Prevalence And Relevant Factors Of Psychiatric Symptoms Among Different Populations In Different Periods During The Remission Stage Of The COVID-19 Pandemic

Objective COVID-19,identified as an international public health emergency by the WHO,is a severe infectious desease which seriously endangers our health.Although the pandemic situation has been controlled domestically,its spreading keeps going on worldwide,causing devastating damage and life threats to not only infected patients,but also to frontier healthcare workers,convalescents as well as general population.This study was aimed to investigate the current situation of psychological status during the remission stage of COVID-19 like OCD symptoms and vicarious traumatic symptoms,providing support for scientific management of mental problems nowadays.Methods This study was implemented in 3 phases.The first phase was from July 9,2020 to July 19,2020,"Wenjuanxin" and "We Chat" apps were used to have the questionnaire entitled "Obsessive compulsive symptoms and related health evaluation for residents in the central cities of Wuhan during the post-pandemic era" distributed.Five hundred and forty one residents were included in the analysis.According to the Yale Brown Obsessive-Compulsive Symptom Scale(Y-BOCS),a score of 0-5 was considered subclinical OCD symptoms(non-p OCD),6-15 as mild,16-25 as moderate,and 26 as severe.Those with mild or above were considered as possible OCD(p OCD),and the rest were considered non-p OCD.The Social Support Rating Scale(SSRS)and Pittsburgh Sleep Scale Index-Revised(PSQI-R)were applied for assessment of levels of social support and sleep quality respectively.Binary stepwise logistic regression was used to screen the independent relevant factors of p OCD,and the odds ratio(OR value)was calculated to determine the risk.Following the first phase,volume of samples were expanded to 818 in the trial(July 9,2020-August 17,2020),while more kinds of data on lifestyle and behavioral variables were included.The samples were classified into youth and middle-aged/old people as per a cutoff point of age 45.A comparison between two age groups on epidemiological features such as p OCD,social support,and sleep status were made,and a multivariate linear regression model was established for investigation of factors independently correlated to the above variables.Based on the previous findings,a convenient sampling method was adopted in the third phase from October 26,2020 to February 4,2021,during which a questionnaire entitled "Investigation of COVID-19-related vicarious traumatic symptoms and mental health in the remissing stage of the COVID-19 pandemic" were distributed to non-schizophrenic inpatients from psychiatric department of Renmin hospital of Wuhan University.Two hundred and sixty six patients were included in the trial(excluding those with a history of COVID-19 infection),and a revised version of the Event Impact Scale(IES-R)was used to assess the impact of COVID-19 related traumatization,a score of 0-8 was considered as subclinical vacrious traumatic symptoms(VTS),9-25 as mild VTS,26-43 as moderate VTS,and 44-88 as severe VTS.Obsessive-compulsive,depression,and anxiety symptoms were respectively evaluated by Obsessive Compulsive Inventory-Revised(OCI-R),Self-Rating Depression Scale(SDS),Self-Rating Anxiety Scale(SAS).Evaluation on sleep and social support were as before,suicidal ideation and risk were conducted with Scale for Suicide Ideation(SSI),the quality of life was evaluated with the 12-Item Short-Form Health Survey(SF-12),and inpatients were divided into two groups as per IES-R with a cutoff point of 35,namely possible vicarious traumtic disorders(p VT)and non-p VT.A binary logistic regression was used to analyze the independent relevant factors of p VT,and then the variable named Average Length of Stays(ALOS)was deemed as the dependent variable,a multivariate linear regression equation was established to investigate the influencing factors of ALOS.After excluding 6 patients with incomplete blood routine data,univariate analysis was used to make a preliminary exploration on the correlation between inflammation and p VT in 260 patients.Results Phase 1: The detection rate of p OCD was quite high in the remission stage of the COVID-19 pandemic as approaching 17.93%.Those affected with obsessions alone was8.25%,with compulsions alone was 3.09%,and with both obsessions and compulsions was 88.66%;miscellaneous,aggression,and contamination were common in obsessions;miscellaneous,checking,and cleaning were common in compulsions;logistic regression suggested that single status,students,comorbidity,family history,and long sleep latency might be relevant to p OCD.Phase 2: The detection rate of p OCD in the youth group was higher than that of middle-aged and elderly people(18.57% vs.9.49%,p=0.001),so was the average Y-BOCS score(2.60±5.04 vs.1.31±3.43,p=0.000);scores of SSRS(36.49±8.13 vs.39.48±8.8,p=0.000)and PSQI-R(7.56±2.62 vs.8.28±2.86,p=0.001)were lower in youth than in middle-aged and elderly;factors independently relevant to Y-BOCS in youth included history of OCD,family history,static hours on weekend,daily hours focused on COVID-19 news,and sleeping hours during weekday.Independent relevant factors of Y-BOCS in the middle-aged and elderly people were history of COVID-19 infection and history of OCD.Phase 3: The detection rates of mild,moderate,and severe VTS were respectively 40.98%,25.56%,and 14.29%,adding up to 80.83%;the detection rate of p VT was 27.07%;almost all inpatients with VTS(93.49%)had a combination of symptoms of avoidance,intrusion,and hypervigilance.Regression analysis showed that having acquaintances infected with or died from COVID-19,worrying about the re-outbreak,high OCI-R scores,low SF-12 scores,and long duration of VTS were relevant factors of p VT;moderate and severe VTS patients had longer ALOS,linear regression results showed OCI-R score and unemployed status positively affect the ALOS,while SSI suicide ideation negatively affected the ALOS.Compared with the non-p VT group,the WBC count,Neu count,PLR,and NLR ratios of patients in the p VT group had increasing tendencies.Conclusion Three months after the lockdown was lifted in Wuhan,the detection rate of possible OCD in the general population in the urban areas is still high,and significantly higher in the young population compared with the older.History of OCD,family history of mental illness,sleep duration,static behavior,excessive attention to COVID-19 news,marital status,COVID-19 infection,acquaintance infection and whatnot were factors relevant to the possible OCD of different groups of people;one year after the outbreak,the inpatients in the psychiatric wards were still severely impacted by the stress from COVID-19.With acquaintances diagnosed with or died from COVID-19,fear of the re-outbreak of COVID-19 in a large scale,severe obsessive-compulsive symptoms,low quality of life,and long incubation period of traumatic symptoms are relevant factors for p VT,and changes in the level of inflammation might exist in p VT patients.The remission stage is not a guarantee for safety yet.More screening would help in identification of risk groups,prompt intervene,and reduction of adverse events.