As of March 23, 2020, there have been 81171 cases of and 3140 deaths due to Coronavirus (COVID-19) in China (National Health Commission of the People’s Republic of China, 2020). COVID-19 is a respiratory disease that can also bring about challenges for mental health, such as anxiety, depression, and post-traumatic stress disorder (Shigemura et al., 2020; Tandon, 2020). COVID-19 was first reported in Hubei Province and cases in this region account for 80 % of total cases in China, making it the most seriously affected region of China. Previous studies have reported high rates of depression and anxiety among healthcare workers exposed to COVID-19 (Chew et al., 2020; Lai et al., 2020), raising widespread concern. The purpose of this study was to investigate the prevalence of severe depression and anxiety symptoms in the Chinese population based on their risk of COVID-19 and residence within or outside of Hubei Province.
A nationwide survey was conducted online in March 2020. The survey was approved by the Ethics Committee of Shenzhen Kangning Hospital. The survey included demographic information (gender, age, educational background, and place of residence), exposure to COVID-19, the Zung self-report depression scale (SDS) (Hunter and Murphy, 2011), and the self-report anxiety scale (SAS) (Zung, 1971). According to Chinese population norms, severe depression is defined as an SDS score of 72 or higher (Xuan, 2020), and severe anxiety as an SAS score of 70 or higher (LIiZihui et al., 2018). Respondents were divided into three groups according to their exposure to COVID-19: (i) infected (i.e., a confirmed diagnosis); (ii) high risk of infection (i.e., close contact with people diagnosed with COVID-19 or with symptoms of COVID-19); and (iii) low risk of infection. Respondents were also grouped according to whether or not they resided within Hubei Province during the outbreak.
A total of 7143 people completed the survey. The infected group (n = 318) reported the highest rates of severe depression (48.11 %) and severe anxiety (53.46 %). The high risk group (n = 614) reported similar rates of severe depression (46.42 %) and severe anxiety (50.16 %). Subjects in the low risk group (n = 6211) reported the lowest rates of severe depression (12.20 %) and severe anxiety (13.98 %). Univariate binary logistic regression analysis showed that those with either a high risk of infection or existing infection were at a higher risk of severe depression and severe anxiety compared to the low risk group. For severe depression, the unadjusted odds ratios (OR) were 6.671 and 6.232 for the high-risk group and infected group, respectively, compared with the low risk group. For severe anxiety, the unadjusted ORs were 7.071 and 6.196 for the high-risk group and infected group, respectively, compared with the low risk group. After controlling for gender, age, residence, and educational background, the adjusted ORs were 5.68 and 5.10 respectively for severe depression and 5.96 and 4.95 respectively for severe anxiety compared with the low risk group (Fig. 1 ).
Fig. 1.
Prevalence of severe depression and anxiety symptoms among individuals with different COVID-19 exposure living in regions with different levels of risk. (Note: Odds ratios (OR) are adjusted for gender(male/female), age (18–30/31-50/above 50), residence(city/town/countryside), and educational background (middle school and below/ high school/ college and above).
Further analysis based on place of residence showed that respondents infected with COVID-19 reported similarly high rates of severe depression and anxiety regardless of whether they lived in Hubei Province (47.58 % and 53.90 %, respectively) or elsewhere (51.02 % and 51.02 %). Among high risk people, those living in Hubei Province reported higher rates of severe depression (47.57 %) and severe anxiety (51.53 %) than those living outside of Hubei Province (rates of 35.59 % and 37.29 % for severe depression and anxiety, respectively). Lower rates of severe depression (5.39 %) and severe anxiety (5.73 %) were reported among low risk people living outside of Hubei Province compared to low risk people living in Hubei Province (23.26 % and 27.35 %, respectively). Multivariate logistic regression analysis revealed that, after controlling for gender, age, residence, and educational background, high risk people living outside of Hubei Province were more likely to have severe depression (adjusted OR: 11.45) and severe anxiety (adjusted OR: 10.94) symptoms compared with low risk people living outside of Hubei Province, while those living in Hubei Province had adjusted ORs of 2.89 and 2.92 for severe depression and anxiety, respectively, compared with low risk people living in Hubei Province. Among respondents who had been infected living outside of Hubei Province, the adjusted ORs were 6.72 for severe depression and 6.76 for severe anxiety compared with low risk people living outside of Hubei Province, and 2.82 and 2.58, respectively, for those living in Hubei Province compared with low risk people (Fig. 1).
This is one of the first studies to explore the prevalence of severe anxiety and depression symptoms in individuals with different COVID-19 infection statuses residing in regions with different COVID-19 infection risks. In summary, the prevalence of severe anxiety and depression symptoms varied with COVID-19 risk and region of residence. This finding highlights the need to formulate psychological intervention programs for different regions and different infection risk groups.
Funding source
This work was supported by Hunan Provincial Innovation Foundation for Postgraduate (CX20190159), Sanming Project of Medicine in Shenzhen (SZSM201612079) and Shenzhen Key Medical Discipline Construction Fund（SZXK042）.
Declaration of Competing Interest
The authors declare that they have no conflicts of interest.
Acknowledgment
The authors would like to acknowledge the volunteers who participated in the study.
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