This study investigated the quality of life among 2435 employees in Deqing County and Taizhou City during the lockdown of COVID-19 epidemic in March 2020, shortly after their return to work. Our study found that employees in Taizhou where epidemic was more severe, were more likely to worry about the epidemic and had relatively low quality of life compared with Deqing, a low risk area. The awareness of the COVID-19 was common and most people implemented some measures to protect themselves accordingly, which were also associated with a higher quality of life. Being married and having no isolation were associated with better quality of life, while worrying about the epidemic led to a reduced quality of life.
Our study showed an average EQ-5D utility value of 0.990(0.033) and VAS score of 93.5(9.5) among enterprise workers in Deqing and Taizhou during the epidemic lockdown, respectively. both the average EQ-5D utility value and VAS score were higher than those from studies conducted before the epidemic among Chinese adult population (0.951 and 88.0) (29, 39)and workers (0.959 and 81.1)(29, 39). Compared with the recent researches during the epidemic, they were also higher than scores measured in patients with Alzheimer's disease (utility: 0.62, VAS:52.9)(40), cancer patients (VAS:66.1)(41) and other general Chinese population (utility:0.949, VAS: 85.5)(21) as well as Moroccans with home confinement (utility: 0.86, VAS: 80.3) (42).
Moderate pain/discomfort and anxiety/depression were the common problems affecting quality of life in our study population, which was consist with results from recent studies(21, 42). However, our study showed a low proportion of pain (2.3%) and anxiety/depression (3.9%), which was similar to results before the epidemic among Chinses population, especially in anxiety/depression(anxiety/depression:5.3%)(43), but lower than those in the findings of Ping Weiwei(pain:19.0%, anxiety/depression: 17.6%) and Asmaa Azizi(pain:30%, anxiety/depreesion:56%)(21, 42).
There are several possible reasons for the higher utility of EQ-ED and lower proportion of health problems (pain and anxiety/depression) observed in enterprise workers in Deqing and Taizhou during the COVID-19 pandemic lockdown. A study in Spain reported that people with chronic diseases had higher levels of depression and anxiety compared to those without(44). Whereas, most participants aged 18 to 45 years old and no participants reported common non-communicable diseases (e.g. hypertension, diabetes). Besides, a relatively low risk of infection compared with Wuhan could reduce the negative psychological impact of quarantine and home confinement(45). In addition, 72.2% participants lived with more than 4 family members. Most people received increased support and spiritual solace from their friends and family members, what would keep the participants away from the influence of social isolation and eased their anxiety or depression(15).
Our results indicated that marital status, physical activities, wearing a mask, keep home ventilation and worry about COVID-19 were related to HRQoL. Adequate physical activity and being married were related to the increased quality of life in our study, which was consist with the findings from some other Chinese studies (12, 46, 47). However, worrying about COVID-19 showed a negative impact on the quality of life for enterprise workers, which was similar to the findings from recent studies(21, 48). Face mask use was an evidenced strategy to reduce the risk of infection from COVID- 19, which perhaps explained the protective effect on the quality of life in our study. Home ventilation perhaps had played a role in alleviating the boredom from long-term home confinement, and thereafter improved the quality of life during the lockdown.
There were different influencing factors for workers in Deqing and Taizhou. Regular physical activity was related to a better quality of life in Deqing, while centralized or home quarantine, worrying about the epidemic, wearing a mask, and marital status were associated with quality of life in Taizhou. Deqing was a low-risk epidemic area with only 3 confirmed cases of COVID-19 while Taizhou was a high-risk epidemic area with 146 confirmed cases of COVID-19(22). People in Deqing were less affected by COVID-19 and the lockdown mainly changed their lifestyles, which partly explained why only physical activity and keep home ventilation were associated with their quality of life. On the contrast, people in Taizhou were much stressful and were more likely worried about COVID-19 (58.7% in Taizhou vs. 50.2% in Deqing).
The main strength of our study was the relatively large sample size of 2435 participants and we assessed quality of life during the epidemic just after those participants returned to work. The present study also has limitations. First, as cross-sectional study, we did not have information on the quality of life before the epidemic and were unable to evaluate the overall effect of COVID-19 epidemic on the quality of life for enterprise workers. Second, as it was still in the period of COVID-19 epidemic control and prevention in early March in China, it was hard to conduct a survey in a random fashion. Purposive sampling was performed in this study, with a pre-set sample of 1800 participants (900 from Deqing, 900 from Taizhou), which might bring some selection bias and might not generalize the results to broader populations. In addition, due to the lack of details on job related information, we were not able to assess the association of quality of life with potential conditions that existed in the workplace.