Mental health status of medical staff in emergency departments during the Coronavirus disease 2019 epidemic in China
Open accessAbstract
Background The emergency department is considered to be a high-risk area, as it is often the first stop for febrile patients who are subsequently diagnosed with coronavirus disease 2019. This study, which employed a cross-sectional design, aimed to assess the mental health of emergency department medical staff during the epidemic in China.Methods Demographic data and mental health measurements were collected by electronic questionnaires from February 28, 2020 to March 18, 2020.Outcomes A total of 14,825 doctors and nurses in 31 provinces of mainland China completed the survey. The prevalence rates of depressive symptoms and post-traumatic stress disorder (PTSD) were 25.2% and 9.1%, respectively. Men were more likely to have depressive symptoms and PTSD than women. Those who were middle aged, worked for fewer years, had longer daily work time, and had lower levels of social support were at a higher risk of developing depressive symptoms and PTSD. Working in the Hubei province was associated with a higher risk of depressive symptoms, while those working in the Hubei province but residing in another province had a lower risk of depressive symptoms and PTSD. Being a nurse was associated with a higher risk of PTSD.Interpretation The findings suggest that targeted psychological interventions to promote the mental health of medical staff with psychological problems need to be immediately implemented. Special attention should be paid to local medical staff in Hubei.
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- Findingown data
Among 14,825 emergency department medical staff in China surveyed between February 28 and March 18, 2020, 25.2% had depressive symptoms.
“Many participants experienced psychological symptoms, with 3733 (25.2%) and 1353 (9.1%) qualifying as having depressive symptoms and PTSD, respectively.”
- Also stated in: § Discussion · plain
“In the current cross-sectional study of 14,825 medical staff, 25.2% and 9.1% of participants reported depressive symptoms and PTSD, respectively, during the COVID-19 epidemic in China.”
Quote in the paperSubstantial claim - Also stated in: § Discussion · plain
- Findingown data
Compared with ages 18-25, emergency department medical staff aged 26-30, 31-40, and older than 40 had higher odds of depressive symptoms (ORs 1.49, 1.43, and 1.36, respectively).
“In the final model, compared to those between the ages of 18 and 25, the ORs (95% CI) were 1.49 (1.28, 1.72), 1.43 (1.19, 1.72), and 1.36 (1.02, 1.81) for those between the age of 26 and 30 years, 31 and 40 years, and older than 40 years, respectively.”
Quote in the paperNot a substantial claim - Findingown data
Among the same 14,825 emergency department medical staff, 9.1% had PTSD.
“Many participants experienced psychological symptoms, with 3733 (25.2%) and 1353 (9.1%) qualifying as having depressive symptoms and PTSD, respectively.”
- Also stated in: § Discussion · plain
“In the current cross-sectional study of 14,825 medical staff, 25.2% and 9.1% of participants reported depressive symptoms and PTSD, respectively, during the COVID-19 epidemic in China.”
Quote in the paperSubstantial claim - Also stated in: § Discussion · plain
- Findingown data
Men were more likely than women to have depressive symptoms (OR 1.12, 95% CI 1.01-1.24).
“Men were more likely to have depressive symptoms than women (OR: 1.12, 95% CI: 1.01, 1.24).”
Quote in the paperNot a substantial claim - Findingown data
Compared with technical school or college graduates, undergraduates had lower odds of PTSD (OR 0.83, 95% CI 0.72-0.97).
“Compared with those who were married and technical school or college graduates, unmarried and undergraduates had a lower risk of PTSD, with ORs (95% CI) of 0.76 (0.64, 0.91) and 0.83 (0.72, 0.97), respectively.”
Quote in the paperNot a substantial claim
- Findingown data
Compared with working outside Hubei province, working in Hubei province while residing in another province was associated with lower odds of PTSD (OR 0.39, 95% CI 0.25-0.63).
“Compared to working outside of the Hubei province, those who were working in the Hubei province but residing in another province had a lower risk of PTSD (OR: 0.39, 95% CI: 0.25, 0.63).”
Quote in the paperNot a substantial claim - Findingown data
Men were more likely than women to have PTSD (OR 1.75, 95% CI 1.51-2.03).
“Men (OR: 1.75, 95% CI: 1.51, 2.03) and nurses (OR: 1.43, 95% CI: 1.20, 1.71) were more likely to have PTSD than women and physicians.”
Quote in the paperSubstantial claim - Findingown data
Nurses were more likely than physicians to have PTSD (OR 1.43, 95% CI 1.20-1.71).
“Men (OR: 1.75, 95% CI: 1.51, 2.03) and nurses (OR: 1.43, 95% CI: 1.20, 1.71) were more likely to have PTSD than women and physicians.”
Quote in the paperSubstantial claim - Findingown data
Compared with ages 18-25, staff aged 26-30 and 31-40 had higher odds of PTSD (ORs 1.48 and 1.34, respectively).
“In the final model, compared to those between the ages of 18 and 25, the OR (95% CI) were 1.48 (1.18, 1.86) and 1.34 (1.02, 1.77) for those between the age of 26 and 30 years and 31 and 40 years, respectively.”
Quote in the paperNot a substantial claim - Findingown data
Compared with high social support, low and moderate social support were associated with higher odds of PTSD (ORs 5.49 and 2.73, respectively).
“Low (OR: 5.49, 95% CI: 4.04, 7.45) and moderate (OR: 2.73, 95% CI: 2.42, 3.07) levels of social support were associated with a higher risk of PTSD compared to high levels of social support.”
Quote in the paperSubstantial claim - Findingown data
Compared with working outside Hubei province, working in Hubei province while residing in another province was associated with lower odds of depressive symptoms (OR 0.50, 95% CI 0.39-0.65).
“Compared to working outside of the Hubei province, working in the Hubei province was associated with a higher risk of depressive symptoms (OR: 1.70, 95% CI: 1.26, 2.29), while those working in the Hubei province but residing in another province had a lower risk of depressive symptoms (OR: 0.50, 95% CI: 0.39, 0.65).”
Quote in the paperNot a substantial claim - Findingown data
Compared with working outside Hubei province, working in Hubei province was associated with higher odds of depressive symptoms (OR 1.70, 95% CI 1.26-2.29).
“Compared to working outside of the Hubei province, working in the Hubei province was associated with a higher risk of depressive symptoms (OR: 1.70, 95% CI: 1.26, 2.29), while those working in the Hubei province but residing in another province had a lower risk of depressive symptoms (OR: 0.50, 95% CI: 0.39, 0.65).”
Quote in the paperSubstantial claim - Findingown data
Compared with having worked 20 years or more, having worked 16-20, 11-15, or fewer than 10 years was associated with higher odds of PTSD (ORs 1.57, 1.73, and 1.62, respectively).
“Compared to those who have worked for 20 years or more, the ORs (95% CI) were 1.57 (1.17, 2.11), 1.73 (1.20, 2.48), and 1.62 (1.11, 2.36) for those who have worked for between 16 and 20 years, 11 and 15 years, and less than 10 years, respectively.”
Quote in the paperNot a substantial claim - Findingown data
Compared with having worked 20 years or more, having worked 16-20, 11-15, or fewer than 10 years was associated with higher odds of depressive symptoms (ORs 1.43, 1.47, and 1.52, respectively).
“Compared to those who have worked for 20 years or more, the ORs (95% CI) were 1.43 (1.16, 1.76), 1.47 (1.14, 1.89), and 1.52 (1.17, 1.98) for those who have worked for between 16 and 20 years, 11 and 15 years, and less than 10 years, respectively.”
Quote in the paperNot a substantial claim - Findingown data
Compared with technical school or college graduates, staff with a graduate degree had higher odds of depressive symptoms (OR 1.26, 95% CI 1.06-1.50).
“Those with a graduate degree were more likely to have depressive symptoms than those with a technical school or college degree (OR: 1.26, 95% CI: 1.06, 1.50).”
Quote in the paperNot a substantial claim - Findingown data
Compared with working fewer than 9 hours per day, working 9-10, 11-12, or more than 12 hours per day was associated with higher odds of PTSD (ORs 1.36, 1.69, and 2.42, respectively).
“Compared to those who work less than 9 h a day, those who work 9–10 h, 11–12 h, and more than 12 h a day were more likely to have PTSD, with ORs (95% CI) of 1.36 (1.18, 1.56), 1.69 (1.43, 2.01), and 2.42 (1.96, 2.99), respectively.”
Quote in the paperSubstantial claim - Findingown data
Compared with married staff, unmarried staff had lower odds of PTSD (OR 0.76, 95% CI 0.64-0.91).
“Compared with those who were married and technical school or college graduates, unmarried and undergraduates had a lower risk of PTSD, with ORs (95% CI) of 0.76 (0.64, 0.91) and 0.83 (0.72, 0.97), respectively.”
Quote in the paperNot a substantial claim - Premisecitation
Panic and anxiety caused by the stress response, separate from the emergency, are common among medical staff.
“The panic and anxiety caused by the stress response, separate from the emergency, are also common among medical staff (Maunder et al., 2003, Bai et al., 2004, Chua et al., 2004).”
Quote in the paperNot a substantial claim0 of 3 sources checked - Interpretationreasoning
The current study found lower prevalence rates of depressive symptoms and PTSD among emergency department medical staff compared with previous research.
“Compared to previous research, (Huang et al., 2020, Lai et al., 2020, Liu et al.) the current study demonstrated lower prevalence rates of depressive symptoms and PTSD among emergency department medical staff.”
Quote in the paperSubstantial claim0 of 3 sources checked- cites Huang et al., 2020
Not checked in the free run.
- cites Lai et al., 2020 source
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- cites Liu et al.
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- Interpretationcitation
The lower prevalence rates may be related to the timing of the study, when the epidemic in China had been controlled and work pressure had significantly reduced compared to the peak period.
“This may be related to the timing of our study. The current study was conducted from February 28, 2020 to March 18, 2020, during which time the epidemic in China had been controlled and the work pressure of the medical staff was significantly reduced compared to the peak period of the epidemic (Pan et al., 2020).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Pan et al., 2020 source
Not checked in the free run.
- May combine two claims. 11
- Classified as probably not a substantial claim. 6
May combine two claims.
Findingown dataStratified analyses by gender and occupation yielded similar associations to the main analyses, although the magnitude of associations varied between strata.
“Similar findings were obtained in the stratified analyses by gender (Table A.1) and occupation (Table A.2), although the magnitude of the associations varied between the different strata.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataCompared with married staff, unmarried and divorced/widowed staff had higher odds of depressive symptoms (ORs 1.12 and 1.35, respectively).
“Compared to married people, the ORs (95% CI) were 1.12 (1.00, 1.26) and 1.35 (1.07, 1.71) for unmarried and divorced/widowed people, respectively.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataCompared with high social support, low and moderate social support were associated with higher odds of depressive symptoms (ORs 9.59 and 3.37, respectively).
“Low (OR: 9.59, 95% CI: 7.22, 12.74) and moderate (OR: 3.37, 95% CI: 3.11, 3.66) levels of social support were associated with higher risk of depressive symptoms compared to a high level of social support.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationThe Chinese version of the PTSD Checklist for DSM-5 has been validated and is widely used in psychological research.
“The Chinese version of the PCL-5 has been validated and is widely used in psychological research (Li et al., 2019, Wang et al., 2015).”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites Li et al., 2019
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- cites Wang et al., 2015 source
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May combine two claims.
Interpretationown dataSocial support had the greatest impact on the mental health of medical staff; lower levels of social support were associated with greater risk of depressive symptoms and PTSD.
“However, social support had the greatest impacts on the mental health of medical staff; the lower the levels of social support, the greater the risk of depressive symptoms and PTSD.”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationNurses are more closely connected with patients and have greater contact time than physicians.
“This finding may be because a nurse is more closely connected with the patient, with greater contact time (Chan, 2003).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Chan, 2003 source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe Chinese version of the Perceived Social Support Scale has shown good reliability and validity in various populations.
“The Chinese version of the PSSS has shown good reliability and validity in various populations (Feng et al., 2018, Wang et al., 2020, Zhang et al., 2018).”
Quote in the paperNot a substantial claim0 of 3 sources checkedMay combine two claims.
Premisenone givenThese medical staff from other provinces were selected after their own registration, usually had adequate psychological preparation, and received infectious disease protection training before going to Hubei.
“These individuals were selected after their own registration, usually with adequate psychological preparations, and also received training of infectious disease protection before going to Hubei.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationAs of February 20, 2020, a total of 2055 laboratory-confirmed COVID-19 infections among medical staff were reported in 476 hospitals in China.
“According to the China-WHO joint investigation report of COVID-19, as of February 20, 2020 a total of 2055 laboratory-confirmed cases of COVID-19 infection among medical staff were reported in 476 hospitals in China (Health, 2020).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Health, 2020
Not checked in the free run.
May combine two claims.
PremisecitationThe Chinese version of the Center for Epidemiologic Studies Depression Scale has confirmed reliability and validity.
“Both the reliability and validity of the Chinese version has been confirmed (Sun et al., 2017).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Sun et al., 2017
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationA previous study during the SARS outbreak found that emergency department nurses were more likely to develop distress and use behavioral disengagement than physicians.
“A previous study conducted among medical staff in emergency departments during the SARS outbreak also showed that nurses were more likely to develop distress and use behavioral disengagement than physicians (Wong et al., 2005).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Wong et al., 2005 source
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May combine two claims.
PremisereasoningThe Hubei province was the center of the epidemic, with most confirmed cases and prolonged high risk of infection for medical staff.
“As the center of the epidemic, most of the confirmed cases occurred in the Hubei province than other regions and medical staff were at a high risk of infection for a long time.”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationThe primary transmission route of COVID-19 is aerosol and close contact, which puts medical staff at high risk of exposure.
“The primary transmission route of COVID-19 is aerosol and close contact, putting medical staff at high risk of exposure (Li et al., 2020).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Li et al., 2020
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationMore than 30,000 medical staff from other provinces worked in Hubei during the outbreak.
“Since the COVID-19 outbreak, more than 30,000 medical staff from other provinces have worked in Hubei (Pan et al., 2020).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Pan et al., 2020 source
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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationWomen tend to pay more attention to their experiences and feelings and are more willing to express their emotions, which is conducive to self-regulation of emotions.
“Women tend to pay more attention to their experiences and feelings and are more willing to express their emotions. This behavior is conducive to the self-regulation of emotions (Neitzke, 2016).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Neitzke, 2016 source
Not checked in the free run.
The paper relies on this without support.
Existing surveys of mental health among medical staff during the COVID-19 epidemic had sample sizes below 5000.
“However, the sample sizes of existing surveys are relatively small (<5000 people) due to the limited timeframe of the investigation.”
The paper relies on this without support.
The emergency department is a high-risk area in a hospital because it is often the first stop for febrile patients who are later diagnosed with COVID-19.
“Moreover, the emergency department is considered to be a high-risk area in a hospital, as it is often the first stop for febrile patients who are subsequently diagnosed with COVID-19.”
The paper relies on this without support.
The early COVID-19 conditions (increasing confirmed cases, insufficient psychological preparation, lack of understanding of COVID-19, overwhelming workload, and lack of personal protective equipment) may cause psychological pressure among medical staff.
“The increasing number of confirmed cases, insufficient psychological preparation, lack of understanding of COVID-19, overwhelming workload, and lack of personal protective equipment in the early stages of this disease may cause varying degrees of psychological pressure among medical staff.”
The paper relies on this without support.
The current study is the largest survey on the mental health of emergency department medical staff during the COVID-19 epidemic in China.
“First, to the best of our knowledge, this is the largest survey on the mental health of emergency department medical staff during the COVID-19 epidemic in China.”
The paper relies on this without support.
Medical staff, as the primary population dealing with public health emergencies, may experience destructive or unpleasant feelings in the initial emotional stages.
“Medical staff, as the primary population dealing with public health emergencies, may experience destructive or unpleasant feelings in the initial emotional stages.”
The paper relies on this without support.
None of the medical staff from other provinces who worked in Hubei were infected with COVID-19 while working there.
“Previous research has also shown that none of these individuals were infected with COVID-19 while working in the Hubei province.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Previous studies tended to measure PTSS in earlier periods, whereas PTSS sometimes takes time to develop and might be less observable during a traumatic period.
“previous studies tended to measure PTSS in earlier periods [e.g., during February to March 2021 among Chinese HCWs [6], whereas PTSS sometimes takes time to develop and might be less observable during a traumatic period [7].”
From Associations between COVID-19 Work-Related Stressors and Posttraumatic Stress Symptoms among Chinese Doctors and Nurses: Application of Stress-Coping Theory (2022) · cites this paper as [6]
The Discussion reports lower PTSD prevalence in this later survey than in earlier studies and suggests that medical staff’s mental health may improve over time. That is the opposite temporal pattern from the claim that symptoms may be less observable during the traumatic period and emerge later; the paper does not discuss delayed development of PTSS. (LLM, conf=0.78)
Checked by a reasoning model — may be wrong.
Experimental — accuracy not yet measuredMost studies assessed prevalence of PTSS during or shortly after the COVID-19 outbreak, when traumatic conditions were still ongoing.
“Nevertheless, most of these studies assessed the prevalence of PTSS during or shortly after the COVID-19 outbreak e.g., during February to March 2021 among Chinese HCWs [6] and during March to April 2021 among Italian HCWs [2], i.e., when the traumatic conditions were still ongoing.”
From Associations between COVID-19 Work-Related Stressors and Posttraumatic Stress Symptoms among Chinese Doctors and Nurses: Application of Stress-Coping Theory (2022) · cites this paper as [6]
The Discussion reports PTSD prevalence among Chinese medical staff during the COVID-19 epidemic, supporting this study as an example of an outbreak-period assessment. But it dates the study to February 28–March 18, 2020, not February–March 2021, and says the epidemic in China had been controlled by then. (LLM, conf=0.89)
Experimental — accuracy not yet measuredThe prevalence of PTSS in the current sample seemed higher than that recently reported in two other studies and was similar to another recent study conducted among HCWs.
“The prevalence of PTSS in the current sample seemed higher than that recently reported in two other studies [6,35] and was similar to another recent study conducted among HCWs [36].”
It is plausible that separated or divorced HCWs were at higher risk of PTSS because they could not be supported by a spouse.
“It is plausible that separation or divorced HCWs were at higher risk as they could not be supported by a spouse [6].”
Nurses were more likely to develop PTSD than other healthcare workers during viral outbreaks.
“A number of studies found that nurses were more likely to develop PTSD (Tang et al., 2017; Barello et al., 2020; Song et al., 2020)”
From Impact of viral epidemic outbreaks on mental health of healthcare workers: a rapid systematic review and meta-analysis (2020) · cites this paper as Song et al., 2020
Low and moderate levels of social support are associated with a higher risk of PTSD compared to high levels of social support among healthcare workers during COVID-19 (low OR 5.49, 95% CI 4.04-7.45; moderate OR 2.73, 95% CI 2.42-3.07).
“in fact, in their study, the authors found that social support had the greatest impact on the mental health of HCWs: low (OR: 5.49, 95% CI: 4.04, 7.45) and moderate (OR: 2.73, 95% CI: 2.42, 3.07) levels of social support were associated with a higher risk of PTSD compared to high levels of social support [19].”
From Post-Traumatic Stress Symptoms in Healthcare Workers Dealing with the COVID-19 Pandemic: A Systematic Review (2021) · cites this paper as [19]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Discussion reverses the PTSD finding for unmarried staff
MajorThe discussion says unmarried staff had a higher risk of PTSD, but the reported result says they had a lower risk than married staff (OR 0.76).
“the current study demonstrated that middle-aged as well as unmarried, divorced, or widowed medical staff were at a higher risk of depressive symptoms and PTSD”
“Compared with those who were married and technical school or college graduates, unmarried and undergraduates had a lower risk of PTSD, with ORs (95% CI) of 0.76 (0.64, 0.91) and 0.83 (0.72, 0.97), respectively.”
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- Authors
- Song, X., Fu, W., Liu, X., Luo, Z., Wang, R., Zhou, N., Yan, S., & Lv, C.
- Affiliations
- Huazhong University of Science and Technology (CN)
- Chinese Academy of Medical Sciences & Peking Union Medical College (CN)
- Hainan Medical University (CN)
- Central People's Hospital of Zhanjiang (CN)
- Corresponding author
- Zhou, Ning
- Yan, Shijiao
- Lv, Chuanzhu
- Venue
- Brain Behavior and Immunity
- Publisher
- Elsevier BV
- Published
- 2020-08
- Volume
- 88
- Pages
- 60-65
- ISSN
- 0889-1591 (ISSN-L)
- PMC
- PMC7273140
- OpenAlex
- W3033726760
- Cited by
- 309
- References
- 31
- Citations by year
- 2026: 5 · 2025: 22 · 2024: 27 · 2023: 41 · 2022: 74 · 2021: 113 · 2020: 27
- FWCI
- 25.52
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Licence
- Locations
- Brain Behavior and Immunity (publishedVersion)
- SSRN Electronic Journal (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Hainan Provincial Department of Science and Technology
- Chinese Academy of Medical Sciences
- Topics
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
- Health Sciences › Health Professions › Occupational Therapy › Occupational Health and Burnout
- Keywords
- mental health, healthcare workers, emergency department staff, COVID-19 pandemic, depressive symptoms, post-traumatic stress disorder, nurses, physicians, social support, Hubei Province, psychological intervention
- MeSH terms
- Betacoronavirus, COVID-19, SARS-CoV-2, Adult, China, Depression, Emergency Medicine, Emergency Service, Hospital, Female, Humans, Male, Mental Health, Nurses, Personnel Staffing and Scheduling, Physicians, Pneumonia, Viral, Social Support, Stress Disorders, Post-Traumatic, Prevalence, Emergency Nursing, Age Distribution, Sex Distribution, Coronavirus Infections, Pandemics
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