The basic situation of themental health of COVID-19 patients
In this study, 50 survey subjects had a total score of more than 160 points, accounting for 27.60%, which was higher than Qin Xuemei survey results on the mental health of 112 COVID-19 patients admitted to Changsha area (the results of the survey showed that the positive rate was 21.4%).
All the COVID-19 patients had varying degrees of psychological symptoms.Besides ADD, ANX is the highest among those with mild abnormalities , accounting for 21.1% of the total.A brief review article emphasized that anxiety is the main emotional reaction during the outbreak of a pandemic. Psychological problems have reached a moderate or more serious degree, mainly DEP and IS, both of which account for 9.4% of the total. Followed by PAR, accounting for 7.7% of the total. Next came ANX, PHOB and ADD, each accounting for 7.2% of the total. A study of COVID-19 patients admitted to Huoshenshan Hospital was similar to the results of this study: mild anxiety accounted for 17.36%, moderate anxiety 12.5%, severe anxiety 4.86%, mild depression 13.89%, moderate 10.42%, severe 4.17%.Another study has shown that anxiety symptoms may be mild at first, but they may suddenly worsen in a few days due to the long hospitalization time.
Compared with Chinese adult norms, there are significant differences in SCL-90 total scores and depression factor scores (P<0. 05), and somatization, anxiety, and fear factor scores are all significantly different (P<0.01). The results of this study are consistent with the results of Qin Xuemei’s investigation on the mental health of 112 COVID-19 patients admitted to Changsha.
The results of the study suggest that the mental health of COVID-19 patients are lower than normal. The author believes that the mental health situation of patients with COVID-19 is not optimistic for the following reasons:
The outbreak of the new corona virus pneumonia coincides with the Chinese New Year period. In a short period of time, the number of infection cases has increased exponentially. The number of hospital emergency and fever clinics has increased significantly, and medical human resources and medical supplies cannot be guaranteed in a short time. Patients experience physical discomfort caused by infections, such as severe fever,dyspnea, and cough, as well as discomfort caused by the side effects of treatment. The patient's physical discomfort is not treated in time and aggravates the somatization symptoms.There is a close correlation between physical and mental illness.
The age group of the subjects in this study is mainly concentrated in 19-59 years old,accounting for 77.7%. People in this age group are also the main users of apps such as Wecom and Tik Tok . Anytime the information age comes, people can actively browse the epidemic information through various apps. According to the reportof the Social Psychology Research Center of the Institute of Sociology, Chinese Academy of Social Sciences on February 18, Wecom had been the main channel for the public to understand the new corona virus pneumonia epidemic since the outbreak began. With prolonged exposure to excessive media information, the anxiety situation might continue to increase, and depression symptoms might appear.
A previous article of Kamara’s emphasized that during a pandemic outbreak, most of the confirmed patients will be mildly troubled, such as depression, anxiety, shame, and sadness.The unpredictability and uncertainty of disease conditions in different aspects of epidemiology, as well as effective treatments, expose people to stressful situations.However, the study found that psychologists accounted for only 12.7% of psychological interventions and 65.7% of the subjects did not carry out psychological intervention. It shows that most patients do not get enough professional psychological intervention.
Isolation as the main means of treatment, the daily activities and social activities of COVID-19 patients are limited, and the access to social support is blocked. Some studies believe that isolation conditions for various reasons, such as travel restrictions, increased social distance, lack of information, depression and stigma, will adversely affect mental health.
In addition, the sensitive factors of interpersonal relationships need attention. The scores of the sensitive factors of interpersonal relationships have no difference compared with Chinese adult norms. However, the sensitivity of interpersonal relationships ranks first in the severity of moderate or above. The treatment of COVID-19 is mainly based on strict isolation treatment, and family cluster infections have occurred. Patients with infected family members need to bear more psychological pressure and are more likely to suffer from depression..These patients will feel guilt and stigma because of the infection to their family members.Those COVID-19 patients need to be treated in designated isolation hospitals. As a result, they feel lonely and socially isolated, and may even cause depression.
The mental health status of COVID-19 patients needs to be paid enough attention to. The author suggests that we should pay more attention to the emotional changes of patients in clinical work and guide patients to accept negative emotions such as anxiety and depression, guide patients to vent their bad emotions correctly.At the same time ,We can provide more authoritative information to patients, including government policies, overall prevention and control of epidemic situation, number of confirmed cases, cure rate and mortality rate and so on. We can also provide more medical information to patients, including their physical condition, laboratory test results and treatment strategy. Information support can reduce perceived threats and improve coping strategies, which are protective factors for mental health.The author believes that patients to use modern communication means to communicate with their relatives, friends, colleagues and organizations, including telephone, SMS, email, online chat, video voice, et al. They were encouraged to express their feelings, the support and encouragement from others are beneficial for their mental health.
Factors affecting of COVID-19 patients mental health
The results of Logistic regression analysis showed that the main influencing factors of the total SCL-90 score of COVID-19 patients were gender, marital status, the number of confirmed cases in the country, and the perpetrators of psychological intervention.
The impact of gender on mental health:
Female patients with confirmed diagnosis are more likely to have sub-symptoms than men. This is consistent with previous findings that compared to men,women are more likely to develop stress-related mental illnesses.A study analyzing the prevalence of gender-related PTSS subsymptoms after a pandemic catastrophe showed that women had a higher incidence of post-traumatic emergency disorder symptoms.Another study had been shown that acute mental disorders characterized by invasive memory were more common in women than men in pandemic disasters throughout the country. Some evidence show that fluctuations of ovarian hormone levels is the reason for the change of sensitivity to emotional stimulation in certain stages of the menstrual cycle, which may be the reason why women are particularly prone to mental illness.
The influence of marital status on mental health:
According to this study, SCL-90 total score was mainly affected by unmarried factors. Some studies have shown that stable marital relationships play a protective role in anxiety.The family is the most solid harbor for individuals. Good family relationships help patients get spiritual and financial support, and can provide patients with emotional, information, and experience support. These are the belief support and the source of motivation for patients to overcome the disease, and help patients through the most difficult stage of diagnosis and treatment.This study shows the difference in marital status in the total score of SCL-90 , the scores from high to low are: unmarried > divorced> married> widowed.A survey of 217 Bedouin Arab women from Negev in Israel showed that divorced women showed the strongest sense of loneliness and married women were more willing to talk about their problems with others. Divorced women show more somatization, paranoia, obsessive-compulsive disorder, depression, anxiety disorder, fear anxiety disorder and psychosis than married women.
The effect of the number of confirmed cases nationwide on mental health:
The report showed that people's sense of security under the epidemic has slowly increased with the gradual control of the domestic epidemic. From January 20th to
February 20th, the social emotional response gradually changed: from higher negative emotions and lower positive emotions in the early stages of the epidemic to more positive in the later period, and optimism and calmness rose to a moderately high level, while worry,fear, anger and panic gradually declined. From the current social mentality, after several weeks of epidemic prevention and control, people had a certain degree of psychological immunity to the epidemic. Under long-term negative emotions, certain self-protection and regulation are needed, and people's epidemic concerns have decreased. With the resumption of work, student education, and the end of the Spring Festival, people's attention began to shift. For most people, the danger around them is decreasing, which eases the negative emotions and makes some people relax their vigilance against the epidemic. This study showed that over time,the total score and scores of SCL-90 of patients diagnosed in the middle and late investigations tend to approach the Chinese adult norm. This is consistent with the development trend of social emotional responses.
The impact of psychological intervention implementers on mental health:
This study showed that psychologist and the responsible nurse in the isolation ward as the implementer of psychological intervention had an effect on the total score of SCL-90 in patients with COVID-19. In order to understand the influence of psychological intervention implementers on mental health, we compared the mental health differences between psychologist group, nurse in the isolation ward group and non-psychological intervention group. There was a significant difference in the mental health level of COVID-19 patients between psychologist group and nurse in the isolation ward group (p < 0.001), and there was significant difference between COVID-19 patients without psychological intervention group and psychologist group (p < 0.001). However, there was no difference in mental health level between the nurse in the isolation ward group and the non-psychological intervention group (p=0.851).The total score of SCL-90 in COVID-19 patients with Psychologist as the implementer of psychological intervention was higher than that of COVID-19 patients with the responsible nurse in the isolation ward as the implementer of psychological intervention. The author believes that this result is due to the current national conditions in China, clinically, responsible nurses in isolation wards have more chances to contact patients. In general, responsible nurses first use a simple psychological assessment scale to roughly evaluate the psychological state of patients, and initially carry out a series of psychological intervention measures, and through the evaluation results to further cooperate closely with psychiatrists, psychologists through screening and triage. Professional psychotherapy is given to patients with serious mental health problems. Studies have shown that this approach minimizes the risk faced by patients.A doctor's report found that providing psychological intervention to people with SARS or other similar infectious diseases can have significant clinical implications. Although the results of this study showed that there was no difference in the total score of SCL-90 between Nurse as a psychological intervention implementer and COVID-19 patients without psychological intervention. However, the author believes that this can not deny the role of nurse in the implementation of psychological intervention.
There are some limitations in this study. First,this study only involves mild and common types of COVID-19 pneumonia, and patients with COVID-19 pneumonia also include severe and critical patients. Second, we cannot tell whether psychological symptoms such as anxiety or depression are caused by COVID-19 or pre-existing. Third,this study has confirmed that with the development of the epidemic situation, the psychological status of patients will be affected, but we only measured at one time point, can not reflect the mental health status of the whole COVID-19 epidemic period.