Psychological State Among the General Chinese Population Before and During the COVID-19 Epidemic: A Network Analysis

Abstract

Background: The infectious disease Coronavirus Disease 2019 (COVID-19) outbroke in 2019 spread to multiple countries. The quick spread of the virus and isolation strategies may trigger psychological problems. Our aim was to explore the dynamic network structure of the psychological state before and during the epidemic. Methods: A web-based survey was conducted in two stages: the T1 stage (1 January 2019 to 31 December 2019) and the T2 stage (1 February 2020 to 8 March 2020). In both stages, the Patient Health Questionnaire-9, General Anxiety Disorder-7, and Pittsburgh Sleep Quality Index were used to assess depression, anxiety, and sleep, respectively. Results: We matched the data based on IP addresses. We included 1,978, 1,547, and 2,061 individuals who completed the depression, anxiety, and sleep assessments, respectively, at both stages. During epidemics, psychomotor agitation/retardation, inability to relax, restless behavior, and the frequency of using medicine had high centrality. Meanwhile, the network structure of psychological symptoms becomes stronger than before the epidemic. Conclusion: Symptoms of psychomotor agitation/retardation, inability to relax, and restless behavior should be treated preferentially. It is necessary to provide mental health services, including timely and effective early psychological intervention. In addition, we should also pay attention to the way patients use medicines to promote sleep quality.

Keywords: COVID-19; general population; longitudinal study; network analysis; psychological state.

Figure 1

Networks of depression at T1 (A) and T2 (B). Nodes present depression symptoms and edges present partial connections between symptoms. Edge darkness and thickness present the connection strength. Edge color demonstrates the association valence (blue, positive; red, negative). C0, anhedonia; C1, depressed mood; C2, sleep disturbance; C3, low energy; C4, change in appetite; C5, worthless; C6, low concentration; C7, psychomotor agitation/retardation; C8,suicide ideation.

Figure 2

Networks of anxiety at T1 (A) and T2 (B). Nodes present anxiety symptoms and edges present partial connections between symptoms. Edge darkness and thickness present the connection strength. Edge color demonstrates the association valence (blue, positive; red, negative). B0, nervous; B1, uncontrollable worry; B2, worry about many thins; B3, unable to relax; B4, restless behavior; B5, irritability; B6,fear of events.

Figure 3

Networks of sleep symptoms at T1 (A) and T2 (B). Nodes present sleep symptoms and edges present partial connections between symptoms. Edge darkness and thickness present the connection strength. Edge color demonstrates the association valence (blue, positive, red, negative). A0, difficulty falling asleep; A1, easy wake up; A2, go to the toilet frequently; A3, cannot breathe comfortably; A4, cough or snore; A5, feel cold; A6, feel hot; A7, nightmare; A8, somatic discomfort; A9, other reasons influence you sleep; A10, the frequency of using medicine; A11, felling sleepy.

Figure 4

Expected influence of depression, anxiety, and sleep symptoms. C0, anhedonia; C1, depressed mood; C2, sleep disturbance; C3, low energy: C4, change in appetite; C5, worthless; C6, low concentration; C7, psychomotor agitation/retardation; C8, suicide ideation. B0, nervous; B1, uncontrollable worry; B2, worry about many things; B3, unable to relax; B4, restless behavior; B5, irritability; B6, fear of events A0, difficulty falling asleep; A1, easy wake up; A2, go to the toilet frequently; A3, cannot breathe comfortably; A4, cough or snore; A5, feel cold; A6, feel hot; A7, nightmare; A8, somatic discomfort; A9, other reasons influence you sleep; A10, the frequency of using medicine; A11, felling sleepy.