Anxiety among Health Care Professionals during COVID-19 in Anhui, China A Cross-Sectional study

  • Author / Creator
    Sullivan, Holly
  • Background

    The World Health Organization has identified the psychological health of those providing care for COVID-19 patients as a research priority. Anxiety is a precursor to other psychosocial health issues such as depression, substance use, and burnout. In health care professionals (HCPs), burnout is associated with personal suffering, decreased quality of patient care, and increased attrition rates, which affect the ability of health care systems to work to their full capacity. The objective of this study was to assess the prevalence and predictors of anxiety among HCPs during the COVID-19 pandemic in Anhui province, China.


    The study design was cross-sectional. Participants were recruited using convenience sampling and data was collected through an online survey. The primary exposure of interest was working directly with patients during COVID-19 in Anhui. The outcomes were state anxiety (S-Anxiety), measured using the State-Trait Anxiety Inventory for Adults (STAI); and generalized anxiety disorder (GAD), measured using a Generalized Anxiety Disorder 7-Item (GAD-7) Scale summary score ≥10. The summary score is the total of all the response scores added together. Summary scores were used to assess anxiety symptoms reported in both the STAI and the GAD-7. Univariate and multiple linear (STAI) and logistic (GAD) regression models were used to examine the relationship between each outcome and several other potential predictors.


    A total of 1657 participants completed the survey, 1521 (92.6%) HCPs, 121 (7.4%) non-HCPs, and 15 (0.9%) participants’ professions were unknown due to errors. The mean age of participants was 38.5 (SD 8.9) years. Females comprised 72.2% (n=1196) of the sample population. The main professional fields of practice in health care were clinical medicine (n=639; 38.7%), nursing (n=558; 33.8%), and public health (n=454; 27.5%). Practice qualifications included medical doctor (MD) (n=787; 47.9%), registered nurse (RN) (n=572; 34.8%), and “Other” allied HCPs and non-HCPs (n=283; 17.2%). The majority of the participants were HCPs with direct patient contact (n=1129; 68.8%), approximately a quarter were HCPs with no direct patient contact (n=392; 23.9%), and a small number were not HCPs (n=121; 7.4%). A small proportion were involved in the direct medical response to COVID-19, including treatment and nursing (n=213; 12.9%). The median years worked was 15 (IQR 7, 25).
    The prevalence of GAD was 12.1% in HCPs with direct patient contact compared to 7.4% in HCPs with no direct patient contact and 7.4% in non-HCPs. The mean STAI score (range 20-80) was 42.2 (SD 9.6) in HCPs with direct patient contact, 39.6 (SD 9.1) in HCPs with no direct patient contact, and 39.3 (SD 10.2) in non-HCPs. 
    The mean STAI scores of HCPs with no direct patient contact (β=-0.77, 95% CI -2.18 to 0.63, p=0.280) and non-HCPs (β=-1.92, 95% CI -4.67 to 0.83, p=0.172) were decreased compared to HCPs with direct patient contact, although the finding lacked statistical significance. 
    Risk factors for state anxiety included working as a nurse (β=2.08, 95% CI 0.74 to 3.43, p=0.002) compared to working as a medical doctor. Working in tertiary hospitals also carries a higher risk for state anxiety compared to working in primary hospitals/township health centres (β=-3.20, 95% CI -4.68 to -1.72, p<0.001), neighbourhood community health clinics (β=-3.08, 95% CI -5.60 to -0.56, p=0.017), other health services agencies (β=-2.37, 95% CI -3.87 to -0.86, p=0.002), or non-health care organizations (β=-3.59, 95% CI -6.96 to -0.22, p=0.037).
    Risk factors for GAD included working as a HCP with direct patient contact compared to non-HCPs (OR=0.35, 95% CI 0.13 to 0.90, p=0.030). Working in secondary hospitals also carries a higher risk for GAD (OR=1.75, 95% CI 1.14 to 2.67, p=0.010) compared to working in tertiary hospitals. Lastly, holding an administrative position in hospitals or health care institutions was a risk factor for GAD (OR=1.98, 95% CI 1.08 to 3.61, p=0.026) compared to not holding an administrative position. Increased age was associated with a reduced risk of state anxiety (β=-0.18, 95% CI -0.25 to -0.12, p<0.001) and GAD (OR=0.97, 95% CI 0.95 to 0.99, p=0.001).


    Health care professionals in Anhui province of China are at increased risk of anxiety and would likely benefit from the development and provision of interventions that support their mental health during times of crisis such as the COVID-19 pandemic.

  • Subjects / Keywords
  • Graduation date
    Fall 2021
  • Type of Item
  • Degree
    Master of Science
  • DOI
  • License
    This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.