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Health Care Workers in China During COVID-19 Outbreak Report Mental Health Issues

March 23, 2020

A significant proportion of physicians and nurses treating patients exposed to COVID-19 in China reported symptoms of depression, anxiety, insomnia, and distress, according to a study published online in JAMA Network Open.

“Together, our findings present concerns about the psychological well-being of physicians and nurses involved in the acute COVID-19 outbreak,” researchers wrote. 

The cross-sectional survey-based study included 1257 health care workers in 34 hospitals in multiple regions of China. Data were gathered between January 29, 2020, and February 3, 2020, and symptoms were assessed using 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.

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Among participants, 60.8% were nurses, 39.2% were physicians, 60.5% worked in hospitals in Wuhan, China, and 41.5% were frontline health care workers. 

Some 50.4% of participants reported symptoms of depression, 44.6% reported symptoms of anxiety, 34.0% reported symptoms of insomnia, and 71.5% reported psychological distress, according to the study. 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.

“Protecting health care workers is an important component of public health measures for addressing the COVID-19 epidemic,” researchers wrote. “Special interventions to promote mental well-being in health care workers exposed to COVID-19 need to be immediately implemented, with women, nurses, and frontline workers requiring particular attention.”

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In an invited commentary, Roy H. Perlis, MD, MSc, of Massachusetts General Hospital in Boston and an associate editor at JAMA Network Open, called the depression and anxiety rates identified in the study “striking,” noting that the depressive symptoms described by 14% of physicians and nearly 16% of nurses were moderate or severe. 

“While the peak of the COVID-19 epidemic remains to be seen, it will ultimately subside,” Dr. Perlis wrote. “The work of Lai et al provides a reminder of the toll that will likely linger: the consequences of chronic stress, including major depression and anxiety disorders.”

—Jolynn Tumolo


Lai J, Ma S, Wang Y, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Network Open. 2020;3(3):e203976.

Perlis RH. Exercising heart and head in managing coronavirus disease 2019 in Wuhan. JAMA Network Open. 2020;3(3):e204006.

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