General distribution of patient’s anxiety or depression
Among 15165 cases of patients with schizophrenia, the mean score of GAD-7 and PHQ-9 were 8.1±2.1 and 10.4±2.7 respectively, and the incidence of anxiety and depression was 100%. The proportion of mild anxiety was 83.2%, moderate anxiety accounted for 15.7%, and 1.2% severe. Meanwhile, 65.1% of participants had minimal symptoms of depression, moderate depression rate was 25.7%, the proportion of severe depression was 8.2%, and 1.0% severe. See Table 1 for details.
Table 1 The severity of depression and anxiety in patients during COVID-19
Severity
|
GAD-7
|
Severity
|
PHQ-9
|
n
|
(%)
|
n
|
(%)
|
Mild
|
12612
|
83.2
|
Mild
|
9867
|
65.1
|
Moderate
|
2377
|
15.7
|
Moderate
|
3902
|
25.7
|
Severe
|
176
|
1.2
|
Severe
|
1249
|
8.2
|
-
|
-
|
-
|
Extremely serious
|
147
|
1.0
|
Total
|
15165
|
100
|
|
15165
|
100
|
n: number; SD, standard deviation; GAD-7: the 7-item Generalized Anxiety Disorder; PHQ-9: the 9-item Patient Health Questionnaire; COVID-19: 2019 Corona Virus Disease.
Subgroup analyses of questionnaire scores
In order to look for the score differences of PHQ-9 and GAD-7, patients with schizophrenia were sub-grouped into six groups by demographic and clinical status, namely sex, age, marital status, educational level, sleep status, and other accompanying long-standing diseases. Regarding the GAD-7 score, group comparison showed that female patients were more anxious than men (t=-2.03, P=0.042). Patients in the 30-39 age group were more anxious than other age groups (F=2.84, P=0.014). Patients receiving university degrees or above had the highest anxiety (F=4.08, P=0.007). Patients with other accompanying long-standing diseases were more anxious than those without other diseases (t=4.18, P<0.001). Patients with poor sleep (F=158.87, P<0.001) had high levels of anxiety. Similarly, PHQ-9 results showed that female patients were more depressed than men (t=-3.27, P=0.001). Patients with poor sleep (F=284.00, P<0.001)had higher levels of depression. Patients with other accompanying long-standing diseases were more depressed than those without other diseases (t=6.86, P<0.001). See Table 2 for details.
Table 2 Comparison of GAD-7 and PHQ-9 scores in patients with different characteristic
Characteristic
|
n(%)
|
GAD-7
(Mean ±SD)
|
F/t/c2
|
P
|
PHQ-9 (Mean ±SD)
|
F/t/c2
|
P
|
Sex
|
|
|
-2.03
|
0.042
|
|
-3.27
|
0.001
|
Male(%)
|
7010(46.2)
|
8.1±2.1
|
|
|
10.3±2.5
|
|
|
Female(%)
|
8155(53.8)
|
8.2±2.2
|
|
|
10.5±2.8
|
|
|
Age(years)
|
|
|
2.84
|
0.014
|
|
1.79
|
0.111
|
≤18
|
24(0.2)
|
8.1±1.9
|
|
|
10.2±2.3
|
|
|
19~29
|
508(3.3)
|
8.0±2.2
|
|
|
10.3±2.9
|
|
|
30~39
|
1647(10.9)
|
8.3±2.3
|
|
|
10.6±3.0
|
|
|
40~49
|
2642(17.4)
|
8.2±2.1
|
|
|
10.4±2.6
|
|
|
50~59
|
4433(29.2)
|
8.1±2.1
|
|
|
10.4±2.6
|
|
|
≥60
|
5911(39.0)
|
8.1±2.1
|
|
|
10.4±2.7
|
|
|
Marital status
|
|
|
1.69
|
0.092
|
|
0.90
|
0.368
|
With partner
|
8607(56.8)
|
8.2±2.2
|
|
|
10.4±2.7
|
|
|
Without partner
|
6558(43.2)
|
8.1±2.1
|
|
|
10.4±2.6
|
|
|
Education(years)
|
|
|
4.08
|
0.007
|
|
0.38
|
0.769
|
Illiteracy
|
2528(16.7)
|
8.1±2.2
|
|
|
10.4±2.8
|
|
|
Primary school
|
4786(31.6)
|
8.1±2.1
|
|
|
10.4±2.7
|
|
|
Junior high school
|
7069(46.6)
|
8.2±2.1
|
|
|
10.4±2.6
|
|
|
University and above
|
782(5.2)
|
8.3±2.2
|
|
|
10.4±2.5
|
|
|
Sleep status
|
|
|
158.87
|
<0.001
|
|
284.00
|
<0.001
|
Better
|
4256(28.1)
|
7.8±1.6
|
|
|
9.8±1.8
|
|
|
Normal
|
10243(67.5)
|
8.2±2.2
|
|
|
10.6±2.7
|
|
|
Poor
|
666(4.4)
|
9.1±3.2
|
|
|
12.0±4.4
|
|
|
Accompanying other long-standing disease
|
|
|
4.18
|
<0.001
|
|
6.86
|
<0.001
|
Yes
|
2648(17.5)
|
8.3±2.3
|
|
|
10.7±3.0
|
|
|
No
|
12517(82.5)
|
8.1±2.1
|
|
|
10.3±2.6
|
|
|
n: number; SD, standard deviation; GAD-7: the 7-item Generalized Anxiety Disorder; PHQ-9: the 9-item Patient Health Questionnaire; COVID-19: 2019 Corona Virus Disease.
Knowledge of the COVID-19 pandemic
T-test showed that patients who understood COVID-19 scored higher on GAD-7 (t=8.17, P<0.001) and PHQ-9 (t=2.29, P=0.022) respectively, compared to those who do not understand COVID-19. ANOVA showed those with general knowledge of COVID-19 scored higher on GAD-7 (F=93.19, P<0.001) and PHQ-9 (F=95.30, P<0.001) respectively than those with simple or deep knowledge about COVID-19. Detailed data was seen in Table 3.
Table 3 Patient’s knowledge of COVID-19 pandemic
|
n (%)
|
GAD-7
(Mean ±SD)
|
F/t
|
P
|
PHQ-9
(Mean ±SD)
|
F/t
|
P
|
Understanding COVID-19
|
|
|
8.17
|
<0.001
|
|
2.29
|
0.022
|
Yes
|
12722(83.9)
|
8.2±2.1
|
|
|
10.4±2.6
|
|
|
No
|
2443(16.1)
|
7.8±2.0
|
|
|
10.3±2.9
|
|
|
Total
|
15165(100)
|
|
|
|
|
|
|
The degree of knowledge about COVID-19
|
|
|
93.19
|
<0.001
|
|
95.30
|
<0.001
|
Simply know
|
12055(79.5)
|
8.0±2.0
|
|
|
10.2±2.5
|
|
|
Generally know
|
2803(18.5)
|
8.6±2.5
|
|
|
11.0±3.1
|
|
|
Deeply know
|
307(2.0)
|
8.4±2.8
|
|
|
10.5±3.2
|
|
|
Total
|
15615(100)
|
|
|
|
|
|
|
n: number; SD, standard deviation; GAD-7: the 7-item Generalized Anxiety Disorder; PHQ-9: the 9-item Patient Health Questionnaire; COVID-19: 2019 Corona Virus Disease.
Multivariate logistic regression models for anxiety and depression among community-dwelling patients with schizophrenia
GAD-7 and PHQ-9 scores were first transformed into binary variables with the threshold of mild anxiety or depression and then served as dependent variables in the respective regression models. Sex, age, marital status, educational level, sleep status, other accompanying long-standing diseases, understanding COVID-19, and the degree of knowledge of COVID-19 served as independent variables. The details about the multivariate analyses of predictors with logistic regression models for anxiety and depression are shown in Table 4.Our study showed that people in the 30-39 (OR:1.14; 95%CI [0.39,3.4];P=0.811) and 40-49 (OR:1.16 ; 95%CI [1.03,1.32] ; P=0.018)age groups, with other accompanying long-standing diseases (OR:1.15; 95%CI [1.03,1.29];P=0.013) , knowing the COVID-19 pandemic (OR:1.44 ; 95%CI [1.26,1.65];P<0.001) are more likely to experience anxiety. Good sleep (OR:0.23; 95%CI [0.19,0.28]; P<0.001) can reduce the risk of anxiety. Meanwhile, patients aged 30-39 (OR:1.23 ; 95%CI [1.09,1.38 ] ; P=0.001), with other accompanying long-standing diseases (OR:1.29; 95%CI [1.18,1.42];P<0.001) , knowing the COVID-19 pandemic (OR:1.49 ; 95%CI [1.34,1.64];P<0.001) are more likely to experience depression. Good sleep(OR:0.26 ; 95%CI [0.22,0.31]; P<0.001) can reduce the risk of depression. Other independent variables are the insignificant predictors in the logistic regression model for anxiety and depression (Table 4). Interestingly, we performed regression analysis separately for males and females and found that male patients with a partner(OR:0.88; 95%CI [0.79,0.97]; P=0.013) had a lower risk of depression (Table 5), and the remaining results did not change much. Detailed data was seen in Table 4-6.
Table 4 Logistic regression analysis of anxiety and depression in patients with schizophrenia in the community
|
|
Anxietya
|
Depressionb
|
|
|
OR(95%CI)
|
P
|
OR(95%CI)
|
P
|
Age
|
≤18
|
1.14(0.39-3.4)
|
0.811
|
0.86(0.35-2.09)
|
0.734
|
|
19~29
|
0.94(0.72-1.21)
|
0.620
|
0.92(0.75-1.12)
|
0.387
|
|
30~39
|
1.26(1.09-1.46)
|
0.002
|
1.23(1.09-1.38)
|
0.001
|
|
40~49
|
1.16(1.03-1.32)
|
0.018
|
1.04(0.94-1.15)
|
0.488
|
|
50~59
|
1.03(0.92-1.15)
|
0.614
|
1.01(0.93-1.10)
|
0.786
|
|
≥60
|
1.00
|
|
1.00
|
|
Sleep status
|
Better
|
0.23(0.19-0.28)
|
<0.001
|
0.26(0.22-0.31)
|
<0.001
|
|
Normal
|
0.47(0.40-0.56)
|
<0.001
|
0.54(0.46-0.63)
|
<0.001
|
|
Poor
|
1.00
|
|
1.00
|
|
Accompanying other long-standing disease
|
Yes
|
1.15(1.03-1.29)
|
0.013
|
1.29(1.18-1.42)
|
<0.001
|
|
No
|
1.00
|
|
1.00
|
|
Understanding COVID-19
|
Yes
|
1.44(1.26-1.65)
|
<0.001
|
1.49(1.34-1.64)
|
<0.001
|
|
No
|
1.00
|
|
1.00
|
|
The degree of knowledge about COVID-19
|
Simply know
|
0.78(0.57-1.05)
|
0.095
|
0.85(0.67-1.08)
|
0.188
|
|
Generally know
|
1.38(1.01-1.87)
|
0.041
|
1.54(1.20-1.99)
|
0.001
|
|
Deeply know
|
1.00
|
|
1.00
|
|
OR: odds ratio; COVID-19: 2019 Corona Virus Disease.
a Anxiety was defined as a patient with a score of >5
b Depression was defined as a patient with a score of >5
Table 5 Logistic regression analysis of anxiety and depression in male patients with schizophrenia in the community (N=7010)
|
|
Anxietya
|
Depressionb
|
|
|
OR(95%CI)
|
P
|
OR(95%CI)
|
P
|
Marital status
|
With partner
|
/
|
/
|
0.88( 0.79-0.97)
|
0.013
|
|
Without partner
|
/
|
/
|
1.00
|
|
Sleep status
|
Better
|
0.30(0.22-0.41)
|
<0.001
|
0.31(0.23-0.40)
|
<0.001
|
|
Normal
|
0.54(0.41-0.72)
|
<0.001
|
0.61(0.47-0.79)
|
<0.001
|
|
Poor
|
1.00
|
|
1.00
|
|
Accompanying other long-standing disease
|
Yes
|
/
|
/
|
1.37(1.20-1.57)
|
<0.001
|
|
No
|
/
|
/
|
1.00
|
|
Understanding COVID-19
|
Yes
|
1.36(1.12-1.65)
|
0.002
|
1.48(1.28-1.72)
|
<0.001
|
|
No
|
1.00
|
|
1.00
|
|
The degree of knowledge about COVID-19
|
Simply know
|
0.66(0.44-1.01)
|
0.055
|
0.69(0.49-0.97)
|
0.032
|
|
Generally know
|
1.18(0.77-1.82)
|
0.443
|
1.33(0.94-1.90)
|
0.112
|
|
Deeply know
|
1.00
|
|
1.00
|
|
OR: odds ratio; COVID-19: 2019 Corona Virus Disease.
a Anxiety was defined as a patient with a score of >5
b Depression was defined as a patient with a score of >5
Table 6 Logistic regression analysis of anxiety and depression in female patients with schizophrenia in the community (N=8155)
|
|
Anxietya
|
Depressionb
|
|
|
OR(95%CI)
|
P
|
OR(95%CI)
|
P
|
Sleep status
|
Better
|
0.20(0.16-0.26)
|
<0.001
|
0.24(0.19-0.30)
|
<0.001
|
|
Normal
|
0.44(0.35-0.55)
|
<0.001
|
0.50(0.41-0.61)
|
<0.001
|
|
Poor
|
1.00
|
|
1.00
|
|
Accompanying other long-standing disease
|
Yes
|
1.16(1.00-1.34)
|
0.046
|
1.21(1.07-1.36)
|
0.002
|
|
No
|
1.00
|
|
1.00
|
|
Understanding COVID-19
|
Yes
|
1.55(1.29-1.86)
|
<0.001
|
1.53(1.33-1.75)
|
<0.001
|
|
No
|
1.00
|
|
1.00
|
|
The degree of knowledge about COVID-19
|
Simply know
|
0.85(0.55-1.30)
|
0.454
|
1.00(0.71-1.41)
|
0.997
|
|
Generally know
|
1.55(1.00-2.40)
|
0.050
|
1.75(1.23-2.50)
|
0.002
|
|
Deeply know
|
1.00
|
|
1.00
|
|
OR: odds ratio; COVID-19: 2019 Corona Virus Disease.
a Anxiety was defined as a patient with a score of >5
b Depression was defined as a patient with a score of >5