak of COVID-19, which was regarded as a public health emergency, not only raised public health concerns but also caused tremendous psychological distress. At present, although the increase of confirmed and suspected cases of COVID-19 has been constrained in China, the first-line health workers still need to keep working. Military health workers who were among the first group to engage in the epidemic prevention experienced stern tests and more pressures due to the long work time, becoming the high risk group with mental health problems.
The prevalence of depression, generalized anxiety and somatic symptoms in military health workers was high, 37.6%, 32.5% and 50%, respectively. Based on Liu and colleagues’ study, it was approximately higher than the prevalence of depression (18.1%) and anxiety (34.0%) for the public. There are three reasons to explain this result. Firstly, patients in the COVID19-specialized hospital were all COVID19-confirmed cases that had older ages and more underlying diseases, such as cognitive disorders and psychotic symptoms. Secondly, military health workers were entrusted with this mission under critical circumstances. They needed to rescue patients at relatively unfamiliar places, with insufficient psychological and materials preparation. Lastly, the living condition and dwelling environment was poor. For instance, they had to travel a long distance from their residence to the hospitals, and they often had irregular meals and insufficient sleep due to heavy workload. However, it was worth noting that their prevalence of mental issues was lowered than that of health workers in the local hospitals during the COVID-19 outbreak. Huang and colleagues’ study revealed that the prevalence of depression and anxiety of health workers in the local hospitals was as high as 50.7% and 44.7%, respectively . Meanwhile, our study shows that the 22.7% of military health workers with depression symptoms had comorbid anxiety and somatization, which was lower than that of primary care clinic patients in the United States . Great tenacity and indomitableness of military medical workers may be picked out as possible causes, protecting their mental health to some extent.
Military health workers with lower grade professional title showed more depression symptoms, which are consistent with previous study , may be related to the following reasons. People with junior-grade professional title faced more challenges, such as economic pressure and limited societal resources. Also, in term of promotion, they need to consider other issues while treatingCOVID-19 patients, such as scientific researches, publishing papers and teaching tasks. Our study also shows that with the increase of age, more symptoms of anxiety and somatization appear in military health workers. These results indicated that older military health workers may endure more occupational exhaustion and family responsibilities.
The present study found depression, generalized anxiety and somatic symptoms were more prevalent in the military health workers with less sleep duration and poor sleep quality. This was in line with previous study done by Kobayashi and colleagues, showing poor sleep was highly associated with symptoms of depression, anxiety and PTSD. Almost 81% military health workers had self-reported poor or ordinary sleep quality in this study. Living far from the hospital, time-consuming medical protection, generalized anxiety caused by severe epidemic situation, working in shifts leading to circadian rhythm disorder, and job burnout may have brought negative influences on the sleep quality.
Many powerful measures had been taken to maintain the mental health of the public in China. The national health commission of the PRC has issued guidelines for emergency psychological crisis intervention in COVID-19 . In the guidelines, intervention subjects have been divided into four grades according to the degree of epidemic influence, of which military health workers were regarded as the first-grade. In order to improve the mental health of military health workers in public health emergencies, some practical suggestions have been put forward based on the assessment of mental health conditions of military health workers and the analysis of related risk factors. Firstly, more attention should be paid to the specific groups, such as nurses and those with junior and medium grade professional titles, providing the support of “physiological-psychological-social” intervention. Secondly, it is not advisable to check information about COVID-19 frequently. Lastly, improvement of sleep quality and sleeping environment is needed. Mindfulness meditation intervention, relaxation training through virtual reality (VR), cognitive behavioral therapy for insomnia (CBTI) and sedative and hypnotic drugs may contribute to solving sleeping problems.
There are several limitations in the current study. Firstly, due to the sudden appearance of COVID-19, only a cross-sectional design was conducted. Secondly, the baseline mental health of military health workers before the outbreak of COVID-19 was lacking. Next, the relationship between mental health and other risk factors such as COVID-19 knowledge reserve and proportion of clinical classification of COVID-19 were not investigated. Lastly, results also needed to be explored in a larger sample size.