The psychological burden experienced by Chinese citizens during the COVID-19 outbreak: prevalence and determinants

In 2019, China experienced an pandemic of COVID-19 at the end of 2019. The impact of COVID-19 was enormous and widespread, and it threatened psychosocial welling, economic stability, and normal daily life in the public. Studies of the psychological effect of COVID-19 at a general population level have been reported. Wang al. (2020) found that approximately 28.8% of respondents reported significant anxiety symptoms, and 16.5% of respondents reported moderate to severe depressive symptoms during the COVID-19 pandemic [1]. Another study reported that approximately 8.1, 28.8, and 16.5% of participants reported clinical symptoms of stress, anxiety, and depression, respectively, and there were no significant changes after 4 weeks of follow-up [2].

According to stress-vulnerability model, emotional problems in stressful situations are related to an individual’s vulnerability to stress, the amount of stress, the influence of the environment, and the individual’s ability to cope with stress [3]. Previous studies have found that people who need to stay in their jobs during the pandemic face double stressors - the stress of overwork load and the risk of infection, which make them susceptible to psychological disturbance such as medical personnel [4, 5]. In addition, people with mental illness have higher levels of anxiety, depression and even suicidal ideation than the general population [6]. Thus, the impact of COVID-19 on the mental health of the different population is prevail and widespread.

In order to provide effective intervention, an increasing number of studies have attempted to determine the potential toxic stressors related to mental disorders among the public, such as anxiety and depression [7]. There has been an increase in outbreak across provinces and countries, and the unpredictable future of this pandemic has been exacerbated by myths and misinformation from the internet, thus inducing anxiety, panic, and desperation in the population [8, 9]. In China, the number of Chinese internet users is 829 million, and an increasing number of individuals are using smartphones as their primary mode of internet access to obtain information, thus increasing opportunities for information dissemination and increasing the potential impact on the population [10]. Obviously, increased exposure to negative news from social media could make it increasingly difficult for people to distinguish fact from fiction, which is a toxic stressor to individual mental health.

Previously reported predictors of psychiatric complications during communicable disease outbreaks include sociodemographic variables [e.g., being a health care worker (HCW)] [4, 5], severe outbreaks of infectious diseases locally [11], health beliefs toward infectious diseases [e.g., perceived risk or threat of infection] [12, 13], and psychosocial variables [e.g., social support, medical history of mental health disorders and physical diseases] [14]. In addition, researchers and clinicians have stated that past experiences toward life adversities could influence an individual’s current response to life incidents, such that individuals who had positive experiences toward life adversities were more likely to engage in positive coping or attitudes toward uncertainty in life, and vice versa [15]. Risk factor analysis can improve the detection of hidden psychiatric complications. The present study aimed to identify the prevalence and determinants of anxiety and depression during the COVID-19 outbreak. This research can lead to effective preventive strategies and recommendations for preventing mental health problems among the general population.

The current study shown that 12% (736/6130) of the participants experienced moderate or severe symptoms of depression, and 7.1% (437/6130) showed moderate or severe symptoms of anxiety. Another systematic review found a wide range of anxiety and depression prevalence rates in the public during the COVID-19 pandemic, ranging from 2.7% to more than 50% [7]. These differences may derive from differences in sampling methods, assessment instrument, severity rating criteria, time point of questionnaire evaluation, and subject inclusion criteria.

Our data suggested that some demographic variables were positively associated with psychological distress. To be specific, firstly, the occupational factors could predict higher distress level, which was reflected by that medical personnel were presented more anxiety and depression symptoms than other occupations. This result was in accordance with previous research which found that medical workers were more vulnerable to facing enormous pressure, including a high risk of infection, helplessness, discrimination, isolation, burnout, lack of social support, frustration, and limited access to psychological support [18]. A lot of scholars have indicated that medical staff working in highly stressful environments were at risk of developing psychological disturbances, which suggests that medical professionals require greater access to mental health services [4, 5]. Secondly, religious belief was associated with severe/pervasive typologies of anxiety. Some researchers found that compare to non-religious individuals, religious individuals may have a generally pessimistic explanatory style (perceiving negative events as punishment), more psychological symptoms and poorer health [19]. Regarding the issues of vulnerability, people with mental illness and people with chronic physical illness who need regular medical visits are more vulnerable to on-going life events. In the context of pandemic outbreak, individuals with chronic physical illness have altered perceptions of personal control and perceived self-efficacy, which weakens their ability to cope with the stress of the COVID-19 outbreak [20]. This finding is consistent with prior studies and suggests that adults with a history of mental health disorders are more vulnerable to developing depressive and anxiety symptoms in the times of the Covid-19 crisis [20, 21]. Previous research claimed that females had higher depression and anxiety level than male during the pandemic of COVID-19 [1, 20]. However, there was also a study stated that gender was not correlated to anxiety and depression during the COVID-19 pandemic [22]. In contrast to the previous study, the current study revealed that male gender was associated with higher self-reported anxiety and depression symptoms. A systematic review disagrees with “anatomy is destiny”, instead, they suggest that different gender tend to be vulnerable to some specific social factors [23]. The gender differences from our current study may in turn reflect that the male participants tend to be more vulnerable to the stresses induced by COVID-19 due to males may undergo more financial pressure in China in terms of supporting their families during the pandemic of COVID-19.

Based on the vulnerability stress model, it claimed that the way individuals see themselves and the world seems to make a major difference to their level of vulnerability to stress [3]. Interestingly, an individual’s perception of the risk level of post-COVID-19 sequelae were found to increase the odds of having a high level of depression, which indicates that the thinking style is related to depression symptoms in the context of the COVID-19 outbreak [15]. The current findings further confirm that an individual with post-traumatic growth experiences is more resilient to current stressful events that can prevent anxiety and depression [24, 25]. These findings were in line with “inoculation hypothesis,” which suggests that experienced with a particular traumatic event may help individuals acquire skills or knowledge related to trauma and may engender a sense of competence in facing similar life crises in the future [26, 27]. This implies that it is important to help the population to obtain more positive experiences from the current stress of COVID-19 outbreak, thereby making the population more resilient rather than vulnerable.

People who mobilize effective coping skills appeared to deal with stress better than those who do not. The current study also stated that individuals who actively search for information are less likely to suffer depression, which implies that it is important to be active rather than passive during the COVID-19 outbreak. This finding was in accordance with a previous study which stated that being passive is a symptom of trauma and advocated that individuals be active in their lives, enabling them to actively cope with the difficulties during the COVID-19 outbreak to prevent psychosocial disturbances [28, 29]. The findings revealed that individuals who spend more time online are at a higher risk of depression and anxiety than individuals who browse the internet for less than 3 h.

According to stress-vulnerability model, stress generated from household, neighborhood, social media or any other environment source is more likely to make impact on mental health of individuals [3]. According to our findings, Individuals who obtain information from official media are less likely to suffer depression. Our current research discovered that the voices from medical experts and official TV programmers with concrete scientific facts and research findings may promote confidence and hope among the public rather than creating uncertainty and confusion, which may prevent people from feeling anxious and depressed. Consistent with previous research, we also found that exposure to information induced by confusion, desperation, sadness, and even somatic discomfort was linked to potentially deleterious outcomes – specifically, anxiety and depression – among the general population [30]. More specifically, information induced by fear also predisposes individuals to anxiety symptoms. Our findings indicate an urgency for health authorities to monitor health information for a more effective dissemination of information related to the COVID-19 pandemic to satisfy the demand of health information for the general public [31, 32].

Some specific individual characteristics maybe more vulnerable for anxiety and depression in the context of COVID-19 outbreak, therefore special attention should be given to individuals with these characteristics, such as individuals with mental illness or traumatic experiences, as well as to medical professionals. They should be provided with effective medical and psychological aids to increase their coping capability in the midst of the pandemic outbreak. In addition, the administration department of media should regulate the dissemination of information related to the pandemic to provide the public with a professional and reliable source of information. It is important to reduce the exposure of susceptible populations to a large amount of negative information and to maintain the mental health of the public in the context of the pandemic.