A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: implications and policy recommendations

Qiu, Jianyin; Shen, Bin; Zhao, Min; Wang, Zhen; Xie, Bin; Xu, Yifeng

This study received a total of 52 730 valid responses from 36 provinces, autonomous regions and municipalities, as well as from Hong Kong, Macau and Taiwan by 10 February 2020. Among all the respondents, 18 599 were males (35.27%) and 34 131 were females (64.73%). The mean (SD) CPDI score of the sample was 23.65 (15.45). Almost 35% of the respondents experienced psychological distress (29.29% of the respondents' scores were between 28 and 51, and 5.14% of the respondents' scores were ≥52). Multinomial logistic regression analyses showed that one's CPDI score was associated with their General Psychiatry gender, age, education, occupation and region. Female respondents showed significantly higher psychological distress than their male counterparts (mean (SD)=24.87 (15.03) vs 21.41 (15.97), p<0.001). It is in accordance with results from previous research which concluded that women are much more vulnerable to stress and more likely to develop post-traumatic stress disorder. 1 People under 18 years had the lowest CPDI scores (mean (SD)=14.83 (13.41)). Individuals between 18 and 30 years of age or above 60 presented the highest CPDI scores (mean (SD)=27.76 (15.69) and 27.49 (24.22), respectively). Two major protective factors may explain the low distress level in juveniles: a relatively low morbidity rate among this age group, and limited exposure to the epidemic due to home quarantine. Higher scores among the young adult group (18-30 years) seem to confirm findings from previous research: young people tend to obtain a large amount of information from social media that can easily trigger stress. 2 Since the highest mortality rate occurred among the elderly during the epidemic, it is not surprising that elderly people are more likely to be psychologically impacted. Similarly, people with higher education tended to have more distress, probably because of high self-awareness of their health. 3 It is noteworthy that migrant workers experienced the highest level of distress (mean (SD)=31.89 (23.51), F=1602.501, p<0.001) among all occupations. The concern about virus exposure in public transportation when returning to work, their worries about delays in work time and subsequent deprivation of their anticipated income may explain the high stress level. 4 The CPDI score of respondents in the middle region of China (including Hubei, the centre of the epidemic) was the highest (mean (SD) 30.94 (19.22), F=929.306, p<0.001), since this region was affected by the epidemic most severely. Meanwhile, psychological distress levels were also influenced by availability of local medical resources, efficiency of the regional public health system, and prevention and control measures taken against the epidemic situation. 5 6 For example, Shanghai is at high risk of carriers of the COVID-19 virus entering the city because of the large population of migrant workers. The distress level is not spiking. This is probably because of the fact that Shanghai has one of the best public health systems in China.