Hospitals are the key places to provide diagnosis and medical treatment and medical staff are the main force to deal with public health emergencies. The coping ability of medical staff has a direct impact on the regional or national response to public health emergencies and the mental health of them is also crucial in the long run. Our study was the first study focusing on the coping ability and mental health of medical staff during the early stage of the outbreak of COVID-19, providing a reference for improving the emergency response and corresponding measures to deal with the epidemic timely and effectively. In this study of 1789 medical staff in Henan Province, the overall coping ability and mental health were relatively well. More than 90% of the participants scored above the passing line in the assessment of coping ability, and about 70% of them had a relatively good mental status. Age, education level, distrust in unofficial information and health condition were main influencing factors on coping ability and mental health condition.
All participants were medical workers with medical backgrounds or engaged in medical-related work, so most of them were very concerned about the epidemic and they held a positive attitude towards the situation. Their knowledge about coronavirus was mainly obtained from official sources and professional knowledge, which ensured the correctness of their knowledge. At the same time, we can discover the importance of government and professional media. When an epidemic breaks out, even professional personnel such as medical staff also need to acquire knowledge and skills through these channels. The uneven information in the external media would affect medical workers and will also seriously influence the knowledge and psychology condition of ordinary people[16–18]. Fortunately, participants in this study had a low level of trust in unofficial information channels. In this way, the re-education of infectious diseases should be strengthened under the situation that the information from the outside public is mixed[19, 20].
Medical workers are mainly responsible for preventing and controlling the epidemic and treating patients, playing an important role in public health emergency response and control. Medical staffs with a high level of protection awareness are essential to prevent the spread of secondary infection and secondary transmission. In this study, the answer status of the questionnaire showed that the participants had a good grasp of most of the epidemic prevention and control knowledge and had corresponding response capabilities toward the COVID-19. However, some previous studies showed that medical staff didn’t have satisfied ability toward public health emergencies[5–8]. This may be due to the fact that since the outbreak of SARS in 2003, Chinese medical personnel has paid more attention to their ability to respond to public health emergencies and the similarities between COVID-19 and SARS. In our study, age, education and whether trust in unofficial information were the main influencing factors on medical workers' knowledge of epidemic prevention and control[8, 19]. Older ages represent more experience and higher title, and some of them have even participated in SARS-epidemic control in 2003 in China. The extensive clinical experience became the basis for their practice in facing the epidemic. A higher education level means a deeper and wider grasp of medical knowledge, which serves as the theoretical basis for medical workers[8, 19]. By keeping vigilant and skeptical attitude towards unofficial information, comparing and analyzing information from different channels, especially trust in official information, medical staff could get correct information and knowledge and improve the coping ability.
Medical workers on the front line dealing with public health emergencies and fighting against epidemic were under tremendous psychological pressure. Especially in the early stages of the outbreak, even when many aspects of COVID-19 have not been fully understood, they still persisted in their posts and tried their best to help patients. Previous studies showed that exposure to a public health emergency can cause mental health problems, depression and even PTSD[9, 23, 24]. From the results of the present study, the psychological status of the participants was not bad. Most of the psychological scores were in the upper-middle level. In line with previous studies, age, participation in the event, health condition and trust in unofficial information were the main influencing factors to mental health[25–29]. Contrary to a recent study, age worked as a facilitating factor to mental health. This may be because older participants have more experience, which makes them have a calm attitude. Participation in outbreak control means close contact with infected patients, which increases the risk of infection and causes anxiety among health care workers. And, we also found that the mental condition of nurses was worse compared to other occupations, which may be due to their more time and frequency of contact with patients. In the face of the severe situation, poor health is a possible risk factor for infection. In addition, the distrust of unofficial information contributes to a better psychological state, which may be due to a more comprehensive understanding of the epidemic through the integration of multiple sources of information, which in turn reduces anxiety and contribute to a good mental state. The Chinese government has provided mental health services for civilians and medical workers[30, 31], but more attention should be paid to medical workers who may face more serious mental problems in the long run[10, 11].
Some of the possible contradictions between this study and existing research may be due to the fact that this study was conducted at the beginning of the outbreak when neither the prevalence nor the mortality rate has yet reached its peak. In the later period of the epidemic, with the gradual enrichment of information, the release and update of official response guidelines, the improvement of training, the supplement of medical supplies, so, the coping ability and mental status of medical workers could change accordingly. Moreover, the study was carried in Henan Province, China, which had performed relatively well in epidemic control and prevention and had not experienced any large-scale spread of the epidemic. In fact, most of China's provinces have not experienced a significant spread of the disease, so the results of this study could be representative of their situation.
This study was conducted at the beginning of the outbreak (first two weeks of the lockdown), and through a direct investigation of primary health care workers, the psychological and coping condition of health care workers at that time can be truly reflected. There are also some limitations. It is a cross-sectional study, so it is difficult to draw robust causality, other follow-up studies are needed. The study subjects were medical personnel in Henan Province, which may not be representative enough to present the entire national situation. The situation is constantly changing, and this study can only show the results of the investigation at the time it was conducted and can’t reflect the changes over time and condition of the general population. Thus, the long-term condition needs further investigation. The online survey was used for this study. Although it is convenient and quick, some factors may influence the results, resulting in a bias. Other undiscovered influencing factors may also have an impact on the results of the study.