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      Cross-sectional study of traumatic stress disorder in frontline nurses 6 mo after the outbreak of the COVID-19 in Wuhan

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          Abstract

          BACKGROUND

          Frontline nurses in Wuhan directly fighting severe acute respiratory syndrome coronavirus-2 diseases are at a high risk of infection and are extremely susceptible to psychological stress, especially due to the global coronavirus disease 2019 (COVID-19) pandemic. The psychological after-effects of this public health emergency on frontline nurses will last for years.

          AIM

          To assess factors influencing post-traumatic stress disorder (PTSD) among frontline nurses in Wuhan 6 mo after the COVID-19 pandemic began.

          METHODS

          A total of 757 frontline nurses from five hospitals in Wuhan, China, participated in an online survey from July 27 to August 13, 2020. This cross-sectional online study used a demographic information questionnaire, the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders, the Connor-Davidson Resilience Scale, and the Patient Health Questionnaire-4. The chi-square test and logistic regression were used to analyze the association of demographics, COVID-19-related variables, and PTSD. Logistic regression was also conducted to investigate which variables were associated with PTSD outcomes.

          RESULTS

          A total of 13.5%, 24.3%, and 21.4% of the frontline nurses showed symptoms of PTSD, depression, and anxiety, respectively. The multivariate logistic regression analysis showed that the following factors were strongly associated with PTSD: Having a relative, friend, or colleague who died of COVID-19; experiencing stigma; or having psychological assistance needs, depressive symptoms or anxiety. Showing resilience and receiving praise after the COVID-19 outbreak were protective factors.

          CONCLUSION

          Frontline nurses still experienced PTSD (13.5%) six months after the COVID-19 outbreak began. Peer support, social support, official recognition, reward mechanisms, exercise, better sleep, and timely provision of information (such as vaccine research progress) by the government via social media, and adequate protective supplies could mitigate the level of PTSD among nurses responding to COVID-19. Stigmatization, depression, and anxiety might be associated with a greater risk of PTSD among nurses.

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          Factors Associated With Mental Health Outcomes Among Health Care Workers Exposed to Coronavirus Disease 2019

          Jianbo Lai, Simeng Ma, Ying Wang … (2020)
          Key Points Question What factors are associated with mental health outcomes among health care workers in China who are treating patients with coronavirus disease 2019 (COVID-19)? Findings In this cross-sectional study of 1257 health care workers in 34 hospitals equipped with fever clinics or wards for patients with COVID-19 in multiple regions of China, a considerable proportion of health care workers reported experiencing symptoms of depression, anxiety, insomnia, and distress, especially women, nurses, those in Wuhan, and front-line health care workers directly engaged in diagnosing, treating, or providing nursing care to patients with suspected or confirmed COVID-19. Meaning These findings suggest that, among Chinese health care workers exposed to COVID-19, women, nurses, those in Wuhan, and front-line health care workers have a high risk of developing unfavorable mental health outcomes and may need psychological support or interventions.
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            Development of a new resilience scale: the Connor-Davidson Resilience Scale (CD-RISC).

            Kathryn M Connor, Jonathan Davidson (2003)
            Resilience may be viewed as a measure of stress coping ability and, as such, could be an important target of treatment in anxiety, depression, and stress reactions. We describe a new rating scale to assess resilience. The Connor-Davidson Resilience scale (CD-RISC) comprises of 25 items, each rated on a 5-point scale (0-4), with higher scores reflecting greater resilience. The scale was administered to subjects in the following groups: community sample, primary care outpatients, general psychiatric outpatients, clinical trial of generalized anxiety disorder, and two clinical trials of PTSD. The reliability, validity, and factor analytic structure of the scale were evaluated, and reference scores for study samples were calculated. Sensitivity to treatment effects was examined in subjects from the PTSD clinical trials. The scale demonstrated good psychometric properties and factor analysis yielded five factors. A repeated measures ANOVA showed that an increase in CD-RISC score was associated with greater improvement during treatment. Improvement in CD-RISC score was noted in proportion to overall clinical global improvement, with greatest increase noted in subjects with the highest global improvement and deterioration in CD-RISC score in those with minimal or no global improvement. The CD-RISC has sound psychometric properties and distinguishes between those with greater and lesser resilience. The scale demonstrates that resilience is modifiable and can improve with treatment, with greater improvement corresponding to higher levels of global improvement. Copyright 2003 Wiley-Liss, Inc.
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              Mental health problems and social media exposure during COVID-19 outbreak

              Junling Gao, Pinpin Zheng, Yingnan Jia … (2020)
              Huge citizens expose to social media during a novel coronavirus disease (COVID-19) outbroke in Wuhan, China. We assess the prevalence of mental health problems and examine their association with social media exposure. A cross-sectional study among Chinese citizens aged≥18 years old was conducted during Jan 31 to Feb 2, 2020. Online survey was used to do rapid assessment. Total of 4872 participants from 31 provinces and autonomous regions were involved in the current study. Besides demographics and social media exposure (SME), depression was assessed by The Chinese version of WHO-Five Well-Being Index (WHO-5) and anxiety was assessed by Chinese version of generalized anxiety disorder scale (GAD-7). multivariable logistic regressions were used to identify associations between social media exposure with mental health problems after controlling for covariates. The prevalence of depression, anxiety and combination of depression and anxiety (CDA) was 48.3% (95%CI: 46.9%-49.7%), 22.6% (95%CI: 21.4%-23.8%) and 19.4% (95%CI: 18.3%-20.6%) during COVID-19 outbroke in Wuhan, China. More than 80% (95%CI:80.9%-83.1%) of participants reported frequently exposed to social media. After controlling for covariates, frequently SME was positively associated with high odds of anxiety (OR = 1.72, 95%CI: 1.31–2.26) and CDA (OR = 1.91, 95%CI: 1.52–2.41) compared with less SME. Our findings show there are high prevalence of mental health problems, which positively associated with frequently SME during the COVID-19 outbreak. These findings implicated the government need pay more attention to mental health problems, especially depression and anxiety among general population and combating with “infodemic” while combating during public health emergency.
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                Author and article information

                Contributors
                Zhi-Qing Zhou
                Ting Yuan
                Xiu-Bing Tao
                Long Huang
                Yu-Xin Zhan
                Li-Ling Gui
                Mei Li
                Huan Liu
                Xiang-Dong Li
                Journal
                Journal ID (nlm-ta): World J Psychiatry
                Journal ID (publisher-id): WJP
                Title: World Journal of Psychiatry
                Publisher: Baishideng Publishing Group Inc
                ISSN (Electronic): 2220-3206
                Publication date Collection: 19 February 2022
                Publication date (Electronic): 19 February 2022
                Volume: 12
                Issue: 2
                Pages: 338-347
                Affiliations
                Department of Nursing, Yijishan Hospital Affiliated to Wannan Medical College, Wuhu 241001, Anhui Province, China
                School of Nursing, Wannan Medical College, Wuhu 241001, Anhui Province, China
                Department of Nursing, Yijishan Hospital Affiliated to Wannan Medical College, Wuhu 241001, Anhui Province, China
                School of Humanities and Management, Wannan Medical College, Wuhu 241001, Anhui Province, China
                Department of Nursing, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, Hubei Province, China
                Department of Radiation and Medical Oncology, Zhongnan Hospital, Wuhan University, Wuhan 430071, Hubei Province, China
                Department of Intensive Care Unit, The Central Hospital of Wuhan Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430014, Hubei Province, China
                Department of Blood Purification Centre, Yijishan Hospital of Wannan Medical College, Wuhu 241001, Anhui Province, China
                Department of Gerontology, Yijishan Hospital Affiliated to Wannan Medical College, Wuhu 241001, Anhui Province, China. lxdvvc@ 123456163.com
                Author notes

                Author contributions: All authors contributed to the concept of this study; Zhou ZQ, Liu H, and Li XD conceived the study; Tao XB and Huang L carried out the literature searches; Zhan YX, Gui LL, Li M, and Liu H distributed the online questionnaires and extracted the data; Tao XB assessed the study quality; Yuan T, Liu H performed the statistical analysis; Zhou ZQ and Yuan T wrote the manuscript; Zhou ZQ, Yuan T, Liu H, and Li XD revised the manuscript; all the authors read the published version of the manuscript and gave their consent.

                Supported by Anhui Provincial Department of Education College Outstanding Talent Cultivation Funding Project , No. gxgwfx2019032; the Teaching Quality and Teaching Reform Project of Anhui Provincial Department of Education , No. 2020jyxm2090; Anhui Wuhu Novel Coronavirus Pneumonia Epidemic Prevention and Control Science and Technology Emergency Project , No. 2020rkx1-5; and Wannan Medical College Teaching Quality and Teaching Reform Project, No. 2019jyxm20.

                Corresponding author: Xiang-Dong Li, Doctor, Associate Chief Physician, Department of Gerontology, Yijishan Hospital Affiliated to Wannan Medical College, No. 2 Zheshan West Road, Wuhu 241001, Anhui Province, China. lxdvvc@ 123456163.com

                Article
                Other ID: jWJP.v12.i2.pg338
                DOI: 10.5498/wjp.v12.i2.338
                PMC ID: 8900583
                PubMed ID: 35317336
                SO-VID: be21b177-08cd-479f-b8a0-4c3e8fe1a3a9
                Copyright © ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
                License:

                This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/

                History
                Date received : 6 July 2021
                Date revision received : 18 September 2021
                Date accepted : 14 January 2022
                Categories
                Subject: Observational Study

                Keywords: post-traumatic stress disorder,frontline nurses,covid-19,mental health,pandemic
                Data availability:
                Keywords: post-traumatic stress disorder, frontline nurses, covid-19, mental health, pandemic

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