| ObjectivesSince the beginning of the 21 st century,public health emergencies(PHE)have occurred frequently.Studies have found that individuals can experience a significant psychological burden after experiencing a PHE,including depression,anxiety,sleep disorders,mood disorders,post-traumatic stress disorder(PTSD)and suicidal behavior.Among them,PTSD is one of the most concerned mental health problems,and is characterized by delayed onset.However,there are relatively few studies on the incidence of PTSS under the influence of PHE,and the research objects mainly focus on patients and health care workers(HCW).In addition,most of the studies are cross-sectional surveys and lack dynamic observation on the incidence of PTSS.Based on this,this study systematically analyzed the incidence of PTSS in individuals affected by PHE since the21 st century,and dynamically investigated and analyzed the incidence and influencing factors of PTSS in the public at the beginning of the outbreak of coronavirus disease 2019(COVID-19)and after 1 year.To provide reference for further elucidating the pathogenesis of psychological disorders under the influence of PHE and further exploring effective prevention and intervention measures.Methods1.A comprehensive search was conducted in both Chinese and English databases to systematically review 40 literatures on the incidence of PTSS in individuals affected by PHE from January 1,2000 to March 21,2020,which met the inclusion criteria.Relevant data were extracted and combined with random effects model to estimate the incidence of PTSS in individuals affected by PHE.Q value was used as heterogeneity index to evaluate the heterogeneity among the studies,and the average incidence of PTSS in the National Epidemiologic Survey(NES)of the United States was compared with the results of this study.The incidence of PTSS among individuals was analyzed by country,epidemic,time period,population,screening method and study quality,and the source of heterogeneity was determined.The maximum likelihood method was used to establish a meta regression model to identify the moderating factors that explained the inter-study heterogeneity.Sensitivity analysis was further conducted to assess the impact of individual studies on overall incidence estimates by sequentially removing them;Publication bias was assessed using funnel plots and Egger’s tests.2.Online questionnaires were compiled based on the PTSD Checklist for DSM-5(PCL-5),the Pittsburgh Sleep Quality Index(PSQI)and socio-demographic data.An anonymous online survey was conducted from 30 January to 3 February 2020 to analyze and estimate the incidence of PTSS in the public at the beginning of the COVID-19 outbreak.The differences of PCL-5 score and incidence of PTSS among different age,gender,education level,current location,epidemic exposure risk,categories of people and different subjective sleep quality were compared,and the influence of the above factors on the level of PTSS was analyzed to evaluate the potential related variables.Multiple linear regression analysis was conducted with the score of PCL-5 as the dependent variable to identify the influencing factors of public PTSS level under the influence of COVID-19.3.On the basis of the second study,some contents of the questionnaire were adjusted(considering that the current epidemic situation in China is generally at a low level of fluctuation,and all walks of life are greatly affected,delete the current location,risk of exposure to the epidemic,and person category,and include occupation),and an anonymous online survey was conducted from January 30 to February 3,2021.The incidence of PTSS among the public 1 year after the COVID-19 outbreak was analyzed and compared with the incidence of PTSS among the public at the beginning of the outbreak.The effects of different age,gender,occupation,education level and subjective sleep quality on PCL-5 score and the incidence of PTSS were analyzed and compared,and multiple linear regression analysis was conducted with PCL-5 score as the dependent variable to identify the influencing factors of PTSS level of the public.Results1.Forty eligible studies were identified(n=15,538).The pooled incidence of PTSS was estimated to be 17.0%(95%CI: 13.5%-21.2%),higher than the NES average in previous surveys,with high inter-study heterogeneity(Q=1,199,I2=96.75%,P<0.001).2.In order to further determine the source of heterogeneity,a meta-analysis with multiple regulatory factors was conducted,and the results showed that: there was significant heterogeneity among countries(Q=31.931,P<0.001),no significant heterogeneity among PHE estimates(Q=7.921,P=0.095),and the incidence of PTSS fluctuated over time(Q=6.173,P=0.290).The incidence of PTSS in patients(26.2%)was higher than that in medical staff(18.5%)and the general public(12.4%),and the incidence of PTSS in front-line medical staff(22.2%,95% CI: 16.0%-30.1%)was slightly higher than that in general medical staff(10.4%,95% CI: 6.4%-16.6%);The estimated co-incidence of interview screening was lower than that of self-report scale screening(10.8%,95%CI: 6.3%-18.1% vs.19.1%,95%CI: 14.8%-24.3%),with marginal significance heterogeneity between the two groups(Q=3.393,P=0.05).In terms of research quality,the incidence of high-quality studies was low(high: 12.4%;medium:17.3%;low: 18.0%),and the meta-regression model estimated the total variance of subgroup regulatory explanations to be 64%.3.At the beginning of the COVID-19 outbreak,a total of 2,091 members of the public participated in the study.Descriptive statistical analysis showed that the incidence of PTSS among the public at the early stage of COVID-19 outbreak was 4.6%.Gender(P<0.001),epidemic exposure risk(P<0.001),current location(P=0.003),person category(P<0.001)and subjective sleep quality(P<0.001)had significant effects on PCL-5 score.Gender(P<0.001),current location(P=0.001),person category(P<0.001)and subjective sleep quality(P<0.001)had significant effects on the incidence of PTSS.Multiple linear regression analysis showed that women(P<0.001),the risk of exposure to the epidemic(P=0.047),the high-risk public(P<0.001),and poor subjective sleep quality(P<0.001)were the factors affecting the level of PTSS among the public.4.One year after the COVID-19 outbreak,a total of 2,092 members of the public participated in the study.Descriptive statistical analysis showed that the incidence of PTSS in the public one year after the outbreak of COVID-19 was 17.8%,which was significantly higher than the initial stage of the outbreak,showing a cumulative effect of trauma.Age(P<0.001),gender(P=0.007),occupation(P=0.046)and subjective sleep quality(P<0.001)had significant effects on PCL-5 score,and age(P<0.001),occupation(P=0.007)and subjective sleep quality(P<0.001)had significant effects on the incidence of PTSS.Multiple linear regression analysis showed that female(P<0.001),school students(P=0.036),college degree or above(P=0.020)and poor subjective sleep quality(P<0.001)were the factors affecting the level of PTSS among the public.Conclusions1.Since the 21 st century,the combined incidence of PTSS in the public under the influence of PHE is 17.0%.Rates vary across countries,populations and screening methods.2.The incidence of PTSS among the public at the early stage of COVID-19 outbreak was 4.6%.Females,risk of exposure to recent outbreaks,high-risk public,and poor sleep quality are factors influencing PTSS level.3.One year after the outbreak of COVID-19,the incidence of PTSS among the public was 17.8%,which was significantly higher than that in the early stage of the outbreak,with a cumulative effect of trauma.Female,college students,college degree or above,and poor subjective sleep quality were the influencing factors of PTSS level. |
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