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. In this study of 1735 medical staff in Henan Province, participants performed well in coping ability and mental health. More than 90% of the participants scored above the passing line in the assessment of coping ability, and most of them (65.0%) didn’t have a severely unhealthy mental status. The analysis showed that older age, higher education, and distrust of unofficial information were contributing factors to medical workers' coping ability. Mental health status had three contributing factors: older age, distrust of unofficial information, and non-involvement in outbreak prevention and control; moreover, poor physical health was a risk factor. This provides a direction for improving the coping skills of medical staff and protecting their mental health, which could help improve the medical system's ability to respond and control the spread of the epidemic.
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 COVID-19 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 and other mainstream media. When an epidemic breaks out, even professional personnel such as medical staff also need to acquire knowledge and skills through these channels[18]. The uneven information in the external media could affect medical workers, but also seriously affect the knowledge and psychological state of the general population, even causing panic and damages[19-24]. In this way, the re-education about COVID-19 should be strengthened under the situation that the information from the outside public is mixed and incorrect information needs to be controlled in a timely manner[25, 26].
Medical workers are mainly responsible for timely detection, diagnosis and treatment of patients, playing an important role in epidemic response and control. A high level of COVID-19 knowledge among medical staff is necessary to prevent secondary infection and secondary transmission[27]. 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 coping ability towards the epidemic, inconsistent with some previous studies that showed opposing results[7-10]. 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. Consistent with previous studies, age, education and whether trust in unofficial information were the main influencing factors on medical workers' coping ability[10, 25]. Older age represents a higher title and more experienced, and some of them have even participated in SARS-epidemic control in 2003[25]. A higher degree also means more medical knowledge, experience and skills[10, 25]. Extensive clinical experience, knowledge and skills would become a strong guarantee in the face of the epidemic. Distrust of unofficial information indicates a vigilant and cautious attitude, free from external inaccurate messages so that medical staff could adhere to correct information and knowledge and make unmistakable diagnoses and treatments.
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[28]. Previous studies showed that exposure to a public health emergency can cause mental health problems, depression and even PTSD[13, 29, 30]. However, results of the present study showed that the psychological status of the participants was not bad and most mental health scores were in the upper-middle range, which is also inconsistent with some recent studies[12, 31, 32]. The reason for the difference may be that the study was conducted in different periods and regions. This study was conducted in the early stage of the epidemic in Henan Province, and Henan Province did not experience a large-scale spread of the epidemic and took timely countermeasures. 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[12, 31, 33-35]. Contrary to a recent study, age worked as a facilitating factor to mental health. This may be because although the older participants were not as physically fit or vigorous as the younger ones, they had more experience and skills, which allowed them to have a calmer attitude, especially in the early stages of the epidemic[12]. Participation in epidemic control means close contact with infected patients, increasing the risk of infection, which inevitably leads to an altered mental state of medical workers[31]. And we also found that the mental status of nurses was worse compared to other occupations, which may be due to their more time and frequency of contact with patients[29]. Poor health was originally an important factor in mental health, and this effect was also present among health workers during the epidemic[31]. In addition, distrust of unofficial information and belief in official information demonstrate their confidence in and approval of the state and society, indicating a positive attitude towards the situation. The Chinese government has provided mental health services medical workers[32, 36], but more attention should be paid to medical workers who may face more serious mental problems in the long run[14, 15].
This study was conducted at the beginning of the outbreak (first two weeks of the lockdown), and through a direct investigation of primary medical workers, the coping ability and mental health status of them in the early stage of epidemic can be truly reflected. There are also some limitations. At the beginning of the outbreak, neither the prevalence nor the mortality rate has yet reached its peak. With subsequent enrichment of information, the release and update of official response guidelines, the improvement of training and the supplement of medical supplies, the coping ability and mental status of medical workers would change accordingly. Facing the changing situation, 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 other follow-up studies are needed to investigate long-term status. Online survey was used for this study, although it is convenient and quick, some factors may influence the results, resulting in a bias. And other undiscovered influencing factors may also have an impact on the results of the study.