Peng Sun1†
Duo-jiao Fan- 1Department of Emergency Medicine, Baoding Second Hospital, Baoding, China
- 2Department of Tuberculosis, Tangshan Infectious Disease Hospital, Tangshan, China
- 3Department of Science and Education, Baoding Second Hospital, Baoding, China
- 4Department of Otolaryngology, Hospital of the Joint Logistic Support Force of the People's Liberation Army, Tangshan, China
- 5Department of Surgical Oncology, Baoding Second Hospital, Baoding, China
- 6Department of Respiratory, Dingzhou City People's Hospital, Baoding, China
Objective: This study aimed to investigate the gender difference in anxiety in novel coronavirus pneumonia (COVID-19) patients in the quarantine ward during the outbreak.
Methods: The self-rating anxiety scale (SAS) was used on the seventh day of isolation to analyze the anxiety levels of a total of 242 suspected or confirmed COVID-19 patients in the quarantine wards of two hospitals; 232 of these patients (112 males and 120 females) completed the anxiety scoring. The anxiety scores were compared between male and female patients using the t-test, and a scatter diagram was used for analysis.
Results: The SAS scores of females in quarantine wards were higher than those of males at seven days of isolation.
Conclusion: Women with COVID-19 are more prone to anxiety than men while in isolation. It is necessary to give more attention to female patients in quarantine wards in the future, and psychological counseling may be necessary.
Introduction
An outbreak of the novel coronavirus occurred in China in December 2019. China is a country with a large population, and the epidemic is a challenge for public health. A study revealed that the latent period of novel coronavirus pneumonia is 1–14 days and can be up to 24 days. This indicates that both infected and suspected patients need to be isolated for a long time. During the epidemic isolation period, the psychological anxiety of those patients in isolation for a long time may be very serious for both sexes; however, women may be less likely to tolerate excessive psychological pressure. Anxiety disorder is a neurosis characterized by paroxysmal or persistent emotional anxiety and tension. In recent years, the incidence of anxiety disorders in China has been increasing; anxiety and depression now rate highest in the total burden of diseases in China, accounting for around 20%, and seriously threatening people's health (1, 2). As a result of the COVID-19 outbreak, women are experiencing higher levels of psychological distress than men (2, 3).
The purpose of this study is to evaluate whether gender factors have an impact on the anxiety state of isolated patients, and to provide a reference for clinical practice.
Methods
The self-rating anxiety scale (SAS) (2, 3) was used on the 17th day of isolation to analyze the anxiety levels of 242 patients, 69 of which were suspected COVID-19 patients in the quarantine wards of the Infectious Diseases Department of Baoding Second Hospital and 173 were suspected or confirmed COVID-19 patients in Tangshan City Infectious Disease Hospital. The date range for the study is from January 24th to April 9th, 2019. One patient with severe infection (in Tangshan City Infectious Disease Hospital) died, and nine children were unable to complete the SAS; the remaining 232 patients (112 males and 120 females) completed the anxiety scoring at 7 days of isolation. There were 145 patients who lost follow-up when we collected the scales. In the end, 145 lost follow-up when we collected the scales, and 97 eventually completed the follow-up.
Data were statistically analyzed using statistical software SPSS17.0. All results were expressed as mean ± standard deviation (x ± SD). Intergroup comparison was conducted using the t-test. Scatter diagram was devolopped to demonstrate the relationship between gender and SAS scors. A P-value of < 0.05 was considered statistically significant.
Results
A total of 232 patients participated in the anxiety scoring, and the anxiety scores of male and female patients were compared. The 97 patients completing final follow-up included 47 males and 50 females. The mean age of male patients were 43.45 ± 16.64 years, ranging from 13 to 85 years. The mean age of female patients were 49.14 ± 17.33 years, ranging from 17 to 86 years. The results revealed that women had higher anxiety scores than men (Table 1). This suggests that women are more prone to anxiety than men during isolation. The scatter diagram (Figure 1) reflects the correlation and demonstrates that the SAS score of females were higher than those of males, indicating that women are more likely to have anxiety in quarantine wards than men.
Table 1. Influence of gender on SAS scores.
Figure 1. Impact of gender on SAS score.
Discussion
In 1992, the Institute of Medicine published a report on emerging infections, which were bringing more and more challenges to public health (3). This paper explained that people should attach great importance to the risk of infectious diseases, and it even used an “alarm” as a warning. Medical development and scientific progress during the second half of the twentieth century aimed to reverse the earlier trend of complacency toward infectious disease risk (4). In March 2003, the International Organization for Migration published an article by James M. Hughes, M.D. (the director of the National Center for Infectious Diseases, Disease Control and Prevention) that described the challenges of infectious diseases to human beings and emphasized the need for more countries to recognize and respond to the threat caused by infectious diseases. In the past few years, infectious disease pathogens have emerged at an alarming rate. Recent examples include West Nile virus, monkey smallpox, and anthrax in the United States (5–9). Currently, all over the world, the isolation of COVID-19-positive patients is widely used to prevent and deal with the epidemic. However, while many scholars have conducted a great deal of research on the prevention and treatment of the epidemic, few studies have examined the anxiety of isolated patients (10–13).
Epidemiological investigation of COVID-19 has revealed that we should direct attention to both the prevention of hospital infection and to psychological intervention as well as the prevention of mental health problems in patients, survivors, isolated people, volunteers and above (14–18). The significance of this study lies in the fact that during the epidemic isolation period, the psychological anxiety of those patients in isolation for a long time is likely to be very serious; in particular, female patients in isolation should be given more attention by medical staff in order to avoid suicide, medical injury, and other adverse events (19–22).
Because of the timeframe and the hospital level, only 97 cases were analyzed in this study, all the patients were over 18 years old; in the future, more cases will be analyzed and summarized. This study has scientific significance for the early detection and psychological intervention for anxiety in isolated patients. It provides a strong basis for the necessity of identification and treatment of the psychological anxiety of patients who are isolated, both during the COVID-19 epidemic now and for epidemics in the future.
Data Availability Statement
The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.
Ethics Statement
The studies involving human participants were reviewed and approved by Baoding Second Hospital. The patients/participants provided their written informed consent to participate in this study.
Author Contributions
PS and TH: conceptualized and designed the study, drafted the initial manuscript, and reviewed and revised the manuscript. CX, YW, S-wS, and FJ: designed the data collection instruments, collected data, carried out the initial analyses, and reviewed and revised the manuscript. D-jF: coordinated and supervised data collection and critically reviewed the manuscript for important intellectual content. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.
Conflict of Interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher's Note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
References
1. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. (2020) 395:497–506. doi: 10.1016/S0140-6736(20)30183-5
2. Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet. (2020) 395:565–74. doi: 10.1016/S0140-6736(20)30251-8
3. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. China novel coronavirus investigating and research team. a novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. (2020) 382:727–33. doi: 10.1056/NEJMoa2001017
4. Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. (2020) 395:514–23. doi: 10.1016/S0140-6736(20)30154-9
5. Phan LT, Nguyen TV, Luong QC, Nguyen TV, Nguyen HT, Le HQ, et al. Importation and human-to-human transmission of a novel coronavirus in Vietnam. N Engl J Med. (2020) 27:872–4. doi: 10.1056/NEJMc2001272
6. Rothe C, Schunk M, Sothmann P, Bretzel G, Froeschl G, Wallrauch C, et al. Transmission of 2019-nCoV infection from an asymptomatic contact in Germany. N Engl J Med. (2020) 382:970–1. doi: 10.1056/NEJMc2001468
7. Wu JT, Leung K, Leung GM. Nowcasting and forecasting the potential domestic and international spread of the 2019-nCoV outbreak originating in Wuhan, China: a modeling study. Lancet. (2020) 395:689–97. doi: 10.1016/S0140-6736(20)30260-9
8. Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med. (2020) 382:1199–207. doi: 10.1056/NEJMoa2001316
9. Holshue ML, DeBolt C, Lindquist S, Lofy KH, Wiesman J, Bruce H, et al. Washington State 2019-nCoV case investigation team. first case of 2019 novel coronavirus in the United States. N Engl J Med. (2020) 382:929–36. doi: 10.1056/NEJMoa2001191
10. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. (2020) 395:507–13. doi: 10.1016/S0140-6736(20)30211-7
11. Metlay JP, Waterer GW, Long AC, Anzueto A, Brozek J, Crothers K, et al. Diagnosis and treatment of adults with community-acquired pneumonia: an official clinical practice guideline of the American thoracic society and infectious disease Society of America. Am J Respir Crit Care Med. (2019) 200:e45–e67. doi: 10.1164/rccm.201908-1581ST
12. Zumla A, Hui DS, Perlman S. Middle east respiratory syndrome. Lancet. (2015) 386:995–1007. doi: 10.1016/S0140-6736(15)60454-8
13. Assiri A, McGeer A, Perl TM, Price CS, Al Rabeeah AA, Cummings DA, et al. KSA MERS-CoV investigation team. hospital outbreak of middle east respiratory syndrome coronavirus. N Engl J Med. (2013) 369:407–16. doi: 10.1056/NEJMoa1306742
14. Sun L. Psychological discussion and nursing of patients in isolation ward [J]. J. Contemp. Med. (2010) 17:106–7. doi: 10.3969/j.issn.1674-4721.2010.31.068
15. Zung W.W. A rating instrument for anxiety disorders. Psychosom. (1971) 12:371–9. doi: 10.1016/S0033-3182(71)71479-0
16. Congzhong L, Qiuyun V, Yan J, Huang X. Psychological characteristics and intervention of SARS patients and related groups. J Peking Univ. (2003) 3:47–50. doi: 10.19723/j.issn.1671-167x.2003.s1.019
17. Xiao J, Wu Q, Hao Y, Gao L, Sun H, Ning N, et al. Study on mental health status, influencing factors and intervention strategies of Harbin residents during SARS. China Health Econ. (2007) 03:20–3. doi: 10.3969/j.issn.1003-0743.2007.03.006
18. Lu J, Tang D. Investigation and Analysis on knowledge, psychology and behavior of avian influenza among some people in Daxing District of Beijing [J]. China Health Educ. (2004) 10:62–63. doi: 10.3969/j.issn.1002-9982.2004.10.021
19. Minodier L, Charrel RN, Ceccaldi PE, van der Werf S, Blanchon T, Hanslik T, et al. Prevalence of gastrointestinal symptoms in patients with influenza, clinical significance, and pathophysiology of human influenza viruses in faecal samples: what do we know? Virol J. (2015) 12:215. doi: 10.1186/s12985-015-0448-4
20. Guo L, Wei D, Zhang X, Wu Y, Li Q, Zhou M, et al. Clinical features predicting mortality risk in patients with viral pneumonia: the MuLBSTA score. Front Microbiol. (2019) 10:2752. doi: 10.3389/fmicb.2019.02752
21. James M. SARS:an emerging global microbial threat. Trans Am Clin Climatol Assoc. (2004) 115:361–74. Available online at: https://www.researchgate.net/publication/6735061
Keywords: novel coronavirus pneumonia, anxiety, mood, gender difference, quarantine ward
Citation: Sun P, He T, Fan D-j, Xu C, Wang Y, Song S-w, Jin F, Chen X-x and Yang M (2022) Impact of Gender Difference on Anxiety in COVID-19 Patients in Quarantine Wards. Front. Psychiatry 12:799879. doi: 10.3389/fpsyt.2021.799879
Received: 22 October 2021; Accepted: 07 December 2021;
Published: 21 January 2022.
Edited by:
Elnara Shafiyeva, Baku State University, AzerbaijanReviewed by:
Juan Moisés De La Serna, Universidad Internacional De La Rioja, SpainOguz Arkonuç, Iǧdır Üniversitesi, Turkey
Copyright © 2022 Sun, He, Fan, Xu, Wang, Song, Jin, Chen and Yang. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Duo-jiao Fan, djfandoc@163.com
†These authors have contributed equally to this work