Risk Management and Healthcare Policy Dovepress open access to scientific and medical research Open Access Full Text Article ORIGINAL RESEARCH The Psychological Impact and Associated Factors of COVID-19 on the General Public in Hunan, China This article was published in the following Dove Press journal: Risk Management and Healthcare Policy Chunhong Shi, 1 Zhihua Purpose: This study aimed to assess the psychological impact of the COVID-19 pandemic Guo,2 Chan Luo,3 Changbin among the general public in Hunan Province, China, which could help develop psychological Lei, 4 Pan Li1 interventions and mental health programs. This online cross-sectional study recruited 571 participants 1School of Nursing, Xiangnan University, Participants and Methods: Chenzhou 423000, People’s Republic of through snowball sampling between February 2 and February 5, 2020. Data were collected through 2 China; Nursing Department, Changsha a general information questionnaire, the Public Emergency Psychological State Questionnaire, the Health Vocational College, Changsha 410100, People’s Republic of China; 3Nursing Simple Coping Style Questionnaire, and the Public Disease Awareness on COVID-19 Scale. Department, The First AffiliatedHospital of Results: The total mean score of the public emergency psychological state of the sample University of South China, Hengyang 421001, was 0.27 (0.31) points, with only 5.78% of participants (n = 33) developing psychological People’s Republic of China; 4Clinical Medicine Research Center, AffiliatedHospital of distress. Avoidant coping style and disease awareness were weakly positively correlated (rs = Xiangnan University, Chenzhou 423000, 0.257, p < 0.01) and weakly negatively correlated (rs = −0.124, p <0.01) with psychological People’s Republic of China responses, respectively. There were significant psychological differences among the follow­ ing variables: occupation, symptoms of fever or fatigue, discernment of the authenticity of Video abstract COVID-19 information, and level of concern regarding COVID-19 (p < 0.05). Conclusion: The COVID-19 pandemic appears to have had a minor psychological impact on the general population in Hunan Province. However, psychological health promotion in the general public is still required, especially for employees (such as company employees, migrant workers, and businessmen), individuals with COVID-19-like symptoms, limited discernment competence and unconcerned attitudes. Implications: The initiatives for improving psychological health among the general public could focus on delivering COVID-19 knowledge and alleviating avoidant coping styles. Our findings could provide important insight for the development of psychological support strategies in China, as well as in other places affected by the epidemic. Keywords: coping style, coronavirus disease 2019, disease awareness, psychological health, Point your SmartPhone at the code above. If you have a QR public health emergency code reader the video abstract will appear. Or use: https://youtu.be/KxrNDv4m4vo Introduction Correspondence: Changbin Lei As an international public health emergency, the coronavirus disease 2019 (COVID- Clinical Medicine Research Center, Affiliated Hospital of Xiangnan University, No. 25 Renmin 19) has gained widespread attention from the public. Owing to COVID-19’s high West Road, Beihu District, Chenzhou, 423000 infectivity and mortality rate (3–4%),1 China initiated its first-level public health Hunan, People’s Republic of China 2 Tel +86 13762563779 emergency response on January 25, 2020. The Chinese government and health Fax +86-735-2223633 Email [email protected] authorities strived to slow the virus’ spread by adopting a series of preventive measures, such as strict quarantining, contact tracing, and social distancing.3 In Pan Li School of Nursing, Xiangnan University, 889 addition to the health-related and socio-economic concerns associated with COVID- Chenzhou Avenue, Suxian District, Chenzhou, 423000 Hunan, People’s Republic of China 19, the psychological impact of the disease has also attracted considerable attention. In Tel +86 17773560292 March, the World Health Organization4 released mental health guidelines to support Fax +86-735-2325007 Email [email protected] the psychosocial and mental well-being of the general population. submit your manuscript | www.dovepress.com Risk Management and Healthcare Policy 2020:13 3187–3199 3187 DovePress © 2020 Shi et al. This work is published and licensed by Dove Medical Press Limited. 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Shi et al Dovepress Background protective behaviors and improve environmental adaptability 18,19 With the virus’ exponential diffusion and the related large- by developing a warning system, long-term or intense scale quarantine policies enacted by most governments, stress causes psychological impairment and physical disease. a wide range of psychological disorders, including panic, This phenomenon has been explained through a stress sys­ fear, anxiety, depression, and frustration, gradually emerged. tem model, which suggests that adverse life events (stressors) To date, various studies have reported the psychological can directly lead to individual stress responses or indirectly impact of the COVID-19 pandemic on different populations. affect an individual’s physical and mental health through their For example, patients with COVID-19 have been reported to coping style, social support, personality traits, and 20 not only experience several physical symptoms but also awareness. Figure 1 shows the stress system model. diverse psychological effects.5 Similarly, healthcare provi­ Coping style refers to individuals’ cognitive and ders, especially nurses and physicians caring for COVID-19 behavioral efforts to maintain mental balance in stressful 21 patients, experience considerable psychological distress situations. Previous studies demonstrated that coping associated with fear of infection.6 The general population is style functions as a mediator between stress and psycho­ 22 simultaneously affected by COVID-19 infection as well as logical health. Adopting appropriate coping strategies social distancing measures. Qiu et al7 found that 5.14% of the against stressful situations is positively linked to quality 23 Chinese public experienced severe mental distress. Another of life. Additionally, the role of coping strategies in Chinese online study by Wang et al8 showed that 16.5% of medical settings has been well-documented. For exam­ the general population had moderate to severe depressive ple, task-based coping strategies appear to prevent the symptoms and 28.8% suffered from moderate to severe onset of depressive symptoms24 and help reduce the anxiety symptoms. As the virus spreads globally, studies on severity of hypertension.25 Disease awareness (which the psychological impact of the COVID-19 pandemic have refers to the self-evaluation of knowledge about disease proliferated among different nations.9,10 For instance, an transmission, common symptoms, potential treatment, Australian nationwide survey found that the mental problems and risk factors associated with the disease)26 is critical of residents during the pandemic were at least twice as high to control and prevent COVID-19. Further, having as those prior to the pandemic.11 Italian series of studies have knowledge about a specific disease can influence indivi­ reported that the COVID-19 pandemic was an important duals’ perception and behavior towards it.27 Earlier stu­ stressor comparable to a traumatic event.12–14 dies have shown that a higher level of COVID-19 Stress is a physiological, psychological, and behavioral knowledge is beneficial for the public to maintain an process that occurs in individuals as a response to environ­ optimistic attitude and maintain appropriate preventive mental stimuli.15 Previous studies have demonstrated that measures and care-seeking behaviors.28 In addition, stress causes various mental health problems.16,17 Although research during the SARS outbreak suggests that the moderate pressure is beneficial to stimulate individual public’s knowledge was associated with a reduction in Figure 1 Adaptation of the theoretical framework of the stress system model. 3188 submit your manuscript | www.dovepress.com Risk Management and Healthcare Policy 2020:13 DovePress Dovepress Shi et al symptoms of anxiety, fear and panic.29 Limited disease calculation method, the sample size should be 5–10 times knowledge may aggravate psychological distress and the number of items in the questionnaire.31 Therefore, emotional responses.30 Therefore, coping styles and dis­ considering three scales comprising 54 items, a sample ease awareness play a significant role in handling the size of 270–540 was required for this study. Assuming psychological stress associated with the COVID-19 a 20% dropout rate, the study needed a sample size of pandemic. 324–648 participants. Finally, 571 valid questionnaires There is already extensive