Survey respondents
In this study, we used snowball sampling strategy to implement the online survey. We focused on recruiting frontline HCWs fighting against the COVID-19 outbreak outside the central epidemic area(i.e., Wuhan City and Hubei Province). The survey was initially disseminated to the Department of Medical Administration, Jinzhong Health Committee of Shanxi Province and was then passed to hospitals at all levels.These hospitals were designated to fight against the COVID-19 outbreak and were center for disease control and prevention.
Overall,we received 1,317 completed questionnaires, of which 2 were rejected due to age errors, and final 1,315 respondents were valid. The validity rate was 99.85%.
Demographic Characteristics Of Respondents
As shown in Table 1, the majority of the frontline HCWs were women, with median age of 37 years. Nearly half of the female HCWs were well educated (bachelor degree: 49.9%). Moreover, 97.6%(1,284/1,315) of the frontline HCWs worked in hospitals, and more than half of them worked in public hospitals (60.2%).Less than 20% of these HCWs worked in isolation wards, and most of them had been participating in the fight against the COVID-19 outbreak in fever clinics, emergency departments, and other auxiliary examination departments.In the battle against the COVID-19 outbreak, physicians and nurses accounted for more than 80%, and most of them were experienced HCWs with work time of more than 10 years.
Table 1
Demographic characteristics of the participants (n = 1315)
Characteristics | Percent, n (%) |
Age, median (Interquartile, IQR), yr | 37(28–47) |
≤30 | 426(32.4) |
30 ~ 40 | 381(29.0) |
40 ~ 50 | 356(27.1) |
≥50 | 152(11.6) |
male: female | 316: 999 |
Education degree |
Bachelor degree | 656(49.9) |
Lower than bachelor | 659(50.1) |
CDC | 31(2.4) |
Hospital | 1284(97.6) |
Classification |
Grade 3 | 168(12.8) |
Grade 2 | 215(16.3) |
Community | 377(28.7) |
Others | 524(39.8) |
Department |
Fever clinic | 426(32.4) |
Emergency | 168(12.8) |
Isolation ward | 218(16.6) |
Laboratory or Radiology | 503(38.3) |
Professional titles |
Physician | 512(38.9) |
Nurse | 577(43.9) |
Technician | 120(9.1) |
Hygiene | 106(8.1) |
Working time |
< 10 years | 598(45.5) |
≥ 10 years | 717(54.5) |
CDC: center for disease control and prevention. |
Psychological Effect Of Covid-19 Outbreak
The psychological effect of the COVID-19 outbreak on frontline HCWs was evaluated in two aspects. The first aspect was perceived stress. The median PSS score of the frontline HCWs was 13(IQR, 9, 18), and 646(49.1%) of these HCWs reported a moderatetosevere stress (score ≥ 14). Then, general anxiety and depression were evaluated using GAD-7 and PHQ-9, respectively. Of the respondents, 806(61.3%) were considered to have a normal score (score: 0–4), 368 (28%) were considered to suffer from mild anxiety (score:5–9), 74 (5.6%) were considered to suffer from moderate anxiety (score: 10–14), and 67(5.09%) were considered to suffer from severe anxiety (score: ≥15).For depression screening, 164(12.4%) reported a major depression (score:≥10); 221(16.8%) reported at least one core item (score:>1), of which 123(9.4%) with either item 1or 4 (score:>1) and 22(1.7%) with item 9 (score:>1).Collectively, we found that during the early stage of the fight against COVID-19, most frontline HCWs outside the central epidemic area had moderate to severe perceived stress, and nearly a quarter had moderate to severe anxiety or depressive performance that deserves attention.
Demographic Variables And Perceived Stress
As shown in Table 2, female HCWs had significant higher median PSS score than male coworkers (14 vs. 12, P = 0.000), and female gender was positively correlated with perceived stress degree(r = 0.097, P = 0.000). The median perceived stress score of different age groups differed significantly, with the lowest median stress score in the post-70 s age group. No significant difference was observed on the median perceived stress score among HCWs working in different levels of hospitals in fighting against the COVID-19 outbreak;however, the hospital level was weakly correlated with the stress level. Nevertheless, significant differences were observed in the perceive stress scores of HCWs with different professional titles, among them nurses had the highest median score (14, IQR: 10–18).The median perceived stress scores of the physicians was significantly lower than that of the nurses;however, the proportion of reports of severe stress was significantly higher than that of nurses (4.1%vs. 1.7%, P = 0.018). Work experience was negatively correlated with the perceived stress degree, and experienced workers had lower median perceived stress score and reported lower proportion of moderate or severe stress.
Table 2
Demographic characteristic and perceived stress
Characteristics | Stress | P Value | Spearman§ |
Score median(IQR)* | Score ≥ 14,n(%)# | * | # | r | P value |
Gender (n) | | |
Male(316) | 12(7–17) | 128(40.5) | 0.000 | 0.000 | 0.097 | 0.000 |
Female(999) | 14(9–18) | 518(51.9) |
Age, median (interquartile, IQR), yr |
≤30(426) | 14(10–18) | 232(54.5) | 0.000 | 0.001 | -0.092 | 0.001 |
30 ~ 40(381) | 14(9.5–18) | 197(51.7) |
40 ~ 50(356) | 11(7.25-16) | 146(41) |
≥50 (152) | 13(7–17) | 71(46.7) |
Education degree | | |
Bachelor degree( 656) | 13(9–18) | 315(48) | 0.597 | 0.423 | 0.022 | 0.423 |
Lower than bachelor(659) | 14(9–17) | 331(50.2) |
Hospital classification(N = 1284) |
Grade 3(168) | 11(8–17) | 69(41.1) | 0.085 | 0.103 | -0.064 | 0.023 |
Grade 2(215) | 13(9–18) | 103(47.9) |
Community(377) | 13(9–17) | 181(48) |
Others(524) | 14(9–18) | 272(51.9) |
Department |
Isolation ward (218) | 13(8-17.25) | 101(46.3) | 0.102 | 0.065 | 0.052 | 0.061 |
Fever clinic(426) | 13(9–17) | 193(45.3) |
Emergency (168) | 15(10–19) | 94(56) |
Laboratory or Radiology(503) | 14(9–18) | 258(51.3) |
Professional titles |
Physician | 13(8–17) | 229(44.7) | 0.025 | 0.076 | / | / |
Nurse | 14(10–18) | 297(51.1) |
Technician | 14(9–18) | 62(51.7) |
Hygiene | 14(8–18) | 58(54.7) |
Working time |
< 10years, n (%) | 14(10–18) | 330(55.2) | 0.000 | 0.000 | -0.111 | 0.000 |
≥ 10years, n (%) | 12(8–17) | 316(44.1) |
§Correlation between demographic characteristics and perceived stress degree |
Demographic Variables And General Anxiety
For general anxiety, Table 3 shows that the median GAD-7 score of female HCWs was significantly higher than that of male HCWs. Age was significantly associated with general anxiety degree, and post-90 s HCWs had the lowest median anxiety score and the lowest proportion of reports of moderate to severe anxiety. Well-educated respondents had a significantly higher median anxiety score(3.5 vs. 2, P = 0.000). A statistical difference was observed in the median anxiety score among HCWs working in different levels of hospitals and different departments during the fight against the COVID-19 outbreak. The anxiety level of those working in isolation wards was the lowest (2, IQR: 0–7), and that of those working in the emergency department was the highest (4, IQR: 1–7).
Table 3
Demographic characteristic and general anxiety
Characteristics | Anxiety | P Value | Spearman§ |
Score median(IQR)* | Score ≥ 10,n(%)# | * | # | r | P value |
Gender (n) |
Male(316) | 2(0–6) | 27(8.5) | 0.022 | 0.151 | 0.040 | 0.151 |
Female(999) | 3(0–7) | 114(11.4) |
Age, median (interquartile, IQR), yr |
≤30(426) | 2(0–6) | 29(6.8) | 0.000 | 0.010 | 0.083 | 0.003 |
30 ~ 40(381) | 4(0–7) | 47(12.3) |
40 ~ 50(356) | 3(0–7) | 42(11.8) |
≥50 (152) | 4(0–7) | 23(15.1) |
Education degree |
Bachelor degree( 656) | 3.5(0–7) | 77(11.7) | 0.000 | 0.235 | -0.033 | 0.235 |
Lower than bachelor(659) | 2(0–6) | 64(9.7) |
Hospital classification(N = 1284) |
Grade 3(168) | 3(0–6) | 14(8.3) | 0.045 | 0.714 | -0.030 | 0.280 |
Grade 2(215) | 3(0–7) | 22(10.2) |
Community(377) | 2(0–6) | 39(10.3) |
Others(524) | 3(0–7) | 60(11.5) |
Department |
Isolation ward (218) | 2(0–7) | 22(10.1) | 0.026 | 0.602 | -0.021 | 0.456 |
Fever clinic(426) | 3(0–7) | 52(12.2) |
Emergency (168) | 4(1–7) | 19(11.3) |
Laboratory or Radiology(503) | 3(0–7) | 48(9.5) |
Professional titles |
Physician | 3(0–7) | 57(11.1) | 0.571 | 0.347 | / | / |
Nurse | 3(0–7) | 65(11.3) |
Technician | 2(0–6) | 7(5.8) |
Hygiene | 3(0–7) | 12(11.3) |
Working time |
< 10years, n (%) | 3(0–7) | 51(8.5) | 0.086 | 0.019 | -0.065 | 0.019 |
≥ 10years, n (%) | 3(0–7) | 90(12.6) |
§Correlation between demographic characteristics and general anxiety degree |
Demographic Variables And Depression
As shown in Table 4, the depression score showed a statistical difference between female and male HCWs, among different educated groups, and among different age groups(P < 0.05).
Table 4
Demographic characteristic and depression
Characteristics | Depression | P Value | Spearman§ |
Score median(IQR)* | Score ≥ 10,n(%)# | * | # | r | P value |
Gender (n) |
Male(316) | 2(0–6) | 33(10.4) | 0.005 | 0.211 | 0.030 | 0.211 |
Female(999) | 4(1–8) | 131(13.1) |
Age, median (interquartile,IQR), yr |
≤30(426) | 3(0–7) | 46(10.8) | 0.039 | 0.558 | 0.025 | 0.359 |
30 ~ 40(381) | 4(1–8) | 53(13.9) |
40 ~ 50(356) | 3(1–7) | 44(12.4) |
≥50 (152) | 3(0–7) | 21(13.8) |
Education degree |
Bachelor degree( 656) | 4(1–8) | 96(14.6) | 0.000 | 0.018 | -0.065 | 0.018 |
Lower than bachelor(659) | 3(0–7) | 68(10.3) |
Hospital classification(N = 1284) |
Grade 3(168) | 3(0–7) | 25(14.9) | 0.231 | 0.417 | -0.005 | 0.862 |
Grade 2(215) | 4(1–8) | 25(11.6) |
Community(377) | 3(0–7) | 38(10.1) |
Others(524) | 3(1–8) | 66(12.6) |
Department |
Isolation ward (218) | 3(0–7) | 25(11.5) | 0.182 | 0.088 | -0.004 | 0.895 |
Fever clinic(426) | 3(0–7) | 52(12.2) |
Emergency (168) | 4(1–8) | 31(18.5) |
Laboratory or Radiology(503) | 3(1–7) | 56(11.1) |
Professional titles |
Physician | 3(1–7) | 63(12.3) | 0.914 | 0.985 | / | / |
Nurse | 3(0–8) | 73(12.7) |
Technician | 4(0.25-7) | 14(11.7) |
Hygiene | 3(0.75-7) | 14(13.2) |
Working time |
< 10years, n (%) | 4(0–8) | 77(12.9) | 0.432 | 0.685 | -0.011 | 0.685 |
≥ 10years, n (%) | 3(1–7) | 87(12.1) |
§Correlation between demographic characteristics and depression degree |