In major disasters and during the post-disaster recovery process, there is an increase in the incidence of mental illness such as depression, post-traumatic stress disorder, insomnia, obsessive-compulsive disorder and suicide[17, 18]. Psychological trauma repair is an important component of post-disaster recovery. Different from common natural disasters [11, 12], COVID-19 has serious effects on human life, health, economic activity and living order etc., and may lead to damage to the mental of patients.
The present study found that the depressive emotions, somatic symptoms and CES-D score in male patients were significantly lower than those in female patients. In other words, female group developed severer depressive symptoms than the male controls. These results differ from those of other studies. The study of Kuang Chunyan et al did not found that the depression degree of COVID-19 was different significantly in gender group. This may be related to different sampling sites. For this study, participants were recruited from Wuhan, Hubei, with a centralized outbreak of COVID-19 in China. The epidemic caused serious impact to local normal economic activities and supply of living materials and brought heavy pressure to medical system and resources. As Chinese government promptly took strictest preventive measures, the epidemic could be controlled in other regions outside Hubei, patients and their family members had adequate confidence in defeating the epidemic at a low level of the overall social emergency atmosphere, and the depression degree did not have a significant difference between patients in gender. However, in Wuhan, the interaction of the stressful overall social atmosphere, the gender role and personality traits of females and other factors caused severer depression symptoms in females. Investigators found that females were prone to paying attention to, indulging in and ruminating on negative information. According to the investigators, this rumination was a vulnerable response strategy that would put patients in a vicious circle of immersing in negative information [20. 21] and make them even more pessimistic and inactive towards treatment, rehabilitation and future life. In addition, females would be more likely to have personality traits such as sensitivity, fragile and suggestibility [22, 23], so that they tend to magnify the negative information they received, underestimate their response capabilities and physical resistance
The results of correlation analysis and regression analysis of the relationship between the depressive symptoms and stress / purpose in life in individuals with infectious history of COVID-19 in this study showed that the total score of CES-D was significantly negatively correlated with the total score of PLT, and positively correlated with factors in IES. The feeling of life, life goal, intrusiveness and alertness had significant predicative effects on the total score of CES-D, which can explain 69.3% of variations in the total score of CES-D. The results aforementioned suggested there were significant predictive effects of stress and purpose in life on the depressive symptoms in individuals with infectious history of COVID-19. On the one hand, patients may develop severer depressive symptoms under increasing stress. Stress, resulted from fully isolated treatment and living environment, lack of social support, threat of death, and expectation of the low cure rate [24–26] may increase the risk of depression. On the other hand, the variable of purpose in life was a protective factor for the mental health of individuals with infectious history of COVID-19. With a positive vulnerability towards feeling of life, a clear goal and direction in life, reverence for and love of life, and a sense of self-control [27–28], individuals with infectious history of COVID-19 may present a positive attitude towards the environment, treatment, prognosis, efficacy, death and future, and developed less unhealthy emotions such as depression, pessimism and despair, thus reducing the incidence of depression.
The analysis of mediating effect of purpose in life between depressive symptoms and stress in individuals with infectious history of COVID-19 showed that purpose in life had a partial mediating effect between stress and depressive symptoms, and the mediating effect accounted for 13.33% of the total effect. The results indicated that purpose in life had a mediating effect between the stress and depressive symptoms. The depression level in individuals with infectious history of COVID-19 may be affected by stress shock directly or by purpose in life indirectly. Diseases, rumors, dramatic changes in the order of production and life, and uncertainty of prognosis may cause great stress impacts on individuals. According to the logotherapy theory proposed by Frankl, individuals may lose the sense of meaning, deviate from the purpose and direction in life and indulge in the satisfaction of sensory feelings and instinctive needs when they suffer from life threat, social isolation and future uncertainty. Meanwhile, they may develop fear to death and future, become depressed, pessimistic and hopeless, lower their senses of self-value and control, lose the sense of purpose in life, and exhibit social and emotional alienation [29–31], thus further worsening depressive symptoms and presenting suicidal ideation and attempts.
The implications of this study was to suggest the necessity of enhancing psychological assistance to female population. At the same time, it was required to guide females to give themselves more positive self-suggestions, multi-perspective cognition and analysis of themselves, others, diseases, environment and future life, pay more attention to positive perspectives, plan their present and future lives and define their purpose and direction in life, and avoiding clutter and aimlessness. These actions are beneficial to psychological rehabilitation, and provide scientific basis for interventions of psychological crises in females during the COVID-19 epidemic.
This study is a cross-sectional study, with the limitation that the long-term psychological effect of COVID-19 infection, treatment, isolation, impaired somatic function and stigmatization on patients cannot be observed. Some studies have demonstrated long-term and potential damage of infectious disease to individuals’ mental health. Thus, future studies are required to trace and observe relevant situations, evaluate psychological problems in patients with COVID-19 and propose necessary measures for intervention and rehabilitation training of social function.