Currently, the number of COVID-19 patients is increasing rapidly, which is a serious threat to human's health [13, 14]. Community hospitals play an important role and are the main battlefields to fight against COVID-19. The COVID-19 brought to medical workers in community hospitals not only the fear of infection, but also unbearable psychological pressure [5], which in turn affects the quality of medical care and health of medical workers. One meta-analysis once revealed that Chinese doctors experienced more severe psychological symptoms than the general Chinese population [15]. Therefore, it is very important to assess the psychological status of medical workers in community hospitals.
SCL-90 questionnaire is an international, self-report questionnaire to investigate psychological factors. Increasing studies suggest that the SCL-90 questionnaire could be useful in evaluating the patients’ psychological states and have made recommendations for psychosocial approaches in clinical practice [10, 16, 17]. There are some researches on the psychological states of doctors and nurses in China. It is reported that the tendency of nurses' job burnout has been neglected in the past 19 years, and the mental health level of nurses in China has declined [4, 18]. One study once showed the mental health problems of nurses were significantly higher than those of doctors, and the main reasons were low occupational levels and adverse workstyles which include shift work, heavy workload and so on [19]. A meta-analysis of Chinese nurses revealed that SOM item-scores and PAR item-scores of nurses were 2.04 ± 0.55 and 1.49 ± 0.53 in 2016, respectively [18]. Meanwhile, a similar research suggested that SOM item-scores and PAR item-scores in pooled Chinese doctors are 1.57 ± 0.53 and 1.50 ± 0.52, respectively [15]. There were no normal values of SCL-90 for Chinese medical professionals for now. The available normal values of the Chinese version were derived from a representative state-wide sample with SCL-90R [15], so we didn’t manage to compare our results with the SCL-90R norm above. To the best of our knowledge, few studies have addressed the difference on SCL-90 score among health professionals in COVID19 pandemic. In our study, the sum scores of SCL-90 showed no difference among medical workers during the pandemic, but the SOM item-scores and PAR item-scores of nurses were significantly higher.
Somatization is described as a pseudo-clinical condition only mimicking real symptoms of a medical disease, and it mainly reflects physical discomfort, including cardiovascular, gastrointestinal, respiratory and other system discomfort. These disorders often cause significant emotional distress, and management of patients with dysfunctional somatoform disorders is complex and challenging [20, 21]. During the fighting against COVID-19, nurses had to wear heavy protective clothing and work continuously in the contaminated area every day, which caused nurses to develop symptoms such as back pain, stomach discomfort, muscle aches and dyspnea. All these may be the reasons that nurses had higher SOM item-scores.
Paranoid ideation mainly refers to projective thinking, hostility, suspicion, delusion, passive experience and exaggeration. The higher PAR item-scores, and the more prone to paranoia and extreme individual thinking. As mentioned above, nurses undertook a great deal of work and were in urgent need of recognition and encouragement from society and others. However, due to the nature of work, nurses often had difficulties in gaining social recognition. Therefore, nurses had significantly higher PAR item-scores compared with doctors and technicians.
For further analyzing the causes of psychological symptoms in nurses, we compared the SCL-90 scores judging by sex, profession and education level, and found females and nurses had higher item-scores and were more prone to mental disorders. A series of researches found women showed more symptoms on the depression and somatic complaints, and the increase in the workload of the nursing team had an impact on quality of care and safety for patients [22, 23]. In our study, 87.1% of nurses were female and all nurses undertook a high workload, which may be important reasons for mental disorders in nurses. However, no relationship was found between SCL-90 scores and the levels of education.
In order to further clarify the impact of the epidemic situation on nurses' psychological status, we compared the SCL-90 scores of nurses during and after the epidemic and found that the scores of each dimension of SCL-90 in nurses during the pandemic were relatively higher than that in nurses after the pandemic. Considering that there were no differences between the two groups of nurses in terms of gender, age and education level, we believed that the emergence of COVID-19 is the main factor leading to psychological problems of nurses.
This study also has some limitations. First, because of the sudden outbreak of epidemic, we were not able to follow up and investigate the mental health status of participants in during-pandemic group. Instead, to observe the changes in the psychological status of the nurses, we managed to conduct a survey on nurses in the same hospital returning from the front line of COVID-19. Second, this study was conducted at a single-center hospital with a limited sample size, there may also be a selection bias. A larger cohort study would help to further define the psychological status of medical workers.
In summary, our study showed that nurses suffered with more psychological symptoms than doctors and technicians when fighting against COVID-19, especially on somatization and paranoid ideation. The emergence of COVID-19 was the main factor leading to psychological problems of nurses.