Coronavirus Disease 2019 (COVID-19), named by the World Health Organization (WHO) on January 2020, soon afterwards has been declared an epidemic so as to increase the awareness of its severity globally. At present, there are no specific medicine as well as treatments for COVID-19, only supportive care is provided to the patients. In addition, COVID-19 is a highly infectious disease that can be transmitted person-to-person, people who was infected by COVID-19 can be asymptomatic. As the disease still exists and complex elements continue puzzling us, human beings should face this crisis vigilantly and have a long way to go. To some extent, this horrible disease has aroused panic for the population.
Fighting against crucial challenges during COVID-19 outbreak, people have undergone an emergency, which may develop different psychological issues respectively. Accordingly, as for frontline health care workers in COVID-19 epidemic[6, 7], overwhelming workload, inadequate equipment and social support, as well as high risk of infection may lead to their urgent and long-term mental problems. What has been approved in the previous experience was that, health care workers in the Emergency Department from Hong Kong during SARS outbreak felt distress because of loss of control, fear of personal health and the spread of the virus. In spite of distress, depression, anxiety, insomnia and other psychological problems would appear on medical staff when there is an epidemic outbreak. Confirmed patients, however, may experience fear and anxiety due to the severity of the disease, and the infectious symptoms of COVID-19 should be to blame because they may cause any other disturbances, like insomnia, distress and so on. Similarly, since the epidemic is still uncertain, and the quarantine environment is somehow scary, suspected patients and those who isolated would develop fear, stress, hypochondriasis and other mental issues. Of note, in order to successfully control the infection of COVID-19, strict measures like quarantine is of utmost significance. However, quarantine and home staying could bring out unexpected results. During staying home, the individuals would adopt psychological distress, frustration and boredom due to long duration of quarantine, fear of being infected and having insufficient information as well as protective supplements. As for the general public, correct and adequate information was needed, but they often searched for overwhelming information, and some of them received rumors, which may lead to anxiety and fear among the population[11, 12].
To provide mental services to the individuals specifically, populations are categorized into 4 levels[11, 13], according to the degree to which the population is affected by COVID-19: Level 1 population consists of confirmed patients with COVID-19, frontline health care workers, etc.; Level 2 population includes isolated mild-symptoms patients with COVID-19 or suspected COVID-19 patients; Level 3 population contains people related to the Level 1 or Level 2 population, including relatives, friends etc.; and Level 4 population mainly involves the susceptible and the general public.
If preventive measures were not taken immediately, mental issues may lead to serious psychological disorders[14, 15]. Therefore, agencies from different fields spared no efforts in carrying out various forms of prompt interventions all over China. First of all, government authorities, especially health authorities like the NHC, have adopted some psychological intervention and mental service guidelines so as to make it more regularized. According to the Principle, social power, 24-hour psychological assistance hotlines, clinical psychological assistance teams as well as psychological expert teams should be organized and coordinated by the government. The Principle has called for every qualified mental health associations and academic agencies take the responsibilities to set up professional expert teams, provide mental services, establish psychological assistance hotline and conduct guidelines and instructions. During the COVID-19 outbreak, it is reported that there were at least 29 guidelines and instructions established to direct mental health services nationwide between January 26th and February 20th. Compared with the SARS outbreak in 2003, online mental health services are more convenient and accessible for population recently due to the promulgation of internet services and smart phones. Online mental health surveys related to COVID-19, for example, were conducted to collect information about public mental issues so as to understand the latest situation of people with various identities. Moreover, online mental health education for the general public as well as online mental consulting for those who were in need have been released to provide targeted services. Nevertheless, online services play a significance role to solve public psychological issues during COVID-19.
Though telephone-, internet- and application-based as well as offline psychological health services have been conducted throughout China during COVID-19 epidemic, evidence-based assessments were limited, most of which were mostly targeting health care workers and vulnerable populations such as older adults, mental illness and Chinese students studying overseas.
The current study would represent mental health status and psychological health survey to people in different four levels in China firstly. Researches about mental health status and mental health interventions related to COVID-19 for population with different identities are deficient. To address the gap, participants were selected from 4 different levels illustrated above in the current study. The magnitude of anxiety, depression and stress symptoms were evaluated to examine the mental health status of populations, which would be helpful to provide evidence to draw up constructive and specific measurements to promoting the mental well-being for each defined group facing the challenge in the epidemic.