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The psychological impact of the COVID-19 outbreak among the fever patients in the lockdown zone
BMC Psychology volume 11, Article number: 69 (2023)
COVID-19 pandemic is still ongoing, which not only impact physical health but psychological health. This research aims to analyze the psychological impact of residents with a fever (> 37 °C) during the COVID-19 outbreak in one community.
There were 105 participants surveyed online from 7th March to 21st March 2022. Collected the data included the socio-demographics, health status, COVID-19 knowledge and concerns and the Impact of Events Scale-Revised (IES-R) ratings.
Among those participants, the IES-R mean score was 24.11 (SD = 6.12), and 30.48% of respondents reported a moderate to the severe psychological impact. Female gender; youth age; single status; other specific symptoms; concerns about family members, and discrimination were significantly associated with the greater psychological impact of the COVID-19 event (p < 0.05).
In the lockdown zone, about one-third of the residents have an obvious psychological impact after fever. The factors identified can be used to make effective psychological support strategies in the early stages of the COVID-19 outbreak.
The COVID-19 pandemic is still ongoing which caused a serious impact on individuals globally at any age, and ethnicity . This infectious disease has led to a high mortality rate and morbidity around the world [2, 3]. It not only affects physical health but has a negative impact on psychological health like increasing the rates of anxiety, and depression [4, 5]. The fear of sickness or infection with the new coronavirus, helplessness, and anxiety due to isolation also lead to the spread of public mental health and psychological crises which meaning symptoms related to discomfort and distress or worse, such as anxiety or panic attacks .
Fever is one of the most common symptoms in COVID-19 patients which have been aroused the great attention of the public. Now in China, the government has established lots of specialized fever clinics to screen COVID-19 patients. So patients with fever will be given lots of attention and they will experience more surveys like the history of the epidemic, nucleic acid screening or isolated observation. Those in quarantine might experience boredom, loneliness, and anger .
The community is the main activity area for residents, which would be divided into lockdown zones if one COVID-19 case was found, then it would cause outbreak events. So the requirements for health management are more strict in the community. Once there is a patient with a fever, he/she as a key healthcare object will be isolated alone. During the quarantine, such patients will bear psychological pressure, which will affect the treatment effect but also cause certain psychological pressure on the patient’s family. For this reason, we conducted the present research with the aim of analyzing the psychological impact among fever patients in the lockdown zone and identifying risk factors contributing to the psychological crisis.
Study design, setting and participants
The present study was performed from 7th March 2022 to 21st March 2022, All the patients in one community which was divided into lockdown zone in China during the outbreak of COVID-19, and cross-sectional analysis in The Armed Police Forces Hospital of Shandong and First Affiliated Hospital, School of Medicine, Shihezi University. There were 105 residents who had a high temperature (> 37 °C) were selected as the objects. Before participation, experimental procedures were explained to all the participants, who gave their voluntary written informed consent. The entire research procedure was conducted online. None of the participants had previous or recent experience in these processes.
The survey included information on socio-demographics, personal symptoms, knowledge and concerns about COVID-19, and the Impact of Events Scale-Revised (IES-R) instrument [8, 9]. The Impact of Event Scale-Revised (IES-R) has 22 items. This 22-item scale is factorized of three dimensions, namely: intrusion with eight items; avoidance with eight items; and hyperarousal with six items. The IES-R is designed with five Item Response Anchors rated from 0 to 4, where 0 indicates not at all; 1 = a little bit; 2 = moderately; 3 = quite a bit; and 4 = extremely. Subsequently, scores on the 22-item IES-R range from 0 to 88. Higher scores are interpreted as having more severe impact.
The statistical analysis was conducted using SPSS version 21.0 for Windows (SPSS Inc., Chicago, IL, USA). Frequency and percentage were applied to describe variables. The scores of IES-R were expressed as mean and standard deviation (SD). Association analysis using chi-square test. p value < 0.05 was considered statistically significant. We used the logistic regression models to analyse which were the influence factors for the psychological reaction. For the logistic regression models, the total score of the scale was treated as a dichotomous categoric variable accounting for either normal and mild psychological impact (score below the cutoff, i.e., IES-R < 33) or severe psychological impact (score equal or higher of the cut-off, i.e., IES-R > 33) .
The baseline characteristics of participants were presented in Table 1. And 105 participants were enrolled in the present study, among the enrolled patients, 62 (59.04%) patients were male and 43 (40.96%) patients were female, well-educated (12.38%, at least a bachelor’s degree), single status (36.19%) and members of the household size of 3–4 people (44.76%). The mean age of respondents was 24 years (SD, 2. years).
The psychological impact was measured using the IES-R scale, which revealed a sample mean score of 24.11 (SD, 6.12). Of all respondents, there were 23 (21.90%) reported minimal psychological impact (score: 0–23); 50 (47.62%) rated mild psychological impact (score: 24–32); and 32 (30.48%) reported a moderate to severe psychological impact (score: > 33). The male respondents had significantly lower scores in IES-R (p < 0.05) compared to females. The patients in the young age group (< 20 years) and the single group had significantly high IES-R scores (p < 0.05). The non-healthcare professionals had significantly higher IES-R scores (p = 0.023) than healthcare professionals. Respondents who had a higher level of education (Bachelor’s) had significantly lower IES-R scores (p = 0.026). Respondents who were not local residents had higher IES-R scores (p < 0.05).
The Physical health status and association with psychological impact are in Table 2. There were 20.96% of the respondents had a fever at least 3 days within the 1 week before the survey with higher IES-R scores (p = 0.022) and 37.14% had a high fever with a body temperature over 38 °C, and there were other respondents reported headache (71.43%), cough (56.19%), breathing difficulty (45.71%), sore throat (65.71%), recent testing for COVID-19 in the past 7 days (90.48%) These symptoms were significantly associated with higher scores for IES (p < 0.05).
Concerns about COVID-19 and its association with psychological impact in Table 3. Most respondents (90.48%) knew that the routes of transmission of the virus COVID-19 were airborne, respectively. Information was mainly sourced from social media and the internet by 71.43% of the respondents. The proportion of respondents who had confidence in their own doctors’ ability to recognize COVID-19 was 83.81%. About 46.61% of participants felt they will likely infect with COVID-19 during the outbreak if they had a fever. The proportion of respondents who felt discriminated by other people was 24.76%.
We found there was an interesting phenomenon that the high satisfaction with the amount of health information available about COVID-19 was associated with low IES-R scores (p < 0.001). Very confidence in a doctor’s ability to diagnose or recognize COVID-19 was associated with low IES-R scores (p = 0.003).
Logistic regression analyses for psychological impact at least of moderate level in Table 4. We performed logistic regression analyses to analyse the factors that cause patients to be more prone to the psychological stress response. The patients with age lowed 20 years, female sex and who was not healthcare professional was more suffered a moderate level of psychological impact (p < 0.05).
Fever is the typical symptom of COVID-19 patients, and it had aroused great concern for the government in China. The community will be divided into the lockdown zone if there appeared COVID-19 patients, which will get stricter management . The residents in the lockdown zone would be more inclined to anxiety than other communities and face more stress if they had at least one symptom compared to the COVID-19 patients . This survey was conducted in the first month when COVID-19 was broken out, and enhanced community quarantine was implemented in one community in China in 2022. In this research, we surveyed a total of 105 residents who had a fever (> 37 °C) but had not been diagnosed with COVID-19. There were 30.48% of the respondents reported moderate to a severe psychophysiological stress response. Since the high mortality rate and disability rate during COVID-19, the prevalence of severe psychophysiological stress response is still increasing with the increasing trend of confirmed cases in many studies [12, 13]. In the present study, we noticed that this level was higher than in the other studies, indicating the effect on psychology among patients with fever was more obvious than among general people. We found females were more affected than males. Younger, less educated, single people, not local residents reported a more obvious psychological impact. These subgroups, considered at higher risk for developing adverse psychological outcomes, may get low social and emotional support once they were isolated, which will increase the chance of feelings of fear, and isolation .
The respondents with higher temperatures or longer fevers lasting were more tend to have stress on psychology. The longer the symptoms last, the longer quarantine periods will be demanded, which means the respondents would arouse more attention and cause greater psychological stress . The respondents with cough, headache, breathing difficulty, and sore throat, which were more affected by psychological health according to reports from China and the Philippines [16, 17]. Those common phenomena were more obvious in COVID-19 patients, so the respondents would be more fearful and anxious about the COVID-19 event . Many patients with those symptoms would suspect that they had been infected with a novel coronavirus that will make a heavy burden on their psychology. Besides that, with more symptoms, they would get more attention no matter from their family or the medical worker. That will make a deep imply that they had more possibility to be a COVID-19 patient.
The fever respondents with a positive view of COVID-19 would be more possible to assess their health correctly and be more confident that they would not be the COVID-19 patient. More knowledge about COVID-19 will help the respondents take effective measures to protect themself and lowdown the risk of being a COVID-19 patient [19, 20]. Others lacked the knowledge and cannot rightly analyse their health status once they heard there was someone who got COVID-19 which will heighten their suspicion of others and make them more anxious about the external environment [21, 22]. Most respondents were confident in their doctors’ abilities. The confidence seemed to be protective against negative mental health states and lower levels of stress. The respondents maybe also were affected by the others' health. In this research, there were 78.14% of respondents felt worried when other family members got COVID-19. During the pandemic, the individual would pay more attention to the report about the COVID-19 event, especially the residents in quarantine . Once there was one report about there increased new COVID-19 cases in the quarantine, the respondents would improve their vigilance giving them great mental stress like changing their sleeping and normal eating habits . Some negative information about COVID-19 would also cause deeper harmful effects for the residents of quarantine, like the Increasing incidence of depression and suicide [25, 26]. The respondents who felt discriminated against by others will be more likely to cause psychological stress than others, which would make a harmful effect on their health and increase the incidence of other diseases like depression and bipolar disorder .
In the lockdown zones, the residents were restricted to a small area which is stressful as it prevents face-to-face connections and traditional social interactions . For the fever patient who would be subjected to further quarantine, might be more fears of the infection spreading among family members, frustration and boredom from being isolated .
The present study showed that females and younger age reported psychological impact during the pandemic. This is in line with a review and meta-analysis by Serrano-Ripoll et al. , which identified female sex, younger age, lack of support, stigma and occupational parameters as risk factors for mental health deterioration during epidemic outbreaks. One of the few China studies conducted in Hubei also found that females reported more severe symptoms of depression, anxiety, and distress . A possible explanation for this may be provided by the fact among the nurses most of them were female, they had direct and longer contact with patients, except that the female would face more duties including work or family.
Another finding of the present was that healthcare professionals exhibited low IES-R scores which were different from the studies in Italy and Spain. Giusti E.M. found that front-line healthcare workers had a higher risk of symptoms of depression . This difference may be attributed to the fact that in this Italian study, the majority of participants were employed in COVID-19 units and thus directly confronted with the COVID-19 disease. In this study, the healthcare professionals were quarantined at home after they had a fever, and they could assess their health more properly than the other patients.
The present study has several strengths. First, it is the first time the association between psychological impact and normal fever people was discovered during the COVID-19 epidemic, Second, the demographic in normal fever patients was documented, which conveyed valuable information on following studies to screen new risk factors for psychological impact in special era. Thirdly, this study is a cross-sectional study with community as the unit and has good representativeness. Our study has several limitations. First, the survey was done online and lacked effective guidance. Some respondents may not answer the questionnaire truly and accurately. Second, the survey was implemented in the early stage of the COVID-19 event and the respondents may change their psychological outcomes throughout the public health crisis.
During the early phase of the COVID-19 outbreak in the lockdown zone, one-third of the respondents reported a moderate-to-severe psychological impact of the outbreak. Female gender, youth age of 12–20 years, single status, lower level of education, not a local resident, presence of specific physical symptoms (i.e., headache, cough), dissatisfied with the health information about COVID-19, worry about family members getting COVID-19, being discriminated by others This study will be used to make appropriate measures psychological to avert the occurrence of mental health problems preventing psychological crisis on the early stage during the outbreak of COVD-19.
Availability of data and materials
The data sets generated and/or analysed during the current study are not publicly available due to the necessity to ensure participant confidentiality policies and laws of the country but are available from the corresponding author upon reasonable request.
Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020;395(10227):912–20.
Alwani M, Yassin A, Al-Zoubi RM, Aboumarzouk OM, Nettleship J, Kelly D, et al. Sex-based differences in severity and mortality in COVID-19. Rev Med Virol. 2021;31(6):e2223.
Chung JY, Thone MN, Kwon YJ. COVID-19 vaccines: the status and perspectives in delivery points of view. Adv Drug Deliv Rev. 2021;170:1–25.
Jones EAK, Mitra AK, Bhuiyan AR. Impact of COVID-19 on mental health in adolescents: a systematic review. Int J Environ Res Public Health. 2021;18(5):2470.
Kar SK, Menon V, Yasir Arafat SM, Kabir R. Research in mental health during the COVID-19 pandemic: quality versus quantity. Sultan Qaboos Univ Med J. 2020;20(4):e406–7.
Dubey S, Biswas P, Ghosh R, Chatterjee S, Dubey MJ, Chatterjee S. Psychosocial impact of COVID-19. Diabetes Metab Syndr. 2020;14(5):779–88.
Xiang YT, Yang Y, Li W, Zhang L, Zhang Q, Cheung T, et al. Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. Lancet Psychiatry. 2020;7(3):228–9.
Watson D, Clark LA, Tellegen A. Development and validation of brief measures of positive and negative affect: the PANAS scales. J Pers Soc Psychol. 1988;54(6):1063–70.
Creamer M, Bell R, Failla S. Psychometric properties of the impact of event scale—revised. Behav Res Ther. 2003;41(12):1489–96.
Yee A, Hodori NM, Tung YZ, Ooi PL, Latif SABA, Isa HM, et al. Depression level and coping responses toward the movement control order and its impact on quality of life in the Malaysian community during the COVID-19 pandemic: a web-based cross-sectional study. Ann Gen Psychiatry. 2021;20(1):31.
Perrin P, McCabe OL, Everly GS Jr, Links JM. Preparing for an influenza pandemic: mental health considerations. Prehosp Disaster Med. 2009;24(3):223–30.
Salari N, Hosseinian-Far A, Jalali R, Vaisi-Raygani A, Rasoulpoor S, Mohammadi M, et al. Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: a systematic review and meta-analysis. Glob Health. 2020;16(1):57.
Wang C, Pan R, Wan X, Tan Y, Xu L, Ho CS, et al. Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. Int J Environ Res Public Health. 2020;17(5):1729.
Wang C, Pan R, Wan X, Tan Y, Xu L, McIntyre RS, et al. A longitudinal study on the mental health of general population during the COVID-19 epidemic in China. Brain Behav Immun. 2020;87:40–8.
Zheng R, Zhou Y, Qiu M, Yan Y, Yue J, Yu L, et al. Prevalence and associated factors of depression, anxiety, and stress among Hubei pediatric nurses during COVID-19 pandemic. Compr Psychiatry. 2021;104:152217.
Tee ML, Tee CA, Anlacan JP, Aligam KJG, Reyes PWC, Kuruchittham V, et al. Psychological impact of COVID-19 pandemic in the Philippines. J Affect Disord. 2020;1(277):379–91.
Dong M, Zheng J. Letter to the editor: headline stress disorder caused by Netnews during the outbreak of CoViD-19. Health Expect. 2020;23:259–60.
McElfish PA, Willis DE, Shah SK, Bryant-Moore K, Rojo MO, Selig JP. Sociodemographic determinants of COVID-19 vaccine hesitancy, fear of infection, and protection self-efficacy. J Prim Care Community Health. 2021;12:215.
Habib MA, Dayyab FM, Iliyasu G, Habib AG. Knowledge, attitude and practice survey of COVID-19 pandemic in Northern Nigeria. PLoS ONE. 2021;16(1):e0245176.
Nwagbara UI, Osual EC, Chireshe R, Bolarinwa OA, Saeed BQ, Khuzwayo N, et al. Knowledge, attitude, perception, and preventative practices towards COVID-19 in sub-Saharan Africa: a scoping review. PLoS ONE. 2021;16(4):e0249853.
Hiremath P, Suhas Kowshik CS, Manjunath M, Shettar M. COVID 19: impact of lock-down on mental health and tips to overcome. Asian J Psychiatry. 2020. https://0-doi-org.brum.beds.ac.uk/10.1016/j.ajp.2020.102088.
Kang L, Li Y, Hu S, Chen M, Yang C, Yang BX, et al. The mental health of medical workers in Wuhan, China dealing with the 2019 novel coronavirus. Lancet Psychiatry. 2020;7(3):e14.
Mamun MA, Griffiths MD. First COVID-19 suicide case in Bangladesh due to fear of COVID-19 and xenophobia: possible suicide prevention strategies. Asian J Psychiatr. 2020;51:102073.
Di Renzo L, Gualtieri P, Pivari F, Soldati L, Attinà A, Cinelli G, et al. Eating habits and lifestyle changes during COVID-19 lockdown: an Italian survey. J Transl Med. 2020;18(1):229.
Sher L. The impact of the COVID-19 pandemic on suicide rates. QJM Int J Med. 2020. https://0-doi-org.brum.beds.ac.uk/10.1093/qjmed/hcaa202.
Sepúlveda-Loyola W, Rodríguez-Sánchez I, Pérez-Rodríguez P, Ganz F, Torralba R, Oliveira DV, et al. Impact of social isolation due to COVID-19 on health in older people: mental and physical effects and recommendations. J Nutr Health Aging. 2020;24(9):938–47.
Wang Q, Xu R, Volkow ND. Increased risk of COVID-19 infection and mortality in people with mental disorders: analysis from electronic health records in the United States. World Psychiatry. 2021;20(1):124–30.
Zhang J, Wu W, Zhao X, Zhang W. Recommended psychological crisis intervention response to the 2019 novel coronavirus pneumonia outbreak in China: a model of West China Hospital. Precis Clin Med. 2020;3(1):3–8.
Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020;395:912–20.
Serrano-Ripoll MJ, Meneses-Echavez JF, Ricci-Cabello I, et al. Impact of viral epidemic outbreaks on mental health of healthcare workers: a rapid systematic review and meta-analysis. J Affect Disord. 2020;1(277):347–57.
Lai J, Ma S, Wang Y, Cai Z, Hu J, Wei N, et al. Factors associated with mental health outcomes among health care workers exposed to coronavirus disease 2019. JAMA Netw Open. 2020;3(3):e203976.
Giusti EM, Pedroli E, D’Aniello GE, Stramba Badiale C, Pietrabissa G, Manna C. The psychological impact of the COVID-19 outbreak on health professionals: a cross-sectional study. Front Psychol. 2020;11:1684.
Ethics approval and consent to participate
This study has got the ethical approval and consent to participate from Jinan Central Hospital Affiliated with Shandong University ethical review committee. Written informed consent was obtained from all participants and/or their legal guardians. All participants gave their voluntary written informed consent in accordance with the Declaration of Helsinki. Informed consent was obtained from all the participants at the beginning of the online survey link. All methods were carried out in accordance with relevant guidelines and regulations.
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Chen, Y., Ma, Q., Xie, X. et al. The psychological impact of the COVID-19 outbreak among the fever patients in the lockdown zone. BMC Psychol 11, 69 (2023). https://0-doi-org.brum.beds.ac.uk/10.1186/s40359-023-01113-6
- Psychological impact
- Fever patients