This cross-sectional study enrolled 307 participants firstly found the prevalence of anxiety, depression, poor sleep quality two months after the COVID-19 epidemic for Fangcang shelter hospital in China. Overall, 18.57%, 13.36%, 84.69% of the participants had symptoms of anxiety, depression, poor sleep quality, respectively. Compared with previous studies in the initial stage COVID-19 epidemic in China, which reported the occurrence of moderate to severe depressive, anxiety symptoms were 16.5%, 28.8% among the general population, respectively[8]; and symptoms of depression, anxiety were 50.4%, 44.6% among health care workers treating patients with COVID-19[21], this is in sharp contrast to a low prevalence of anxiety, depression in our study. Similarly, the same period study, conducted in China, which showed that prevalence rates of anxiety, depression of total participants (including medical health workers and nonmedical health workers) were 10.4%,10.6% [22]. Hence, the prevalence rates difference in anxiety and depression might be caused by different research time. With the COVID-19 epidemic outbreak, the National Health Commission of China (NHC) has performed psychological crisis intervention into the general deployment of disease prevention and mental health professionals and expert groups Provide psychological intervention for different sub-populations, including patient isolation in Fangcang hospitals [13, 23]. Early psychological crisis intervention reduced the prevalence rates of negative psychological outcomes caused by the COVID-19 outbreak. In addition, using the summary t tests, both scores of SAS (42.92 ± 7.30) and SDS (39.77 ± 10.11) in the participants of our study were higher than the scores in Chinese norms(SAS, 29.78 ± 10.07,n = 1158;SDS, 33.46 ± 8.55, n = 1340)[24] (both P < 0.05), it indicates more severe levels of anxiety and depression in COVID-19 patients admitted to Fangcang hospital than general public. Clearly, anxiety and depression symptoms were common response to the COVID-19 outbreak, and patients in shelter Fangcang hospital had severe levels of anxiety, depression symptoms. The possible reason for these may be related to the uncertainty of the epidemic progression and feared that the disease was hard to recover [25].
After multivariate logistic regression analyses, our study further indicated the risk factors associated with anxiety and depression symptoms. Having poor sleep quality and presenting more current physical symptoms were risk factors for patient in shelter Fangcang hospital with anxiety symptoms. Sleep is an important time for the recuperation and rejuvenation of the brain. Unfortunately, a substantial body literature showed stressful life events and outbreaks of infectious disease including COVID-19 can affect the sleep quality[21, 26–29], 84.69% of the participants in our study with the poor sleep quality demonstrate it again. Using the correlation analysis, we also found levels of anxiety symptoms are associate with sleep quality in COVID-19 patients admitted to shelter Fangcang hospital. Syntheses of longitudinal studies suggested sleep quality were bidirectionally related to anxiety [30]. There were large data investigating the effect of sleep quality on the anxiety symptom in other populations such as shift-workers, firefighters, paramedics, pregnant women, older adults, poor sleep quality had higher odds of anxiety symptoms, greater anxiety were associate with poorer sleep quality [31–35]. Similarly, anxiety affects sleep quality because anxious people find it hard to fall asleep and wake up frequently [30]. In addition, we found patients with more symptoms were more vulnerable to anxiety symptoms. The possible reasons are as follows: firstly, common symptom of COVID-19 such as fever, short of breath, headache can induce anxiety symptom [36]; secondly, patients with more symptoms are more serious than asymptomatic patients, and the prevalence of anxiety is also related to the severity of the disease [37, 38]; lastly, patient with more symptoms were more worried about the progression of illness.
Another finding from the present study was female, family member confirmed COVID-19, more current physical symptoms were more likely to have anxiety symptom. As early as 1970s, Myrna Weissman underscored the gender difference in depression, and noted that women more easily experience depression than men [39], since then, there was a proliferation of research and theories on gender differences in depression. A recent meta-analysis after analyzing these researches showed that females are more vulnerable to not only depression disorders but also depression symptoms [40]. There now is consensus that the gender difference in depression has a multifactorial etiology, for example, there is a confluence of hormonal and neurodevelopmental changes that vary by sex during the pubertal transition and may influence the gender difference in depression [40]. In addition, when patient’s family members were also diagnosed COVID-19, patients were more vulnerable to depression symptoms, owing to greater family burden and psychological distress[41, 42].Compared to patients with less physical symptoms, patients with more physical symptoms were more likely have depression symptoms, because they were more severe and prevalence of depression symptom in relation to the severity of the disease [38].
We also found that poor sleep quality was not independent risk factor for depression symptom, but the scores of PSQI was positively associate with SDS. Is there a contradiction? -but perhaps not. We consider because of weak correlation, so there was a difference in poor sleep quality between depression group and no depression group from the univariate analysis.
This study has limitations. Firstly, this is a cross-sectional design, the time frame is short and future longitudinal approach studies are need for follow up and intervention, secondly, psychological assessment was based on an online survey and on self-report tools. The use of clinical interviews is encouraged in future studies to draw a more comprehensive assessment of the problem. Thirdly, it is not a multinational, multicenter study, lack of data support from other Fangcang shelter hospitals.