Table 1 describes the socio-demographic distribution of the study participants and the results of univariable analyses. During the study period, a total of 3803 residents participated in the study, with 34.4% male and 63.6% female. Participants aged below 30, 30–49 years old, 50 years old and above accounted for 30.2%, 52.2%, 17.5% respectively. 77.6% of participants were urban residents. Among the participants, people living in Wuhan and other cities in Hubei Province accounted for 31.4% and 24.3%, respectively. Residents in and outside Hubei Province each accounted for about half. The data showed that the large majority(83.7%) of the participants had university degrees or above, more than half (66.5%) of the subjects were married. The proportion of medical staff was 26.7%. At the time of the data collection, 432 (11.44%) people were in quarantine and 718 (18.9%) said that people they knew were diagnosed with COVID-19.
Table 1
Factors affecting anxiety, depression, and stress in the survey (n = 3803;X ± S ;n/%)
Variable
|
N(%)
|
Anxiety
|
t/F
|
P
|
Depression
|
t/F
|
P
|
Stress
|
t/F
|
P
|
Gender
|
|
|
0.038
|
0.845
|
|
0.014
|
0.907
|
|
0.034
|
0.853
|
Male
|
1307(34.4)
|
-2.96 ± 5.61
|
|
|
-2.73 ± 7.22
|
|
|
-2.16 ± 4.14
|
|
|
Female
|
2496(65.6)
|
-2.99 ± 5.36
|
|
|
-2.70 ± 6.91
|
|
|
-2.18 ± 3.94
|
|
|
Age
|
|
|
0.440
|
0.644
|
|
0.281
|
0.755
|
|
0.016
|
0.984
|
< 30
|
1150(30.2)
|
-3.02 ± 5.70
|
|
|
-2.65 ± 7.58
|
|
|
-2.16 ± 4.24
|
|
|
30–49
|
1986(52.2)
|
-3.02 ± 5.43
|
|
|
-2.79 ± 6.93
|
|
|
-2.18 ± 3.98
|
|
|
≥ 50
|
667(17.5)
|
-2.80 ± 5.06
|
|
|
-2.58 ± 6.23
|
|
|
-2.16 ± 3.68
|
|
|
Place of living
|
|
|
40.493
|
<0.001
|
|
32.425
|
<0.001
|
|
29.019
|
<0.001
|
Urban
|
2953(77.6)
|
-2.68 ± 5.23
|
|
|
-2.36 ± 6.67
|
|
|
-1.98 ± 3.84
|
|
|
Rural
|
850(22.4)
|
-4.02 ± 6.03
|
|
|
-3.91 ± 7.99
|
|
|
-2.82 ± 4.48
|
|
|
Usual Residence
|
|
|
28.854
|
<0.001
|
|
17.346
|
<0.001
|
|
29.307
|
<0.001
|
Wuhan
|
1196(31.4)
|
-2.04 ± 5.17
|
|
|
-1.73 ± 6.45
|
|
|
0.33 ± 1.71
|
|
|
Other cities of Hubei
|
923(24.3)
|
-3.09 ± 5.70
|
|
|
-3.01 ± 7.29
|
|
|
-0.05 ± 1.93
|
|
|
Other areas of China
|
1684(44.3)
|
-3.59 ± 5.41
|
|
|
-3.24 ± 7.19
|
|
|
-0.21 ± 1.81
|
|
|
Education
|
|
|
1.786
|
0.148
|
|
1.520
|
0.207
|
|
1.879
|
0.131
|
Middle school or below
|
130(3.4)
|
-3.05 ± 5.76
|
|
|
-2.76 ± 6.97
|
|
|
-2.22 ± 4.37
|
|
|
High school
|
489(12.9)
|
-3.21 ± 5.91
|
|
|
-2.96 ± 7.63
|
|
|
-2.24 ± 4.35
|
|
|
College
|
2413(63.4)
|
-3.05 ± 5.47
|
|
|
-2.81 ± 7.10
|
|
|
-2.25 ± 4.03
|
|
|
Master degree and above
|
771(20.3)
|
-2.59 ± 4.98
|
|
|
-2.71 ± 7.02
|
|
|
-1.87 ± 3.63
|
|
|
Marital status
|
|
|
0.532
|
0.588
|
|
0.812
|
0.444
|
|
0.241
|
0.786
|
Single
|
1101(29.0)
|
-2.99 ± 5.62
|
|
|
-2.55 ± 7.56
|
|
|
-2.15 ± 4.23
|
|
|
Married
|
2530(66.5)
|
-3.01 ± 5.38
|
|
|
-2.81 ± 6.78
|
|
|
-2.19 ± 3.91
|
|
|
Divorced/Other
|
172(4.5)
|
-2.56 ± 5.33
|
|
|
-2.31 ± 6.86
|
|
|
-1.99 ± 4.08
|
|
|
Occupation
|
|
|
0.203
|
0.652
|
|
1.151
|
0.283
|
|
0.032
|
0.859
|
Medical staff
|
1015(26.7)
|
-2.91 ± 5.51
|
|
|
-2.91 ± 6.98
|
|
|
-2.19 ± 4.08
|
|
|
Non-medical staff
|
2788(73.3)
|
-3.00 ± 5.42
|
|
|
-2.64 ± 7.03
|
|
|
-2.16 ± 3.99
|
|
|
Monthly income(Yuan)
|
|
|
3.171
|
0.023
|
|
3.914
|
0.008
|
|
2.804
|
0.038
|
<2000
|
779(20.5)
|
-3.48 ± 5.86
|
|
|
-3.31 ± 7.80
|
|
|
-2.50 ± 4.38
|
|
|
2000–5000
|
1143(30.1)
|
-2.87 ± 5.59
|
|
|
-2.65 ± 6.97
|
|
|
-2.16 ± 4.08
|
|
|
5001–10000
|
1030(27.1)
|
-2.96 ± 5.27
|
|
|
-2.79 ± 6.94
|
|
|
-2.14 ± 3.87
|
|
|
>10000
|
851(22.4)
|
-2.69 ± 5.03
|
|
|
-2.14 ± 6.36
|
|
|
-1.93 ± 3.71
|
|
|
Number of cohabitants
|
|
|
0.943
|
0.419
|
|
1.225
|
0.299
|
|
0.488
|
0.691
|
0
|
216(5.7)
|
-2.40 ± 5.93
|
|
|
-1.84 ± 7.64
|
|
|
-1.88 ± 4.29
|
|
|
1
|
455(12.0)
|
-2.97 ± 5.61
|
|
|
-2.88 ± 7.12
|
|
|
-2.26 ± 4.12
|
|
|
2–3
|
1921(50.5)
|
-2.98 ± 5.37
|
|
|
-2.74 ± 6.93
|
|
|
-2.17 ± 3.94
|
|
|
≥ 4
|
1211(31.8)
|
-3.08 ± 5.41
|
|
|
-2.75 ± 7.00
|
|
|
-2.19 ± 4.02
|
|
|
Quarantine or not
|
|
|
1.593
|
0.207
|
|
2.158
|
0.142
|
|
3.245
|
0.072
|
Yes
|
432(11.4)
|
-2.67 ± 5.48
|
|
|
-2.24 ± 7.15
|
|
|
-1.84 ± 4.05
|
|
|
No
|
3371(88.6)
|
-3.02 ± 5.44
|
|
|
-2.77 ± 7.00
|
|
|
-2.21 ± 4.00
|
|
|
Confirmed infected in personal network
|
|
|
36.915
|
<0.001
|
|
28.420
|
<0.001
|
|
32.041
|
<0.001
|
Yes
|
718(18.9)
|
-1.87 ± 5.20
|
|
|
-1.46 ± 6.40
|
|
|
-1.41 ± 3.77
|
|
|
No
|
3085(81.1)
|
-3.24 ± 5.47
|
|
|
-3.00 ± 7.13
|
|
|
-2.35 ± 4.04
|
|
|
Level of attention
|
|
|
29.968
|
<0.001
|
|
11.985
|
<0.001
|
|
27.088
|
<0.001
|
Decreased
|
1503(39.5)
|
-3.77 ± 5.34
|
|
|
-3.23 ± 7.20
|
|
|
-2.72 ± 3.98
|
|
|
Unchanged
|
1148(30.2)
|
-2.17 ± 4.85
|
|
|
-1.90 ± 6.21
|
|
|
-1.59 ± 3.53
|
|
|
Increased
|
1152(30.3)
|
-2.76 ± 5.98
|
|
|
-2.83 ± 7.46
|
|
|
-2.04 ± 4.39
|
|
|
Self-assessed infection risk
|
|
|
166.344
|
<0.001
|
|
102.190
|
<0.001
|
|
153.937
|
<0.001
|
Decreased
|
2738(72.0)
|
-3.92 ± 5.56
|
|
|
-3.69 ± 7.38
|
|
|
-2.84 ± 4.10
|
|
|
Unchanged
|
849(22.3)
|
-0.87 ± 4.08
|
|
|
-0.38 ± 5.07
|
|
|
-0.66 ± 3.04
|
|
|
Increased
|
216(5.7)
|
0.65 ± 4.81
|
|
|
0.57 ± 5.72
|
|
|
0.38 ± 3.49
|
|
|
Impact of the daily life
|
|
|
138.122
|
<0.001
|
|
141.736
|
<0.001
|
|
132.702
|
<0.001
|
Decreased
|
873(23.0)
|
-5.42 ± 6.14
|
|
|
-5.95 ± 8.38
|
|
|
-3.93 ± 4.52
|
|
|
Unchanged
|
1701(44.7)
|
-2.73 ± 4.66
|
|
|
-2.27 ± 5.99
|
|
|
-1.99 ± 3.43
|
|
|
Increased
|
1229(32.3)
|
-1.60 ± 5.36
|
|
|
-1.01 ± 6.51
|
|
|
-1.17 ± 3.96
|
|
|
Self-perceived health status
|
|
|
44.227
|
<0.001
|
|
32.554
|
<0.001
|
|
36.854
|
<0.001
|
Good/Very good
|
3509(92.3)
|
-3.22 ± 5.40
|
|
|
-2.97 ± 7.01
|
|
|
-2.33 ± 4.00
|
|
|
Average
|
272(7.2)
|
-0.22 ± 5.00
|
|
|
0.28 ± 6.08
|
|
|
-0.27 ± 3.56
|
|
|
Poor/Very poor
|
22(0.5)
|
0.73 ± 7.19
|
|
|
1.95 ± 8.58
|
|
|
-0.14 ± 4.24
|
|
|
Mental health help-seeking
|
|
|
34.648
|
<0.001
|
|
35.967
|
<0.001
|
|
32.557
|
<0.001
|
Found and tried
|
263(6.9)
|
-4.33 ± 5.80
|
|
|
-4.63 ± 7.97
|
|
|
-0.45 ± 1.92
|
|
|
Found but not tried
|
79(2.1)
|
-2.91 ± 5.69
|
|
|
-1.43 ± 6.72
|
|
|
0.05 ± 1.71
|
|
|
Not found yet
|
82(2.2)
|
0.13 ± 5.59
|
|
|
0.72 ± 6.76
|
|
|
1.05 ± 1.94
|
|
|
Not looked for
|
1169(30.7)
|
-1.73 ± 5.21
|
|
|
-1.04 ± 6.52
|
|
|
0.44 ± 1.78
|
|
|
No need to adjust
|
2210(59.1)
|
-3.60 ± 5.35
|
|
|
-3.54 ± 6.96
|
|
|
-0.22 ± 1.77
|
|
|
Satisfaction with community work
|
|
|
29.250
|
<0.001
|
|
22.894
|
<0.001
|
|
29.421
|
<0.001
|
Satisfied
|
3140(82.6)
|
-3.29 ± 5.50
|
|
|
-3.06 ± 7.15
|
|
|
-2.40 ± 4.04
|
|
|
General
|
441(11.6)
|
-1.62 ± 4.87
|
|
|
-1.13 ± 6.02
|
|
|
-1.20 ± 3.71
|
|
|
Dissatisfied
|
222(5.8)
|
-1.33 ± 5.09
|
|
|
-0.89 ± 6.27
|
|
|
-0.90 ± 3.58
|
|
|
Univariate analysis showed that participants with different place of living, usual residence, monthly income, and whether there were diagnosed patients in the relationship network had significant differences in the scores of anxiety, depression and stress (Table 1). In addition, the differences in the six indicators of self-perception factors, that is, level of attention, self-assessed infection risk, impact of the daily life, self-perceived health status, mental health help-seeking and satisfaction with community work, also had significant differences in the scores of the three psychological conditions.
The assumptions for linear regression were met for our data. Linearity, homoscedasticity and normal distribution of residuals were validated in the models. The VIFs were less than 10, indicating multicollinearity was not observed in the models.
Multivariable analyses were then performed to identify these variables with a significantly independent impact on the changes in psychological status (Table 2). The scores of anxiety, depression, and stress were dependent variables and independent variables of the models were age (≥ 50 as reference), gender (male as reference), place of living (urban as reference), usual residence (other areas in China as reference), education (middle school or below as reference), marital status (single as reference), occupation (medical staff as reference), monthly income (< 2,000 yuan as reference), number of cohabitants (0 as reference), quarantine or not (yes as reference), confirmed infected in personal network (yes as reference), level of attention (increased as reference), self-assessed infection risk (increased as reference), mental health help-seeking (not found yet as reference) and satisfaction with community work (dissatisfied as reference).
Table 2
Multivariate regression model for factors associated with anxiety, depression, and stress
Variables
|
Categories
|
Anxiety
|
Depression
|
Stress
|
Gender
|
Male
|
Reference
|
Reference
|
Reference
|
|
Female
|
-0.10(-0.44 to 0.25)
|
-0.10(-0.56 to 0.35)
|
-0.07(-0.32 to 0.19)
|
Age
|
≥ 50
|
Reference
|
Reference
|
Reference
|
|
<30
|
0.39(-0.33 to 1.11)
|
0.48(-0.46 to 1.43)
|
0.45(-0.08 to 0.99)
|
|
30–49
|
0.01(-0.45 to 0.46)
|
-0.06(-0.65 to 0.53)
|
0.14(-0.20 to 0.47)
|
Place of living
|
Urban
|
Reference
|
Reference
|
Reference
|
|
Rural
|
-1.27*(-1.71 to -0.82)
|
-1.47* (-2.06 to -0.88)
|
-0.79*(-1.13 to -0.46)
|
Usual residence
|
Other provinces and cities
|
Reference
|
Reference
|
Reference
|
|
Wuhan, Hubei
|
0.63* (0.20 to 1.06)
|
0.34(-0.22 to 0.90)
|
0.51* (0.20 to 0.83)
|
|
Other cities in Hubei
|
0.58* (0.13 to 1.03)
|
0.43(-0.17 to 1.02)
|
0.39* (0.05 to 0.72)
|
Education
|
Middle school or below
|
Reference
|
Reference
|
Reference
|
|
High school
|
-1.01* (-1.99 to -0.03)
|
-1.21(-2.50 to 0.07)
|
-0.60(-1.33 to 0.12)
|
|
College
|
-1.38* (-2.30 to -0.45)
|
-1.90* (-3.12 to -0.69)
|
-1.03* (-1.71 to -0.34)
|
|
Master degree and above
|
-1.13* (-2.14 to -0.13)
|
-1.68* (-2.99 to -0.37)
|
-0.82* (-1.56 to -0.08)
|
Marital status
|
Single
|
Reference
|
Reference
|
Reference
|
|
Married
|
-0.67* (-1.30 to -0.05)
|
-1.14* (-1.96 to -0.33)
|
-0.47* (-0.93 to 0.00)
|
|
Divorced/Other
|
-0.41(-1.38 to 0.56)
|
-0.88(-2.14 to 0.39)
|
-0.36(-1.08 to 0.35)
|
Occupation
|
Medical staff
|
Reference
|
Reference
|
Reference
|
|
Non-medical staff
|
-0.25(-0.65 to 0.15)
|
-0.51(-1.03 to 0.02)
|
-0.24(-0.53 to 0.05)
|
Monthly income(Yuan)
|
<2000
|
Reference
|
Reference
|
Reference
|
|
2000–5000
|
0.29(-0.26 to 0.84)
|
0.66(-0.06 to 1.38)
|
0.21(-0.20 to 0.61)
|
|
5001–10000
|
0.27(-0.33 to 0.86)
|
0.56(-0.22 to 1.34)
|
0.30(-0.14 to 0.74)
|
|
>10000
|
0.73* (0.08 to 1.38)
|
1.45* (0.60 to 2.30)
|
0.65* (0.17 to 1.13)
|
Number of cohabitants
|
0
|
Reference
|
Reference
|
Reference
|
|
1
|
-0.23(-1.05 to 0.59)
|
-0.84(-1.91 to 0.23)
|
-0.15(-0.76 to 0.45)
|
|
2 ~ 3
|
0.01(-0.72 to 0.74)
|
-0.34(-1.30 to 0.61)
|
0.11(-0.43 to 0.65)
|
|
≥ 4
|
0.12(-0.64 to 0.88)
|
-0.11(-1.11 to 0.88)
|
0.20(-0.37 to 0.76)
|
Quarantine or not
|
Yes
|
Reference
|
Reference
|
Reference
|
|
No
|
0.30(-0.21 to 0.81)
|
0.43(-0.23 to 1.10)
|
0.32(-0.05 to 0.70)
|
Confirmed infected in personal network
|
Yes
|
Reference
|
Reference
|
Reference
|
|
No
|
-0.32(-0.79 to 0.14)
|
-0.52(-1.13 to 0.09)
|
-0.18(-0.52 to 0.16)
|
Level of attention
|
Increased
|
Reference
|
Reference
|
Reference
|
|
Reduced
|
-0.95* (-1.35 to -0.54)
|
-0.39(-0.92 to 0.15)
|
-0.67* (-0.97 to -0.36)
|
|
Unchanged
|
0.24(-0.19 to 0.67)
|
0.53(-0.02 to 1.09)
|
0.19(-0.13 to 0.50)
|
Self-assessed infection risk
|
Increased
|
Reference
|
Reference
|
Reference
|
|
Reduced
|
-3.47* (-4.18 to -2.76)
|
-2.88* (-3.81 to -1.95)
|
-2.44* (-2.96 to -1.91)
|
|
Unchanged
|
-1.17* (-1.93 to -0.42)
|
-0.60(-1.59 to 0.40)
|
-0.81* (-1.37 to -0.25)
|
Impact of the daily life
|
Increased
|
Reference
|
Reference
|
Reference
|
|
Reduced
|
-2.86* (-3.32 to -2.41)
|
-4.06* (-4.66 to -3.47)
|
-2.10* (-2.43 to -1.76)
|
|
Unchanged
|
-0.81* (-1.19 to -0.43)
|
-1.02* (-1.52 to -0.52)
|
-0.60* (-0.89 to -0.32)
|
Mental health help-seeking
|
Not found yet
|
Reference
|
Reference
|
Reference
|
|
Found and tried
|
-3.29* (-4.53 to -2.05)
|
-4.05* (-5.68 to -2.42)
|
-2.22* (-3.14 to -1.29)
|
|
Found but not tried
|
-2.22* (-3.76 to -0.67)
|
-1.09(-3.12 to 0.93)
|
-1.55* (-2.69 to -0.40)
|
|
Not looked for
|
-1.34* (-2.47 to -0.22)
|
-1.18(-2.65 to 0.29)
|
-0.79(-1.62 to 0.04)
|
|
No need to adjust
|
-2.60* (-3.71 to -1.50)
|
-3.02* (-4.47 to -1.57)
|
-1.71* (-2.53 to -0.89)
|
Satisfaction with community work
|
Dissatisfied
|
Reference
|
Reference
|
Reference
|
|
satisfied
|
-0.40(-1.10 to 0.31)
|
-0.48(-1.40 to 0.44)
|
-0.39(-0.91 to 0.13)
|
|
general
|
0.18(-0.64 to 0.99)
|
0.12(-0.94 to 1.18)
|
0.01(-0.59 to 0.61)
|
People living in cities had more negative emotions than people in rural areas. The anxiety (B=-1.27, 95%CI=-1.71 to -0.82), depression (B=-1.47, 95%CI=-2.06 to -0.88), and stress (B=-0.79, 95%CI=-1.13 to -0.46) scores of people in rural areas are lower than those in urban areas. Besides, the mental state of people in Hubei Province is not as good as those in other parts of China. Compared with people living in Hubei Province, people in other parts of China have lower anxiety and stress scores. Compared to people with middle school education and below, the mental health status of people with high education is better. Married persons had lower anxiety, depression, and stress scores than single persons, that is, their mental health was relatively better. People with monthly incomes above 10,000 have higher anxiety, depression, and stress scores than those with monthly incomes below 2,000. The scores of anxiety and stress increased as the frequency of attention to the epidemic increased. Anxiety, depression, and stress were higher among those who thought they had an increased risk of contracting COVID-19 in recent days and those who believed that the epidemic's impact on their lives had increased. Taking people who had sought mental health help but not yet as a reference, people who had tried to adjust their mental state in some way and those who thought they did not need to adjust their mental state had lower scores of anxiety, depression, and stress. In addition, people who had received psychological help but had not yet tried had lower anxiety and stress scores. Gender, age, occupation, confirmed infected in personal network and satisfaction with community work appeared not to be significant correlates of the anxiety, depression, stress scores.