Previous surveys on the psychological impacts of SARS and influenza outbreaks were reviewed [18 (link),21 (link),24 ]. Authors included additional questions related to the COVID-19 outbreak. The structured questionnaire consisted of questions that covered several areas: (1) demographic data; (2) physical symptoms in the past 14 days; (3) contact history with COVID-19 in the past 14 days; (4) knowledge and concerns about COVID-19; (5) precautionary measures against COVID-19 in the past 14 days; (6) additional information required with respect to COVID-19; (7) the psychological impact of the COVID-19 outbreak; and (8) mental health status.
Sociodemographic data were collected on gender, age, education, residential location in the past 14 days, marital status, employment status, monthly income, parental status, and household size. Physical symptom variables in the past 14 days included fever, chills, headache, myalgia, cough, difficulty in breathing, dizziness, coryza, sore throat, and persistent fever, as well as persistent fever and cough or difficulty breathing. Respondents were asked to rate their physical health status and state any history of chronic medical illness. Health service utilization variables in the past 14 days included consultation with a doctor in the clinic, admission to the hospital, being quarantined by a health authority, and being tested for COVID-19. Contact history variables included close contact with an individual with confirmed COVID-19, indirect contact with an individual with confirmed COVID-19, and contact with an individual with suspected COVID-19 or infected materials.
Knowledge about COVID-19 variables included knowledge about the routes of transmission, level of confidence in diagnosis, level of satisfaction of health information about COVID-19, the trend of new cases and death, and potential treatment for COVID-19 infection. Respondents were asked to indicate their source of information. The actual number of confirmed cases of COVID-19 and deaths in the city on the day of the survey were collected. Concern about COVID-19 variables included self and other family members contracting COVID-19 and the chance of surviving if infected.
Precautionary measures against COVID-19 variables included avoidance of sharing of utensils (e.g., chopsticks) during meals, covering mouth when coughing and sneezing, washing hands with soap, washing hands immediately after coughing, sneezing, or rubbing the nose, washing hands after touching contaminated objects, and wearing a mask regardless of the presence or absence of symptoms. The respondents were asked the average number of hours staying at home per day to avoid COVID-19. Respondents were also asked whether they felt too much -unnecessary worry had been made about the COVID-19 epidemic. Additional health information about COVID-19 needed by respondents included more information about symptoms after contraction of COVID-19, routes of transmission, treatment, prevention of the spread of COVID-19, local outbreaks, travel advice, and other measures imposed by other countries.
The psychological impact of COVID-19 was measured using the Impact of Event Scale-Revised (IES-R). The IES-R is a self-administered questionnaire that has been well-validated in the Chinese population for determining the extent of psychological impact after exposure to a public health crisis within one week of exposure [25 (link)]. This 22-item questionnaire is composed of three subscales and aims to measure the mean avoidance, intrusion, and hyperarousal [26 (link)]. The total IES-R score was divided into 0–23 (normal), 24–32 (mild psychological impact), 33–36 (moderate psychological impact), and >37 (severe psychological impact) [27 (link)].
Mental health status was measured using the Depression, Anxiety and Stress Scale (DASS-21) and calculations of scores were based on the previous study [28 (link)]. Questions 3, 5, 10, 13, 16, 17 and 21formed the depression subscale. The total depression subscale score was divided into normal (0–9), mild depression (10–12), moderate depression (13–20), severe depression (21–27), and extremely severe depression (28–42). Questions 2, 4, 7, 9, 15, 19, and 20 formed the anxiety subscale. The total anxiety subscale score was divided into normal (0–6), mild anxiety (7–9), moderate anxiety (10–14), severe anxiety (15–19), and extremely severe anxiety (20–42). Questions 1, 6, 8, 11, 12, 14, and 18 formed the stress subscale. The total stress subscale score was divided into normal (0–10), mild stress (11–18), moderate stress (19–26), severe stress (27–34), and extremely severe stress (35–42). The DASS has been demonstrated to be a reliable and valid measure in assessing mental health in the Chinese population [29 (link),30 (link)]. The DASS was previously used in research related to SARS [31 (link)].
Sociodemographic data were collected on gender, age, education, residential location in the past 14 days, marital status, employment status, monthly income, parental status, and household size. Physical symptom variables in the past 14 days included fever, chills, headache, myalgia, cough, difficulty in breathing, dizziness, coryza, sore throat, and persistent fever, as well as persistent fever and cough or difficulty breathing. Respondents were asked to rate their physical health status and state any history of chronic medical illness. Health service utilization variables in the past 14 days included consultation with a doctor in the clinic, admission to the hospital, being quarantined by a health authority, and being tested for COVID-19. Contact history variables included close contact with an individual with confirmed COVID-19, indirect contact with an individual with confirmed COVID-19, and contact with an individual with suspected COVID-19 or infected materials.
Knowledge about COVID-19 variables included knowledge about the routes of transmission, level of confidence in diagnosis, level of satisfaction of health information about COVID-19, the trend of new cases and death, and potential treatment for COVID-19 infection. Respondents were asked to indicate their source of information. The actual number of confirmed cases of COVID-19 and deaths in the city on the day of the survey were collected. Concern about COVID-19 variables included self and other family members contracting COVID-19 and the chance of surviving if infected.
Precautionary measures against COVID-19 variables included avoidance of sharing of utensils (e.g., chopsticks) during meals, covering mouth when coughing and sneezing, washing hands with soap, washing hands immediately after coughing, sneezing, or rubbing the nose, washing hands after touching contaminated objects, and wearing a mask regardless of the presence or absence of symptoms. The respondents were asked the average number of hours staying at home per day to avoid COVID-19. Respondents were also asked whether they felt too much -unnecessary worry had been made about the COVID-19 epidemic. Additional health information about COVID-19 needed by respondents included more information about symptoms after contraction of COVID-19, routes of transmission, treatment, prevention of the spread of COVID-19, local outbreaks, travel advice, and other measures imposed by other countries.
The psychological impact of COVID-19 was measured using the Impact of Event Scale-Revised (IES-R). The IES-R is a self-administered questionnaire that has been well-validated in the Chinese population for determining the extent of psychological impact after exposure to a public health crisis within one week of exposure [25 (link)]. This 22-item questionnaire is composed of three subscales and aims to measure the mean avoidance, intrusion, and hyperarousal [26 (link)]. The total IES-R score was divided into 0–23 (normal), 24–32 (mild psychological impact), 33–36 (moderate psychological impact), and >37 (severe psychological impact) [27 (link)].
Mental health status was measured using the Depression, Anxiety and Stress Scale (DASS-21) and calculations of scores were based on the previous study [28 (link)]. Questions 3, 5, 10, 13, 16, 17 and 21formed the depression subscale. The total depression subscale score was divided into normal (0–9), mild depression (10–12), moderate depression (13–20), severe depression (21–27), and extremely severe depression (28–42). Questions 2, 4, 7, 9, 15, 19, and 20 formed the anxiety subscale. The total anxiety subscale score was divided into normal (0–6), mild anxiety (7–9), moderate anxiety (10–14), severe anxiety (15–19), and extremely severe anxiety (20–42). Questions 1, 6, 8, 11, 12, 14, and 18 formed the stress subscale. The total stress subscale score was divided into normal (0–10), mild stress (11–18), moderate stress (19–26), severe stress (27–34), and extremely severe stress (35–42). The DASS has been demonstrated to be a reliable and valid measure in assessing mental health in the Chinese population [29 (link),30 (link)]. The DASS was previously used in research related to SARS [31 (link)].
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