The outbreak of COVID-19 is a rare pandemic. The closing of schools, businesses, sporting events, and meetings is a critical element in “social distancing,” a powerful tool to restrict transmission of this disease . Such unprecedented steps create anxiety and uncertainty in humans that is unparalleled in modern history. MHD patients who experience the COVID-19 epidemic situationare vulnerable to emotional pain and other difficulties . The current study quantitatively examined the psychological characteristics of HD patients’ experiences during this epidemic in addition to the influencing factors of PTSD.
Probable causes of psychological crisis in MHD patients in the COVID-19epidemic
MHD patients constitute a distinct and high-risk group , which is often associated with low immunity, decline or even loss the ability of work, substantial economic burden, inability to fulfill family responsibilities and participate in active social life, and suffer from various complications such as, muscle weakness, pruritus, fatigue, diabetic, hypertension, and restless legs. These factors are associated with lower QOL and poor clinical outcomes, leading to a higher risk of psychological crisis in MHD patients than that in the general population [21, 22].
Due to the characteristics of novelty, asymptomatic shedding, long incubation period, COVID-19 can be directly transmitted from person to person, spreading rapidly and exhibiting variable manifestations; thus, the outbreak of COVID-19 is a challenge to the existing health systems [23, 24].To date, specific treatment and prevention options, such as targeted antiviral drugs and vaccines, are not available . Hence, the WHO recommended traditional public health outbreak response tactics—quarantine, isolation, social distancing, and community containment . However, in order to obtain hemodialysis, MHD patients need to travel from home to the HD center three times each week for 4 h/session, serving as potential vectors for infection. This same shift of MHD patients should be set in the same closed space in a HD unit, and thus, home isolation cannot be realized. In thisstudy, the risk of PTSD occurrence in COVID-19 designated hospital is higher than that in the non-COVID-19 designated hospital, indicating that MHD patients in COVID-19 designated hospitals were facing more serious psychological stress and more anxious mental health conditions. Moreover, due to the specificity of the HD center, i.e., donning biohazard suits by medical staff managing patients and inquiry into the history of exposure and clinical symptoms, by each shift, which will inevitably bring about strong fear and aggravate the psychological harm in MHD patients .
Indubitably, a myriad of incorrect and false information is spread on the Internet. Many citizens express their negative emotions such as anxiety, fear, worry, and tension, through social media, and hence, excessive mass media exposure, including the latest updated epidemic reports, the number of confirmed cases, and increasing death-toll lead to the "information epidemic." The spreading of rumors and difficulty in obtaining trustworthy information further aggravates the anxiety and fear of MHD patients. During the dialysis interphase, the MHD patients were isolated at home, resulting in less contact with the outside world, which increased the feelings of loneliness and helplessness, in turn increasing the risk of psychological crisis.
Despite the introduction of the psychological first aid manual (PFA) by the WHO in 2005, there has been a lack of psychological support and counseling model based on local cultural characteristics pertaining to MHD. Thus, the management of MHD patients under the COVID-19 pandemic needs to be under intensive focus, especially the MHD patients in COVID-19 designated hospitals who exhibit depressive tendencies.
Firstly, the COVID-19-related and mental health education of MHD patients is strengthened using bulletin board, phone Application, official accountsof WeChat, improving the scientific understanding of the outbreak, and ensuring that every patient (or families/carers) focuses on the official accounts of HD center and join the WeChat group of HD center. The WeChat group and official accounts may provide mental health knowledge and COVID-19-related protection information regularly. For example, the questionnaire survey revealed that few patients know diarrhea as one of the symptoms of COVID-19 , but have a poor understanding of the correct disinfection methods at home; the education with respect to such situation is strengthened via WeChat.
Secondly, effective psychological monitoring should be carried out by medical teams, especially in COVID-19 designated hospitals. The medical staff in COVID-19 designated hospitals should recognize that adjustment and intervention measuresfor mental disorders should be initiated as early as possible. The psychological evaluation form and questionnaire identified the high-risk patients who were then selected for interviews. Targeted professional psychological support was provided by psychological therapists among patients with unstable emotions or obvious depression and anxiety behaviors. In addition, the medical staff of the HD unit should provide appropriate humane care to enhance the sense of belonging and social support in MHD patients .
Finally, if medical conditions permit, the ventilation and alexipharmic environment should be recommended in the HD unit. The access control system and epidemic buffer zone should be set up, attaining the pre-examination in batches to reduce the aggregation of patients, thereby creating a comfortable, clean, and relaxed environment in the HD unit. During the dialysis interphase, the patients’ communication with family members should be increased, such as perform chores and enjoy entertainment together, which would reduce negative emotions, maintain a balanced diet, and gain adequate sleep. Therefore, an optimistic and healthystate of mind is created.