COVID-19 is a new, highly infectious disease with varying incubation periods and clinical manifestations; elderly patients and those with chronic diseases appear to be at the greatest risk. It has substantially affected normal life, work and study. In late January 2020, China initiated prevention and control measures for COVID-19 and initiated the "first-level emergency response". COVID-19 has become a severe epidemic that constitutes a major public health emergency, and it is spreading rapidly. People are prone to various psychological problems during the epidemic.
Patients with suspected and confirmed cases of COVID-19 require strict medical observation and isolation during treatment. During this period, during which they lack face-to-face communication with people, they often experience serious concerns, fear, depression and anxiety; in addition, the patients must endure coughing, fever, dyspnea and other physical discomfort, which all have effects on their psychological state.
On January 17, 2020, our hospital started to treat the first cases of COVID-19 in Zhuhai. Currently, 98 patients have been diagnosed, and more than 200 patients with suspected cases of COVID-19 have been admitted. During the treatment of COVID-19, we often see young mothers who are anxious about whether their children will be well taken care of at home. Even when patients experience improvements in their symptoms, they still worry about fluctuations in their condition. Some patients' body temperature may increase slightly, and if there is an increase, the patients become nervous and anxious. Some patients suffer from poor sleep due to anxiety, physical dysfunction, and symptoms such as chest tightness, shortness of breath, fatigue and poor appetite, which are not conducive to the treatment of and recovery from the disease.
This study conducted a cross-sectional survey of 66 patients with suspected and confirmed cases of COVID-19 during hospitalization and isolation and found that psychological problems such as anxiety, depression, and sleep disorders were common in all patients. The patients had a mean anxiety score of 41.3 points, a mean depression score of 47.5 points, and a mean sleep disorder score of 7.6 ± 4.7 points. The incidences of anxiety, depression, and sleep disorders were higher than domestic norms among these patients, and the differences were statistically significant (P <0.05); this finding indicates that these patients experienced anxiety and depression. In addition to the abovementioned common factors, anxiety and depression can result from isolation and the general concern about the progress of the epidemic in the population. Most of the medical staff's energy is focused on treating the physical symptoms of the infection, which reduces their ability to intervene in psychological conditions. With the current shortage of protective materials and personnel, it is difficult to conduct routine psychological consultations and provide treatment [9]. This is consistent with the results of Cheng Li's research [10], which showed that patients with COVID-19 had significant anxiety; during the SARS epidemic in 2003, there were also studies that showed that patients with suspected cases of SARS who were totally isolated experienced anxiety, fear, loneliness and other psychological problems [11]. During the Ebola outbreak in Sierra Leone from 2014 to 2015, the number of people with mental illnesses in the region increased significantly: 71 patients (50%) experienced mild pain, depression, anxiety, grief or social problems, while thirty patients developed psychosis requiring medication [12]. Therefore, during epidemics of infectious diseases, monitoring patients’ psychological behavior and providing interventions at an early stage is very important for their rehabilitation.
Currently, most patients with COVID-19 have a good prognosis, while a few patients are critically ill. Elderly patients and those with chronic underlying diseases have a poor prognosis, while the symptoms are relatively mild in children. The investigation found that the incidences of anxiety, depression, and sleep disorders were relatively higher in confirmed cases; the survey results showed that in patients with a negative nucleic acid test, the incidence of anxiety was 18.2%, and the incidence of sleep disorders was 39.4%. Among patients with a positive nucleic acid test, the incidence of anxiety was 42.41%, the incidence of depression was 57.6%, and the incidence of sleep disorders was 69.7%. These incidences were much higher than those in patients with a negative nucleic acid test, and the differences were statistically significant. These differences are related to the relatively severe physical symptoms in the diagnosed patients, who may worry that the disease will be difficult to cure or that it will affect their future work and burden their family. At the time of the SARS outbreak, Gabriel M. Leung found that those who were aware of their higher likelihood of infection and those who ultimately died of SARS had significantly higher anxiety scores than their counterparts. The level of anxiety is closely related to the intensity of the outbreak and to the number of new cases per day [13]. In this study, Spearman correlation analysis was used to analyze the relationships among the anxiety, depression, and sleep disorder scores. There were significant positive correlations among anxiety, depression, and sleep disorders. There are currently no specific therapeutic drugs for COVID-19. The main treatment methods are systemic supportive therapy and improving the patient’s own immunity. Sleep disorders can lead to a decline in the body's immunity, adversely affecting the host's resistance to infectious diseases, and aggravating the severity of the disease [14-16]. Timely counseling in response to the psychological problems experienced by patients can alleviate negative emotions and assist in treatment in ways that cannot be achieved by drugs [11]; therefore, during the treatment of COVID-19, medical staff should pay attention to the impact of psychological disorders on the disease. The timely identification of problems and the initiation of clinical interventions, if necessary, may better help patients overcome these difficulties.
Gabriel M. Leung also found that women, people between the ages of 30 and 49, and people with a primary education or below were more likely to feel anxious [13]. However, the results of this study show that sociological factors such as education and sex had no significant effect on anxiety and depression in patients with COVID-19. This may be related to China's national mobilization, consistent epidemic prevention measures, and strong communication strategies by the news media. Most patients have a strong awareness of the disease, and the country's free treatment of COVID-19 reduces the economic pressure on patients. The proportions of patients with anxiety, depression, and sleep disorders were high, and the differences in incidence between patients and the general population norms were statistically significant. Considering that the elderly population is more likely to have chronic diseases and that patients with underlying diseases have a worse prognosis, these patients are experiencing physical discomfort and are concerned about their own condition progressing at any time. Symptoms of anxiety and depression are aggravated, which induces or aggravates sleep disorders. Sleep disorders can reduce the body's resistance to disease. COVID-19 is more likely to become severe in the elderly population, and the prognosis is poor [2, 4]; this prompts our medical staff to pay attention to the diagnosis and treatment of these patients each day. Psychological problems in such patients could be detected early and promptly addressed.
In summary, COVID-19 patients have significant anxiety, depression, and sleep disorders, especially in people aged 50 and older. Medical staff should focus on the psychological state of such patients, strengthen health education, and actively conduct psychological counseling. By reducing anxiety and depression through targeted interventions during a psychological crisis, it is possible to reduce the psychological harm caused by the epidemic and subsequent psychosocial problems.