Why is the recognition rate of psychological distress under-estimated in general hospitals? A cross-sectional observational study in China

Prevalence and correlates of suicide risk among non-psychiatric inpatients in a general hospital in China

OBJECTIVE

This study aims to investigate the suicide risk and mental health status of non-psychiatric inpatients in general hospital and explore the risk factors of suicide.

METHODS

A prospective study was conducted at a tertiary general hospital in Guangzhou, Guangdong Province, China. On-line assessment of mental health status and suicide was completed at admission and discharge. We assessed depression, anxiety, insomnia and suicide of inpatients and binary logistics regression was used to examine the risk factors of suicide.

RESULTS

From April 1, 2021 and January 31, 2022, 3685 inpatients were included. The detection rates of depression, anxiety and insomnia were 14.6 %, 9.0 % and 17.8 %, respectively. There were 2.7 % of inpatients at suicide risk. Binary logistics regression demonstrated that the inpatients with anxiety were at higher risk of suicide.

LIMITATIONS

(1) Single-center study limits the generalization of conclusion, (2) low response rate at discharge.

CONCLUSIONS

The comorbidity of physical illnesses and mental health problems, including depression, anxiety, insomnia, and suicide among non-psychiatric patients in general hospital was common. An assessment of anxiety may help identify individuals at high suicide risk. Medical staff in general hospitals should be trained to improve their ability to identify mental disorders and high-risk individuals for suicide, provide timely interventions and effectively reduce the suicide risk of patients.

Augmenting Mental Health Support for Patients Accessing Different Degrees of Formal Psychiatric Care through a Supportive Text Messaging Program: Protocol for a Randomized Controlled Trial

Patients feel more vulnerable when accessing community mental health programs for the first time or after being discharged from psychiatric inpatient units. Long wait times for follow-up appointments, shortage of mental health professionals, lack of service integration, and scarcity of tailored support can weaken their connection to the health care system. As a result, patients can present low adherence, dissatisfaction with treatment, and recurrent hospitalizations. Finding solutions to avoid unnecessary high-cost services and providing tailored and cost-effective mental health interventions may reduce the health system burden and augment patient support. We propose implementing an add-on, supportive text messaging service (Text4Support), developed using cognitive-behavioural therapy (CBT) principles to augment mental health support for patients attending to or being discharged from psychiatric care in Nova Scotia, Canada. This randomized controlled trial aims to investigate the effectiveness of Text4Support in improving mental health outcomes and overall mental well-being compared with usual care. We also will examine the intervention's impact on health services utilization and patient satisfaction. The results from this study will provide evidence on stepped and technology-based mental health care, which will contribute to generating new knowledge about mental health innovations in various clinical contexts, which is not only helpful for the local context but to other jurisdictions in Canada and abroad that are seeking to improve their health care.

Impact of sleep quality on post-stroke anxiety in stroke patients

OBJECTIVE

To explore whether poor sleep is associated with post-stroke anxiety (PSA) in Chinese patients with acute ischemic stroke (AIS) and to verify whether poor sleep is a predictor of PSA.

METHODS

A total of 327 patients with AIS were enrolled and followed up for 1 month. Sleep quality within 1 month before stroke was evaluated using the Pittsburgh Sleep Quality Index (PSQI) at admission. The patients were divided into the poor sleep group (PSQI > 7, n = 76) and good sleep group (PSQI ≤ 7, n = 251). One month after stroke, patients with obvious anxiety symptoms and a Hamilton Anxiety Scale score >7 were diagnosed with PSA.

RESULTS

Eighty-seven patients (26.6%) were diagnosed with PSA. Compared to the good sleep quality group, the incidence of PSA in patients with poor sleep quality was higher (42.1% vs. 21.9%, p = .001). Poor sleep quality is more common in patients with PSA (35.6% vs. 18.8%, p = .001). A logistic regression analysis indicated that poor sleep quality was significantly associated with PSA (OR: 2.265, 95% CI: 1.262-4.067, p = .003). After adjusting for conventional and identified risk factors, poor sleep quality was found to be independently associated with PSA (OR: 2.676, 95% CI: 1.451-4.936, p = .001).

CONCLUSIONS

Poor sleep quality before stroke was associated with PSA and may be an independent risk factor of PSA 1 month after AIS onset.

Prevalence and correlates of somatization in anxious individuals in a Chinese online crisis intervention during COVID-19 epidemic

BACKGROUND

Somatization is a common comorbidity in anxious people. From January 31 to February 2, 2020, a high prevalence of moderate to severe anxiety was detected due to COVID-19 outbreak. The purpose of this study was to investigate the prevalence and correlates of somatization among Chinese participants with anxiety receiving online crisis interventions from Feb 14 to Mar 29 during the COVID-19 epidemic.

METHODS

A total of 1134 participants who participated in online crisis interventions completed the Generalized Anxiety Disorder-7 (GAD-7) scale and the Symptom Checklist-90 (SCL-90) and demographic questions online. Somatization was defined as the average score of each item ≥ 2 in SCL-90 somatization subscale. Moderate to severe anxiety was defined as a score ≥ 10 in the GAD-7 scale.

RESULTS

Among all participants, 8.0% reported moderate to severe anxiety and 7.4% reported somatization. After March 1, the prevalence of anxiety with or without somatization did not significantly change (both p > 0.05), while the prevalence of somatization increased significantly (p < 0.01). Logistic regression analysis indicated that somatization was associated with chronic disease history (with an odds ratio of 4.80) and female gender (with an odds ratio of 0.33).

CONCLUSIONS

Our findings suggest that the history of chronic diseases is associated with somatization in individuals with anxiety, indicating some stress-related mechanisms. Chinese men in crisis intervention need more attention because they are more likely to report anxiety comorbid somatization.

Psychological distress surveillance and related impact analysis of hospital staff during the COVID-19 epidemic in Chongqing, China

BACKGROUND

Hospital staff are vulnerable and at high risk of novel coronavirus disease (COVID-19) infection. The aim of this study was to monitor the psychological distress in hospital staff and examine the relationship between the psychological distress and possible causes during the COVID-19 epidemic.

METHODS

An online survey was conducted from February 1 to February 14, 2020. Hospital staff from five national COVID-19 designated hospitals in Chongqing participated. Data collected included demographics and stress responses to COVID-19: 1) the impact of event scale to measure psychological stress reactions; 2) generalizedanxietydisorder 7 to measure anxiety symptoms; 3) Patient Health Questionnaire 9 to measure depression symptoms; 4) Yale-Brown Obsessive-Compulsive Scale to measure obsessive-compulsive symptoms (OCS); and 5) Patient Health Questionnaire 15 to measure somatization symptoms. Multiple logistic regression analysis was used to identify factors that were correlated with psychological distress.

RESULTS

Hospital staff that participated in this study were identified as either doctors or nurses. A total of 456 respondents completed the questionnaires with a response rate of 91.2%. The mean age was 30.67 ± 7.48 years (range, 17 to 64 years). Of all respondents, 29.4% were men. Of the staff surveyed, 43.2% had stress reaction syndrome. The highest prevalence of psychological distress was OCS (37.5%), followed by somatization symptoms (33.3%), anxiety symptoms (31.6%), and depression symptoms (29.6%). Univariate analyses indicated that female subjects, middle aged subjects, subjects in the low income group, and subjects working in isolation wards were prone to experience psychological distress. Multiple logistic regression analysis showed "Reluctant to work or considered resignation" (odds ratio [OR], 5.192; 95%CI, 2.396-11.250; P < .001), "Afraid to go home because of fear of infecting family" (OR, 2.099; 95%CI, 1.299-3.391; P = .002) "Uncertainty about frequent modification of infection and control procedures" (OR, 1.583; 95%CI, 1.061-2.363; P = .025), and"Social support" (OR, 1.754; 95%CI, 1.041-2.956; P = .035) were correlated with psychological reactions. "Reluctant to work or considered resignation" and "Afraid to go home because of fear of infecting family" were associated with a higher risk of symptoms of Anxiety (OR, 3.622; 95% CI, 1.882-6.973; P < .001; OR, 1.803; 95% CI, 1.069-3.039; P = .027), OCS (OR, 5.241; 95% CI, 2.545-10.793; P < .001; OR, 1.999; 95% CI, 1.217-3.282; P = .006) and somatization (OR, 5.177; 95% CI, 2.595-10.329; P < .001; OR, 1.749; 95% CI, 1.051-2.91; P = .031). "Stigmatization and rejection in neighborhood because of hospital work", "Reluctant to work or considered resignation" and "Uncertainty about frequent modification of infection and control procedures" were associated with a higher risk of symptoms of Depression(OR, 2.297; 95% CI, 1.138-4.637; P = .020; OR, 3.134; 95% CI, 1.635-6.006; P = .001; OR, 1.645; 95% CI, 1.075-2.517; P = .022).

CONCLUSIONS

Hospital staff showed different prevalence of psychological distress during the COVID-19 epidemic. Our study confirmed the severity of negative psychological distress on hospital staff and identified factors associated with negative psychological distress that can be used to provide valuable information for psychological interventions to improve the mental health of vulnerable groups during the COVID-19 epidemic.

Prevalence of and Risk Factors Associated With Mental Health Symptoms Among the General Population in China During the Coronavirus Disease 2019 Pandemic

IMPORTANCE

People exposed to coronavirus disease 2019 (COVID-19) and a series of imperative containment measures could be psychologically stressed, yet the burden of and factors associated with mental health symptoms remain unclear.

OBJECTIVE

To investigate the prevalence of and risk factors associated with mental health symptoms in the general population in China during the COVID-19 pandemic.

DESIGN, SETTING, AND PARTICIPANTS

This large-sample, cross-sectional, population-based, online survey study was conducted from February 28, 2020, to March 11, 2020. It involved all 34 province-level regions in China and included participants aged 18 years and older. Data analysis was performed from March to May 2020.

MAIN OUTCOMES AND MEASURES

The prevalence of symptoms of depression, anxiety, insomnia, and acute stress among the general population in China during the COVID-19 pandemic was evaluated using the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Insomnia Severity Index, and Acute Stress Disorder Scale. Logistic regression analyses were used to explore demographic and COVID-19-related risk factors.

RESULTS

Of 71 227 individuals who clicked on the survey link, 56 932 submitted the questionnaires, for a participation rate of 79.9%. After excluding the invalid questionnaires, 56 679 participants (mean [SD] age, 35.97 [8.22] years; 27 149 men [47.9%]) were included in the study; 39 468 respondents (69.6%) were aged 18 to 39 years. During the COVID-19 pandemic, the rates of mental health symptoms among the survey respondents were 27.9% (95% CI, 27.5%-28.2%) for depression, 31.6% (95% CI, 31.2%-32.0%) for anxiety, 29.2% (95% CI, 28.8%-29.6%) for insomnia, and 24.4% (95% CI, 24.0%-24.7%) for acute stress. Participants with confirmed or suspected COVID-19 and their family members or friends had a high risk for symptoms of depression (adjusted odds ratios [ORs], 3.27 [95% CI, 1.84-5.80] for patients; 1.53 [95% CI, 1.26-1.85] for family or friends), anxiety (adjusted ORs, 2.48 [95% CI, 1.43-4.31] for patients; 1.53 [95% CI, 1.27-1.84] for family or friends), insomnia (adjusted ORs, 3.06 [95% CI, 1.73-5.43] for patients; 1.62 [95% CI, 1.35-1.96] for family or friends), and acute stress (adjusted ORs, 3.50 [95% CI, 2.02-6.07] for patients; 1.77 [95% CI, 1.46-2.15] for family or friends). Moreover, people with occupational exposure risks and residents in Hubei province had increased odds of symptoms of depression (adjusted ORs, 1.96 [95% CI, 1.77-2.17] for occupational exposure; 1.42 [95% CI, 1.19-1.68] for Hubei residence), anxiety (adjusted ORs, 1.93 [95% CI, 1.75-2.13] for occupational exposure; 1.54 [95% CI, 1.30-1.82] for Hubei residence), insomnia (adjusted ORs, 1.60 [95% CI, 1.45-1.77] for occupational exposure; 1.20 [95% CI, 1.01-1.42] for Hubei residence), and acute stress (adjusted ORs, 1.98 [95% CI, 1.79-2.20] for occupational exposure; 1.49 [95% CI, 1.25-1.79] for Hubei residence). Both centralized quarantine (adjusted ORs, 1.33 [95% CI, 1.10-1.61] for depression; 1.46 [95% CI, 1.22-1.75] for anxiety; 1.63 [95% CI, 1.36-1.95] for insomnia; 1.46 [95% CI, 1.21-1.77] for acute stress) and home quarantine (adjusted ORs, 1.30 [95% CI, 1.25-1.36] for depression; 1.28 [95% CI, 1.23-1.34] for anxiety; 1.24 [95% CI, 1.19-1.30] for insomnia; 1.29 [95% CI, 1.24-1.35] for acute stress) were associated with the 4 negative mental health outcomes. Being at work was associated with lower risks of depression (adjusted OR, 0.85 [95% CI, 0.79-0.91]), anxiety (adjusted OR, 0.92 [95% CI, 0.86-0.99]), and insomnia (adjusted OR, 0.87 [95% CI, 0.81-0.94]).

CONCLUSIONS AND RELEVANCE

The results of this survey indicate that mental health symptoms may have been common during the COVID-19 outbreak among the general population in China, especially among infected individuals, people with suspected infection, and people who might have contact with patients with COVID-19. Some measures, such as quarantine and delays in returning to work, were also associated with mental health among the public. These findings identify populations at risk for mental health problems during the COVID-19 pandemic and may help in implementing mental health intervention policies in other countries and regions.

Case report of a patient with suspected COVID-19 with depression and fever in an epidemic stress environment

During the COVID-19 pandemic, the number of suspected cases, confirmed cases and those who passed away from the virus has been reported in major media and the internet, and has caused a high degree of tension. In addition, people’s outdoor activities have been limited, making it more difficult to find outlets for releasing stress. Under this situation, some people began to experience emotions of anxiety and depression. This article reports a case of depression with fever caused by the stress tension of the pandemic. The patient was highly suspected to have contracted COVID-19. The reported patient, who had a history of depression and had been to Wuhan to attend an exam, showed obvious pre-exam anxiety under the epidemic situation, which gradually increased the patient's pressure and then caused some adverse symptoms, such as insomnia, anxiety, sweating and a reoccurrent fever. Local community authorities paid close attention to him and later sent him to a general hospital in Jingmen for quarantine and treatment, as he was suspected of having COVID-19. After being hospitalised for half a month, he was ruled out from having ‘COVID-19’ and was cured of depression and discharged from the hospital. From this case, we can realise that, under the situation of the epidemic, people are easily prone to insomnia, anxiety and even depression. As clinicians in general hospitals, especially when encountering large emergencies, we must carefully inquire about the patient’s medical history while strengthening our understanding of psychiatric knowledge to improve the recognition rate for depression.