Letter to the Editor "A longitudinal study on the mental health of general population during the COVID-19 epidemic in China".

To the editor

We read the article by Wang et al. (2020a) with great interest, which we think is very valuable and the investigation is timely and persuasive. In the face of a major epidemic, the mental health of ordinary people is easily overlooked. This article not only surveyed the psychological state in the early days of the pandemic, but also compared the situation after 4 weeks. In addition, this paper also points out the protective factors, which has important guiding significance.

The COVID-19 pandemic has a huge extensive influence, and some articles have studied the psychological status of the public (Zhong et al., 2020, Zhang and Ma, 2020, Wang et al., 2020b, Qiu et al., 2020), but rarely described the temporal distribution of mental state. We recently conducted a relevant cross-sectional study from February 14 to March 29 of 2020 in an attempt to supplement this area. A total of 1172 subjects completed online questionnaires from 133 cities, including demographical data and self-assessment results of the following 8 common mental states: depression (Patient Health Questionnaire-9, PHQ-9), anxiety (Generalized Anxiety Disorder Scale-7, GAD-7), somatization (somatization of Symptom Check List 90, SOM of SCL-90), stress (Perceived Stress-10 Scale, PSS-10), psychological resilience (10-item Connor-Davidson Resilience Scale, CD-RISC-10), suicidal ideation and behavior (Mini-International Neuropsychiatric Interview suicidality module, MINI suicidality module), insomnia (7-item Insomnia Severity Index, ISI), and stress disorder (Acute stress disorder scale, ASDS & Posttraumatic Stress Disorder Checklist for DSM-5, PCL-5). The ASDS was originally designed, but in the middle of the survey, we found that the PCL-5 was more suitable, so we replaced ASDS with PCL-5. As a result, 714 participants filled out ASDS, and the other 458 participants completed PCL-5. Our scale results showed that the incidence of most mental disorders was as follows: 18.8% of depression, 13.3% of anxiety, 7.6% of mental health problems, 2.8% of high risk of suicidal and behavior, 7.2% of clinical insomnia, and 7.0% of clinical post-traumatic stress disorder symptoms, while the incidence of moderate-to-high levels of perceived stress was 67.9%. Further, the temporal distribution showed that the overall fluctuation range of each mental state was relatively small, but on February 20, 24 to 26 and March 25, the psychological states of the subjects relatively deteriorated, especially on March 25.

From February 20 to February 24–26, the psychological status deteriorated slightly. The median of each negative scale was rising, while the median of CD-RISC-10 declined. The reason may be related to the news these days. It was reported that on February 20, the prison systems in Shandong and Zhejiang provinces broke out. On February 24, the number of confirmed cases of COVID-19 cases rose in Japan, South Korea and Italy, while the stock market plummeted. On February 26th, fever travelers were found among overseas travelers flying to China.

Interestingly, on the worst day (25 March 2020), the median of total scores for all scales were high, including the psychological resilience scale. We checked in the nearby news for several days and found that the Hubei Provincial COVID-19 Pandemic Prevention and Control headquarters issued an important notice on March 24, saying that in Hubei Province, except for Wuhan City, the control of Hubei passageway will be lifted on March 25, and Wuhan will cancel channel control measures on April 8. Hubei Province and Wuhan City were the most serious pandemic places in China. People were worried that deregulation will cause another pandemic to worsen, so their psychological and emotional states were not good. In addition, another pandemic report said that on March 24, 47 new confirmed cases in China were imported from abroad, which means that the number of new cases in China has been cleared, but the situation of overseas imports was becoming more and more serious. This undoubtedly brought a lot of worry and pressure to the public. However, in view of the effective control measures taken by the country in the past two months, people were fully confident of overcoming this pandemic (Zhong et al., 2020). Therefore, the psychological resilience scale was also in good condition.

In summary, our results show that the incidence of mental disorders in the Chinese public is relatively low within one month of the beginning of the COVID-19 pandemic. More importantly, the development of the pandemic and real-time news trends affect the psychological state of the public, so it is necessary to make the information open, transparent and timely. The government will alleviate the poor mental state of all people while effectively controlling the pandemic.