What proportion of healthcare workers reported symptoms of insomnia?
34.0%
IMPORTANCE: Health care workers exposed to coronavirus disease 2019 COVID-19 could be psychologically stressed. OBJECTIVE: To assess the magnitude of mental health outcomes and associated factors among health care workers treating patients exposed to COVID-19 in China. DESIGN, SETTINGS, AND PARTICIPANTS: This cross-sectional, survey-based, region-stratified study collected demographic data and mental health measurements from 1257 health care workers in 34 hospitals from January 29, 2020, to February 3, 2020, in China. Health care workers in hospitals equipped with fever clinics or wards for patients with COVID-19 were eligible. MAIN OUTCOMES AND MEASURES: The degree of symptoms of depression, anxiety, insomnia, and distress was assessed by the Chinese versions of the 9-item Patient Health Questionnaire, the 7-item Generalized Anxiety Disorder scale, the 7-item Insomnia Severity Index, and the 22-item Impact of Event Scale–Revised, respectively. Multivariable logistic regression analysis was performed to identify factors associated with mental health outcomes. MAIN OUTCOMES AND MEASURES: The degree of symptoms of depression, anxiety, insomnia, and distress was assessed by the Chinese versions of the 9-item Patient Health Questionnaire, the 7-item Generalized Anxiety Disorder scale, the 7-item Insomnia Severity Index, and the 22-item Impact of Event Scale–Revised, respectively. Multivariable logistic regression analysis was performed to identify factors associated with mental health outcomes. RESULTS: A total of 1257 of 1830 contacted individuals completed the survey, with a participation rate of 68.7%. A total of 813 64.7% were aged 26 to 40 years, and 964 76.7% were women. Of all participants, 764 60.8% were nurses, and 493 39.2% were physicians; 760 60.5% worked in hospitals in Wuhan, and 522 41.5% were frontline health care workers. A considerable proportion of participants reported symptoms of depression 634 50.4% , anxiety 560 44.6% , insomnia 427 34.0% , and distress 899 71.5% . Of all participants, 764 60.8% were nurses, and 493 39.2% were physicians; 760 60.5% worked in hospitals in Wuhan, and 522 41.5% were frontline health care workers. A considerable proportion of participants reported symptoms of depression 634 50.4% , anxiety 560 44.6% , insomnia 427 34.0% , and distress 899 71.5% . Nurses, women, frontline health care workers, and those working in Wuhan, China, reported more severe degrees of all measurements of mental health symptoms than other health care workers eg, median IQR Patient Health Questionnaire scores among physicians vs nurses: 4.0 1.0-7.0 vs 5.0 2.0-8.0 ; P = .007; median interquartile range {IQR} Generalized Anxiety Disorder scale scores among men vs women: 2.0 0-6.0 vs 4.0 1.0-7.0 ; P < .001; median IQR Insomnia Severity Index scores among frontline vs second-line workers: 6.0 2.0-11.0 vs 4.0 1.0-8.0 ; P < .001; median IQR Impact of Event Scale–Revised scores among those in Wuhan vs those in Hubei outside Wuhan and those outside Hubei: 21.0 8.5-34.5 vs 18.0 6.0-28.0 in Hubei outside Wuhan and 15.0 4.0-26.0 outside Hubei; P < .001 . Multivariable logistic regression analysis showed participants from outside Hubei province were associated with lower risk of experiencing symptoms of distress compared with those in Wuhan odds ratio OR , 0.62; 95% CI, 0.43-0.88; P = .008 . Frontline health care workers engaged in direct diagnosis, treatment, and care of patients with COVID-19 were associated with a higher risk of symptoms of depression OR, 1.52; 95% CI, 1.11-2.09; P = .01 , anxiety OR, 1.57; 95% CI, 1.22-2.02; P < .001 , insomnia OR, 2.97; 95% CI, 1.92-4.60; P < .001 , and distress OR, 1.60; 95% CI, 1.25-2.04; P < .001 . CONCLUSIONS AND RELEVANCE: In this survey of heath care workers in hospitals equipped with fever clinics or wards for patients with COVID-19 in Wuhan and other regions in China, participants reported experiencing psychological burden, especially nurses, women, those in Wuhan, and frontline health care workers directly engaged in the diagnosis, treatment, and care for patients with COVID-19. Frontline health care workers engaged in direct diagnosis, treatment, and care of patients with COVID-19 were associated with a higher risk of symptoms of depression OR, 1.52; 95% CI, 1.11-2.09; P = .01 , anxiety OR, 1.57; 95% CI, 1.22-2.02; P < .001 , insomnia OR, 2.97; 95% CI, 1.92-4.60; P < .001 , and distress OR, 1.60; 95% CI, 1.25-2.04; P < .001 . CONCLUSIONS AND RELEVANCE: In this survey of heath care workers in hospitals equipped with fever clinics or wards for patients with COVID-19 in Wuhan and other regions in China, participants reported experiencing psychological burden, especially nurses, women, those in Wuhan, and frontline health care workers directly engaged in the diagnosis, treatment, and care for patients with COVID-19. Text: Abbreviation: PHQ-9, 9-item Patient Health Questionnaire; GAD-7, 7-item Generalized Anxiety Disorder; ISI, 7-item Insomnia Severity Index; IES-R, 22-item Impact of Event Abbreviation: IES-R, 22-item Impact of Event Scale-Revised; IQR, interquartile range. Hyperarousal, median IQR 6.0 2.0, 10.0 6.0 2.0, 9.0 .29