The results of our study revealed a high prevalence of PTS among Chinese medical care workers during the outbreak of COVID-19 virus. Nearly half of the participants suffered from PTS meeting clinical cut-off of PTSD and 97.9% experienced at least one PTSD symptoms, which was much higher than in other population in the same study (34.0% and 94.0% respectively among university students, data not tabulated). The rate was also out of the range of 10–27% probable and clinical PTSD diagnosis reported in Ebola epidemic during 2014–2016 in general population [9] and in SARS outbreak among medical care workers in 2003 [24]. Compare to the PTS symptoms, the prevalence of depression (13.6%) measured by DASS-21 were lower, but still significantly higher than the all age prevalence rate of 3.2% in Chinese population in recent decades [25].
Posttraumatic stress disorder (PTSD) is a common mental disorder manifesting through symptoms of intrusion, hyperarousal and avoidance following a traumatic event [26]. According to earlier studies, medical care workers are likely to develop adverse psychological problems, such as depression and post-traumatic stress as a result of their trauma experience [6, 27]. Under the circumstances of an infectious disease outbreak, the frontline medical care workers always have fears of being infected or infecting others, especially when they experience any physical symptoms related to the infection [6, 8, 28]. Meanwhile, with the lockdown of cities or even countries due to the COVID outbreak, the medical care workers became obviously the high-risk population to transmit the virus to whom have close contacts with them, and unsurprisingly, were under the situation of being stigmatized or distanced by others. In our study, EFA yielded three dimensions from the 8 perceive threat items, namely stigmatization/distancing, fears of infection and perceived high-risk of their job. These are highly concerned issues by medical care workers in the COVID-19 outbreak and in other similar epidemic, and were proved to be associated with adverse psychological outcomes in this study and previous others, especially PTSD symptoms [4, 6, 8, 9]. Therefore, apart from providing appropriate psychological counseling and accurate information targeting the stigmatization against the frontline health care workers to alleviate their perceived threat, a more supportive social environment and more friendly mass media would be helpful to medical care workers’ psychological health during an infectious disease outbreak. In addition, while the shortage on medical supplies among medical care workers is not very common in China in this pandemic, it is still worth considering in other countries and in future similar scenario, it may cause severe adverse psychological outcomes among them, even committing suicide.
Active coping strategies focusing on problem-solving can result in an improvement of person-environment relationship and thus lead to a positive emotional response [29]. Our data suggested strategies promoting active coping styles and providing sufficient social support may help to decrease the occurrence of adverse psychological symptoms like depression, anxiety and stress. This is consistent with the previous studies that active coping and social support were the most important buffering factors of negative psychological health among medical care workers [30, 31]. Our study also revealed passive coping strategies mainly focusing on the emotional distress were significantly related to a worse psychological health including PTS, depression, anxiety and stress symptoms. It can be explained that passive coping may lead to additional emotional exhaustion apart from the original stressful situation [22, 30]. The findings that active coping was not significantly related to PTSD symptoms demonstrated the importance of reducing passive coping strategies on PTSD among medical care workers in this extreme situation occurred very rarely in recent years and people have not prepared well to the pandemic both mentally and materially.
In this study, we found nurses were more likely to have anxiety symptoms compare to others. It can be easily interpreted that the nurses always contact patients with different illness, with various social-economic status, and directly access the patients’ blood sample, hence have the highest risk of being infected by the COVIDS-19 virus. Therefore, the occupational role of medical care workers should be considered in future outbreaks and the employers should encourage a supportive workplace to minimize the adverse psychological impact, and pay attention to the medical care worker with the most patient contact and most at risk [32]. Meanwhile, special attention should be taken to those with confirmed cases in their living community or among their acquaintances, they always have higher levels of concern to the epidemic, and hence prone to have adverse psychological symptoms.
Although current tobacco users were less likely to have PTS in our study, we could not agree that smoking is a proper way to alleviate PTS. A study recently published indicated that post-trauma anhedonia(PTA)is associated with increased substance use in a recently-traumatized population and PTA may be a mechanism through which substance use problems emerge in recently-traumatized individuals [33]. To those experienced PTS, caution should be taken to monitor their tobacco and substance use behavior when taking care of their psychological health in the aftermath of a trauma event, since cigarettes and marijuana are very easy to be accessed in many countries for general people, not mention to the medical care workers.
This study has several limitations. Since this is the first study of IES-6 utilized in Chinese medical care workers during the ongoing COVID-19 epidemic, the assessment of PTS symptoms using the cut-off value suggested in earlier studies does not necessarily accurate to suggest a clinical diagnosis in this study. Still, it can be a measure to identify those with significant PTS for further PTSD assessment and intervention. In addition, while we performed an EFA for extracting factors of perceived threat and proved an acceptable reliability and validity for further multivariate analysis, a more complicated validation analysis including confirmatory factor analysis (CFA) and others should be conducted in current sample and other study in the future.
In summary, adverse psychological symptoms were prevalent among medical care workers in China during the COVID-19 epidemic and a screening for PTS would be helpful to identify those might develop PTSD in the following months or years. The medical care workers experienced numerous threats including stigmatization, risk of being infected or infecting others, lack of necessary medical supplies and overwhelming workload. Lack of social support and maladaptive coping were important risk factors for occurrence of negative psychological outcomes among them. Preventive measures and mitigation strategies among medical care workers to prevent early traumatic stress reactions developing into chronic PTSD would be beneficial in decreasing adverse psychological outcomes [34].