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Tackling the mental health burden of frontline healthcare staff in the COVID-19 pandemic: China's experiences

Published online by Cambridge University Press:  13 May 2020

Yifang Zhou
Affiliation:
Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China Department of Geriatric Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
Yuning Zhou
Affiliation:
Department of Geriatric Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
Yanzhuo Song
Affiliation:
Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
Luyu Ren
Affiliation:
Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
Chee H. Ng
Affiliation:
Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, Victoria, Australia
Yu-Tao Xiang*
Affiliation:
Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China Center for Cognition and Brain Sciences, University of Macau, Macao SAR, China
Yanqing Tang*
Affiliation:
Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China Department of Geriatric Medicine, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning Province, China
*
Author for correspondence: Yu-Tao Xiang, E-mail: xyutly@gmail.com, Yanqing Tang, E-mail: tangyanqing@cmu.edu.cn
Author for correspondence: Yu-Tao Xiang, E-mail: xyutly@gmail.com, Yanqing Tang, E-mail: tangyanqing@cmu.edu.cn
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Abstract

Type
Correspondence
Creative Commons
Creative Common License - CCCreative Common License - BYCreative Common License - NCCreative Common License - SA
This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike licence (http://creativecommons.org/licenses/by-nc-sa/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the same Creative Commons licence is included and the original work is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use.
Copyright
Copyright © The Author(s), 2020. Published by Cambridge University Press

The 2019 novel coronavirus disease (COVID-19) was first identified in Wuhan, China. To treat thousands of infected patients, over 42 600 healthcare staff volunteered to combat the outbreak in Hubei province (Xiang et al., Reference Xiang, Jin, Wang, Zhang, Zhang and Cheung2020). Frontline healthcare staff are at high risk of mental health problems due to the overwhelming clinical workload, fear of contagion, and inadequate protective gears. One online survey in the early stage of the COVID-19 outbreak at the end of January 2020 found that the prevalence of depression, anxiety, insomnia, and distress symptoms was 50.4%, 44.6%, 34.0%, and 71.5%, respectively, among the frontline healthcare staff (Lai et al., Reference Lai, Ma, Wang, Cai, Hu, Wei and Hu2020). In response, relevant national guidelines and measures, such as hotline services and crisis psychological interventions, have been adopted to address mental health issues in frontline health staff. As the impacts of these measures were unclear, we therefore examined the general mental health, psychological stress, and sleep quality among the frontline healthcare staff during the late stage of the COVID-19 outbreak in China.

An online survey was carried out from 21 February to 6 March 2020 with a smartphone-based questionnaire program. Frontline healthcare staff included doctors and nurses who were working in fever clinics and designated isolation hospitals or wards to care for confirmed and suspected cases of COVID-19. Both frontline healthcare staff in Liaoning province and healthcare staff sent from Liaoning province to Hubei province were included. Poor mental health status was defined as a Symptom Checklist-90 (SCL-90) total score of ⩾160. Poor sleep quality was defined as a Pittsburgh sleep quality index (PSQI) total score of >7, while ‘having significant stress’ was defined as a Stress Scale (CPSS) total score of ⩾26.

Of 1001 frontline healthcare staff who participated in the survey, 397 (39.7%) worked in Hubei province. The mean age of the participants was 33.8 ± 6.6 years, and the vast majority of participants (88.9%) were females. The prevalence of poor mental health status was 11.2% (95% CI 9.2–13.2%) in the whole sample, with 10.8% (95% CI 7.6–13.9%) among the healthcare staff in Hubei province, and 11.5% (95% CI 8.8–14.2%) among the healthcare staff in Liaoning province (p > 0.05). In contrast, the prevalence of having significant stress among healthcare staff in the whole sample was 27.5% (95% CI 24.5–30.4%), with 23.2% (95% CI 18.7–27.6%) in Hubei and 30.4% (95% CI 26.4–34.4%) in Liaoning (p > 0.05), while the prevalence of poor sleep quality 16.8% (95% CI 14.3–19.2%) in the whole sample, and 18.9% (95% CI 14.9–23.0%) in Hubei and 15.3% (95% CI 12.3–18.4%) in Liaoning (p > 0.05).

This was the first study to investigate the mental health status, psychological stress, and sleep quality of frontline healthcare staff in the late stage of the COVID-19 outbreak. We found that although the reported prevalence estimates of depression, anxiety, insomnia, and distress symptoms in frontline healthcare staff were high in the early stage of the outbreak (Huang, Han, Luo, Ren, & Zhou, Reference Huang, Han, Luo, Ren and Zhou2020; Lai et al., Reference Lai, Ma, Wang, Cai, Hu, Wei and Hu2020; Liu et al., Reference Liu, Yang, Zhang, Xiang, Liu, Hu and Zhang2020), the overall mental health status, psychological stress and sleep problems appeared to improve substantially among frontline healthcare staff in the late stage of the outbreak. This could be attributed to a range of effective psychosocial measures that were adopted to address their mental health, although direct comparisons between these surveys should be made with caution due to different assessment instruments and survey methods.

To reduce the risk of mental health problems among frontline healthcare staff, on 11 February, the National Health Commission, the Ministry of Human Resources and Social Security, and the Ministry of Finance of China jointly issued a guideline titled ‘Key Measures on Improving the Working Conditions of Frontline Healthcare Workers: Caring for the Physical and Mental Health of Healthcare Workers’ (General Office of the State Council of China, 2020). The guidelines addressed the need to balance the work and rest hours for frontline healthcare staff, strengthen their occupational health and safety conditions, and improve crisis psychological intervention and counseling. The latter included assisting their families to deal with daily life requirements, creating a safe working environment, and securing their financial status. Other measures also included the establishment of timely telehealth psychological services and the provision of on-site mental health services for frontline healthcare staff in isolation hospitals.

To conclude, when frontline healthcare staff are responding to any epidemic of severe infectious disease, mental health problems are common. The development and implementation of timely and appropriate mental health interventions as well as social and financial supports could effectively address the mental health needs of frontline healthcare staff. The experiences from China in tackling the mental health challenges in frontline healthcare staff may benefit other countries who are fighting the COVID-19 pandemic.

Financial support

The study was supported by the National Key R&D Program of China (Grants #2018YFC1311600 and 2016YFC1306900) and the University of Macau (MYRG2019-00066-FHS).

Conflicts of interest

The authors have no conflicts of interest to declare and no financial interests with regard to this study.

Footnotes

*

These authors contributed equally to this work.

References

General Office of the State Council of China (2020). Key measures on improving the working conditions of frontline healthcare workers: Caring for the physical and mental health of healthcare workers (in Chinese). Beijing, China: General Office of the State Council of China. Available at http://www.gov.cn/zhengce/content/2020-02/11/content_5477399.htm.Google Scholar
Huang, J. Z., Han, M. F., Luo, T. D., Ren, A. K., & Zhou, X. P. (2020). [Mental health survey of 230 medical staff in a tertiary infectious disease hospital for COVID-19]. Chinese Journal of Industrial Hygiene and Occupational Diseases 38, E001.Google Scholar
Lai, J., Ma, S., Wang, Y., Cai, Z., Hu, J., Wei, N., … Hu, S. (2020). Factors associated With mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open 3, e203976.CrossRefGoogle ScholarPubMed
Liu, S., Yang, L., Zhang, C., Xiang, Y. T., Liu, Z., Hu, S., & Zhang, B. (2020). Online mental health services in China during the COVID-19 outbreak. The Lancet. Psychiatry 7, e17e18.CrossRefGoogle ScholarPubMed
Xiang, Y.-T., Jin, Y., Wang, Y., Zhang, Q., Zhang, L., & Cheung, T. (2020). Tribute to health workers in China: A group of respectable population during the outbreak of the COVID-19. International Journal of Biological Sciences 16, 17391740.CrossRefGoogle ScholarPubMed
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