| Objective:This study aimed to investigate the psychological status of the Chinese general public and patients with depression disorder after the COVID-19 pandemic was initially controlled.Part 1 focused on investigating the prevalence and related factors of depressive symptoms,somatic symptoms,stress symptoms,and insomnia symptoms among the Chinese general public after the COVID-19 pandemic was initially controlled.Based on the findings in Part 1,Part 2 was further designed and carried out among patients with depression disorder in China,aiming to explore the longitudinal changes of their stress symptoms,depressive symptoms,anxiety symptoms and insomnia symptoms,and to verify the longitudinal impact of stress symptoms on anxiety symptoms and insomnia symptoms.Methods:Both parts of the study were conducted using self-rated questionnaires.In Part 1,the study was conducted online among the Chinese general public.Patient Health Questionnaire-9(PHQ-9),Somatic Symptom Scale-8(SSS-8),Impact of Events Scale-Revised(IES-R),and Insomnia Severity Index(ISI)were used for measuring depressive symptoms,somatic symptoms,stress symptoms and insomnia symptoms,respectively.Chi-square test and Logistic regression analyses were used to explore the factors associated with insomnia symptoms.Sub-group analyses were performed based on ethnicity and psychiatric disorder history.Part 2 was conducted further among patients with depression disorder,who were recruited from 56 hospital outpatients in Mainland of China for the survey at baseline.The follow-up survey was conducted 5 months later.IES-R,PHQ-9,ISI,and the Generalized Anxiety Disorder Scale(GAD-7)were used to assess stress symptoms,depressive symptoms,insomnia symptoms,and anxiety symptoms,respectively.Marginal homogeneity test and McNemar’s test were used to analyze the longitudinal changes of their stress symptoms and other psychological symptoms.Poisson regression analyses and cross-lagged analyses wereused to explore the causal impact of stress symptoms on other psychological symptoms.Results:(1)In Part 1,a total of 14,894 eligible participants were recruited,of whom 6277(42.1%),6501(43.6%),8635(58.0%)and 4601(30.9%)were found to have depressive symptoms,somatic symptoms,stress symptoms and insomnia symptoms,respectively.(2)The Logistic regression analyses revealed that female gender(adjusted ORs 1.31～1.44),having bachelor or above education(adjusted ORs 1.26～1.35),drinking alcohol routinely(adjusted ORs 1.32～2.29),smoking(adjusted ORs 1.15～1.37),having history of chronic physical diseases or psychiatric disorders(adjusted ORs 1.78～8.33),having suspected symptoms of COVID-19(adjusted ORs 2.02～2.65),having someone around confirmed infected with COVID-19(adjusted ORs 1.60～3.62),feeling estranged from family members(adjusted ORs 1.69～2.25)and feeling aliened from others(adjusted ORs 1.27～1.45)were all positively associated with suffering from psychological symptoms(P<0.05).Meanwhile,age over 40(adjusted ORs 0.68～0.91),living in Wuhan city(adjusted OR 0.78,95%CI 0.62～0.98),feeling closer with family members(adjusted ORs 0.83～0.86),not feeling estranged from others(adjusted ORs 0.41～0.54)and being satisfied with the available information about COVID-19(adjusted ORs 0.54～0.70)were negatively associated with suffering from psychological symptoms(P<0.05).The scores of PHQ-9,SSS-8,IES-R and ISI were found significantly correlated with each other(P<0.001).(3)Subgroup analyses in ethnicity found no significant differences in psychological symptoms between participants of minority ethnicity and those of Han ethnicity in the total sample.However,minority ethnicity was found positively associated with suffering from psychological symptoms in the participants who were female,having history of chronic physical diseases or psychiatric disorders,drinking alcohol routinely and smoking(crude ORs 1.21～5.48,P<0.01).Subgroup analyses in psychiatric patients found that 576(85.0%),607(89.5%).594(87.6%)and 540(79.6%)psychiatric patients suffered from depressive symptoms,somatic symptoms,stress symptoms and insomnia symptoms,respectively.Notably,female gender was found negatively associated with having depressive symptoms in psychiatric patients(adjusted OR 0.60,95%CI 0.38～0.94).(4)In Part 2,a total of 5047 valid participants were recruited into the survey at baseline.2113 of them responded at follow-up.From the baseline to the follow-up,the prevalence of stress symptoms decreased from 68.7%to 51.1%(P<0.001),the prevalence of depressive symptoms decreased from 62.1%to 45.7%(P<0.001),the prevalence of anxiety symptoms decreased from 52.5%to 35.8%(P<0.001),and the prevalence of insomnia symptoms decreased from 54.6%to 32.2%(P<0.001).(5)The Poisson regression analyses revealed that having stress symptoms at baseline was positively associated with the new incidences of anxiety symptoms(adjusted RR 2.26,95%CI 1.64～3.12,P<0.001)and insomnia symptoms(adjusted RR 2.32,95%CI 1.64～3.28,P<0.001).Cross-lagged analyses also found that the scores of IES-R at baseline were positively associated with the scores of GAD-7(r=0.11,P<0.001)and ISI(r=0.12,P<0.001)at follow-up.Conclusion:After the COVID-19 pandemic was initially controlled,the prevalence of depressive,somatic,stress and insomnia symptoms in the Chinese general public was still high.Significant positive correlations were found among these psychological symptoms.Participants who were female,had the history of chronic physical diseases,drank alcohol routinely,smoked,had suspected symptoms of COVID-19,had someone around confirmed infected with COVID-19,felt estranged from family members and felt aliened from others were found to have higher risk to suffer from psychological symptoms,while participants who were over 40 years old,felt closer to family members,not felt estranged from others,and were satisfied with the available information about COVID-19 were found to have lower risk.Particularly,participants with higher education level and participants having psychiatric disorder history had higher risk to suffer from psychological symptoms.The further study demonstrated that the prevalence of psychological problems was found higher among patients with depression disorder than among the general public after the COVID-19 pandemic was initially controlled Significant declines were found in the prevalence of psychological symptoms among patients with depression disorder over time.Having stress symptoms at baseline was identified as a predictor for the new incidences of anxiety symptoms and insomnia symptoms. |
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